This document provides information on pneumonia and lung abscess from a seminar presentation. It begins with an introduction to pneumonia, defining it as an infection of the lungs. It then discusses the incidence of pneumonia globally and in various countries. Etiology, risk factors, pathophysiology, classification, signs and symptoms, complications, diagnosis, and management of pneumonia are explained. It also provides detail on lung abscess including definition, risk factors, pathophysiology, signs and symptoms, complications, diagnosis, and management. Surgical interventions for complications like empyema are also mentioned.

1. SEMINAR ON
PNEUMONIA AND LUNG
ABSCESS
PRESENT BY:
Gwenneth. Z. Nongkhlaw
1st year Bsc. Nursing (Post
Basic)
CON,CIHSR

2. pneumonia
INTRODUCTION
A wide variety of problems affect the
lower respiratory tract system. The
conditions simply means infection of lungs
and a person with pneumonia is usually
quiet. In pre- antibiotics days it was
often fatal, occur especially elderly
people and in case where diagnosis are
delayed.

3. DEFINITION
Pneumonia is an acute infection and
inflammation of the lung parenchyma or
alveolar are filled with fluid usually
caused by variety of organisms.
Pneumonitis predispose or place the
patient at risk for microbial infection.
Consolidation is a term used for gross and
radiologic appearance of the lungs in
pneumonia.

5. INCIDENCE
Acute respiratory infection accounts:
Major cause of death among all age groups
especially below 5yrs children and adults
older than 75 years of age
3.9 million young children dying globally
40% deaths occur in Bangladesh, Nepal,
India and Indonesia
90% of ARI are due to pneumonia: developed
countries less than 3-4% and in developing
countries as high as 20%
India: infant death-9,87,000 out of which
9,69,000 are due to ALRI

6. ETIOLOGY
Factors predisposing to pneumonia.
Inhalation of microbes like;
Mycoplasma Pneumonia and Fungal
pneumonia.
Hematogenous spread from a
primary infection elsewhere in the
body like Staphylococcus aureus.

7. 1. Community acquired pneumonia(CAP)
Occurs within 48hrs after hospitalization.
Organisms are streptococcus P, mycoplasma P,
H. influenzae, clamydia, Legionellapneumophila,
oral anaerobes, S. aureus, klebsiella, fungi,
nocardia and mycobacterium tuberculosis.

8. 2. Hospital-Acquired Pneumonia(HAP)
Develops 48hrs or more after
admission and does not appear to be
incubating at the time of admission.
Common organisms include Pseudomonas
aeruginosa, enterobacter species, E.coli,
H.influenzae, klebsiella, proteus,
S.aurues,Streptococci pneumonia and oral
anaerobes.

9. 3. Pneumonia in immunocompromised host
The host includes Pneumocystitis
pneumonia (PCP), fungal pneumonia and
mycobacterium tuberculosis. PCP is caused
by organisms known as Pneumocystitis
jiroveci.
Other causes are corticosteriods,
chemotheraphy, nutritional depletion, use
of broad spectrum antimicrobial agents
and Long term mechanical ventilation.
It maybe caused by organisms also
observed in CAP and HAP.

10. 4. Aspiration Pneumonia
Pulmonary consequences resulting
from entry of endogenous or exogenous
substances in the lower airway. Common
causes are:
Aspiration of bacteria: S. aurues,
streptococcus species and gram negative
bacilli
Other substances: gastric contents,
exogenous chemical and irritating gases

11. ANATOMY AND PHYSIOLOGY
Introduction
The cells and the body require energy
for metabolic activities. The respiratory
system provides this energy which is
derived from chemical reaction of oxygen
supplied throughout the body and also a
route for excretion of carbon dioxide.

12. Definition
Respiration is exchange of gases which
occurs between the atmosphere, blood
and body cells. In this process oxygen is
inhaled and carbon dioxide is exhaled.
Blood transport gases between lungs and
cell of the body.

13. Types of respiration
1. External respiration: exchange of
gases between the blood and the lungs
2. Internal respiration: exchange of
gases between the blood and the cells

14. Structure of Respiratory tract system

16. The lung and its pleura

17. Functions
Two main processes
breathing
exchange of gases
Others
Defence against microbes
Warming and humidifying

18. CLASSIFICATION
1) According to causes.
2) According to anatomic distribution.
3) Others.

19. 1. According to causes:
a) Bacterial pneumonia
b) Viral pneumonia
c) Fungal pneumonia
d) Chemical pneumonia
e) Inhalation pneumonia.

20. 2. According to anatomic distribution
a) Lobar pneumonia:
A large segment of one
or more lobules is involved when both
lungs are affected, it is called bilateral
or double pneumonia.

23. b) Broncho pneumonia or lobular
pneumonia:
Infection begins
in the terminal bronchioles to
become mucous purulent exudates
to form consolidated patches in
lobules. (this conditions is usually
present in the extremes of life
infancy and old age).

25. c) Interstitial pneumonia:
It is a form of lung
disease characterized by
progressive scarring of both lungs.

28. 3. Others:
1. Community acquired pneumonia(CAP)
Infection of lung parenchyma
Onset in the community is during first 2
days or 48hrs of hospitalization
Peaks in midwinter
Smoking is a risk factor
35% S. pneumoniae and
10% H. influenza

29. 2. Hospital care acquired pneumonia
(HAP)
Occuring 48hrs or longer after hospital
admission
Does not appear to be incubating at the
time of admission
Subdivided to two types:
a. Ventilator-associated pneumonia (VAP)
b. Health care associated
pneumonia(HCAP)

30. 3. Aspiration pneumonia
Sequelae occuring from abnormal entry
of secretions or substances into the
lower airway
History of LOC, gag and cough reflexes
are depressed.
Risk factor- tube feeding
Two distinct forms:
a. Mechanical aspiration
b. Chemical
(noninfectious) pneumonitis

31. 4. Opportunistic pneumonia
Patients with altered immune responses
are highly susceptible to respiratory
infections
Individuals at risk are severe protein-
calorie malnutrition, immune deficiency,
patients undergoing transplantation
treated with immunosuppressant drugs,
corticosteroids.

32. It maybe caused by pneumocystitis
jiroveci
Commonest most acquired
immunodeficiency syndrome (AIDS-
associated pneumonitis)

33. Lobar pneumonia:
A large segment of one or more lobules
is involved when both lungs are
affected, it is called bilateral or double
pneumonia. It is an acute bacterial
infection. Organism responsible for
pneumonococcal pneumonia,
staphylococcus, streptococcus
pneumonia and gram negative aerobic
bacillus

34. Morphologic features: Laennec’s original
description divides lobar pneumonia into
4 sequential pathologic phase. However,
these classic stages seen in untreated
cases are found much less often
nowadays due to early institution therapy
of antibiotic therapy.

35. 1. Stage of congestion
2. Stage of red hepatization
3. Stage of gray hepatization
4. Stage of resolution

36. STAGES OF PNEUMONIA
1. Stage of congestion
pneumococcus organism reaches the
alveoli
outpouring of fluid in the alveoli
multiplication of organisms in serous fluid
infection and interfering with lung
function

37. 2. Stage of red hepatization
massive dilation of capillaries
alveoli are filled with organisms,
neutrophils, RBCs and fibrin
lungs appear red and granular similar
to the liver known as hepatization

38. 3. Stage of gray hepatization
massive decrease blood flow
leukocytes and fibrin consolidate in
the affected part of the lungs

39. NORMAL COLOUR OF THE LUNGS

40. Red hepatization Gray hepatization

41. 4. Stage of resolution
complete resolution and healing
occurs if no complications
exudates becomes lysed by macrophages
normal lung tissue is restored and
gas exchange returns to normal

42. PATHOPHYSIOLOGY
aspiration of s. pneumonia
Inflammatory response(release of
endotoxin)
attraction of neutrophils
releases of inflammatory mediators
Accumulation of fibrous exudates, RBCs
and bacteria

43. alveoli fill with fluid increased
mucus and debris production
of mucus
(consolidation)
(airwayobstruction)

44. decreased gas exchange
resolution gas exchange
omacrophages in alveoli ingest and
remove debris
onormal lung tissue restored
ogas exchange returns to normal

45. CLINICAL MANIFESTATION

46. COMPLICATIONS
1. Pleurisy
2. Pleural effusion
3. Atelectasis
4. Bacteremia
5. Lung abscess and Empyema
6. Pericarditis and Endocarditis
7. Meningitis

47. DIAGNOSTIC EVALUATION
1. History
Dyspnea
Chest pain
Cough
Hemoptysis
2. Physical assessment
Bronchial breath sounds and aegophony

48. General appearance: confused mental
stage and weak, cyanosis of the lips and
tongue.
Hoarseness and stridor
Peripheral cyanosis
Decreased blood pressure diastolic
</=60mmhg (severe pneumonia)
Respiratory rate >30bpm (severe
pneumonia)
Fever with rigors

49. 3. Diagnostic test
Chest x-ray
Gram stain, culture and sensitivity test
Pulse oximetry and ABG
Blood culture
Complete blood count
Bronchoscopy
Computed tomography
Thoracentesis (pleural fluid culture)

50. NORM
Amount
Colour
Specific
gravity
pH
Protein
<20ml
clear
<1.016
Equal to
serum level
<3g/dl
Normal composition of pleural fluid

51. NORM TRANSUDATE EXUDATES
Specific gravity <1.016 >1.016
Colour clear Cloudy turbid
pH Equal to serum level <7.3
Protein <3g/dl >3g/dl
Fibrinogen None or maybe present Present
Cells Few lymphocytes May or maybe few RBCs
or purulent
Lactate
Glucose
Equal to serum level
Equal to serum level
Maybe lactate
dehydrogenous
Maybe <serum
Abnormal accumulation of transudate and exudate

52. MANANGEMENT
1. Medical management
Intravenous therapy
Pharmacologic treatment
a. macrolides
b. fluroquinolones
c. ramantidine /amantadine(viral
pneumonia)
d. aspirin, NSAIDs or acetaminophen
e. expectorant and bronchodilator
f. antihistamines
g. nasal decongestants

53. Non-pharmacological treatment
a. hydration: increased 2-3l/day
b. bed rest
c. warm-moist inhalation
d. supplemental oxygen
e. turning, coughing and breathing
exercises
f. postural drainage and chest
physiotherapy

55. 2. Surgical management
Complications like empyema,
bronchiestasis, pleural effusion, lung
abscess in which surgical intervention
is needed.
Thoracentesis under guidance of
ultrasonography depending on the size
of the pleural effusion.

56. Purpose
Remove fluid and air
Aspiration for therapeutic and
diagnostic reasons
Biopsy or instillation of medications

57. SURGICAL MANAGEMENT:
Surgical resection should be
considered in patients with evidence
of pulmonary necrosis.
Resections is indicated in cases of
severe sepsis, high output broncho
pleural fistula or acute respiratory
failure

59. 3. Nursing management
Ineffective breathing pattern related
to copious tracheobronchial secretions
secondary to pneumonia as evidenced by
dyspnea, nasal flaring and altered chest
excursion.
Activity intolerance related to impaired
respiratory function secondary to
pneumonia as evidenced by inability to
perform activity and patient is
restricted to strict bed rest.

60. Risk for deficient fluid volume
related to fever and rapid
respiratory rate secondary to
pneumonia.
Risk for complications related to
altered hemodynamic functions and
impaired respiratory functions
secondary to pneumonia.

61. PROGNOSIS
The prognosis depends entirely on the
patient’s medical therapy. Long term
antibiotics is given for treatment of
pneumonia and is revaluated because if
medications is stopped abruptly, patient
might relapse back to pneumonia.

62. AMERICAN NURSING
JOURNAL
Research: mouth care to reduce
ventilator-associated pneumonia.
Overview: despite the establishment
association between good oral hygiene
and the prevention of VAP, the
importance of mouth care in infection
control is seldom recognized.

63. A linked has been established
between oral care and VAP.
1. In well patients, the oral cavity is
home to species of normal flora and
infectious microbes which are kept
intact by immune defenses.
2. In critically ill patients,
immunologic denfenses maybe unable
to overcome organisms.

64. When oral care is provided
a. reduces mouth’s bacterial burden
but also stimulates the flow of
saliva which aids in removal of
microbial plague
b. contains immunoglobulin
c. minimized bacteria proliferation
secondary to xerostomia.

65. When oral care not provided
especially mechanically ventilated
patients
a. Opportunistic organisms flourish
often colonizing oropharyngeal site
which later notoriously become
resistance to antibiotics
b. Has distinct odor-sweet, slightly
putrid frquently describe as
grapefruit of fruity

66. Results: research shows that
implementing oral care protocol
reduces the incidence of VAP by 46%
to nearly 90% sustainably decreasing
associated costs.

67. LUNG ABSCESS
INTRODUCTION
Lung abscess is type of liquefactive
necrosis of the lung tissue and
formation of cavities more than 2cm
containing necrotic debris or fluid
caused by microbial infection

68. DEFINTION
Lung abscess is necrosis of the
pulmonary parenchyma caused by
microbial infection containing pus
lesion, by definition the chest x-ray
demonstrates a cavity of at least
2cm.

69. ETIOLOGY
Gram-negative organism: klebsiella,
s. aurues and anaerobic
bacilli(bacteroides)
Malignant growth
Tuberculosis
Parasitic and fungal diseases of the
lungs

70. RISK FACTOR
 Impaired cough reflexes
CNS disorders: seizures and strokes
Alcoholism
Drug addiction
Esophageal disease
Compromised immune function
Patients with altered state of
consciousness due to anesthesia
Nasogastric tube feeding

71. PATHOPHYSIOLOGY
bacteria aspirated form GI tract or due to
periodontal disease
infection causes abscess to develop slowly
necrotic tissues forms leading to
accumulation of fluid filled cavity with
purulent material
lung abscess

72. CLINICAL MANIFESTATIONS
Pleuritic chest pain
Fever with chills
Productive cough with copious amount of
foul smelling, sometimes bloody sputum
Prostration
Dyspnea
Weakness, anorexia and weight loss

73. COMPLICATIONS
Complications that can occur include
chronic pulmonary abscess,
bronchiectasis, bronchopleural fistula,
brain abscess as a result of
hematogenous spread of infection and
empyema from abscess perforation
into the pleural cavity

74. PROGNOSIS
Most cases respond to antibiotics and
prognosis is usually excellent unless
there is a debilitating underlying
condition. Mortality from lung abscess
alone is around 5% and is improving

75. DIAGNOSTIC EVALUATION
Physical assessment: dullness on
percussion and decrease breath sounds
and presence of crackles in later stages
Oral examination: dental caries,
gingivitis and periodontal infection
Diagnostic test:
a. chest x-ray(fluid like abscess,
effusion and caverns)
b. sputum culture
c. fiber optic bronchoscopy

77. LUNG
ABSCESS

78. LUNG
ABSCESS

79. MANAGEMENT
Medical management
a. Chest physiotherapy and postural
drainage
b. Protein diet
c. Antimicrobial therapy(clindamycin)
d. Prolonged antibiotic therapy

80. Surgical management
a. selective patients for drianage of
pus
b. Therapeutic use of bronchoscopy
and percutaneous chest catheter
c. Surgical procedure performed are
lobectomy or pneumonectomy

81. JOURNAL BRASILEIRO DE
PNEUMOLOGIA
Objective: to relate the experience of the
staff at a health care facility specializing
in the management of patients with
aspiration lung abscess.
Methods: diagnostic aspects and
therapeutic results of 252 consecutive
cases of lung abscess seen in patients
hospitalized between 1986 and 2004.

82. Results: out 252% patients, 209 were
male and 43 were female. The men
age was 41.4years and 70.2% were
alcoholic

83. CONCLUSION
Lung abscess occuring predominantly
in male adults presenting dental
disease and having a history of LOC
(especially in alcohol abuse). Most of
the were treated clinically with
antibiotics and postural drainage
although some surgical procedure was
required in 1/5th of the study sample.

84. BOOKS
1. Hinkle Janice L. Cheever Kerry H. (2011)
Brunner and Siddhart’s Textbook of Medical
Surgical Nursing (13th ed. Vol 1. Pp:573-582,
591-92, 508-514) Wolters Kluwer Health. Pvt.
Ltd. New Delhi.
2. Chintamini (2014) Lewis Medical Surgical
Nursing (1st ed. Pp:561-568) Elsevier, a division
of Reed Elsevier India (P) Ltd.
3. Swearingen Pamela M. (2012) All in one Care
Planning Resource (3rd ed. Pp:120-129) Elsevier
Inc.
4. Dr. Ramchandar P. V Parasannababy. Lippincott
Manual of Nursing Practice (9th ed. Pp-288-
289) Wolter Kluwer India (P) Ltd.

85. 1. Cynthia L. Chennecky. Barabara J.B (2013)
Laboratory test and Diagnostic Procedures (6th ed.
Pp:1068-1069) Elsevier Saunder publisher.
2. Waugh Anne Grant Allison. (2012) Ross and
Wilson Anatomy and Physiology in Health and
Illness (11th ed. Pp:234-251) Library Congress
Cataloging in Pubication.

86. JOURNAL
1. Booker Staja, MS(RN). Murff Sharon, MS(RN).
Kitko Lisa, Phd(RN). Jablonski Rita, Phd (RN).
(2013 October) Mouth Care to reduce VAP.
America Journal Nursing (Vol:113 No:10. Pp:24-
25)
2. Moreira Jose de Silva. Felicetti Jose Carlos.
Goldenfun Roberto Paulo. Porto Nelson da Silva.
(2016 April) Lung Abscess: analysis of 252
consecutive cases diagnosed between 1968-2004

87. WEBSITE
1. All 4 Natural Health.com (2007-2014) Treatment
for pneumonia Discussion and Tips.
www.all4naturalhealth.com. Retrieved on 4th
September 2016
2. www.scielo.br/scielo.php. Retrived on 4th
September 2016