سسقبشققثابياففف

1. Prepared By
Dr. Doaa El-Beltagy
Lower RespiratoryTract Infections

2.  Introduction
 Pneumonia:
This infection can be caused by bacteria, a virus, a fungus, or
even a protozoan.
Symptoms include fever, difficulty breathing, and chest pain.
In this type of infection, fluid accumulates in the alveoli
(pulmonary edema), and inflammation causes the respiratory
membrane to thicken, thereby reducing gas exchange.
Lower RespiratoryTract Infections (pneumonia )

3.  Pneumonia
 An inflammation of the lung tissue that is caused by
infectious agents (microbial agent)
 Causes
 Bacterial Causes
 Gram-positive organisms
 Streptococcus
 Staphylococcus
 Gram-negative organisms
 Haemophilus influenza
 Klebsiella
 Viral causes
 Influenza virus
 Other causes
 Tuberculosis
 Fungal infections
 Parasites
Lower RespiratoryTract Infections (pneumonia)

4.  Pathology:
Alveolar
 Bronchopneumonia (Streptococcus pneumoniae, Haemophilus
influenza, Staphylococcus aureus)
 Lobar (Streptococcus pneumoniae)
Interstitial
 (Influenza virus, Mycoplasma pneumoniae)
 Pathogenesis
Inhalation of air droplets
Aspiration of infected secretions or objects
Hematogenous spread
Lower RespiratoryTract Infections (pneumonia)

5.  Bronchopneumonia
Suppurative inflammation of lung tissue caused by Staph, Strep,
Pneumo & H. influenza
 Patchy consolidation – not limited to lobes.
 Usually bilateral
 Lower lobes common, but can occur anywhere
 Complications:
• Abscess
• Empyema
• Dissemination
Lower RespiratoryTract Infections (pneumonia)

6.  Lobar Pneumonia:
 Fibrino-suppurative consolidation – whole lobe
 Rare due to antibiotic treatment.
 ~95% - Strep pneumoniae
 The course runs in four stages:
• Congestion.
• Red Hepatization.
• Gray Hepatizaiton.
• Resolution.
Lower RespiratoryTract Infections (pneumonia)

7.  Pathophysiology
 The streptococci reach the alveoli and lead to inflammation and
pouring of an exudates into the air spaces.
 WBCs migrates to alveoli, the alveoli become more thick due to its
filling consolidation, involved areas by inflammation are not
adequately ventilated, due to secretion and edema. This will lead to
partial occlusion of alveoli and bronchi causing a decrease in
alveolar oxygen content.
 Venous blood that goes to affected areas without being oxygenated
and returns to the heart. This will lead to arterial hypoxemia and
even death due to interference with ventilation.
Lower RespiratoryTract Infections (pneumonia)

8. • Community Acquired
CAP
• Health Care Associated
HCAP
• Hospital Acquired
HAP
• ICU Acquired
ICUAP
• Ventilator Acquired
VAP
Lower RespiratoryTract Infections (pneumonia)

9.  Types of Pneumonia
 Community-Acquired (CAP)
1. Occurs either in community setting or within the first 48 hrs
of hospitalization
2. Most common in people younger than 60 yrs
3. Most prevalent during winter & spring
4. Caused by pneumococcus & Haemophilus influenza
5. Virus the cause in infants & children
Lower RespiratoryTract Infections (pneumonia)

10.  Health-Care Associated Pneumonia (HCAP)
• Hospitalization for > 2 days in the last 90 days
• Residence in nursing home or long-term care facility
• Home Infusion Therapy
• Long-term dialysis within 30 days
• Home Wound Care
• Exposure to family members infected with MDR bacteria
 Hospital-Acquired Pneumonia (HAP)
• Pneumonia that develops after 5 days of hospitalization includes:
 Ventilator-Associated Pneumonia (VAP)
 ICU Pneumonia (ICUAP)
Lower RespiratoryTract Infections (pneumonia)

11.  Hospital Acquired Pneumonia (HAP) the onset of pneumonia
symptoms more than 48 hrs after admission to hospital. Also
called nosocomial infection
1. Common organism E.colli ,Klebsiella ,S.aurious
2. It occurs when host defense impaired in certain conditions
 Pneumonia in the Immuno compressed host
1. Caused by organisms also observed in CAP,HAP.
2. Has subtle onset with progressive dyspnea , fever ,
&productive cough
Lower RespiratoryTract Infections (pneumonia)

12.  Clinical Manifestations
1. Sudden onset of shaking chills
2. Rapidly increase in body temperature 38-40 C
3. Chest pleuritic pain increased by deep breathing
4. Patient looks severely ill with marked tachypnea
5. Shortness of breath
6. Orthopnea
7. Poor appetite
8. Diaphoresis &tires easily
9. Purulent sputum
Lower RespiratoryTract Infections (pneumonia)

14.  Diagnostic Methods
 History, physical examination
 Chest X-Ray
 Sputum examination (gram stained)
 Sputum , blood cultures
 Serological tests
 Peripheral blood analysis
Lower RespiratoryTract Infections (pneumonia)

15.  Medical Management
1. Appropriate antibiotics depend on culture result (bl.& sputum)
2. Analgesics for chest pain
3. Oxygen & respiratory supportive measures for hypoxemia
4. Hydration (increase fluid intake )
5. Antipyretic for fever & Headache
6. Warm moist inhalation to relieve irritation
7. Antihistamine to relieve sneezing & rhinorrhea
8. Caloric intake at least 1500 per day
 Complications : Shock & respiratory failure ,
Atelectasis & plural effusion Super infection
Lower RespiratoryTract Infections (pneumonia)

16.  Assessment
Nursing assessment is critical in detecting pneumonia. A fever, chills, or night sweats
in a patient who also has respiratory symptoms should alert the nurse to the
possibility of bacterial pneumonia.
A respiratory assessment will further identify the clinical manifestations of
pneumonia: pleuritic-type pain, fatigue, tachypnea, use of accessory muscles for
breathing, bradycardia or relative bradycardia, coughing, and purulent sputum. It is
important to identify the severity, location, and cause of the chest pain, along with
any medications or procedures that provide relief. The nurse should monitor the
following:
• Changes in temperature and pulse
• Amount, odor, and color of secretions
• Frequency and severity of cough
• Degree of tachypnea or shortness of breath
• Changes in physical assessment findings (primarily assessed
by inspecting and auscultating the chest)
• Changes in the chest x-ray findings
In addition, it is important to assess the elderly patient for unusual behavior, altered
mental status, dehydration, excessive fatigue, and concomitant heart failure.

17.  Nursing diagnoses
 Based on the assessment data, the patient’s major nursing diagnoses
may include:
 Ineffective airway clearance related to copious tracheobronchial
secretions
 Activity intolerance related to impaired respiratory function
 Risk for deficient fluid volume related to fever and dyspnea
 Imbalanced nutrition: less than body requirements
 Deficient knowledge about the treatment regimen and preventive
health measures

18.  Planning and Goals
 The major goals for the patient may include:
1. Improved airway patency,
2. Rest to conserve energy,
3. Maintenance of proper fluid volume,
4. Maintenance of adequate nutrition,
5. An understanding of the treatment protocol and preventive
measures, and absence of complications.

19.  Nursing intervention
1. Maintain a patent airway and adequate oxygenation.
2. Obtain sputum specimens as needed.
3. Use suction if the patient can’t produce a specimen.
4. perform chest physiotherapy.
5. Provide a high calorie, high protein diet of soft foods.
6. To prevent aspiration during nasogastric tube feedings, check the
position of tube, and administer feedings slowly.
7. To control the spread of infection, dispose secretions properly.
8. Provide a quiet, calm environment, with frequent rest periods.
9. Monitor the patient’s ABG levels, especially if he’s hypoxic.

20. Nursing intervention cont……
1. Assess the patient’s respiratory status. Auscultate breath sounds at least
every 4hs.
2. Monitor fluid intake and output.
3. Evaluate the effectiveness of administered medications.
4. Explain all procedures to the patient and family.
5. Preventive measures
 Frequent turning of bed ridden patients and early ambulation as much as
possible.
 Coughing and breathing techniques.
 Sterilization of respiratory therapy equipment
 Suctioning of secretion in the unconscious who have poor cough and
swallowing reflexes, to prevent aspiration of secretions and its accumulation.

21.  Nursing intervention
 Promoting rest and conserving energy
The nurse encourages the debilitated patient to
1. Rest and avoid overexertion and possible exacerbation of
symptoms.
2. The patient should assume a comfortable position to promote rest
and breathing (eg, semi-fowler’s) .
3. Change positions frequently to enhance secretion clearance and
ventilation/perfusion in the lungs.
It is important to instruct outpatients not to overexert themselves and to
engage in only moderate activity during the initial phases of treatment.