This document provides an overview of pneumonia, including: - Pneumonia is an infection of the lungs caused by bacteria, viruses, fungi or parasites that leads to lung inflammation. It can range from mild to life-threatening. - There are several types of pneumonia classified by cause, including bacterial, viral, fungal, chemical and aspiration pneumonia. - Pneumonia is also classified by location (lobar vs. lobular), duration (acute vs. chronic), location of infection (community acquired vs. hospital acquired) and pathology (typical vs. atypical).

2.  INTRODUCTION
 Pneumonia is an infection of the lungs that is
caused by bacteria, viruses, fungi, or parasites. It is
characterized primarily by inflammation of the
alveoli in the lungs or by alveoli that are filled with
fluid (alveoli are microscopic sacs in the lungs that
absorb oxygen). At times a very serious condition,
pneumonia can make a person very sick or even
cause death. Although the disease can occur in
young and healthy people, it is most dangerous for
older adults, babies, and people with other
diseases or impaired immune systems.

3. Pneumonia is an inflammation or infection of
the lungs most commonly caused by a
bacteria or virus. Pneumonia can also be
caused by inhaling vomit or other foreign
substances. In all cases, the lungs' air sacs fill
with pus , mucous, and other liquids and
cannot function properly.This means oxygen
cannot reach the blood and the cells of the
body.

4. .

5.  Classification by cause
 Bronchiolitis obliterans organizing
pneumonia:(BOOP) is caused by inflammation
inflammation of the small airways of the lungs.It is
also known as cryptogenic organizing
pneumonitis(COP).
 Eosinophilic pneumonia
 Eosinophilic pneumonia is invasion of the lung by
eosinophils, a particular kind of white blood cell.
Eosinophilic pneumonia often occurs in response to
infection with a parasite or after exposure to
certain types of environmental factors.

6.  Chemical pneumonia
 Chemical pneumonia (usually called
chemical pneumonitis) is caused by
chemical toxicants such as pesticides,
which may enter the body by inhalation or
by skin contact. When the toxic substance
is an oil, the pneumonia may be called
lipoid pneumonia.

7.  Aspiration pneumonia: This type of pneumonia
occurs when people inhale foreign materials.The
inhaled foreign materials cause inflammation of the
bronchial tubes and lungs and May also result in
formation of pus in the lungs. Often the inhaled foreign
materials are stomach contents like secretions, vomits,
food items and drinks. Dental problems, old age,
having sedative drugs, being alcoholic, coma, and
anesthesia are some of the contributing factors of
aspiration pneumonia. The lung’s response depends
primarily on the quantity and nature of the inhaled
substance.The more will be the acidic nature of the
material, the more will be the intensity of the lung
injury.

8.  Dust pneumonia: It is caused by excessive exposure
to dust storms.With dust pneumonia, dust settles all
the way into the alveoli of the lungs stopping the cilia
from moving and preventing the lungs from ever
clearing themselves.
 Necrotizing Pneumonia: Although overlapping with
many other classification , necrotizing P pneumonia
include Pneumonias that cause substantial necroses
of lung cells and sometimes even lung abscess

9.  Opportunistic pneumonia: includes those that
frequently strike immunocompromised victims.
Main pathogens are cytomegalovirus,
Pneumocystis jiroveci, Mycobacterium avium-
intracellulare, invasive aspergillosis, invasive
candidiasis, as well as the "usual bacteria" that
strike immunocompetent people as well.
 Double Pneumonia: This is historical term for acute
lung injury or acute respiratory syndrome .
However the term was and is still used by the
people to denote Pneumonia affecting both lungs.

10.  Lobar pneumonia
 Involvement of entire lobe
 Lobular pneumonia
 Involvement of parts of lobe only,
segmental or of alveoli contiguous to
bronchi

11.  Usual Interstitial pneumonia (UIP)
 UIPInterstitial pneumonia is form of lung
disease characterized by progressive
scarring of both lungs.The scarring involves
supporting framework (interstitial) of the
lungs

13.  Acute Pneumonia: Acute pneumonia lasts less than
three weeks indurations . Acute Pneumonia further
divided into :- Classic bacterial bronchopneumonia such
as streptococcus pneumonia and atypical pneumonia
such as interstitial pneumonitis of mycoplasama
pneumonia and aspiration pneumonia syndromes.
 Chronic pneumonia syndrome:- This occurs or tend to
be either non infectious or mycobacterial fungal or
mixed bacterial infection caused by airway obstruction .
It includes actinomyces and blastomyces dermatitidis
as well as mycobacterium tuberculosis and atypical
mycobacterium.

14.  Community Acquired pneumonia
 Community acquired pneumonia occurs outsides of
hospital setting .Most people get CAP by breathing in
germs (especially by sleeping)that live in mouth nose or
throat
 Nosocomial and others
Organisms that have been exposed to strong
antibiotics and have developed resistance are called
nosocomial organisms. If they enter the lungs, a person
may develop nosocomial pneumonia. Resistant bacteria
are often found in nursing homes and hospitals. An
example is MRSA, or methicillin-resistant Staph aureus,
which can cause skin infections as well as pneumonia.

15.  Similarly, outbreaks of the H5N1 influenza
(bird flu) virus and severe acute respiratory
syndrome (SARS) have resulted in serious
pneumonia infections. Anthrax, plague,
and tularemia also may cause pneumonia,
but their occurrences are rare.

16.  Atypical pneumonia :It also known as walking pneumonia, is
the type of pneumonia not caused by one of the more
traditional pathogens. Its clinical presentation contrasts to that
of "typical" pneumonia. A variety of microorganisms can cause
it. When it develops independently from another disease it is
called primary atypical pneumonia (PAP). atypical organisms
include special bacteria, viruses, fungi, and protozoa. In
addition, this form of pneumonia is atypical in presentation
with only moderate amounts of sputum, no consolidation, only
small increases in white cell counts, and no alveolar exudate. At
the time that atypical pneumonia was first described,
organisms like Mycoplasma, Chlamydophila, and Legionella
still were not recognized as bacteria and instead considered
viruses. Hence "atypical pneumonia" was also called "non-
bacterial.It includes following.

17.  Bacterial pneumonia : As the name suggests, this type of pneumonia
is caused by different types of bacteria.The most pneumonia inducing
bacterium is Streptococcus pneumonia.This pneumonia types
generally affects people who have weakened immune system for
reasons like old age, illness, malnutrition etc. Bacterial pneumonia is
indicated with signs like rapid breathing, increased pulse rate, high
fever with chills and shaking, acute chest pain, chattering teeth,
palpitations, greenish and rust colored mucus, heavy perspiration etc.
 Viral pneumonia :This variant of pneumonia can be caused by
different types of viruses.The most common forms of viruses causing
viral pneumonia are flu virus, parainfluenza virus, herpes simplex
virus, rhinovirus, adenovirus, Hantavirus, cytomegalovirus and
respiratory syncytial virus. Symptoms of virus induced pneumonia are
similar to that of the pneumonia episodes caused by bacteria. People
with viral pneumonia are at risk of developing bacterial pneumonia.

18.  The pneumonia episodes triggered by cytomegalovirus or CMV
are more common among immune suppressed individuals. CMV
belongs to the group of herpes viruses. Patients undergoing
processes like bone marrow transplants and solid organ
transplants often get infected with CMV.The CMV induced
pneumonia is generally accompanied by no significant
symptom. However, if CMV causes pneumonia in AIDS
patients, people undergoing chemotherapy, bone marrow or
organ transplant patients the consequences can be quite
severe. Recently obtained statistics have revealed that 20
percent of the patients undergoing bone marrow transplants
develop CMV pneumonia.The mortality rate is exceedingly
high among patients who suffer from CMV pneumonia
simultaneously with hypoxemia (a condition characterized by
decreased levels of oxygen in blood).

19.  Mycoplasma Pneumonia : The condition is named
so as it is triggered by mycoplasmas (tiniest free-
living agents causing diseases in human beings).
The mycoplasmas are known to possess features of
both bacteria and viruses. People of every age
group can suffer from mycoplasma pneumonia.The
symptoms of mycoplasma pneumonia differ
significantly from symptoms of the other types of
pneumonia. Patients may experience symptoms
like rashes and anemia. Some patient may also
develop neurological syndromes like encephalitis,
myelitis and meningitis.

20.  Fungal pneumonia : Fungal pneumonia is
one of the rarest types of pneumonia.The
fungus causing this type of pneumonia is
Pneumocystis carinii.This pneumonia types
is also more common among people with
weak immune system. Often pneumocystis
carina pneumonia is described as a
complication experienced by AIDS patients.
Cancer patients are also at risk of
pneumocystis carinii pneumonia.

21.  Ventilator-associated and hospital-acquired
pneumonia
 Ventilator-associated pneumonia (VAP) is
pneumonia that develops 48 hours or longer
after mechanical ventilation is given by means of
an end tracheal tube or tracheotomy.Ventilator-
associated pneumonia (VAP) results from the
invasion of the lower respiratory tract and lung
parenchyma by microorganisms. Intubation
compromises the integrity of the or pharynx and
trachea and allows oral and gastric secretions to
enter the lower airways.

22.  Congestion: In the first 24 hours:This stage is
characterized histological by vascular engorgement,
intra- alveolar fluid, small numbers of neutrophils,
often numerous bacteria. Grossly, the lung is heavy
and hyperemic.
 Red hepatization or consolidation:Vascular
congestion persists, with extravasations of red cells
into alveolar spaces, along with increased numbers
of neutrophils and fibrin.The filling of airspaces by the
exudates leads to a gross appearance of solidification,
or consolidation, of the alveolar parenchyma.This
appearance has been likened to that of the liver,
hence the term "hepatization

23.  Grey hepatization: Red cells disintegrate, with
persistence of the neutrophils and fibrin.The
alveoli still appear consolidated, but grossly the
color is paler and the cut surface is drier.
 Resolution (complete recovery):The exudates
is digested by enzymatic activity, and cleared
by macrophages or by cough mechanism.
Enzymes produced by neutrophils will liquefy
exudates, and this will either be coughed up in
sputum or be drained via lymph.

24.  Bacteria and viruses are the primary causes of
pneumonia.When a person breathes
pneumonia-causing germs into his lungs and his
body's immune system cannot otherwise
prevent entry, the organisms settle in small air
sacs called alveoli and continue multiplying. As
the body sends white blood cells to attack the
infection, the sacs become filed with fluid and
pus - causing pneumonia.

25.  Bacterial
Streptococcus pneumoniae is the most common cause of bacterial
pneumonia. People who suffer from chronic obstructive pulmonary
disease (COPD) or alcoholism most often get pneumonia from Klebsiella
pneumoniae and Hemophilus influenzae.Atypical pneumonia, a type of
pneumonia that typically occurs during the summer and fall months, is
caused by the bacteria Mycoplasma pneumoniae. People who have
Legionnaire's disease caused by the bacterium Legionella pneumoniae
(often found in contaminated water supplies and air conditioners) may
also develop pneumonia as part of the overall infection.Another type of
bacteria responsible for pneumonia is called Chlamydia pneumoniae.
Pneumocystis carinii pneumonia is a form of pneumonia that usually
affects both lungs and is found in patients with weakened or
compromised immune systems from such conditions as cancer and
HIV/AIDS and those treated withTNF (tumor necrosis factor) for
rheumatoid arthritis

26.  Viral
Viral pneumonias are pneumonias that do not typically
respond to antibiotic treatment (in contrast to bacterial
pneumonias). Adenoviruses, rhinovirus, influenza virus
(flu), respiratory syncytial virus (RSV), and parainfluenza
virus are all potential causes of viral pneumonia.
 Fungal
 Fungal pneumonia is uncommon,but it may occur in
individuals with weakened immune systems due to AIDS,
immunosuppressive drugs, or other medical problems.
Histoplasmosis, coccidiomycosis, blast mycosis,
aspergillosis, and cryptococcosis are fungal infections that
can lead to fungal pneumonia

27.  Risk Factors
 1. Cigarette smoking disrupts both mucocillary
and macrophage activity.
 2. Immuno-compromised patients and those
with a low neutrophil count.
 3.Prolonged immobility and shallow breathing.
 4. Conditions which causes pneumonia like
cancer, COPD.
 5.Alcohol intoxication: Alcohol suppress the
body reflexes, may be associated with aspiration
and decrease white cell mobilization and
tacheobronchial culinary motion.

28.  Advanced age: In advanced age possible depressed
cough and glottis reflexes and nutritional depletion.
 7.Respiratory therapy with improperly cleaned
equipment.
 8.People living in environment or social settings in
which the risk of disease is high.
 9.General anesthetic, sedative or opioid preparations
that promote respiratory depression , which causes a
shallow breathing pattern and predispose to the
pooling of bronchial secretions and potential
development of pneumonia.
 10.Nothing-by-mouth(NPO) status, placement of
nasogastric or end tracheal tube.

30.  Cough
 Rusty or green mucus (sputum) coughed up
from lungs
 Fever
 Fast breathing and shortness of breath
 Shaking chills
 Chest pain that usually worsens when taking
a deep breath (pleuritic pain)
 Fast heartbeat
 Fatigue and feeling very weak

31.  Nausea and vomiting
 Diarrhea
 Sweating
 Headache
 Muscle pain
 Confusion or delirium
 Dusky or purplish skin color (cyanosis) from
poorly oxygenated blood

32.  In a community setting (general practice), pneumonia is
usually diagnosed based on symptoms and physical
examination alone. But in the hospitals following tests
should be conducted to make a diagnose
 History( particularly of a recent respiratory infection),
physical examination.
 Chest x-rays can reveal areas of opacity (seen as white)
which represent consolidation.
 Chest CT (computed tomography) can reveal
pneumonia that is not seen on chest x-ray.

33.  Sputum cultures generally take at least two to three days,
so they are mainly used to confirm that the infection is
sensitive to an antibiotic that has already been started.
 5.Acomplete blood count may show a high white blood
cell count, indicating the presence of an infection or
inflammation.
 6.Bronchoscopy is a procedure in which a thin, flexible,
lighted viewing tube is inserted into the nose or mouth
after a local anesthetic is administered.The breathing
passages can then be directly examined by the doctor,
and specimens from the infected part of the lung can be
obtained.

34.  Goal:The goal of treatment is to control symptoms
such as fever cough and shortness of breath until the
person recover another goal is to minimize
development of serious complications such as severe
shortness of breath and hypoxia.,
 First step in treatment of Pneumonia is prevention.
The risk of developing Pneumonia can be reduced by
not smoking and avoiding air pollutants, and contact
with people who are sick with Pneumonia, influenza
and other respiratory infections. Good hand washing
practice minimizes the spread of viruses, bacteria and
microorganism that cause Pneumonia.

35.  Mild cases of pneumonia that occur in
generally healthy adults may be treated at
homes.Treatment includes getting plenty of
rest and fluids and using a humidifier.The
physician will also recommend over- the -
counter or prescription medications to relieve
pain, fever and cough. Antibiotics are
prescribed if the illness is a form of bacterial
pneumonia.Antibiotics are ineffective in
curing viral pneumonia.

36.  Hospitalization:- Moderate to severe
Pneumonia result in low level of oxygen in the
blood and require hospitalization and
intravenous antibiotic administration if the
cause is a bacterial infection. .
 Oxygen therapy: - Supplemental oxygen helps
to relieve the shortness of the breath and ensure
that the vital organs such as the Heart and the
Brain get the enough oxygen. Concentrations of
the oxygen and the types of the devices used
vary depending on the severity of an individual's
condition.

37.  In the most severe cases in which complications
such as hypoxia, respiratory failure and shock
occurs are likely to occur, a breathing tube may be
inserted into the lungs through the mouth to keep
the airway open ( intubation). Bronchodilators:- If
there is a shortness of breath, a bronchodilator may
be needed. Bronchodilators help to relax and open
up the lower airways in the lungs and are inhaled
into the lungs using a device called an inhaler.
 Albuterol, Formoterol, Arformoterol,
Aminophylline,Theophylline are common
examples of the bronchodilators used.

38.  Bacterial pneumonias are usually treated with antibiotics.
Initially antibiotic choice depends on the characteristics of
the person affected, such as age, underlying health, and
the location the infection was acquired.
 Amoxicillin is recommended first line for community-
acquired pneumonia.The duration of treatment has
traditionally been seven to ten days, but there is
increasing evidence that short courses (three to five days)
are similarly effective.
 Antibiotics recommended for hospital-acquired
pneumonia include third- and fourth-generation
cephalosporin’s, carbapenems, fluoroquinolones, amino
glycosides, and vancomycin.These antibiotics are often
given intravenously, and may be used in combination

39.  Viral pneumonias are treated with rest and plenty
of fluids. Neuraminidase inhibitors may be used to
treat viral pneumonia caused by influenza viruses
(influenza A and influenza B). Influenza A may be
treated with rimantadine or amantadine, while
influenza A or B may be treated with oseltamivir,
zanamivir.These are of most benefit if they are
started within 48 hours of the onset of symptoms.
 Fungal pneumonias are usually treated with
antifungal medications.

40.  Over-the-counter medications are also commonly prescribed to
better manage pneumonia symptoms.These include
treatments for reducing fever, reducing aches and pains, and
suppressing coughs. In addition, it is important to get plenty of
rest and sleep and drink lots of fluids.
Hospitalization for pneumonia may be required if symptoms
are especially bad or a patient has a weakened immune system
or other serious illness. At the hospital, patients generally are
treated with intravenous antibiotics and possibly put on
oxygen.
 Typically, oral antibiotics, rest, simple analgesics, and fluids are
sufficient for complete resolution.


41.  There are several ways to prevent pneumonia.There are two
vaccines that are available to prevent pneumococcal disease
(the bacterial infection that is the most common cause of
pneumonia):
pneumococcal conjugate vaccine (Prevnar) : Prevnar is
generally administered as part of the normal infant
immunization procedure and is recommended for children less
than 2 years of age or between two and four years with certain
medical conditions.
 pneumococcal polysaccharide vaccine (Pneumovax) :
Pneumovax is provided for adults who are at increased risk of
developing pneumococcal pneumonia, such as the elderly,
diabetics, those with chronic heart, lung, or kidney disease,
alcoholics, smokers, and those without a spleen.

42.  The pneumonia vaccine may not
completely prevent older adults from
getting pneumonia, but it can reduce the
severity of a future pneumonia.

43.  In addition to vaccinations, physicians
recommend that people
 wash hands
 refrain from smoking
 eat healthfully
 exercise
 stay away from sputum or cough particles from
others with pneumonia.
 Avoid over crowding
 Never neglect a common cold
 Sleep in the well ventilated room

44.  Educate mothers to burp babies after
giving feeds
 When child has measles, whooping cough
etc, try to prevent pneumonia by proper
treatment & care
 If pneumonia develops start treatment as
quickly as possible.

45.  Assessment
 The nursing history should explore following area
with the client in whom pneumonia is suspected or
confirmed:
 Contact with other clients experiencing similar
manifestation (suggests viral or mycoplasmal
pneumonia)
 Factors suggesting the presence of noninfectious
diseases that produce manifestations similar to
pneumonia (e.g pulmonary embolism, allergic
reaction to drugs or other substance, cancer)
 Lowered levels of consciousness, which increase
the risk of aspiration.

46.  Presence of tuberculosis or contact with
others who have active tuberculosis.
 Presence & character of any chest pain.
 Presence & character of cough & sputum
production.

47.  Perform respiratory infection every 4 hour,
including determination of the rate &
character of respiration, auscultation of
breath sounds, & assessment of skin & nail
beds to determine the severity of hypoxia. In
addition to physical examination,
transcutaneous oxygen level analysis or ABG
measurements may be used to evaluate the
need for oxygen support.

48.  Nursing Diagnosis
 Impaired gas exchange related to retained
secretion & inflammatory pulmonary
infection.
 Interventions:
 Administer oxygen to maintain oxygen
saturation above 92% or as ordered.
 If oxygen administered, monitor oral mucus
membranes.
 Assess the skin underneath the oxygen tubing
for signs of pressure ulcer

49.  Ineffective airway clearance related to excessive
secretion & weak cough
 Interventions:
 Teach client to take increase fluid intake, effective
coughing & deep breathing techniques.
 Encourage client to use their incentive spirometclient
er every 2 hours while awake.
 Only thickened liquid should give to with dysphasia.
 If indicated more aggressive measures to maintain
airway patency may be required (e.g. chest
physiotherapy, suctioning, and artificial airway).

50.  Activity intolerance related to decreased oxygen
levels for metabolic demands.
 Interventions: Assess the client’s baseline activity
level & response to activity.
 Schedule activities after treatments or
medications.
 Provide psychological support & quite environment
to reduce anxiety & promote rest.
 Regulate nursing care & visitors as warranted by
clients condition.
 Gradually increase activities on the basis of
tolerance.

51.  Impaired oral mucus membrane related to
breathing through mouth.
 Interventions:
 Assess the oral mucus membrane every
shift.
 If the client can swab the mouth, leave
swabs & water on the over-bed table.
 If the client can’t moisten the mouth, swab
the mouth for the client.