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PNEUMONIA
Nursing Path
www.drjayeshpatidar.blogspot.com
Definition:
 An inflammatory
process in lung
parenchyma
usually
associated with
a marked
increase in
interstitial and
alveolar fluid.
6/6/2018 2
www.drjayeshpatidar.blogspot.com
6/6/2018 3
www.drjayeshpatidar.blogspot.com
Etiology & Risk factors:
Etiology:
 Bacteria, viruses, mycoplasmas, fungal
agents & protozoa.
 Aspiration of food, fluids, / vomitus.
 Inhalation of toxic/caustic chemicals, smoke,
dusts/gases.
 Influenza.
6/6/2018 4
www.drjayeshpatidar.blogspot.com
Risk Factors:
• Advanced age.
• History of smoking.
• Upper respiratory infection.
• Tracheal intubation.
• Prolonged immobility.
• Immunosuppressive therapy.
• Nonfunctional immune system.
• Malnutrition.
• Dehydration.
• Chronic disease state.
6/6/2018 5
www.drjayeshpatidar.blogspot.com
 Cigarette smoking
 Recent viral respiratory infection (common
cold, laryngitis, influenza)
 Difficulty swallowing (due to stroke,
dementia, Parkinson's disease, or other
neurological conditions)
 Chronic lung disease (COPD, bronchiectasis,
cystic fibrosis)
 Cerebral palsy
 Other serious illnesses, such as heart
disease, liver cirrhosis, /diabetes mellitus
6/6/2018 6
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Cont….
 Exposure to air pollution.
 Altered consciousness(Alcoholism, Drug
overdose, General anesthesia, Seizure
disorder).
 Inhalation of noxious substances.
 Residing in Institutional settings.
6/6/2018 7
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 Living in a nursing facility
 Impaired consciousness (loss of brain
function due to dementia, stroke, or other
neurologic conditions)
 Recent surgery or trauma
 Immune system problem
6/6/2018 8
www.drjayeshpatidar.blogspot.com
Path-physiology:
Offending organism/agent.
Inflammatory pulmonary response.
Lose defense mechanisms of the lungs.
Allow organisms to penetrate the sterile LRT.
Develop inflammation.
6/6/2018 9
www.drjayeshpatidar.blogspot.com
Disruption of the mechanical defenses
(cough & ciliary motility)
Colonization of the lungs.
Inflamed & fluid-filled alveolar sacs.
Alveolar exudates tends to consolidate.
Difficult to expectorate.
6/6/2018 10
www.drjayeshpatidar.blogspot.com
Types:
1. Pneumococcal pneumonia:
 Caused by Streptococcus pneumonia.
 C/M:- high fever.
- stabbing pleuritic chest pain.
- malaise.
- weakness.
- elevated WBC count.
- tachypnea.
- dyspnea.
- blood-streaked purulent sputum.
6/6/2018 11
www.drjayeshpatidar.blogspot.com
2. Staphylococcal pneumonia:
 Caused by Staphylococcus aureus.
 C/M:- fever with multiple chills.
- pleuritic pain.
- rales.
- decreased breath sounds.
- elevated WBC count.
- dyspnea.
- blood-streaked purulent sputum.
6/6/2018 12
www.drjayeshpatidar.blogspot.com
3. Influenzal pneumonia:
 Caused by Haemophilus influenza.
 C/M:- high fever.
- stabbing pleuritic chest pain.
- malaise.
- weakness.
- elevated WBC count.
- tachypnea.
- dyspnea.
- blood-tinged purulent sputum.
6/6/2018 13
www.drjayeshpatidar.blogspot.com
4. Gram-negative bacterial pneumonia:
 Caused by Klebsiella pneumonia.
 C/M:- fever with multiple chills.
- pleuritic pain.
- rales.
- cyanosis.
- elevated WBC count.
- dyspnea.
- blood-streaked purulent sputum.
6/6/2018 14
www.drjayeshpatidar.blogspot.com
5. Anaerobic bacterial pneumonia:
 Caused by normal oral flora.
 C/M:- low-grade fever.
- hypertension.
- crackles.
- cyanosis.
- elevated WBC count.
- dyspnea.
- foul smelling purulent sputum.
- tachycardia.
6/6/2018 15
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6. Legionnaires’ disease:
 Caused by Legionella pneumophila.
 C/M:- fever.
- pleuritic pain.
- nausea.
- confusion.
- elevated WBC count.
- dyspnea.
- blood-tinged sputum.
6/6/2018 16
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7. Mycoplasma pneumonia:
 Caused by Mycoplasma microorganisms.
 C/M:- slowly rising fever.
- headache.
- myalgia.
- malaise.
- normal WBC count.
- scant mucoid sputum.
6/6/2018 17
www.drjayeshpatidar.blogspot.com
8. Viral pneumonia:
 Caused by Influenza A virus.
 C/M:- high fever.
- headache.
- myalgia.
- dyspnea.
- normal/slightly WBC count.
- mucoid sputum.
- normal breath sounds.
6/6/2018 18
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9. Aspiration pneumonia:
 Caused by aspiration of gastric contents.
 C/M:- tachypnea.
- apnea.
- cyanosis.
- hypotension.
- leukocytosis.
- adventitious lung sounds.
- fever.
6/6/2018 19
www.drjayeshpatidar.blogspot.com
Clinical manifestations:
♥ Fever.
♥ Chills.
♥ Sweats.
♥ Pleuritic chest
pain.
♥ Cough.
♥ Sputum
production.
♥ Hemoptysis.
♥ Dyspnea.
♥ Headache &
fatigue. 6/6/2018 20
www.drjayeshpatidar.blogspot.com
6/6/2018 21
www.drjayeshpatidar.blogspot.com
Diagnostic evaluation:
Chest auscultation.
Sputum culture analysis & sensitivity/
serologic testing.
Fiber optic bronchoscopy/ Transcutaneous
needle aspiration/ biopsy.
Skin tests.
Blood & urine cultures.
Transcutaneous oxygen level analysis/ ABG
measurements.
Chest X-ray examination.
6/6/2018 22
www.drjayeshpatidar.blogspot.com
Classification:
i. Based on area affected:
Segmental pneumonia.
Lobar pneumonia.
Bilateral pneumonia.
ii. Basis of location & radiologic appearance:
Bronchopneumonia.
Interstitial(reticular) pneumonia.
Alveolar(acinar) pneumonia.
Necrotizing pneumonia.
6/6/2018 23
www.drjayeshpatidar.blogspot.com
Medical Management:
☻Specific antibiotic therapy: Broad spectrum
antibiotics.
☻Respiratory support:
 Administer oxygen.
 Bronchodilator medications.
 Postural drainage.
 Chest physiotherapy.
 Tracheal suctioning.
☻Nutritional support.
☻Fluid & electrolyte management.
6/6/2018 24
www.drjayeshpatidar.blogspot.com
Nursing management:
Ineffective airway clearance R/t excessive
secretions & weak cough.
Ineffective breathing pattern R/t tachypnea.
Activity intolerance R/t decreased oxygen
levels for metabolic demands.
Deficient fluid volume R/t fever, diaphoresis,
& mouth breathing.
Imbalanced nutrition: less than body
requirements R/t dyspnea.
Pain R/t frequent coughing.
6/6/2018 25
www.drjayeshpatidar.blogspot.com
Cont….
Impaired oral mucous membrane R/t mouth
breathing & frequent cough.
6/6/2018 26
www.drjayeshpatidar.blogspot.com
Possible complications:
 Respiratory failure.
 Empyema or lung abscesses. These are
infrequent, but serious, complications of
pneumonia. They occur when pockets of pus
form inside or around the lung. These may
sometimes need to be drained with surgery.
 Sepsis, a condition in which there is
uncontrolled swelling (inflammation) in the
body, which may lead to organ failure
 Acute respiratory distress syndrome (ARDS),
a severe form of respiratory failure
6/6/2018 27
www.drjayeshpatidar.blogspot.com
Pneumonia At A Glance:
Pneumonia is a lung infection that can be caused by
different types of microorganisms, including bacteria,
viruses, and fungi.
Symptoms of pneumonia include cough with sputum
production, fever, and sharp chest pain on inspiration
(breathing in).
Pneumonia is suspected when a doctor hears abnormal
sounds in the chest, and the diagnosis is confirmed by a
chest x-ray.
Bacteria causing pneumonia can be identified by sputum
culture.
6/6/2018 28
www.drjayeshpatidar.blogspot.com
Thank You
6/6/2018 29
www.drjayeshpatidar.blogspot.com

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pneumonia-180606035507.pdf

  • 2. Definition:  An inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid. 6/6/2018 2 www.drjayeshpatidar.blogspot.com
  • 4. Etiology & Risk factors: Etiology:  Bacteria, viruses, mycoplasmas, fungal agents & protozoa.  Aspiration of food, fluids, / vomitus.  Inhalation of toxic/caustic chemicals, smoke, dusts/gases.  Influenza. 6/6/2018 4 www.drjayeshpatidar.blogspot.com
  • 5. Risk Factors: • Advanced age. • History of smoking. • Upper respiratory infection. • Tracheal intubation. • Prolonged immobility. • Immunosuppressive therapy. • Nonfunctional immune system. • Malnutrition. • Dehydration. • Chronic disease state. 6/6/2018 5 www.drjayeshpatidar.blogspot.com
  • 6.  Cigarette smoking  Recent viral respiratory infection (common cold, laryngitis, influenza)  Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)  Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)  Cerebral palsy  Other serious illnesses, such as heart disease, liver cirrhosis, /diabetes mellitus 6/6/2018 6 www.drjayeshpatidar.blogspot.com
  • 7. Cont….  Exposure to air pollution.  Altered consciousness(Alcoholism, Drug overdose, General anesthesia, Seizure disorder).  Inhalation of noxious substances.  Residing in Institutional settings. 6/6/2018 7 www.drjayeshpatidar.blogspot.com
  • 8.  Living in a nursing facility  Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)  Recent surgery or trauma  Immune system problem 6/6/2018 8 www.drjayeshpatidar.blogspot.com
  • 9. Path-physiology: Offending organism/agent. Inflammatory pulmonary response. Lose defense mechanisms of the lungs. Allow organisms to penetrate the sterile LRT. Develop inflammation. 6/6/2018 9 www.drjayeshpatidar.blogspot.com
  • 10. Disruption of the mechanical defenses (cough & ciliary motility) Colonization of the lungs. Inflamed & fluid-filled alveolar sacs. Alveolar exudates tends to consolidate. Difficult to expectorate. 6/6/2018 10 www.drjayeshpatidar.blogspot.com
  • 11. Types: 1. Pneumococcal pneumonia:  Caused by Streptococcus pneumonia.  C/M:- high fever. - stabbing pleuritic chest pain. - malaise. - weakness. - elevated WBC count. - tachypnea. - dyspnea. - blood-streaked purulent sputum. 6/6/2018 11 www.drjayeshpatidar.blogspot.com
  • 12. 2. Staphylococcal pneumonia:  Caused by Staphylococcus aureus.  C/M:- fever with multiple chills. - pleuritic pain. - rales. - decreased breath sounds. - elevated WBC count. - dyspnea. - blood-streaked purulent sputum. 6/6/2018 12 www.drjayeshpatidar.blogspot.com
  • 13. 3. Influenzal pneumonia:  Caused by Haemophilus influenza.  C/M:- high fever. - stabbing pleuritic chest pain. - malaise. - weakness. - elevated WBC count. - tachypnea. - dyspnea. - blood-tinged purulent sputum. 6/6/2018 13 www.drjayeshpatidar.blogspot.com
  • 14. 4. Gram-negative bacterial pneumonia:  Caused by Klebsiella pneumonia.  C/M:- fever with multiple chills. - pleuritic pain. - rales. - cyanosis. - elevated WBC count. - dyspnea. - blood-streaked purulent sputum. 6/6/2018 14 www.drjayeshpatidar.blogspot.com
  • 15. 5. Anaerobic bacterial pneumonia:  Caused by normal oral flora.  C/M:- low-grade fever. - hypertension. - crackles. - cyanosis. - elevated WBC count. - dyspnea. - foul smelling purulent sputum. - tachycardia. 6/6/2018 15 www.drjayeshpatidar.blogspot.com
  • 16. 6. Legionnaires’ disease:  Caused by Legionella pneumophila.  C/M:- fever. - pleuritic pain. - nausea. - confusion. - elevated WBC count. - dyspnea. - blood-tinged sputum. 6/6/2018 16 www.drjayeshpatidar.blogspot.com
  • 17. 7. Mycoplasma pneumonia:  Caused by Mycoplasma microorganisms.  C/M:- slowly rising fever. - headache. - myalgia. - malaise. - normal WBC count. - scant mucoid sputum. 6/6/2018 17 www.drjayeshpatidar.blogspot.com
  • 18. 8. Viral pneumonia:  Caused by Influenza A virus.  C/M:- high fever. - headache. - myalgia. - dyspnea. - normal/slightly WBC count. - mucoid sputum. - normal breath sounds. 6/6/2018 18 www.drjayeshpatidar.blogspot.com
  • 19. 9. Aspiration pneumonia:  Caused by aspiration of gastric contents.  C/M:- tachypnea. - apnea. - cyanosis. - hypotension. - leukocytosis. - adventitious lung sounds. - fever. 6/6/2018 19 www.drjayeshpatidar.blogspot.com
  • 20. Clinical manifestations: ♥ Fever. ♥ Chills. ♥ Sweats. ♥ Pleuritic chest pain. ♥ Cough. ♥ Sputum production. ♥ Hemoptysis. ♥ Dyspnea. ♥ Headache & fatigue. 6/6/2018 20 www.drjayeshpatidar.blogspot.com
  • 22. Diagnostic evaluation: Chest auscultation. Sputum culture analysis & sensitivity/ serologic testing. Fiber optic bronchoscopy/ Transcutaneous needle aspiration/ biopsy. Skin tests. Blood & urine cultures. Transcutaneous oxygen level analysis/ ABG measurements. Chest X-ray examination. 6/6/2018 22 www.drjayeshpatidar.blogspot.com
  • 23. Classification: i. Based on area affected: Segmental pneumonia. Lobar pneumonia. Bilateral pneumonia. ii. Basis of location & radiologic appearance: Bronchopneumonia. Interstitial(reticular) pneumonia. Alveolar(acinar) pneumonia. Necrotizing pneumonia. 6/6/2018 23 www.drjayeshpatidar.blogspot.com
  • 24. Medical Management: ☻Specific antibiotic therapy: Broad spectrum antibiotics. ☻Respiratory support:  Administer oxygen.  Bronchodilator medications.  Postural drainage.  Chest physiotherapy.  Tracheal suctioning. ☻Nutritional support. ☻Fluid & electrolyte management. 6/6/2018 24 www.drjayeshpatidar.blogspot.com
  • 25. Nursing management: Ineffective airway clearance R/t excessive secretions & weak cough. Ineffective breathing pattern R/t tachypnea. Activity intolerance R/t decreased oxygen levels for metabolic demands. Deficient fluid volume R/t fever, diaphoresis, & mouth breathing. Imbalanced nutrition: less than body requirements R/t dyspnea. Pain R/t frequent coughing. 6/6/2018 25 www.drjayeshpatidar.blogspot.com
  • 26. Cont…. Impaired oral mucous membrane R/t mouth breathing & frequent cough. 6/6/2018 26 www.drjayeshpatidar.blogspot.com
  • 27. Possible complications:  Respiratory failure.  Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.  Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure  Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure 6/6/2018 27 www.drjayeshpatidar.blogspot.com
  • 28. Pneumonia At A Glance: Pneumonia is a lung infection that can be caused by different types of microorganisms, including bacteria, viruses, and fungi. Symptoms of pneumonia include cough with sputum production, fever, and sharp chest pain on inspiration (breathing in). Pneumonia is suspected when a doctor hears abnormal sounds in the chest, and the diagnosis is confirmed by a chest x-ray. Bacteria causing pneumonia can be identified by sputum culture. 6/6/2018 28 www.drjayeshpatidar.blogspot.com