Pneumonia is an inflammatory lung condition caused by microbial infection. It has many risk factors including age, smoking history, chronic diseases, and conditions that compromise the immune system. Nursing management of pneumonia involves assessing symptoms, administering antibiotics, encouraging airway clearance and breathing exercises, ensuring adequate hydration and nutrition, and educating patients to promote recovery and prevent recurrence. Close monitoring is needed to watch for complications and evaluate treatment effectiveness.

1. TOPIC:- PNEUMONIA AND ITS NURSING
MANAGEMENT
[BSC (HONS.) NURSING

2. PNEUMONIAAND ITS NURSING
MANAGEMENT

3. INTRODUCTION
*It is the inflammatory condition of the lung that is caused by microbial
agent.
*Pneumonitis is a general term that describes an inflammatory process
in the lung tissue that may predispose a patient at risk for microbial
invasion.
*It is the leading cause of death from infectious disease.

5. DEFINITION OF PNEUMONIA
Pneumonia is a inflammatory process in lung parenchyma(the
respiratory bronchioles, and the alveoli ) associated with a marked
increase in interstitial alveolar fluid. The air sacs may filled with fluid
or pus.
The infection can be life threatning to anyone but particularly to infants,
children and people over 65.

6. epidemiology
* Comman illness affecting approximately 450 million people a year
occuring in all part of the world, and a 4 million death yearly.
*Rates are greater in children less than 5 years and adult older than 75
years.
*In India, it is the single largest cause of death in children, resulting in
nearly 120 million cases a year.

7. RISK FACTORS
Major risk factors for pneumonia include the following:
*Age 60 or older
*History of smoking
*Upper respiratory tract infection
*Tracheal intubation
* Prolonged immobility
*Malnutrition
*Altered consciousness:Alcoholism,head injury,anaesthesia,drug overdose
*Dehydration
*Chronic disease states(such as diabetes,heart disease,chronic lung
disease,renal disease and cancer)
*Inhalation of noxious substance
*Residence in such area/setting where transmission
is prone

8. ETIOLOGY
- There are many cause of pneumonia including bacteria,virus,
Mycoplasmas,fungal agents,viruses and protozoa.
- It may also result from inhalation of toxic or causatic chemicals,
smoke, dusts , gases or aspiration of food, fluids or vomitus.
Pneumonia may complicate to chronic illness.

9. CLASSIFICATION
 1. ACCORDING TO CAUSATIVE ORGANISMS
 2.ACCORDING TO ENVIRONMENT
 3.ACCORDING TO AREAS OF LUNG AFFECTED
 4.ACCORDING TO CAUSE

10. 1. ACCORDING TO CAUSATIVE ORGANISMS
(a.)Bacterial :-
*Pneumococcal pneumonia caused by Streptococcus pneumoniae
*Staphylococcus pneumoniae caused by Staphylococcus
pneumoniae
*Gram negative bacterial pneumonia caused by Kleibseilla
pneumoniae
*Anaerobical bacterial pneumonia caused by normal flora.

11. b.) Viral
*Rhino virus, corona virus, influenza virus and adenovirus
*Herpex simplex virus rarely causes pneumonia in newborns,person
with cancer and transplant recepients or patient with burns
c.)Fungal
*Fungal pneumonia caused by histoplasmosis,blastomycosis etc

12. 2. ACCORDING TO ENVIRONMENT
* Community Acquired Pneumonia

13. *Ventilator Acquired Pneumonia

14. *Pneumonia in the immuno-compressed host
*Hospital Acquired Pneumonia

15. c
d.) Parasitic
*Parasitic pneumonia caused by protozoa, nematodes etc.

16. 3. ACCORDING TO AREAS OF LUNG AFFECTED
*Lobar pneumonia
*Necrotizing pneumonia
*Segmental pneumonia
*Alveolar pneumonia
*Interstitial pneumonia
*Bronchial pneumonia

17. 4.ACCORDING TO CAUSE
*Eosinophillic pneumonia
*Chemical pneumonia
*Aspiration pneumonia
*Allergic pneumonia
*Bilateral pneumonia

18. PATHOPHYSIOLOGY
Infectious agent,foreign substances,blood borne organisms that enter the blood
circulation or aspiration of gastric content.
Cause inflammation of pulmonary tissue affecting both ventilation and diffusion
The alveoli fills with exudates Mucosal edema of alveolar membrane occur
Interferes with the diffusion of oxygen causing occultion of alveoli
and carbon dioxide resulting in decrease alveolar oxygen
tension
Hypoxia occur with retention of carbon dioxide ,shortness of breath , crackles
in lungs, fatigue or decrease breath sounds

19. CLINICAL MANIFESTATIONS
The onset of all pneumonia by any or all of the following
manifestations:fever,chills,,sweat,fatigue,cough and sputum production.
Less comman symptoms include haemoptysis,pleuritric chest pain and
headache.Older clients may not present with fever respiratory
manifestations but with altered mental status and dehydration.
Other manifestations may include:-
*Crackling sound over affected area
*Hypoxemia
*Tachypnea
*Productive cough
*Dyspnea
*Decrease in breath sounds
*Dulness or percussion over affected area
*Unequal chest expansion

20. DIAGNOSTIC EVALUATION
*CHEST X-RAY
A chest radiograph provides information about the location and extent
of the pneumonia consiladation.
Definite diagnosis is usually determined through sputum culture and
analysis and sensitivity or serologic testing

21. *FIBEROPTIC BRONCHOSCOPY OR
TRANSCUTANEOUS NEEDLE ASPIRATION OR BIOPSY
It is a procedure that allows your physician to examine the breathing
passage of lungs. This procedure can either be for diagnostic
reasons, to find out more about a problem or for therauptic
reasons,to treat an existing problems.

22. *POLYMERISE CHAIN REACTION
PCR applied to whole blood sample appears to be sensitive and very
specific diagnostic test for identifying patients with pneumococcal
pneumonia with a potential application in clinical practice.
Additional evaluation may consist of:-
1. Transcutaneous oxygen level analysis or arterial blood gas(ABG)
measurement to assess the need for supplemental oxygen
2. Skin test,if tuberculosis and coccidioidomycosis is suspected
3. Blood and urine culture to assess symetric speed
LINK:https://www.youtube.com/watch?v=Mmc1ImuKJ1g
.

23. COMPLICATIONS
1.Empyema
2.Lung abscess
3. Sepsis
4. Bacterimia
5.Hypotension and shock
6.Atelectasis
7.Pleural effusion
8.Pericardiatis
9.Acute Respiratory Disease Syndrome

24. PROGNOSIS
With treatment most type of bacterial pneumonia will
stabilize in 3-6 days.It often takes a few weeks before
most symptoms resolved.In persons requiring
hospitisation, mortality may be as high as 10%,and those
requiring intensive care as it may reach 30-50%.

25. NURSING MANAGEMENT OF PATIENT
WITH PNEUMONIA
ASSESSMENT
*Take careful history to help establish etiologic diagnosis
*Assess the elderly patient for unusual behavior,altered mental
status,dehydration ,excessive fatigue and concominant heart failure
*Observe for anxious,flushed appearance,shallow respirations,splinting
of affected side,confusion,disorientation
*Perform respiratory assessment for every 4 hrs,including
determination of rate and character of respirations ,auscultations of
breath sounds and assessment of skin and 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

26. NURSING DIAGNOSIS
i).Ineffective airway clearance related to copious
tracheo-bronchial secretion
GOAL: To improve airway patency
INTERVENTIONS:
*The nurse encourages hydration 2-3L/day
*Humidification may be used to loosen secretions and improve
ventilation
*Deep breathing exercise should be performed
*Spirometry
*Chest physiotherapy
*Coughing can be initiated either voluntarily or reflex

27. ii).Ineffective breathing pattern related to hypoxia as
evidenced by shortness of breath.
 GOAL: To maintain the effective breathing pattern
 INTERVENTIONS:
 *Place patient with proper body alignment for maximum breathing pattern.
 *Encourage sustained deep breaths by:
 Using demonstration:highlighting slow inhalation, holding end inspiration for
a few seconds and passive exhalation.
 Utilising incentive spirometer.
 *Encourage diaphragmatic breathing for patients with chronic disease.
 *Stay with the patient during actual period of distress.
 *Encourage frequent rest periods and teach patient to pace activity.
 *Encourage small frequent meals to prevent crowding of diaphragm.
 * Avoid high concentrations of oxygen in patients with COPD.
 *Ambulate patient as tolerated with doctor’s order three times a daily.


28. iii). 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:-Semi fowler’s position)
*Positions of the patient should be changed frequently to enhance
secretion clearance and ventilation of the lungs
*Instruct outpatients not to overexert themselves and to engage only in
moderate activities during the initial phase of treatment
*The nurse encourages the debilitated patient to rest and avoid
overexertion and possible exacerbation of symptoms

29. iv).Risk for defecient flood volume related to fever and
dyspnea
GOAL:To promote adequate fluid intake
INTERVENTIONS:
*Encourage increase fluid intake atleast(2L/day)
*Respiratory rate of the patient should be maintained.
* Careful monitoring in patients with pre- existing conditions such as
heart disease.

30. v).Imbalanced nutrition:less than body requirements
GOAL:To maintain adequate nutrition
INTERVENTIONS:
*Provide more fluid to the patient with shortness of breath as they have
decreased apetite
*Fluid with electrolytes(commercially available drinks such as gatrode)
may help provide fluid and electrolytes
*Nutritionally enriched shakes and drinks are helpful
*Fluids and nutrients may be administered intravenously,if necessary

31. vi).Defecient knowledge about the treatment
regime and preventive measures
GOAL:To promote patients knowledge
INTERVENTIONS:
*The patient and family are instructed about the cause of pneumonia,
management of symptoms of pneumonia and the need to follow up
*The patient should also be informed about factors(both risk and
external factors)that have contributed to developing pneumonia and
stratgies to promote recovery and to promote recurrence
*The patient is instructed about the purpose and the importance of
management stratgies that have been implemented and the
importance of adhering to them during and after the hospital stay

32. *The patient may require that instructions and explanations be
repeated several times,because of severity of symptoms
*If possible,written instruction and information should
be provided
EVALUATION
Expected patient outcomes may include:
1.Demonstrates improved airway patency as evidenced by pulse,adequate
oxygenation by pulse oximetry or arterial b;lood gas analysis,normal breath
sounds and effective coughing
2.Rests and conserves energy by limiting activities and remaining in bed while
asymptomatic and slowly increasing activities
3.Maintains adequate hydration as evidenced by an adequate fluid intake and
urine output

33. 4.Consumes adequate dietary intake,as evidenced by maintenance or
increase in body weight without excessive fluid gain
5.Exhibits no complications:
a.) Has normal vital signs,pulse oximetry and arterial blood gas
b.)Reports productive cough that deminishes over time
c.)Has absence of signs and symptoms of shock
d.)Remains oriented and aware of surroundings
e.)Maintains or increase weight

34. PATIENT EDUCATION AND HEALTH
MAINTENANCE
*Advise patient to complete entire course of antibiotics
*Once clinically stable , encourage gradual increase in activities to
bring energy level back to pre-illness stage
*Explain that a chest x-ray usually taken 4 to 6 weeks after recovery
*Advise smoking cessation
*Advise patient to keep up natural resistance with good nutrition and
adequate rest
*Instruct patient to avoid fatigue,sudden extremes in temperature and
excessive alcohol intake
* Advise patient to practice frequent handwashing,especially after
contact with others

35. RESEARCH INPUT
 StudyOral health ventilator- associated pneumonia
among critically ill patients : a prospective
Saensom D merchant AT, wara-Aswapati N, Ruaisungneon w , Pitihat W
 OBJECTIVE:-To evaluate the association between oral health and
ventilator associated pneumonia (VAP) among critically ill patients
 METHODS:- A prospective cohort study was conducted among 162
critically ill patients who are newly intubated and treated with
mechanical ventilator in one tertiary hospital in Thailand. Oral health
status was assessed using Oral Health Assessment Tool (OHAT)
,Plaque Index (PI), and number of teeth VAP , defined as Clinical
Pulmonary Infection Score >6, was assessed on Day 4 after
intubation. Hazard ratios 95% confidence intervals (CIs) were
calculated using Cox proportional hazards regression adjusted for
confounders.

36. RESULTS:- Critically ill patient had deteriorating oral health status
after intubation.
Early- onset VAP developed in 69 patients (42.6%) , with VAP
incidence of 117 episodes per 1000 ventilator days.
Patients with moderate – to – very poor oral hygiene assessed by Phad
increased VAP risk of 1.66 folds. The no. of teeth was not associated
with VAP development
CONCLUSIONS:- There is a strong association between poor oral
health and increased risk for early-onset VAP. Routine oral care
possibly prevents VAP development among critical patients treated
with mechanical ventilator.

37. SUMMARY
Today we have discussed about the topic Pneumonia and its nursing
management. Here we studied about what is pneumonia, its
classifications, risk factors and nursing management. Because as a
nurse we encounters so many patient with respiratory tract infection
in which pneumonia is most comman. We have also discussed the
health teachings given to him/her. Hope this teaching will be helpful
in future also and we will treat our patient with proper care.

38. Bibliography
Medical-Surgical Nursing 10th edition Brunner and
Siddharth pg no:-522-531
Black and Joyce: Medical Surgical Nursing 8th edition;
Elsevier publication; pg no:-1599-1603
https://www.slideshare.net/mobile/GAMANDEEP/pne
umonia