Pneumonia

Definition Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent. “Pneumonitis” is a more general term that describes an inflammatory process in the lung tissue that may predispose a patient to or place a patient at risk for microbial invasion

Classification of Pneumonia: 1- Community-Acquired Pneumonia: (CAP) occurs either in the community setting or within the first 48 hours of hospitalization or institutionalization. The agents that most frequently cause CAP requiring hospitalization are S. pneumoniae, H. influenzae, Legionella, Pseudomonas aeruginosa, and other gramnegative rods.

2- Hospital-Acquired Pneumonia: (HAP) Also known as nosocomial pneumonia, is defined as the onset of pneumonia symptoms more than 48 hours after admission to the hospital. The common organisms responsible for HAP include the pathogens Enterobacter species, Escherichia coli, Klebsiella species, Proteus, P.aeruginosa. Certain illnesses may predispose a patient toHAP because of impaired host defenses (severe acute or chronic illness, coma, malnutrition, prolonged hospitalization, hypotension, and metabolic disorders).

3- Pneumonia in Immunocompromised Host: Immunocompromised host are Pneumocystis carinii pneumonia (PCP), fungal pneumonias, and mycobacterium tuberculosis. It is occur in the immunocompetent person and in different settings, but these are less common. Immunocompromised states occur with the use of corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, AIDS, genetic immune disorders.

4- Aspiration pneumonia: Aspiration pneumonia refers to the pulmonary consequences resulting from the entry of endogenous or exogenous substances into the lower airway.

Pathophysiology  Pneumonia arises from normally present flora in a patient whose resistance has been altered, or it results from aspiration of flora present in the oropharynx.  It may also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed.

 Pneumonia often affects both ventilation and diffusion. An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide..  White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air- containing spaces.

Risk Factors Pneumonia is common with certain underlying disorders such as heart failure, diabetes, alcoholism, COPD, and AIDS. Cystic fibrosis, cancer, cigarette smoking Immunosuppressed patients. Prolonged immobility and shallow breathing pattern abnormal swallowing. Antibiotic therapy (in very ill people, the oropharynx is likely to be colonized by gram-negative bacteria). General anesthetic, sedative, or opioid preparations that promote respiratory depression.

Clinical Manifestations Fever (38.5° to 40.5°C). Chills. Pleuritic chest pain that is aggravated by deep breathing and coughing. Tachypnea (25 to 45 breaths/min), shortness of breath, nasal congestion, and sore throat. Headache. Myalgia. Rash, and pharyngitis. Orthopnea. Appetite is poor.

Complications Continuing symptoms after initiation of therapy. Shock. Respiratory failure. Atelectasis. Pleural effusion. Confusion. Super infection.

Assessment and Diagnostic Findings History (particularly of a recent respiratory tract infection). Physical examination. Chest x-ray studies. Blood culture (bloodstream invasion, called bacteremia). Sputum examination. Bronchoscopy is often used in patients with acute severe infection.

Prevention Promote coughing and expectoration of secretions. Encourage smoking end. Reposition frequently and promote lung expansion exercises and coughing. Initiate suctioning and chest physical therapy if indicated. Promote frequent oral hygiene. Encourage reduced or moderate alcohol intake. Promote frequent mobilization, effective coughing, breathing exercises, and nutritious diet.

Medical Management The treatment of pneumonia includes administration of the appropriate antibiotic as determined by the results of the Gram stain. Recommendations for treatment of patient who have no cardiopulmonary disease or other modifying factors include (erythromycin, azithromycin, doxycycline) with enhanced activity against S. pneumoniae.

For patients at high risk for Pseudomonas infection, an antipseudomonal penicillin plus an aminoglycoside (gentamicin) or beta-lactamase inhibitor (ampicillin, ticarcillin). Hydration is a necessary part of therapy because fever and tachypnea may result in insensible fluid losses. Antipyretics may be used to treat headache and fever. antitussive medications may be used for the associated cough.

The patient is placed on bed rest until the infection shows signs of clearing. If hypoxemia develops, oxygen is administered. Pulse oximetry or arterial blood gas (ABGs) use to determine the need for oxygen.

NURSING DIAGNOSES Ineffective airway clearance related to copious tracheobronchial secretions. Activity intolerance related to impaired respiratory function. Risk for deficient fluid volume related to fever and tachypnea.

 Imbalanced nutrition: less than body requirements.  Deficient knowledge about the treatment regimen and preventive health measures

Nursing Interventions 1- Improving airway patency. 2- Promoting rest and conserving energy. 3- Promoting fluid intake. 4- Maintaining nutrition. 5- Promoting the patient’s knowledge. 6- Monitoring and managing potential complications. 7- Promoting home and community- based care.

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