Dr. Maysoon S. Abdalrahim Chapter 23 Pneumoania Dr. Maysoon S. Abdalrahim

Pneumonia Pneumonia an inflammation of the lung parenchyma caused by microorganisms (bacteria, fungi, viruses) Pneumonitis an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion.

Classification (Table 23-1) community-acquired pneumonia (CAP) hospital-acquired (nosocomial) pneumonia (HAP) pneumonia in the immunocompromised host aspiration pneumonia

Pathophysiology Conditions (low immunity, unconsciouness)  normal flora in the oropharynx enter the pulmonary system  affects both ventilation and diffusion. Inflammatory reaction occur in the alveoli  produce exudate  interferes with diffusion of O2 & CO2 WBCs (mostly neutrophils) migrate into the alveoli and fill the normally air-filled spaces. secretions and mucosal edema partial occlusion to areas of the lung  decrease in alveolar O2 tension.

Pathophysiology Bronchospasm may occur in patients Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated  arterial hypoxemia. If a substantial portion of one or more lobes is involvedlobar pneumonia. The term bronchopneumonia: pneumonia that is distributed in a patchy fashion within the bronchi and surrounding lung parenchyma.

Pathophysiology

Risk Factors (Table 23-2) Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (eg, cancer, smoking, COPD) Immunosuppressed patients Smoking Prolonged immobility and shallow breathing pattern Depressed cough reflex aspiration of foreign material into lungs in unconscious patients

Risk Factors (Table 23-2) placement of nasogastric, orogastric, or endotracheal tube Supine positioning in patients unable to protect their airway Antibiotic therapy Alcohol intoxication General anesthetic, sedative, or opioid Advanced age Respiratory therapy with uncleaned equipment

Clinical Manifestations it is not possible to diagnose by clinical manifestations alone. pneumococcal pneumonia a sudden onset of chills, rapidly rising fever (38.5 to 40.5C and pleuritic chest pain aggravated by deep breathing and coughing. tachypnea (25 to 45 breaths/min signs of respiratory distress rapid and bounding pulse (increases 10 bpm for every degree (Celsius) of temperature elevation. A relative

Clinical Manifestations viral infection bradycardia (a pulse–temperature deficit -pulse is slower for a given temperature) Some patients exhibit an URTI headache, low-grade fever, pleuritic pain, rash, and pharyngitis. mucopurulent sputum Flushed cheeks and central cyanosis Orthopnea

Clinical Manifestations Poor appetite Diaphoresis Fatigue Fever, crackles, and percussion dullness, egophony (when auscultated, the spoken “E” becomes a loud, nasal-sounding “A”)  sound is transmitted better through solid or dense tissue (consolidation).

Assessment and Diagnostic Findings Illness history and physical examination chest x-ray blood culture (bacteremia) sputum examination rinse the mouth with water breathe deeply several times cough deeply expectorate the raised sputum into a sterile container. Sputum by nasotracheal or orotracheal suctioning Bronchoscopy

Prevention A pneumococcal vaccine People 65 years of age or older People with functional or anatomic asplenia People living in environments risk of disease Immunocompromised people one-time revaccination after 5 years

Prevention for the prevention of HAP: (1) staff education (2) infection and microbiologic surveillance (3) prevention of transmission (4) modifying host risk for infection.

Medical Management Antibiotics (ineffective in viral) Treatment of viral pneumonia is supportive. Hydration Antipyretics antitussive Warm, moist inhalations Antihistamines Nasal decongestants If hypoxemia develops, oxygen is administered. Pulse oximetry or ABGs analysis to evaluate the effectiveness

Complications Shock and Respiratory Failure Pleural Effusion

Nursing Interventions Improving Airway Patency Removing secretions hydration (2 to 3 L/day), and Humidification to loosen secretions and improve ventilation. Encourage coughing Lung expansion maneuvers (deep breathing + incentive spirometer). Chest physiotherapy (postural drainage) administer and titrate O2 therapy as prescribed

Nursing Interventions Promoting Rest and Conserving Energy Encourage rest and avoid overexertion assume a comfortable position (semi-Fowler’s position) change positions frequently to enhance secretion clearance and pulmonary ventilation and perfusion.

Nursing Interventions Promoting Fluid Intake An increased respiratory rate  increase in insensible fluid loss during exhalation dehydration. Encourage increased fluid intake (at least 2 L/day), unless contraindicated. slowly and with careful monitoring in patients with preexisting conditions such as heart failure.

Nursing Interventions Maintaining Nutrition patients with SOB and fatigue have a decreased appetite and consume only fluids. Fluids with electrolytes (Gatorade) may help provide fluid, calories, and electrolytes. IV fluids and nutrients administered if necessary.

Nursing Interventions Promoting Patients’ Knowledge The patient and family are instructed about the cause of pneumonia, management of symptoms, signs and symptoms that should be reported to the physician. Provide information about risk factors and strategies to promote recovery and prevent recurrence. Instruct about the importance of management strategies and adhering to them Use simple language and written instructions

Nursing Interventions Monitoring and Managing Potential Complications observe for response to antibiotic therapy within 24 to 48 hours Monitor for changes in physical status and for persistent recurrent fever  allergic reaction monitor for other complications, such as shock and multisystem failure and atelectasis, which may develop during the first few days of antibiotic