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


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


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


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


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. 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 Shock & Respiratory failure Atelectasis & Pleural effusion


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


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


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


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


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


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


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


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………. 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….. 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 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 Advice the patient that fatigue & weakness may be prolonged after pneumonia.


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


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


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


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.

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