Pneumonia

By: Ashagre Molla

May 2010 Jimma university

PNEUMONIA
Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent Bacteria commonly enter the lower airway but do not cause pneumonia in the presence of an intact host defense mechanism

Causes of pneumonia
Bacteria Mycobacteria Chlamydiae Mycoplasma Fungi Parasites viruses

Categories of pneumonia
Bacterial (typical) atypical anaerobic(cavitary) Opportunistic A more widely used classification scheme community-acquired pneumonia hospital acquired pneumonia pneumonia in the immuno-compromized host aspiration pneumonia

Pathophysiology
Upper airway characteristics normally prevent potentially infectious particles from reaching the normally sterile LRT an acute or chronic underlying disease that impairs host

defenses exposes to pneumonia

Pnumonia arises from normal flora aspiration of flora from oropharynx foodborne organisms

Pathophysiology.
Pneumonia often affects both ventilation and diffusion Poorly oxygenation leads to arterial hypoxemia

Risk Factors for Pneumonia

Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage Immunosuppressed patients and those with a low neutrophil

count
Depressed cough reflex Antibiotic therapy Alcohol intoxication Advanced age

Clinical Manifestations
its s/s depending on the organism and the patients underlying disease a specific type of pneumonia cannot be diagnosed by clinical manifestations alone

Headache
low-grade fever Pleuritic pain

Myalgia
rash pharyngitis

C/M. . .
mucoid or mucopurulent sputum

cheeks are flushed and the lips and nail-beds

demonstrate central cyanosis Orthopnea (shortness of breath when reclining) Poor appetite diaphoretic and tires easily

Assessment and Diagnostic Findings

History physical examination Chest x-ray studies blood culture sputum examination

Medical Management
administration of the appropriate antibiotic For CAP (mild) Amoxacillin or erythromycin (1st line) Doxycycline (for atypical 1st line) Procaine penicillin (alternative)

Community acquired hospitalized patients (Severe Pneumonia) Non-Drug treatment

Bed rest
Frequent monitoring of vital signs to detect complications

early and to monitor response to therapy

Give attention to fluid and nutritional replacements Administer Oxygen via nasal prongs or facial mask Analgesia for chest pain

Drug treatment
Benzyl penicillin +Gentamicin or Ceftriaxone Alternative Erythromycin or Doxycycline

Drug Rx
Pneumonia due to Gram-negative bacteria Ampicillin + Gentamicin or benzyl penicillin + Gentamicin Pneumonia due to Staphyloccocus Aureus Cloxacillin

Complications
shock and respiratory failure atelectasis and pleural effusion Superinfection

Nursing process
Assessment
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 Changes in the chest x-ray findings

NURSING DIAGNOSES
Ineffective airway clearance related to copious tracheobronchial secretions Activity intolerance related to impaired respiratory

function
Risk for fluid volume deficit related to fever and dyspnea Imbalanced nutrition: less than body requirements Deficient knowledge about the treatment regimen and preventive health measures

Goals
improved airway patency rest to conserve energy maintenance of proper fluid volume

maintenance of adequate nutrition

understanding of the treatment protocol and preventive measures absence of complications

Nursing Interventions
improving airway patency promoting rest and conserving energy promoting fluid intake

maintaining nutrition
promoting the patients knowledge monitoring and managing potential complications

Evaluation
Based on expected patient outcomes
1. Demonstrates improved airway patency, as evidenced by adequate oxygenation, normal temperature, normal breath sounds, and effective coughing

2. Rests and conserves energy by limiting activities and remaining in bed while symptomatic and slowly increasing activities 3. Maintains adequate hydration, as evidenced by an adequate fluid intake and urine output and normal skin turgor

Evaluation .
4. Consumes adequate dietary intake, as evidenced by maintenance or increase in body weight without excess fluid gain 5. States explanation for management strategies 6. Complies with management strategies 7. Exhibits no complications 8. Complies with treatment protocol and prevention strategies

References
1. Brunner and Saddarths text book of medical surgical nursing tenth edition 2. standard treatment guidelines for zonal hospitals, DACA,

Ethiopia, 2004
3. Harrison principle of internal medicine 16th edition

Thank you