1. Pneumonia

2. Pneumonia Acute inflammation of lung caused by microorganism
Leading cause of death until 1936
Discovery of sulfa drugs and penicillin

3. Pneumonia
Still leading cause of death from infectious disease

4. Defense mechanisms are incompetent or overwhelmed
Predisposing Factors
Defense mechanisms are incompetent or overwhelmed
Decreased cough and epiglottal reflexes (may allow aspiration)

5. Mucociliary mechanism impaired
Predisposing Factors
Mucociliary mechanism impaired
Pollution
Cigarette smoking
Upper respiratory infections
Tracheal intubation
Aging

6. Predisposing Factors
Alteration of leukocytes from malnutrition
Increased frequency of gram- negative bacilli (leukemia, diabetes, alcoholism)

7. Acquisition of Organisms
Aspiration from nasopharynx, oropharynx
Inhalation of microbes
Hematogenous spread from primary infection elsewhere

8. Types of Pneumonia Organisms implicated S. pneumoniae Legionella
Mycoplasma
Chlamydia
S. aureus
Respiratory viruses

9. Types of Pneumonia Community-acquired pneumonia (CAP)
Onset in community or during first 2 days of hospitalization
Highest incidence in winter
Smoking important risk factor

10. Types of Pneumonia Hospital-acquired pneumonia (HAP)
Occurs > 48 hours after admission; not incubating at time of hospitalization
Highest mortality rate of nosocomial infections

11. Types of Pneumonia Causes of HAP Pseudomonas Enterobacter S. aureus
S. pneumoniae
Immunosuppressive therapy
General debility
Endotracheal intubation

12. Classification of Patients with HAP
Types of Pneumonia
Classification of Patients with HAP
Severity of illness
Specific host or therapeutic factors predisposing to pathogens present
Early (5 days post admission) or late (more than 5 days post admission) onset

13. Types of Pneumonia Fungal pneumonia Aspiration pneumonia
Sequelae occurring from abnormal entry of secretions into lower airway
Usually history of loss of consciousness
Gag and cough reflexes suppressed
Tube feedings risk factor

14. Types of Pneumonia Forms of aspiration pneumonia
Mechanical obstruction
Chemical injury
Bacterial infection

15. Types of Pneumonia Opportunistic pneumonia Pneumocytis carnii CMV
Fungi
Patients with severe protein-calorie malnutrition, immune deficiencies, chemotherapy/radiation recipients, and transplant recipients are at risk

16. Opportunistic pneumonia
Types of Pneumonia
Opportunistic pneumonia
Clinical manifestations
Fever
Tachypnea
Tachycardia
Dyspnea
Nonproductive cough
Hypoxemia

17. Pathophysiology: Pneumococcal Pneumonia
Congestion from outpouring of fluid into alveoli
Microorganisms multiply and spread infection, interfering with lung function

18. Pathophysiology: Pneumococcal Pneumonia
Red hepatization
Massive dilation of capillaries
Alveoli fill with organisms, neutrophils, RBCs, and fibrin
Causes lungs to appear red and granular, similar to liver

19. Pathophysiologic course of pneumococcal pneumonia
Fig. 27-1

20. Pathophysiology: Pneumococcal Pneumonia
Gray hepatization
Blood flow decreases
Leukocyte and fibrin consolidate in affected part of lung

21. Pathophysiology: Pneumococcal Pneumonia
Resolution
Resolution and healing if no complications
Exudate lysed and processed by macrophages
Tissue restored

22. Clinical Manifestations
CAP symptoms
Sudden onset of fever
Chills
Cough productive of purulent sputum
Pleuritic chest pain

23. Clinical Manifestations
Confusion or stupor may manifest in older or debilitated patient
Physical exam findings
Dullness on percussion
Increased fremitus
Bronchial breath sounds
Crackles

24. Clinical Manifestations
CAP (alternative manifestations)
Gradual onset
Dry cough
Headache
Myalgias
Fatigue
Sore throat
N/V/D

25. Clinical Manifestations
Manifestations of viral pneumonia are
variable
Chills
Fever
Dry and non-productive cough
Extrapulmonary symptoms

26. Complications Pleurisy Pleural effusion Atelectasis
Usually is sterile and reabsorbed in 1-2 weeks or requires thoracentesis
Atelectasis
Usually clears with cough and deep breathing

27. Complications Delayed resolution Lung abscess (pus-containing lesions)
Persistent infection seen on x-ray as residual consolidation
Lung abscess (pus-containing lesions)
Empyema (purulent exudate in pleural cavity)
Requires antibiotics and drainage of exudate

28. Complications Pericarditis Arthritis Meningitis
From spread of microorganism
Arthritis
Systemic spread of organism
Exudate can be aspirated
Meningitis
Patient who is disoriented, confused, or somnolent should have lumbar puncture to evaluate meningitis

29. Complications Endocarditis
Microorganisms attack endocardium and heart valves
Manifestations similar to bacterial endocarditis

30. Diagnostic Tests History Physical exam Chest x-ray
Gram stain of sputum
Sputum culture and sensitivity
Pulse oximetry or ABGs
CBC, differential, chems
Blood cultures

31. Collaborative Care Antibiotic therapy Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics
Influenza drugs
Influenza vaccine
Fluid intake at least 3 L per day
Caloric intake at least 1500 per day

32. Collaborative Care Pneumococcal vaccine Indicated for those at risk
Chronic illness such as heart and lung disease, diabetes mellitus
Recovering from severe illness
65 or older
In long-term care facility

33. Nursing Assessment Lung cancer COPD Diabetes mellitus
History of Predisposing/Risk Factors
Lung cancer
COPD
Diabetes mellitus
Debilitating disease
Malnutrition

34. Nursing Assessment AIDS
History of Predisposing/Risk Factors
AIDS
Use of antibiotics, corticosteroids, chemotherapy, immunosuppressants
Recent abdominal or thoracic surgery
Smoking, alcoholism, respiratory infections
Prolonged bed rest

35. Nursing Assessment
Clinical Manifestations
Dyspnea
Nasal congestion
Pain with breathing
Sore throat
Muscle aches
Fever

36. Nursing Assessment Clinical Manifestations Restlessness or lethargy
Splinting affected area
Tachypnea
Asymmetric chest movements
Use of accessory muscles
Crackles
Green or yellow sputum

37. Nursing Assessment Clinical Manifestations Tachycardia
Changes in mental status
Leukocytosis
Abnormal ABGs
Pleural effusion
Pneumothorax on CXR

38. Nursing Diagnoses Ineffective breathing pattern
Ineffective airway clearance
Acute pain
Imbalanced nutrition: less than body requirements
Activity intolerance

39. Planning Goals: Patient will have Clear breath sounds
Normal breathing patterns
No signs of hypoxia
Normal chest x-ray
No complications related to pneumonia

40. Nursing Implementation
Teach nutrition, hygiene, rest, regular exercise to maintain natural resistance
Prompt treatment of URIs

41. Nursing Implementation
Encourage those at risk to obtain influenza and pneumococcal vaccinations
Reposition patient q2h
Assist patients at risk for aspiration with eating, drinking, and taking meds

42. Nursing Implementation
Assist immobile patients with turning and deep breathing
Strict asepsis
Emphasize need to take course of medication(s)
Teach drug-drug interactions

43. Evaluation Dyspnea not present SpO2 > 95
Free of adventitious breath sounds
Clears sputum from airway

44. Evaluation Reports pain controlled Verbalizes causal factors
Adequate fluid and caloric intake
Performs ADLs