Adult Medical-Surgical Nursing Respiratory Module: Pneumonia

Respiratory Infection: Classification Upper respiratory infection: Affects nasopharynx, larynx, trachea: Common cold (rhinitis), pharyngitis, laryngitis, tracheitis Lower respiratory infection: Affects the bronchi and lungs: Bronchitis, bronchiolitis, pneumonia

Pneumonia

Pneumonia: Description Inflammation of the lung alveoli Broncho-pneumonia: Infection / inflammation around the terminal bronchi and bronchioles (more prevalent in infants and the elderly due to ineffective cough) Lobar Pneumonia: Infection/ inflammation consolidates one or more whole lobes of the lung

Pneumonia: Classification Community-acquired Hospital-acquired (nosocomial) Pneumonia in an immuno-compromised host Aspiration Pneumonia

Pneumonia: Aetiology/ Most Common Pathogens Community-acquired: Pneumococcus (Strep Pneumoniae) Haemophylus Influenzae (HIB) Hospital-acquired (Nosocomial): Pseudomonas Staphylococcus Aureus (MRSA)

Pneumonia: Aetiology/ Most Common Pathogens Immuno-compromised host (AIDS patient, patient undergoing chemotherapy, radiation, post-transplant): Tuberculosis (TB) Pneumocystis Carinii Aspiration Pneumonia (secretions from upper respiratory tract infection or inhaled vomit (acid/ chemical pneumonia) or FB: Pneumococcus, HIB, Staph Aureus

Pneumonia: Aetiology/ Pre-disposing Risk Factors Immobility Post-operative atelectasis and super- imposed infection Upper respiratory infection Old age (and infancy) Smoking Compromised immune response Chronic Obstructive Airways Disease

Pneumonia: Clinical Manifestations Dyspnoea, tachypnoea, orthopnoea Cough (productive but may be dry if the patient is dehydrated: requires hydration to loosen and expectorate viscous sputum) Purulent sputum may be tinged with blood Cyanosis Pyrexia, tachycardia, rigors, sweating Pain especially with lobar, over affected lobe and also pleuritic pain on inspiration

Pneumonia: Diagnosis Chest Xray: AP and lateral Sputum sample for culture and sensitivity Blood culture CBC (WCC ↑ if normal immune response) ABG Pulse oximetry

Pneumonia: Management Bed rest, upright position (lung expansion) Humidified O2 Bronchodilator via nebuliser Mucosolvant IV fluids IV antibiotics Anti-pyretics Adequate pain relief (especially with lobar) Chest physio (includes postural drainage)

Pneumonia: Nursing Considerations O2 and bronchodilator via nebuliser Assist chest physio IV fluids (oral as tolerated) IV antibiotics/ antipyretics (tepid sponging) Emotional support Adequate pain relief Frequent mouth care, change position Monitor vital signs, fluid balance, pulse oximetry, ABG

Pneumonia: Prevention Adequate rest Healthy diet including vitamin C Avoid smoking Avoid crowded places Avoid droplet spread of pathogens Isolation of immuno-compromised patients If immobile deep breathing exercises Vaccination of the vulnerable in population (HIB, Pneumococcus)