This is pdf file for basic knowledge of PNEUMONIA

1. PNEUMONIA AND ITS
MANAGEMENT
Bsc (H)nursing

2. Topic : Pneumonia
& it’s management

3. PNEUMONIA
◦PneUmonia ia an Inflamation in lung parenchyma
caused by Various microrganism including bacteria,
mycobacteria, fungai and viruses . Pneumonitis is
more general term that describes an inflamatory
process on the lung tissue

4. Anatomy and physiology of
Pneumonia
◦The respiratory system inhuman is classified into two
parts :
◦1. Upper respiratory tract : It consist of
nose,paranasal sinuses, pharynx,tonsils ,and
adenoids ,larynx and trachea .
◦2. Lower respiratory tract : It consist of lungs, which
contain bronchial and alvelar structures needed for
gaseous exchange

5. Anatomy and physiology

6. Function of respiratory system
◦ Oxygen transport
◦ Respiration
◦ Ventilation
◦ Gas exchange
◦ Pulmonary Diffusion And perfusion

7. Epidermiology of
pneumonia
◦ Common illness affecting approximately 450 million people
a year occuring in all part of the world and 4 million deaths
yearly.
◦ Rates are greater in childern Less than 5 years and adult
older than 75 years .
◦ In India ,it’s single largest cause of death in childern resulting
in nearly 120 million cases a years.

9. ETIOLOGY
◦ There are many causes of pneumonia including
bacteria,viruses , mycoplasma,fungal agents and protozoans
may also result from inhalation of toxic chemicals, smoke
,dust ,gases or aspiration of food, fluids from vomitus .
◦ PneUmonia may complicate to chronic illness.

11. Classification of Pneumonia
◦ According to causitive organism
◦ 1. Bacteria
◦ Pneumococcal pneumonia caused by streptococcus pnumonia.
◦ Staphyloccocus pnumonia caused by staphylococcus pneumonia.
◦ Gram negative bacteria Pneumonia caused by klebseilla
Pneumonia.
◦ Anaerobic bacteria Pneumonia caused by normal flora .

12. Continue-
◦ 2 . Viral
◦ Rhino virus ,corona virus , influenza virus and adeno virus.
◦ Herpes simplest viruses rarely causes Pneumonia in new born,. Person with
cancer and transplant recipients .
◦ 3. Fungal
◦ Fungal Pneumonia is used by pneumocystis jirovercii.
◦ 4. Parasitic
◦ Parasitic pneumonia caused by protozoa , nematodes etc.

13. ◦ According to environment
◦ 1. Community acquired pneumonia
◦ 2. Ventilator acquired pneumonia
◦ 3. Pneumonia in the compressed host
◦ 4. Hospital acquired Pneumonia.
According to areas of lung affected
1. Lobar Pneumonia
2. Necroting pneumonia
3. Segmental Pneumonia
4. Aleveolar Pneumonia
5. Intestinal Pneumonia
6. Bronchial Pneumonia

14. ◦ According to cause
◦ 1. Eosinophillic Pneumonia
◦ 2. Chemical Pneumonia
◦ 3. Aspiration Pneumonia
◦ 4. Allergic Pneumonia
◦ 5. Bilatéral pneumonia.

15. Clinical manifestations
◦ The onset of Pneumonia by any or all of the following manifestations:
◦ Fever , chills , sweat , fatigue, cough and sputum production
◦ Less common symptoms include hemoptysis, pleuritic chest pain and
headache .
◦ Other clients may not Present with fever , respiratory manifestation
but with altered mental status and dehydration.

16. Continue-
◦ Other manifestations may include :
. Crackling sound over affected area.
. Hypoxemia
. Tachypnea
. Productive cough
. Dyspnea
. Decrease in breath sound
. Dullness Or percussion Over affected area .
. Unequal chest expansion.

18. Diagnostic tests
◦ Chest X ray
◦ Fiberoptic bronchoscopy Or Transcutaneous needle aspiration
Or biopsy
◦ PCR (polymérisé chain reaction)
Additional evaluation may;
Transcutaneous oxygen level analysis or arterial blood gas (ABG )
measurements to assess the need for supplemental oxygen. Skin
test, if TB and coccididomycosis is suspected .Blood and urine
culture to assess symetric speed.

20. Prognosis
◦ With treatment most types of bacterial pnumonia will stabalise in 3-6
days . It’s often taken a few weeks before moat symptoms resolved. In
person requiring hospitalisation, mortality may be as high as 10% and
those requiring intensive as it may reach 30-50%.

21. NURSING
MANAGEMENT OF
A PATIENT WITH
PNEUMONIA

22. Assessment
◦ Take Carefully history to establish etiologic diagnosis.
◦ Assess the early patient for unusual behaviour altereded mental
status, dehydration, fatigue and heart failure .
◦ Observe for anxious, flushed appearance, shallow respirations ,
splinting of affected side, confusion disorientation.
◦ Perform respiratory assessment for every 4 hourly including
determination of rate and character determination of respiraton
auscultation of breath sounds and assessment of skin and nail
beds to determine the severity of hypoxia.
◦ IN addition of physical examination transcutaneous oxygen level
analysis or ABG measurements may be used to evaluate the
need for oxygen support.

23. 1. Ineffective airway clearance related to copioous tracheo-
bronchial secretion.
◦ Goal:- to improve airway patency.
◦ Interventions:- the nurse encourage hydration 2-3L/day
◦ Humidification may be used to loosen secretions And improve
ventilation.
◦ Deep breathing exercise Should be performed.
◦ Spirometry.
◦ Coughing can be initiated either voluntarily or reflex.

24. 2. Activity intolerance related to impaired respiratory
function.
◦ Goal:- to promote rest and conserving energy.
◦ Interventions:- the patient should assume comfortable position to
promote rest and breathing. Eg:- semifowler’s position).
◦ Positions of the pt should be changed frequently to promote to
enhance secretions clearance and ventilation of the lungs.
◦ Instruct out patient not to over exert themselves and to encourage
only in moderate activities during the initial phase of treatment.
◦ The nurse encourage the deliberated patient to rest and avoid over
exertion and possible exertion of symptoms.

25. 3. Risk for deficient food volume related to fever and
dyspnea.
◦ Goal:- to promote adequate fluid intake.
◦ INTERVEVNTIONS:- encourage increase fluid intake atleast (2L/day).
◦ Respiratory rate of the pt. Should be maintained.
◦ Careful monitoring in pt. With pre- existing conditions such as heart
disease.

26. 4. Imbalance nutrition: less than body requirements.
◦ Goal:- to maintain adequate nutrition.
◦ Intervention:- provide more fluid to the pt. With shortness of
breath as they have decreased appetite.
◦ Fluids with electrolyte (commercially available drinks such as
gatrode) may help provide fluid and electrolytes.
◦ Nutritionally enriched shakes and drinks are helpful.
◦ Fluids and nutrients may be administration intravenously, if
necessary.

27. 5. Deficient knowledge about the treatment regimen and preventive
measures.
◦ GOAL:- to promote patient’s knowledge.
◦ Intervention:- the pt. And family are instructed about the cause of
Pneumonia, management of symptoms of Pneumonia and the need to
follow up
◦ The the patient should also be informed about factors that have contributed
to developing Pneumonia and strategies to promote recovery and to
promote recurrence.
◦ The pt. May require that instructions and explanations be repeated several
times, because of severity of symy.
◦ If possible written information and instructions and explanations be repeated
several times, because of severity of symptoms.
◦ If possible written information and instructions should be provided.

28. EVALUATION
Expected patient outcome may include:
1). Demonstrate improved patency as evidence by pulse , adequate oxygenation
by pulse Oxymetry or ABG analysis, normal breathing sound and effective
Laughing.
2). Rest and conserves energy by limiting activities and remaining in bed while
asymptomatic Slowly in increasing activities.
3). Maintain adequate hydration as evidence by an adequate dietary in take as
evidence by maintaince or increase in body weight due to excessive fluid gain
4). Exhibits no complications in following
a). Has normal vital sign pulse Oxymetry and ABG
b). Reports productive cough that dimnishes over time.
c). Has sign and symptoms of shock
d). Remain oriented and award of surrounding.
e). Maintain or increase weight

29. HEALTH TEACHING
1. Advise patient to complete entire course of Antibiotics
2. Once clinically stable encourage gradual increase in activities to bring energy
level pack to pre-illness stage .
3. Explain that a chest x-ray usually taken 4-6 weeks after recovery
4. Advise smoking cessation
5. Advise pt to keep up natural resistance with good nutrition and edequate
6. Instruct upt to avoid fatigue, Sudden extremes in temperature and excessive
alcohol intake.
7. Advise patient to practice frequent hand writing especially after contact with
others

30. Summary and conclusion
◦ Today we have discussed about the topic Pneumonia and
it’s management.Here we studied about Pneumonia, it’s
classification, risk factors and management because as a
nurse we encounter as many patients with respiratory
tract infection in which pneumonia I most common , we
have also discussed the health teaching given to him
.hope this reading will be helpful in future and also we
will treat our patient with proper care.

31. Bibliography
◦Black and hoye , medical surgical
nursing 8 th edition ,Elsevier publication
pg 1596-1603
◦Medical surgical nursing,10 th edition
Brunner and Siddharth ,pg 522-531.