Pneumonia is a serious infection or inflammation of one or both lungs.

Description of Pneumonia
Pneumonia is caused by the inhalation of infected microorganisms (tiny, single-celled living organisms, such as bacteria, viruses, fungi or protozoa) spread through contact with an infected person. The microorganisms enter the body through the mouth, nose and eyes. If the body's resistance is down, the natural process of fighting off diseases is weakened and the microorganisms are free to spread into the lungs and the lungs' air sacs. The air sacs become filled with fluid and pus from the infectious agent, making it more difficult for the body to get the oxygen it needs, and the person may become sick. Potential complications of pneumonia include pleural effusion (fluid around the lung), empyema (pus in the pleural cavity), hyponatremia (low blood sodium) and rarely, an abscess in the lung.

Causes of Pneumonia
There are over 30 different causes of pneumonia, but the most common causes are bacteria (including mycoplasma) and viruses. Corresponding to these causes are the most common types of pneumonia - bacterial pneumonia, viral pneumonia and mycoplasma pneumonia. Bacterial pneumonia Pneumonia-causing bacteria is present in many throats, but when the body's defenses are weakened (for example, by illness, old age, malnutrition or impaired immunity) the bacteria can multiply, working its way into the lungs, inflaming the air sacs and filling the lungs with liquid and pus. The bacteria that cause bacterial pneumonia are streptococcus pneumonia (resulting in lobar pneumonia), hemophilus influenza (resulting in bronchopneumonia), legionella pneumophilia (resulting in Legionnaires' disease) and staphylococcus aureus. Viral pneumonia Half of all pneumonias are believed to be caused by viruses, such as influenza (flu), adenovirus, coxsackievirus, chickenpox, measles, cytomegalovirus and respiratory syncytial virus. These viruses invade the lungs and multiply. Mycoplasmal pneumonia (also called "walking pneumonia") Similar to bacterial pneumonia, the mycoplasmas multiply and spread, causing infection.

Some of the other pneumonia-related disorders are aspiration pneumonia, chlamydial pneumonia, Loffler's syndrome, pneumocystis carinii pneumonia, pediatric pneumonia and necrotizing pneumonia. Risk factors include:
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65 years of age or older People in nursing homes or other chronic care facilities Male Children under the age of two People with colds or other respiratory infections People with reduced immunity People with other lung diseases, such as asthma, cystic fibrosis and lung cancer People with AIDS or HIV Organ transplant recipients People who have had their spleen removed People receiving chemotherapy People who smoke Alcoholics People with chronic health problems, such as lung disease, heart disease, kidney disorders, sickle cell anemia or diabetes

Symptoms of Pneumonia
Symptoms vary, depending on the type of pneumonia and the individual. With bacterial pneumonia, the person may experience:
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shaking chills chattering teeth severe chest pain cough that produces rust-colored or greenish mucus very high fever sweating rapid breathing rapid pulse rate

With viral pneumonia, the person may experience:
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fever dry cough headache

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muscle pain and weakness

These flu-like symptoms may be followed within one or two days by:
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increasing breathlessness dry cough becomes worse and produces a small amount of mucus higher fever bluish color to the lips

With mycoplasma pneumonia, the person may experience:
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violent coughing attacks chills fever nausea vomiting slow heartbeat breathlessness bluish color to lips and nailbeds diarrhea rash muscle aches

Regardless of the type of pneumonia, the person may also experience the following symptoms:
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a loss in appetite feeling ill clammy skin nasal flaring fatigue mental confusion joint and muscle stiffness anxiety, stress and tension abdominal pain

Diagnosis of Pneumonia
To diagnose pneumonia, the doctor begins with a medical history and physical examination. By placing a stethoscope on the chest, the doctor may be able to hear crackling sounds, coarse breathing, wheezing and/or the breathing may be faint in a particular area of the chest. Additionally, the doctor may order a chest x-ray, a sputum gram stain and a blood test. The chest x-ray may show a blotchy-white area, where fluid and pus has accumulated in the lung's air sacs. The sputum grain stain and the blood test may determine the cause and severity of the condition.

If these tests are inconclusive, the doctor may perform a procedure called a bronchoscopy. In this procedure, a flexible, thin and lit viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor and specimens from the infected part of the lung can be obtained. top ^

Treatment for Pneumonia
Treatment depends on the severity of symptoms and the type of organism causing the infection. Bacterial pneumonia (caused by the streptococcus pneumonia bacteria) is often treated with penicillin, ampicillin-clavulanate (Augmentin) and erythromycin. Bacterial pneumonia (caused by the hemophilus influenza bacteria) is treated with antibiotics, such as cefuroxime (Ceftin), ampicillin-clavulanate (Augmentin), ofloxacin (Floxin), and trimethoprim-sulfanethoxazole (Bactrim and Septra). Bacterial pneumonia (caused by legionella pneumophilia and staphylococcus aureus bacteria) are treated with antibiotics, such as erythromycin. Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia usually resolves over time. If the lungs become infected with a secondary bacterial infection, the doctor will prescribe an appropriate antibiotic to eliminate the bacterial infection. Mycoplasma pneumonia is often treated with antibiotics, such as erythromycin, clarithromycin (Biaxin), tetracycline or azithromycin (Zithromax). In addition to the pharmaceutical intervention, the doctor will also recommend bedrest, plenty of fluids, therapeutic coughing, breathing exercises, proper diet, cough suppressants, pain relievers and fever reducers, such as aspirin (not for children) or acetaminophen. In severe cases, oxygen therapy and artificial ventilation may be required. The course of pneumonia varies. Recovery time depends upon the organism involved, the general health of the person and how promptly medical attention was obtained. A majority of sufferers recover completely within a few weeks, with residual coughing persisting between six and eight weeks after the infection has gone.

Prevention of Pneumonia

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Practice good hygiene. Get an influenza shot each fall. Get a pneumonococcal vaccine. People who stand to benefit most from vaccination are those over the age 65; anyone with chronic health problems (such as diabetes, kidney

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disease, heart disease, etc.); anyone who has had their spleen removed; anyone living in a nursing home or chronic care facility; caregivers of the chronically ill (healthcare workers or family caregivers); children with chronic respiratory diseases (such as asthma), and anyone who has had pneumonia in the past (due to increased risk of reinfection). The pneumonococcal vaccine is 90 percent effective against the bacteria and protects against infection for five to 10 years. Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep. Do not smoke.

RELATED DIAGNOSTIC TESTS:

Pneumonia
DEFINITION: An inflammation of the lungs caused by an infection.

Crackles are heard when listening to the chest with a stethoscope (auscultation). Tests include: chest X-ray, sputum gram stain, CBC, arterial blood gases. This disease may also alter the results of the following tests: thoracic CT, routine sputum culture, pulmonary ventilation/perfusion scan, pleural fluid culture, lung needle biopsy . MEDICAL MANAGEMENT: The goal of treatment is to cure the infection with antibiotics. If the pneumonia is caused by a virus, antibiotics will not be effective. Supportive therapy includes oxygen and respiratory treatments to remove secretions.

ETIOLOGY: Pneumonia is a very common, serious illness and affects about 1 out of 100 people each year. It is caused by many different organisms and can range in seriousness from mild to lifethreatening illness. There are different categories of pneumonia.

PATHOPHYSIOLOGY: There are different categories of pneumonia. Two of these types are hospital-acquired and community-acquired. Common types of community-acquired pneumonia are pneumococcal pneumonia and Mycoplasma pneumonia. In some people, particularly the elderly and those who are debilitated, pneumonia may follow influenza. Hospital-acquired pneumonia tends to be more serious because defense mechanisms against infection are often impaired. Some of the specific pneumonia-related disorders include: aspiration pneumonia, pneumonia in immunocompromised host and viral pneumonia

NURSING MANAGEMENT:  Pt will need to have breath sounds monitored q 4r to determine if pneumonia is progressing. O2 sats should be done regularly ( at least q4rduring acute phase) to make sure that patient is getting adequate perfusion. Make sure to give all scheduled antibiotics on schedule so that therapeutic ranges are maintained.  

SIGNS & SYMPTOMS: Cough (with mucus-like, greenish, or pus-like sputum chills with shaking ), fever, easy fatigue, chest pain (sharp or stabbing increased by deep breathing or increased by coughing), headache, loss of appetite, nausea and vomiting, general discomfort, uneasiness, or ill feeling (malaise), joint stiffness (rare), muscular stiffness (rare), rales Additional symptoms that may be associated with this disease: shortness of breath, clammy skin, nasal flaring, coughing up blood, tacypnea, apnea, anxiety, stress, and tension, abdominal pain . REFERENCE: www.Healthcentral.com/pathophysiology, pages 1211-1213

Any s/s of infection must be monitored and reported to MD. HEALTH DEVIATION SELF-CARE REQUISITES:  Pt will need to continue on scheduled antibiotics after discharge. Teaching may be necessary to inform patient of therapeutic ranges and need to take all of meds, even if they are feeling better.  Pt will need to get a PneumonoVax (if does not all ready have0 to help prevent future outbreaks of pneumonia.  Pt will need to be taught S/S of infection and when to report to MD. 

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