This document discusses respiratory tract infections, specifically pneumonia. It defines pneumonia as an acute inflammation of the lung parenchyma. Common causes are bacteria such as Streptococcus pneumoniae and viruses. Symptoms include fever, cough, chest pain, and breathlessness. Diagnosis involves chest x-ray, sputum and blood cultures. Treatment involves antibiotics, oxygen, hydration and nutrition. Nursing care focuses on airway clearance, breathing exercises, pain management and patient education.

1. RESPIRATORY TRACT INFECTIONS
DR. RUBAYAT SHEIK GIASUDDIN
MBBS, MRCP(UK)
Assistant Professor of Medicine

2. RESPIRATORY TRACT

3. UPPER RESPIRATORY TRACT INFECTIONS
acute infection which involves the upper respiratory
tract: nose, sinuses, pharynx or larynx.
 Rhinitis
 Sinusitis
 Pharyngitis
 Laryngitis

4. LOWER RESPIRATORY TRACT INFECTION
 acute bronchitis
 pneumonia

6. Definition
 Pneumonia is an acute inflammation of the lung
parenchyma

7. Mode of transmission

8. Mode of transmission
Inhalation
Aspiration
Hematogenous

9. PATHOGENESIS
 invasion of the lung parenchyma by bacteria produces
an inflammatory immune response (accumulation of
neutrophils).
 This response leads to a filling of the alveolar sacs
with exudate.
 The loss of air space and its replacement with fluid is
called consolidation.
 this exudate in alveoli interferes with exchange of
oxygen & carbon dioxide

13. CLASSIFICATION
A. CLINICAL
 Community Acquired Pneumonia (CAP)
 Hospital Acquired or Nosocomial Pneumonia
 Aspiration pneumonia

14. Pathological Classification

15. B. Pathological Classification

16.  Lobar pneumonia: it is a type of pneumonia where
there is involvement of large & continuous area of
one or more lobes of lung
 Bronchopneumonia: It is a type
of pneumonia characterized by multiple patchy
involvement of one or more lobes.

17. RISK FACTORS THAT PREDISPOSE TO PNEUMONIA
 Cigarette smoking
 Upper respiratory tract infections
 Pre-existing lung disease e. COPD
 Immunosuppression-steroid therapy, Diabetes
 Old age
 Altered consciousness- stroke, Alcohol, seizures

18. Organisms causing CAP
 Bacteria
 Viruses

19. Common bacteria causing CAP
 Streptococcus pneumoniae
 Haemophilus influenzae
 Chlamydia pneumoniae
 Mycoplasma pneumoniae

20. •Pseudomonas aeruginosa
•E. Coli
•Proteus
•Klebsiella

21. Clinical Features
Symptoms
 Sudden onset of High Fever with chills & rigors
 Cough, usually productive
 Pleuritic chest pain-stabbing pain which increases
with inspiration & coughing
 Breathlessness

22. Clinical Features
SIGNS
Chest examination:
Features of consolidation-
 ↑ vocal fremitus,
 bronchial breath sound,
 ↑ vocal resonance

23. HOSPITAL ACQUIRED PNEUMONIA
 Hospital acquired Pneumonia or nosocomial
Pneumonia occur at least 2 days after admission to
hospital.

24. INVESTIGATIONS
 CBC,ESR-neutrophilic leucocytosis
 X-ray chest P/A & Lateral view-consolidation
 Sputum Gram stain & culture-organism
 Blood C/S-organism
 ABG (arterial blood gas analysis)

26. Management
 Oxygen administration
 Antipyretic
 Antibiotics- penicillin, cephalosporins,
macrolides, fluoroquinolones
 Fluid balance

27. COMPLICATIONS OF PNEUMONIA
 Pleurisy
 Para-pneumonic effusion
 Delayed resolution
 Lung abscess
 Empyema
 ARDS (acute respiratory distress syndrome)
 Multi-organ failure
 Metastatic abscess

28. 1. Ineffective airway clearance r/t airway inflammation,
accumulation of secretions, decreased energy,
fatigue
2. Impaired gas exchange r/t changes in alveolar
capillary membrane, altered oxygen delivery
3. Fluid volume deficit r/t inadequate oral intake, fever,
tachypnoea.
4. Imbalanced Nutrition r/t increased metabolic needs

29. 5. Acute Pain r/t pleural inflammation, coughing
6. Changes in comfort r/t fever, dyspnea, cough, chest
pain
7. Deficient Knowledge r/t condition, treatment, self-care

30. Nursing interventions
Maintain effective airway clearance
1. Assess rate & depth of respirations, breathing pattern
2. Monitor for increased respiratory distress
3. Assist patient to cough effectively
4. Give medications properly: antibiotics, bronchodilators, analgesics.
Monitor for side effects and response to therapy
5. Assist with nebulizer treatment
6. Chest physiotherapy for loosening & mobilising secretions
7. Change position frequently to assist in mobilization of secretions.
8. If unable to clear down airway-Suction airway to remove secretions
9. Ensure adequate fluid intake to thin secretions

31. Nursing interventions
Facilitate breathing
 Place the patient in upright or semi upright position
 A pillow may be placed at the patients back to provide
support and thrust thorax slightly forwards allowing free
use of the diaphragm

32. Adequate hydration and nutrition
 Ensure fluid intake
 Ensure proper nutrition
 Give small, frequent feeding
 Monitor vital signs and input and output
Give comfort
 Place in comfortable position eg, head elevated to 45
 Provide comfort measures, e.g., back rubs, change of
position
 analgesics
 Splint chest when patient coughs
 Keep patient warm and dry and avoid chilling
Nursing interventions

33. Nursing interventions
Administration of medication
 Before starting antibiotic, collect sputum and blood for
culture
 Give antibiotics at scheduled time to maintain blood
antibiotic level
 Give analgesics
 Begin oxygen therapy
Prevent spread of infection
 Proper disposal of secretions
 Regular and proper hand washing
 Limit visitors
 Proper administration of antibiotics

34. Nursing interventions
 Patient Education & Home care
 Assess patients understanding of pneumonia
 Teach proper handling of secretions, eg. Covering nose
and mouth with tissue when sneezing or coughing,
proper disposal of tissues, use of container for sputum
 Importance of handwashing after coughing, sneezing
 Encourage breathing exercises
 Patient should stop smoking
 Encourage for influenza and pneumococcal vaccine
Patient should come for follow up chest x ray and
complete examination.