Pneumonia

Definition
http://www.youtube.com/watch?v=aKduNgfePLU

An infection and/or inflammation of the interstitial tissues of the lung

Fluid, WBC, and cellular debris from phagocytosis of the infectious agent accumulate in the alveoli

Incidence
Eighth leading cause of death in US
56,000 deaths annually

Approximately 50% are bacterial

Pneumococcal 25-30% Mycoplasmic 20%

Etiology
Likely to result when defense mechanisms become incompetent or overwhelmed Causes:
Viruses Bacteria Fungi Inhalation of vomitus, food, liquid, gases

Etiology
Mucociliary mechanism impaired
Pollution Cigarette smoking Upper respiratory infections Tracheal intubation Aging

Etiology
Three ways organisms reach lungs:
Aspiration from nasopharynx or oropharynx Inhalation of microbes such as Mycoplasma

pneumoniae

Hematogenous spread from primary infection elsewhere in body

Pathophysiology
Stage 1: Congestion from outpouring of fluid to alveoli
Organisms multiply. Infection spreads. Interferes with lung function

Pathophysiology
Stage 2: Red hepatization
Massive dilation of capillaries Alveoli fill with organisms, neutrophils, RBCs, and fibrin.
Causes lungs to appear red and granular, similar to liver

Pathophysiology
Gray hepatization
Blood flow Leukocyte and fibrin consolidate in affected part of lung.

Pathophysiology
Resolution
Resolution and healing if no complications Exudate lysed and processed by macrophages Tissue restored

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Clinical Findings
Sudden onset of fever Shaking chills Shortness of breath Cough productive of purulent sputum Pleuritic chest pain Crackles on auscultation Increased fremitus Dullness on percussion

THREE TYPES OF PNEUMONIA

Primary Pneumonia
Caused by inhalation or aspiration of a bacterial or viral pathogen into the lower respiratory tract
Onset in community or during first 2 days of hospitalization Highest incidence in midwinter Smoking important risk factor

Primary Pneumonia
Organisms implicated

Streptococcus pneumoniae Haemophilus influenzae Legionella Mycoplasma Chlamydia

Secondary Pneumonia
Results from lung injury that was caused by the spread of bacteria from an infection elsewhere in the body
Inhalation of a noxious chemical

Aspiration Pneumonia
Risk factors
Old age Decreased gag reflex Anesthesia and sedation Debilitation Altered LOC

Sequelae occurring from abnormal entry of secretions into lower airway

Food, vomitus, secretions

Diagnostic Tests
History Physical examination Chest x-ray Gram stain of sputum Sputum culture and sensitivity Pulse oximetry or ABGs CBC, differential, chemistries Blood cultures
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Collaborative Care
Antibiotic therapy Oxygen for hypoxemia Analgesics for chest pain Antipyretics Fluid intake at least 3 L per day Caloric intake at least 1500 per day

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Collaborative Care
Pneumococcal vaccine
Indicated for those at risk
Chronic illness such as heart and lung disease, diabetes mellitus Recovering from severe illness 65 or older In long-term care facility

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Nursing Focus
Position patient to facilitate an open airway and ease breathing
HOB 30-45 degrees

Encourage coughing and deep breathing Suction airway to clear secretions as needed

Patient teaching
Stress the importance of limiting activity and resting frequently to avoid fatigue Eat small frequent meals to maintain adequate nutrition Smoking cessation Pneumonia vaccine