Pneumonia

Pneumonia

Acute inflammation of Lung caused by mycrobial organism
Leading cause of Death and Hospitalization in older ppl and those with chronic diseases in CA
Etiology
1. Likely to result when defense mechanisms become incompetent or overwhelmed
2. Decrease Cough and Epiglottal reflexes may allow Aspiration
3. Mucociliary mechanism impaired
  1. Pollution
  2. Cigarette smoking
  3. Upper Respiratory Infections
  4. Tracheal Intubation
  5. Aging
Acquisition of Organisms
1. Aspiration
2. Inhalation
3. Hematogenous
Type of Pneumonia
1. Community Acquired (CAP)
  1. Lower Respiratory Infection of Lung
  2. Onset in community or during first
  3. 2 Days of Hospitalization
  4. Highest incidence in midwinter
  5. Smoking Important risk factor
2. Hospital Acquired(HAP)
  1. Occuring 48 hrs or longer after admission
  2. Most common Hospital associateed INFECTION
  3. HIGH mortality and morbidity rates
  4. Microorganisms responsible for HAP are different from CAP
3. Fungal
  1. Organisms implicated
    1. Streptococcus pneumoniae
    2. Haemophilus influenza
    3. Legionella
    4. Maycoplasma
    5. Chlamydia
4. Aspiration
  1. Usually follows aspiration of material from the mouth or the stomach into the trachea and cubsequently the lungs
5. Opportunistic
  1. Pts with altered immune response are highly susceptible to respiratory infection
Treatment is based on
1. Know risk factors
2. Severity of illness
3. Early (5 days post admission) or late ( more than 5 days post admission) ONSET
4. Multidrug-Resistant organisms are MAJOR PROBLEM in treating HCAP
Signs & Symptoms
1. Sudden onset of FEVER
2. Shaking chills
3. SOB
4. Cough productive of purulent sputum
5. Pleuritic CHEST PAIN
Physical Examination FINDINGS
1. Dullness to percussion
2. Increase Fremitus
3. Bronchial breath sounds
4. Crackles
Atypical Manifestations
1. Gradual Onset
2. Dry Mouth
3. Extrapulmonary manifestations
4. Crackes
Complication
1. pleurisy
2. Pluenral effusion
3. Atelectasis
4. bacteremia
5. lung abscess
6. Empyema
7. Pericarditis
8. meningitis
9. Endocarditis
DX Tests
1. -Hx, physical examination, Chest x-ray, Gram stain of sputum, Sputum culture and sensitivity, pulse oximetry or ABGs, Bronchoscopy, CBC, Chemistry & Blood cultures
Collaborative Care
1. Antibioric therapy, Oxygen for Hypoxemia, analgesics for Chest pain, antipyretics, Fluid intake at least 3L/ day, Cal. intake ar least 1500 cal/day
2. Pneumococcal vaccine
  1. Indicated for those at risk
    1. Chronic illness such as heart and lung disease, diabetes mellitus
    2. Recovering from sever illness
    3. 65 or older, LCT
Nrsg Assessment; FOCUS ON RESTPIRATORY ASSESSMENT
1. Hx of Lung cancer; COPD; Diabetes; Debilitating Disease; Malnutrition; AIDS
2. Hx of Use of antibiotics, CORTICOSTEROIDS, CHEMOTHERAPY, OR IMMUNOSUPPRESSANTS; Recent abdominal or Thoracic surgery; Smoking; Alcoholism; Respiratory infections
3. Prolonged Bed rest; Dyspnea; Nasal congestionl; Pain w/ breathing; sore throat; Muscle ache; Fever; Restlessness
Dx
1. Ineffective Breathing Pattern
2. Ineffective Airway clearance
3. Acute pain
4. Imbalanced nutrition; less than body requirements
5. Activity intolerance
Planning
1. Clear brathing sound; Normal breathing pattern; No signs of Hypoxia; Normal CXR; No complication r/t pneumonit
Nrsg Implementation
1. Encourage those at risk to obtain influenza and pneumococcal vaccinations; semi-fowler's porition for pt w/ feeding tube; Teaching Nutrition, hygiene, rest, regular exercise to maintain natural resistance; Prompt reatment of URIs; Strict asepsis
2. Pt positioning; Assist immobile pt w/ repositioning Q2hr (high fowler's); emphasize need to take of medication
Evaluation
1. NOT present Dysphnea; Spo2 >95%; No adventitious breath sounds; clear sputum from airway; Report pain control; adequate food &fluid intake; performs ADLs; verbalizes causal factors

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