Pneumonia 9

PNEUMONIA
DEFINITION
Pneumonia is an inflammatory process in lung parenchyma usually

associated with the increased in interstitial and alveolar fluid.
ETIOLOGY
 Bacteria
 Viruses
 Mycoplasma
 Fungal agents
 Protozoa
RISK FACTORS
 Advanced age
 History of smoking
 Immune suppressive therapy
 Non functional immune system
 Malnutrition
 Dehydration
 Chronic disease like; diabetes, heart failure, lung disease, renal failure,
cancer.
 Exposure to air pollution
 Altered consciousness
 Inhalation of toxins
CLASSIFICATION
According to anatomical area
 lobar pneumonia : It is an infection that only involves a single lobe, or section,

of a lung. Lobar pneumonia is often due to Streptococcus
pneumoniae (though Klebsiella pneumoniae is also possible.)[7]
 Multilobar pneumonia : it involves more than one lobe, and it often causes a
more severe illness.
 Bronchial pneumonia : it affects the lungs in patches around the tubes (bronchi
or bronchioles).
 Interstitial pneumonia : It involves the areas in between the alveoli, and it may
be called "interstitial pneumonitis." It is more likely to be caused by viruses or
by atypical bacteria.
According to the etiological agent
Bronchiolitis obliterans organizing pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP) is caused by inflammation
of the small airways of the lungs. It is also known as cryptogenic organizing
pneumonitis (COP)
Eosinophilic pneumonia
Eosinophilic pneumonia is invasion of the lung by eosinophils, a particular kind
of white blood cell. Eosinophilic pneumonia often occurs in response to infection
with a parasite or after exposure to certain types of environmental factors.
Chemical pneumonia
Chemical pneumonia (usually called chemical pneumonitis) is caused by
chemical toxicants such as pesticides, which may enter the body by inhalation or
by skin contact. When the toxic substance is an oil, the pneumonia may be
called lipoid pneumonia.
Aspiration pneumonia (or aspiration pneumonitis)
It is caused by aspirating foreign objects which are usually oral or gastric contents,
either while eating, or after reflux or vomiting which results in bronchopneumonia.
The resulting lung inflammation is not an infection but can contribute to one, since
the material aspirated may contain anaerobic bacteria or other unusual causes of
pneumonia. Aspiration is a leading cause of death among hospital and nursing
home patients, since they often cannot adequately protect their airways and may
have otherwise impaired defenses.
Dust pneumonia
Dust pneumonia describes disorders caused by excessive exposure to dust storms,
particularly during the Dust Bowl in the United States. With dust pneumonia, dust
settles all the way into the alveoli of the lungs, stopping the cilia from moving and
preventing the lungs from ever clearing themselves.
Necrotizing pneumonia
Although overlapping with many other classifications, necrotizing pneumonia
includes pneumonias that cause substantial necrosis of lung cells, and sometimes
even lung abscess. Implicated bacteria are extremely commonly anaerobic bacteria,
with or without additional facultatively anaerobic ones like Staphylococcus
aureus, Klebsiella pneumoniae and Streptococcus pyogenes. The
bacteria Pneumococcus type III is sometimes implicated.
Double pneumonia (bilateral pneumonia)
This is a historical term for acute lung injury (ALI) or acute respiratory distress
syndrome (ARDS). However, the term was and, especially by lay people, still is
used to denote pneumonia affecting both lungs. Accordingly, the term 'double
pneumonia' is more likely to be used to describe bilateral pneumonia than it is ALI
or ARDS.
According to host reaction
Hospital Acquired pneumonia
Hospital-acquired pneumonia is a lung infection obtained during a hospital stay.

This form of pneumonia can be serious because often times the patient, by nature
of being in the hospital in the first place, is in an immune-weakened state due to
illness or traumatic injury and thus is more susceptible to infection.
Infection can occur through inhalation of airborne organisms or through contact

with contaminated healthcare workers. Hospital-acquired pneumonia is also
prevalent in patients who require a ventilator for breathing assistance.
Community-acquired pneumonia : it is an infection that is acquired outside of

the healthcare system, including hospitals, nursing homes, outpatient clinics, or
any other healthcare facility.
Community-acquired pneumonia is the most common type of pneumonia and

generally presents as an acute infection, with symptoms appearing over the course
of hours or days.
Streptococcus pneumonia is the leading cause of community-acquired pneumonia,

responsible for 20% to 60% of all cases. Haemophilis influenza, Staphylococcus
aureus, Legionella pneumophila, Mycoplasma pneumonia, and several viruses are
also leading causes of community-acquired pneumonia.
Pneumocystis Pneumonia (PCP) or Opportunistic pneumonia:
This lung infection, also called PCP, is caused by a fungus, which used to be
called Pneumocystis carinii, but now is named Pneumocystis jirovecii. PCP occurs
in people with weakened immune systems, including people with HIV. The first
signs of infection are difficulty breathing, high fever, and dry cough.
Clinical classification
 Acute pneumonia
 Chronic pneumonia
SIGNS AND SYMPTOMS
 Chest pain
 Usually involve one or more lobes
 Fever with chills
 Cough
 Sore throat
 Ear pain
 Headache
 Low grade fever
 Sputum production
PATHOPHYSIOLOGY
There are four characteristic stages of the disease
CONGESTION: after the pneumococcus organism reach the alveoli via droplet
or saliva there is an out pouring of fluid into the alveoli. The organism multiply in
the serous of fluid and to the infection is spread.
RED HEPATIZATION: There is massive dilation of the capillaries and alveoli

are filled with organism, netrophills, RBC and fibrin. The lung appears red and
granular.
GRAY HEPATIZATION: Blood pressure decrease, mucocytes and consolidate

in the affected part of the lung.
RESOLUSION: Complete resolution and healing occur if there are no

complications. The excudate become lysed and processed by the macrophages.
The normal lung tissue is restored and the person gas exchanges ability returns to
normal.
Aspiration of streptococci pneumonia
Release of bacterial endotoxin
INFLAMATORY RESPONSES:
 Alteration of netrophils
 Release of inflammatory mediators
 Accumulation of fibrinous excudate
R.B.C and bacteria.
Leukocyte infiltration
Gray hepatization
Red hepalization
Neutrophills and macrophages Deposition of fibrin on pleural
Consolidation of lung
surfaces,
parenchyma
Phagocytosis in alveoli
RESOLUTION OF INFECTION
Macrophages in alveoli ingest and remove degenerated neutrophills fibrin and bacteria
INVESTIGATIONS
Blood and urine culture to assist the systemic spread
 Chest X-Ray provides information about the location and extent of

pneumonia
 Definitive diagnosis is usually determined through sputum analysis.
 Pulmonary function test
MEDICAL MANAGEMENT:
Specific antibiotic therapy

Respiratory support
Administration of oxygen
Chest physiotherapy
Postural drainage
Administration of oxygen
 Before o2 therapy nurse should asses hypoxia

Ex: rapid pulse, rapid respiration, dyspnea, restlessness, confusion.
 O2 should be colour less, odourless, tasteless.
 It should be administer low flow or high flow according to the condition of
the patient.
Postural drainage
 To prevent worsening of pneumonia

 Use proper position to avoid the clearance of secretions because muco
purulent secrations are responsible for air way obstructions.
 Support should be given and therapy lasts for 20 to30min.
 It may accompanied by perknsion
Chest physiotherapy
 It is used to loosen secretion
 Perkertion clapping and vibration of one chest are the manual
procedures used.
 Chest physiotherapy is used in congestion, deep breathing and
PREVENTION
 Encourage frequent coughing and expectoration of secretions.
 Teach deep breathing exercises.
 Take special precautions to prevent infection.
 Change position frequently.
 Carryout chest physiotherapy to loosen secretions
 Promote frequent oral hygiene.
 Administer sedatives and opiods to avoid suppressants that suppress respiration.
 Encourage to stop smoking and reduced alcohol irritant.
Nursing management
improve airway patency
 Removal of secretions. Secretions should be removed because retained

secretions interfere with gas exchange and may slow recovery.
 Adequate hydration of 2 to 3 liters per day thins and loosens pulmonary
secretions.
 Humidification may loosen secretions and improve ventilation.
 Coughing exercises. An effective, directed cough can also improve
airway patency.
Chest physiotherapy. Chest physiotherapy is important because it
loosens and mobilizes secretions.
promote rest and conserve energy
 Encourage avoidance of overexertion and possible exacerbation of

symptoms.
Semi-Fowler’s position. The patient should assume a comfortable
position to promote rest and breathing and should change positions
frequently to enhance secretion clearance and pulmonary ventilation and
perfusion.
promote fluid intake
Fluid intake. Increase in fluid intake to at least 2L per day to replace

insensible fluid losses.
maintain nutrition
 Fluids with electrolytes. This may help provide fluid, calories, and
electrolytes.
Nutrition-enriched beverages. Nutritionally enhanced drinks and shakes

can also help restore proper nutrition.
promote patient’s knowledge
 Instruct patient and family about the cause of pneumonia, management of

symptoms, signs, and symptoms, and the need for follow-up.
 Instruct patient about the factors that may have contributed to the
development of the disease.
 Oral antibiotics. Teach the patient about the proper administration,
potential side effects, and symptoms to report.
 Breathing exercises. Teach the patient breathing exercises to promote
secretion clearance and volume expansion.
 Follow-up check up. Strict compliance to follow-up checkups is
important to check the latest chest x-ray result or physical examination
findings.
Smoking cessation. Smoking should be stopped because it inhibits

tracheobronchial ciliary action and irritates the mucous cells of the
bronchi.
COMPLICATIONS
 Abscess formation
 Emphysema
 Sepsis
 Pleurisy
 Pericarditis

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PNEUMONIA

Pneumonia is an inflammatory process in lung parenchyma usually

According to anatomical area

 lobar pneumonia : It is an infection that only involves a single lobe, or section,

Bronchiolitis obliterans organizing pneumonia

Hospital Acquired pneumonia

Hospital-acquired pneumonia is a lung infection obtained during a hospital stay.

Infection can occur through inhalation of airborne organisms or through contact

Community-acquired pneumonia : it is an infection that is acquired outside of

Community-acquired pneumonia is the most common type of pneumonia and

Streptococcus pneumonia is the leading cause of community-acquired pneumonia,

Pneumocystis Pneumonia (PCP) or Opportunistic pneumonia:

SIGNS AND SYMPTOMS

There are four characteristic stages of the disease

RED HEPATIZATION: There is massive dilation of the capillaries and alveoli

GRAY HEPATIZATION: Blood pressure decrease, mucocytes and consolidate

RESOLUSION: Complete resolution and healing occur if there are no

Aspiration of streptococci pneumonia

Release of bacterial endotoxin

Blood and urine culture to assist the systemic spread

 Chest X-Ray provides information about the location and extent of

Specific antibiotic therapy

 Before o2 therapy nurse should asses hypoxia

 To prevent worsening of pneumonia

improve airway patency

 Removal of secretions. Secretions should be removed because retained

 Encourage avoidance of overexertion and possible exacerbation of

Fluid intake. Increase in fluid intake to at least 2L per day to replace

 Instruct patient and family about the cause of pneumonia, management of

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