Pneumonia.ppt

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PNEUMONIA:

PNEUMONIA CONDUCTED BY: MS.MONIKA Clinical instructor Army college of nursing

DEFINITION:

DEFINITION It is an inflammation of lung parenchyma i.e caused by microbial agent It is usually associated with increased in interstitial & alveolar fluid. Currently pneumonia is the sixth most common cause of death for all ages. I

Etiology:

Etiology There are many causes of pneumonia & it include: Bacterial: pneumococcal pneumonia : caused by– streptococcus pneumoniae. Staphylococcus pneumonia: caused by— staphylococcus aureus . Gram –ve bacterial pneumonia: caused by- klebsiella pneumonia . Anaerobic bacterial pneumonia: caused by normal oral flora.

Cont……….d:

Cont……….d b) Viruses: Viral pneumonia: caused by influenza a virus . c) Mycoplasm : mycoplasma pneumonia: caused by mycoplasma microorganism . d) Fungal agents : Fungal pneumonia: caused by histoplasmosis ,candidiasis. e) Protozoa : parasitic pneumonia common organism is pneumocystis carinii .

Cont………d:

Cont………d Nosocomial pneumonia is acquired within a hospital in a patient admitted to the hospital for something else. Risk increased with an underlying illness, recent surgery, recent intubation, and in persons already on antibiotics for something else.

Etiology :

Etiology Pneumonia may also result from aspiration of food ,fluid ,vomitus ,inhalation of toxic or caustic chemicals ,smoke ,dust or gases. OTHER RISK FACTORS Advanced age A history of smoking URTI Prolonged Tracheal intubation Prolonged bed rest & immobility. Chronic disease. HIV infection.

Cont…………..d:

Cont…………..d Immunosuppressive therapy Nonfunctional immune system Malnutrition Dehydration chronic lung disease Additional risk factor : exposure to air pollution ,alcoholism ,inhalation of noxious substances ,aspiration of food ,liquid ,foreign or gastric material.

Segments affected from pneumonia :

Segments affected from pneumonia a) BRONCHIAL PNEUMONIA it involves the terminal bronchial and alveoli.

b) LOBAR PNEUMONIA:

b) LOBAR PNEUMONIA It involves one or more entire lobes.

3)Segmental pneumonia:

3)Segmental pneumonia It involves the a segment of lobes.

4) Bilateral pneumonia:

4) Bilateral pneumonia It affects the lobes in both lungs.

5) Interstitial pneumonia:

5) Interstitial pneumonia It is also called reticular pneumonia. It involves inflammatory response within the lung tissues surrounding the airspaces.

6) Alveolar pneumonia:

6) Alveolar pneumonia It is also acinar pneumonia. There is fluid accumulation in a lung distal air spaces. 7) Necrotizing pneumonia : it causes the death of a portion of lung tissues. X ray examination reveal cavity at the formation at the site of necrosis. Necrotic lung tissue ,which does not heal constitutes a permanent loss of functioning parenchyma.

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Invasion of microbes . Inflammation of airway . Filling of inflammatory exudates in alveolar air spaces. Lung consolidation .( The process of becoming a firm solid mass, as in an infected lung when the alveoli are filled with exudate ) Impaired gas exchange . Hypoxia

CLINICAL MANIFESTATION:

CLINICAL MANIFESTATION Rapidly rising fever. sweats Shaking chills. Pleuritic chest pain. Tachypnoea. Cough & sputum production

Cont……….d:

Cont……….d Hemoptysis ,dyspnea ,headache ,fatigue Chest auscultation reveals bronchial breathe sounds Tactile fremitus is usually increased .

DIAGNOSTIC EVALUATION.:

DIAGNOSTIC EVALUATION. Lab investigations Gram staining Chest X-ray Sputum culture analysis Hypersensitivity test ABG analysis to asses the need for supplemental o2.

Medical management :

Medical management May need admission to hospital if patient has a high fever, shortness of breath, or in shock. Bed rest, plenty of fluids, and Tylenol for pain are usually sufficient for mild uncomplicated cases.

CONT.:

CONT. Antibiotic therapy are used for treatment such as penicillin , amoxicillin , augmentin , erythromycin , zithromax , cephalosporin , depending upon the causative bacteria. General antibiotics (e.g., erythromycin) may be given until the cultures come back from the lab, then changed to the appropriate antibiotic.

CONT..:

CONT.. Antivirus medications such as Amantadine ( Influenza A and B) or Ribavirin are available . Postural drainage Chest physiotherapy Tracheal suctioning

CONT.:

CONT. Intravenous (IV) fluids should be started. Oxygen should be administered as ordered. Bronchodilator medication If one has TB or other dangerous forms of Pneumonia , isolate from other patients. If unable to breathe, respiratory support is provided .

CONT.:

CONT. Follow up laboratory tests and X-Ray s are done to check treatments. Medical follow up after discharge and a repeat X-Ray in 6-9 weeks.

COMPLICATIONS:

COMPLICATIONS Shock & Respiratory failure Atelectasis & Pleural effusion

NURSING MANAGEMENT:

NURSING MANAGEMENT NURSING ASSESSMENT 1.Change in temperature. 2.Amount, odour & colour of secretions. 3.Frequency & severity of cough. 4.Changes in chest X-ray finding. .

CONT.:

CONT. 5.Change in physical assessment findings. 6.Changes in chest X-ray finding. 7.Altered mental status , dehydrations , excessive fatigue , heart failure.

DIAGNOSIS:

DIAGNOSIS Ineffective airway clearance related to copious tracheobronchial secretions. Activity intolerance related to impaired respiratory function. Risk for deficient fluid volume related to fever & dyspnea.

CONT.:

CONT. Imbalanced nutrition less than body requirements. Deficient knowledge about the treatment regimen & preventive heath measures.

NURSING INTERVENTIONS:

NURSING INTERVENTIONS Improving airway patency Removing secretions that interfere gas exchange. Encourage hydration. Coughing can be initiated Encourage increased fluid intake

CONT..:

CONT.. Employ postural drainage to loosen &mobilize secretions. Auscultate the chest for crackles & rhonchi.

CONT.:

CONT. Administer cough suppressants if cough is non-productive. Mobilize the patient to improve secretion clearance & reduce risk of atelectasis . & worsening pneumonia.

MAINTAINING NUTRITION:

MAINTAINING NUTRITION Provide fluid with electrolyte. Enriched drinks or shakes may be helpful.

PROMOTING REST & CONSERVING ENERGY:

PROMOTING REST & CONSERVING ENERGY Give ventilated room for rest. Give comfort position. Change the position periodically.

PROMOTING PATIENT’S KNOWLEDGE:

PROMOTING PATIENT’S KNOWLEDGE Instruct the cause of pneumonia , management , complication ,need for follow up. Instruct how he can recover from it.

Monitor for complications:

Monitor for complications Monitor vital signs, oximetry at regular intervals to assess the patient’s response to therapy .

Cont……….:

Cont………. Assess for resistance fever or returns of fever , potentially indicating bacterial resistance to antibiotics. Auscultate lungs and heart. Heart murmurs or friction rub may indicate acute bacterial endocarditis , pericarditis or myocarditis .

Relieving pleuritic pain:

Relieving pleuritic pain Place in a comfortable position for resting & breathing. Encourage frequent change of position to prevent pooling of secretions. Demonstrate how to splint the chest while coughing. Avoid suppressing a productive cough .

Cont…..:

Cont….. Administer prescribed analgesics agent to relief pain. Encourage modified bed rest . Watch for abdominal distension ,which may be due to swallowing of air during intervals of severe dysponea.

EXPECTED OUTCOMES:

EXPECTED OUTCOMES Cyanosis and dyspnoea reduced,ABG levels improved. Coughs effectively,absence of crackles. Appears more comfortable. Free from pain. Fever controlled. No signs of resistant infection.

PATIENT EDUCATION & HEALTH MAINTAINENCE:

PATIENT EDUCATION & HEALTH MAINTAINENCE Advice the patient that fatigue & weakness may be prolonged after pneumonia.

Cont…….:

Cont……. Encourage chair rest after fever subsides , Encourage breathing exercise.

Cont…..:

Cont….. Explain that a chest X- ray is taken 4 to 6 weeks after recovery to evaluate lungs for clearing & detect any tumour or cause. Advice smoking & alcohol cessation.

Cont….:

Cont…. Advice to take good nutrition. Encourage yearly immunization. Practice frequent hand washing. Advice avoidance of contact with people who have upper respiratory infection

PREVENTION:

PREVENTION Vaccination -- against measles, Influenza , Pneumococcal p., especially in those over age 65 and other diseases Bed-ridden individuals -- avoid prolonged bed rest, perform exercises in bed, breathing and coughing exercises before and after an operation.

CONT…:

CONT… Avoid alcohol, drugs, NGT feeding Avoid smoking Avoid taking antibiotics for viral Pneumonia Foods high in vitamins, minerals, and other nutrients.

BIBLIOGRAPHY:

BIBLIOGRAPHY Sandra m et al,” manual of nursing practice “. Vol 1, 8 th ed, Jaypee brothers medical publishers; India , 286 -2 89. Smeltzer, c.suzanne, Bare,G.Brenda, “medical surgical nursing”, 10 th ed :lippincott raven publishers; Pp-520-532 Joyce M Black & J. Hawks,”medical surgical nursing”,vol 2,7 th ed, Elsavier publishers, Pp -1710-1720. www.goggle.com

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