1. PNEUMONIA

2. Review of Lung Anatomy RUL LUL RML LLL Lingula RLL

3. Definition and Key points
An inflammation in the lungs that produces excess fluid.
It is triggered by:
infectious organisms or
aspiration of an irritant.
The inflammatory process in the lung parenchyma results in edema and exudate that fills the alveoli.

5. Key points Pneumonia may be: a primary disease or
a complication of another disease or condition.
It affects people of all ages, but the young, older adult clients, and clients who are immunocompromised are more susceptible.
Immobility can be a contributing factor in the development of pneumonia

6. Definition and Key points
There are two types of pneumonia.
1. Community acquired pneumonia (CAP); the most common type and often occurs as a complication of influenza.
2. Hospital acquired pneumonia (HAP), OR nosocomial pneumonia, has a higher mortality rate and is more likely to be resistant to antibiotics

7. Types of pneumonia according to the causative agents
Bacteria
Virus
Fungi
Mycobacteria
Aspiration
Also, pneumonia may be:
Lobar
Bronchial; patches through both lungs

9. Pathophysiology
An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of O2 & CO2 ; bronchospasm may also occur if the patient has reactive airway disease.

10. Common Risk Factors for Pneumonia
Advanced age
Recent exposure to viral or influenza infections
Tobacco use
Chronic lung disease (for example, asthma)
Aspiration
Clients with dysphagia
Mechanical ventilation (ventilator acquired pneumonia)
Impaired ability to mobilize secretions (decreased level of consciousness, immobility, recent abdominal or thoracic surgery)
Immunocompromised status

11. Diagnostic Procedures and Nursing Interventions
CXR; Shows consolidation of lung tissue.
Pulse Oximetry; Decreased oxygen saturation levels
CBC; Leukocytosis (may not be present in older adult clients)
Sputum Culture; Obtain specimen by suctioning if the client is unable to cough.
Arterial Blood Gases (ABGs); Decreased PaO2 and increased PaCO2 due to impaired gas exchange in the alveoli
Thoracentesis if pleural effusion present

12. Assessments
Monitor for S&Sx; vary depending on the causative organism and the patient’s disease.
Fever; sudden & rapid ((38.5C to 40.5C))
Dyspnea, tachypnea (25-45 breaths/min); orthopnea
Pleuritic chest pain; aggravated by respiration and coughing
Sputum production
Crackles and wheezes
Coughing
Dull chest percussion over areas of consolidation
Poor oxygen saturation (low SaO2)

13. Other signs
URTI, headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis; mucopurulent secretion.
Severe pneumonia: flushed cheeks; lips and nail beds demonstrating central cyanosis.
Sputum purulent, rusty, blood-tinged, viscous, or green
depending on etiologic agent.
Appetite is poor, and the patient is diaphoretic and tires easily.

14. Assess/Monitor
Respiratory status (airway, respiratory, use of accessory muscles, oxygenation) before and following interventions
Sputum (amount, color)
Hx: smoking and chronic lung conditions
Recent exposure to influenza or other viral agents
Factors increasing the risk of aspiration (for example, following a stroke)
Difficulty mobilizing secretions (generalized weakness)
General appearance (temperature, skin color)
Laboratory findings (ABGs, sputum culture results, WBCs)

15. NANDA Nursing Diagnoses
Impaired gas exchange
Ineffective airway clearance
Activity intolerance
Imbalanced nutrition: Less than body requirements
Acute pain
Risk for deficient fluid volume
Deficient knowledge about treatment regimen and preventive health measures

16. Nursing Interventions
Administer heated and humidified oxygen therapy as prescribed.
Position the client in high-Fowler’s position.
Encourage coughing, or suction to remove secretions.
Encourage deep breathing with an incentive spirometer to prevent alveolar collapse.
Administer medications as prescribed.
Antibiotics are given to destroy the infectious pathogens ( penicillins and cephalosporins, IV and then switched to an oral).
Obtain culture before the first dose of the antibiotic.

17. Interventions Bronchodilators
Short-acting beta2 agonists, such as Ventolin,
Methylxanthines (theophylline ), require close monitoring of serum medication levels due to narrow therapeutic range.
Corticosteroids decrease airway inflammation; monitor for serious side effects
Immunizations can decrease a client’s risk of developing CAP.
Influenza vaccine is recommended annually for clients at risk of complications from influenza

18. Interventions
Supportive treatment includes hydration, antipyretics, antitussive medications, antihistamines, or nasal decongestants.
Bed rest is recommended until infection shows signs of
clearing.
Respiratory support includes endotracheal intubation, and mechanical ventilation.
Treatment of atelectasis, pleural effusion, shock, respiratory failure, or super-infection if needed.

19. Interventions
Determine the client’s physical limitations and structure activity to include periods of rest.
Promote adequate nutrition.
Increased work of breathing increases caloric demands.
Proper nutrition aids in the prevention of secondary respiratory infections.
Provide support to the client and family.
Encourage verbalization of feelings.

20. Complications and Nursing Implications
Atelectasis
Airway inflammation and edema leads to alveolar collapse and increases the risk of hypoxemia.
Diminished or absent breath sounds over affected area.
CXR shows area of density.
Acute Respiratory Failure
Persistent hypoxemia
Monitor oxygenation levels and acid-base balance.
Prepare for intubation and mechanical ventilation as indicated.
Bacteremia (sepsis) can occur if pathogens enter the bloodstream from the infection in the lungs.