Pneumonia is a serious infection that inflames the air sacs in the lungs. It can cause symptoms such as coughing, chest pain, fever, and difficulty breathing. It's important to seek medical attention if you suspect you have pneumonia. Here are some notes for dear medical students, i hope it helps you..

1. PNEUMONIA
Definition :-
•Pneumonia or pneumonitis is an acute inflammation of the lung
tissue (lung parenchyma).
Etiology:-
-Pneumonia is resulting from inhalation or transport via the
blood-stream of infectious agents or noxious
fumes or from radiation treatment.
- Pneumonia is classified according to whether infection was
acquired in the community or in the hospital.

2. -Thus pneumoniais classified as “community acquired
pneumonia(CAP) or hospital acquired pneumonia (HAP).
-HAP is also called nosocomial pneumonia.
●The causes of pneumonia are as follows.
i. Community-acquired pneumonia caused by:
• Streptococcus pneumoniae
• Hemophilus influenzae
• Mycoplasma pneumoniae
• Respiratory viruses

3. • Chlamydia pneumoniae
• Legionella pneumophila
• Oral anaerobes
• Moraxella catarrhalis
• Staphylococcus aureus
• Nocardia
• Enteric aerobic gram-negative bacteria (e.g.
Klebsiella)
• Fungi
• Mycobacterium tuberculosis.
ii. Hospital acquired pneumonia caused by:
• Pseudomonas aeruginosa

4. • Enterobacter
• Escherichia coli
• Proteus
• Klebsiella
• Staphylococcus aureus
• Streptococcus pneumoniae
• Oral anaerobes.
The risk factors which predispose to pneumonia
are:

5. • Smoking
• Air pollution
• Altered consciousness: Alcoholism, head injury,
seizures, anesthesia, drug overdose
• Tracheal intubation (endotracheal intubations,
tracheostomy)
• Upper respiratory tract infection
• Chronic diseases: Chronic lung diseases, diabetes
mellitus, heart disease, uremia, cancer
• Immunosuppression
– Drugs (carciosteroids, cancer chemotherapy,
immunosuppressive therapy after organ
transplant)
– HIV
• Malnutrition

6. • Inhalation of aspiration of noxious substances
• Debilitating illness
• Bedrest and prolonged immobility
• Altered oropharyngeal flora.
The risk factors for hospital acquired pneumonia
are:
• Residence in an ICU
• Mechanical ventilation (those who required 48
hours or more ventilation)
• Endotracheal intubation or tracheostomy
• Recent surgery
• Debilitation, i.e. malnutrition
• Invasive devices
• Neuromuscular disease
• Depressed level of alertness

7. • Aspiration
• Antacid use
• Age 60 or older
• Prolonged hospital stay
• Any serious underlying disease.
Pathophysiology
Normally, the airway distal to the larynx is sterile because
of protective defence mechanisms. These mechanisms
include:

8. • Filtration of air
• Warming and humidification of inspired air
• Epiglottis closure over the trachea
• Cough reflex
• Mucociliary escalator mechanism
• Secretion of immunoglobulin A
• Alveolar macrophages.
Pneumonia results in inflammation of lung tissue.
Depending on the particular pathogen and the hosts’

9. physical status, the inflammatory process may involve
different anatomical areas of the lung parenchyma and
the pleurae.
The normal function of respiratory systemand primary
pathophysiology and clinical manifes tation are as follows:
i. Normally ‘mucociliary system’ cleanses inhaled
air by trapping particles. In pneumonia,
hypertrophy of mucous membrane lining lung,
resulting in hypersecretions leads to increased
sputum production and cough:

10. • Anerobic - Foul-smelling, sputum
• Klebsiella - Current Jelly color
• Staphylococcus - Creamy yellow
• Pseudomonas–Green
• Viral/mucopurulent
And bronchospasms from increased secretions, leads to
localised or diffuse wheezing dyspnea.
ii. Generally ‘alveolocapillary membrane’ exchan ges
oxygen-carbon dioxide. In pneumonia, there is increased
permeability resulting in excess fluid in interstitial space,
shows consolidation (in chest X-ray films)

11. localised/bacterial; diffuse/ viral, and also there is
decreased surface area for gas exchange leads to
hypoxaemia.
iii. Normally pleura maintains close approximation of
lungs and chest wall; minimizes friction during lung
expansion and contraction. In pneumonia there is
inflammation of the pleura which shows, chest pain,
especially on inspiration, pleural effusion, dullness on
percussion, decreased breath sounds and decreased vocal
fremitus.

12. iv. Normally respiratory muscle expands and contracts
chest wall and thus pleura and lungs. In pneumonia there
is hypoventilation and respiratory acidosis (in presence of
underlying disease) leads to decreased chest expansion
and hypercapnoea and low arterial blood pH.
v. The lung defense system protects normally sterile lung
from invasion. In pneumonia there is bacteremia, shows
elevated blood cell counting; leukocytes (15,000 to
25000/mm), neutrophilia and tachypnoea and fever.
In pneumococcal pneumonia there is congestion,
red hepatisation and gray hepatisation.

13. Clinical Manifestation
CAP has been traditionally thought to present any two
syndromes; typical and atypical, although the
distinctions are not clear.
●Typical pneumonic syndrome is characterised by
sudden onset of fever, chills, cough productive of
purulent sputum, and pleuritic chest pain (in some
cases).

14. On physical examination signs of pulmonary
consolidations such as dullness, percussion, increased
fermitus, bronchial breath sounds, and crackles may
be found.
In elderly or debilitated patient, confusion
or stupor may be predominant.
Usually two types of pneumonia caused by S. pneumoniae
and H. influenzae.
The atypical syndrome is characterised by a more
●gradual onset dry cough

15. ●and extrapulmonary manifestation Such as
●headache
●myalgia,
●fatigue,
●sore throat
● nausea
● vomiting
●diarrhea.
●On physical examination, crackles are often heard.
This type of classically produced by mycoplasm,
pneumonia and legonell chlamydia pneumoniae.

16. Viral pneumoniae are characterised by
an atypical presentation with
● chills,
● fever,
●dry non-productive cough
● and extrapulmonary Symptoms.
●Most of the pneumoniae run uncomplicated .

17. If occurs, the complications are pneumonia including
● pleurisy,
●pleural effusion,
● atelectasis,
● delayed resolution,
● lung abscess,
● empyema,
● pericarditis,
●arthritis,
● meningitis
●endocarditis.

18. Management
●History
●, physical examination
● chest X-ray
- provide enough information to take management
decisions without costly laboratory tests. Diagnostic
tests include:

19. • Chest X-ray film to confirm consolidation and
distribution and pleural effusions.
• Sputum studies for culture and sensitivity if unable
to obtain specimen by usual means, may use,
– Transtracheal aspiration,
– Bronchoscopy with aspiration, biopsy or bronchial
brushings.
• Arterial blood gas studies or pulse oximetry.
• Hematology: WBC count, cole agglutinin and
compliment fixation for viral studies.
• Thoracentesis to obtain pleural fluid specimen if
pleural effusion is present.

20. The possible nursing diagnosis on the basis and
assessment will be:
• Airway clearance, ineffective r/t decreased energy,
fatigue, tracheobronchial inflammation.
• Impaired gas exchange r/t alveolar capillary
membrane changes altered oxygen delivery.
• Pain r/t pleural inflammation, coughing paroxysms.
• Rest for infection r/t compromised lung defense
system.
• Knowledge deficient r/t condition, treatment.
• Anorexia r/t infection process-sputum production.
• Altered nutrition/body requirement r/t increased
metabolic needs.

21. Prompt treatment with the appropriate antibiotic
almost always cures bacterial and mycoplasmal pneu-
monia.
In uncomplicated cases, the patient responds to
drug therapy within 48 to 72 hours.
Indications for improvement including decreased
temperature, improved breathing, and reduced chest
pain. Abnormal physical finding lasts for more than 7 days.

22. The nursing intervention includes.
i. Maintaining effective airway clearance
• Monitor for increased respiratory distress
• Assist patient to cough effectively
• If unable to clear down airway, suction airway
using sterile technique
• Assist with nebuliser therapy

23. • Administer bronchiodilator as ordered. Monitor for side
effects and response to therapy
• Change position frequently to assist in mobilising
secretions
• Ensure fluid intake adequate to thin secretions.
ii. Facilitate breathing
Help the patient breathe deeply and expand the chest to
increase ventilation.
• Place the patient in position to facilitate breathing,
usually upright or semiupright position.

24. • A pillow may be placed lengthwise at the patient’s back
to provide support and thrust thorax slightly towards
allowing free use of the diaphragm.
• The patient who must be upright to breathe may find it
restful to place head and arms on a pillow placed on an
overbed table.
• For the patient with severe hypoxemia, side rails should
be in place. The patient can use them to assisting about in
bed.
• Some patients who breathe best when sitting
up in a large armchair while leaning on a Smaller chair.
Placed in front of that. This chair is blocked to prevent it
from slipping.

25. • Assist with ADL pacing activities to prevent fatigue and
respiratory distress.
iii. Administration of medication and treatment
• Before starting prescribed antibiotic, collect sputum for
culture and blood for culture if ordered.
• Maintain antibiotic blood levels by giving antibiotic at
scheduled time.
• Give medication prescribed to relieve pain. Codeine may
be ordered because it is less likely to inhibit cough reflex
than more potent narcotics.
• Begin oxygen therapy.

26. iv. Administering oxygen therapy
v. Promoting comfort
• Place in position of comfort, Preferably head of bed
elevated 45 to 90 degrees.
• Assess character and location of chest pain.
• Administer analgesic for chest pain e.g. acetylsalicylic
acid, acetominophen and codeine.
• Splint chest with hands when patient coughs.
• Administer frequent mouth care. Protect lips and nares
with lubricants.
• Keep patient warm and dry and avoid chilling.

27. vi. Preventing spread of infection.
• Standard precautions are used.
vii. Facilitating learning.
The major teaching emphasis is on prevention.
• Assess patient’s understanding of pneumonia
with questions concerning such information on how
pneumonia is transmitted and risk factor.
• Teach proper handling of secretions. Cover nose and
mouth with tissue when coughing or sneezing. Discard
tissues in paper or plastic bag for disposal. Expectorate
into specimen container provided

28. • Stress importance of handwashing after
coughing, sneezing and expectorating.
• Reinforce importance and follow-up care.
• Reinforce the need for immunization, i.e.,
inlfuenza vaccine and pneumococcal vaccine.
(Pneumonia Polysaccaride vaccine is given
only every 3 to 5 years.
viii. Promoting adequate hydration and nutrition
• Encourage oral fluids. If patient is receiving IV fluids,
monitor rate. Observe for signs of fluid volume deficit or
excess.
• Ask patient what foods he or she would like to eat.

29. • Offer small, frequent feedings.
• Encourage high-carbohydrate and high protein foods
Made by
Priyanshu Verma
Bsc nursing 3rd year student
Reference:- b.v. basavathappa