Pneumonia

pathophysi

due to pathogens -> they release toxin -> inflammatory response & damage lung parenchyma

parenchyma: lung tissue including bronchioles, bronchi, blood vessels, interstitium and alveoli

or due to infected alveoli -> fill with exudate -> consolidation of lung tissue -> impaired gaseous exchange

spread by droplets

risk factor: immunosuppressed patients, smoking, prolong immobility

classification

one

two

community acquired pneumonia = occurs in the community/ within first 48 hrs after hospitalization (streptococcal pneumonia, haemophilus influenza, legionnarires disease, mycoplasma pnuemonia, viral pneumonia)

hospital acquired pneumonia = nosocominal pnuemonia; occurs >48 hours after hospital (pseudomonas pneumonia, staphylococcal pnuemonia, klebsiella pnuemonia)

pneumonia in the immunocompromised host (pneumocystis pnuemonia, fungal pneumonia)

aspiration pneumonia = aspiration of gastric content into lung

typical (bacterial) pneumonia

bacteria cause inflammation & exudation filling into the air-filled spaces of the alveoli (lung infiltration)

atypical (viral) pneumonia

inflammatory changes on the interstitium; less striking symptoms, no alveolar infiltration, nonproductive cough, CXR: usually clear

S/S: chills, fever, severe malaise, purulent sputum, increase in WBC, infiltrates seen on CXR, pleuritic chest pain

S/S

fever, sudden onset of chills (rapid rising fever), sweats, pleuritic chest pain

cough, sputum

hemoptysis, headache, fatigue

signs of respiratory distress (sob, dyspnea, use of accessory muscle in respiration, increase in RR, increase in oxygen saturation

diagnostic investigations/ assessments and findings

ABG (PaO2<80mmHg)

sputum smear & culture

blood & urine culture

CXR (density changes - hazy lobe, consolidation)

unequal chest wall expansion, percussion is dulled over consolidated area, crackling sound over affected area
*more consolidation -> louder sound transmitted

management

admin antibiotic (tx of viral pneumonia is primarily supportive)

hydration for fever -> insensible fluid loss

antipyretics -> headache & fever

med for cough (mucolytic agent, expectorants)

o2 therapy

improving airway patency

ineffective airway clearance related to copious tracheobronchial secretion

monitor by ABG, pulse oximetry, regular vital signs, SPO2, encourage fluid intake -> thin and loosen secretion

deep breathing with incentive spirometry,encourage effective coughing

promote rest (activity intolerance related to impaired respiratory function)

encourage patient rest in a comfortable position (semi fowler), avoid overexertion

promote fluid intake (risk of deficient fluid volume related to fever & a rapid RR

2-3L/ day, monitoring intake & output

maintain nutrition (imbalanced nutrition: less than body requirement)

maintain oral hygiene -> increase appetite

promote patients' knowledge (deficient knowledge about pneumonia, treatment regimen and preventive health measure)

educate the cause of pneumonia, s/s, appropriate disposal of tissue with sputum & cough, handwashing to prevent transmission

prevent the spread of infection (risk of infection)

proper hand hygiene, use of mask, prevent the spread of communicable respiratory infection by using appropriate medical asepsis and isolation

Risk factor

conditional that cause mucus/ bronchial obstruction (e.g. copd)

advanced ages with nutrition depletion

smoking

immunocompromised pt

R/T feeding pt

prolong immobility: stasis of sputum -> stick tgt and become a bacteria harbour