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

2. 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.

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

4. 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.

5. 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.

6. Pathophysiology

7. 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

8. 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

9. 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

10. 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

11. 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).

12. 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

13. 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

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

15. 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

16. Complications
Shock and Respiratory Failure
Pleural Effusion

17. 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

18. 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.

19. 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.

20. 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.

21. 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

22. 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