PNEUMONIA REVIEW NOTES
(NCLEX)
Patients who have pneumonia are
experiencing an infection of the lower
respiratory system that affects the alveolar
sacs. Pneumonia leads to impaired gas
exchange which can require mechanical
ventilation if severe enough.
Definition: a lower respiratory tract
infection that causes inflammation of the
alveoli sacs
Key Players:
• Germs: Bacteria, Virus,
Fungi
• Lung Parenchyma: Alveoli,
Alveolar Ducts, and
Bronchioles (the trio in gas
exchange)
Process of normal gas exchange:
oxygen is inhaled through the upper
respiratory system down
through trachea, the bronchus (right
and left primary bronchi) which splits
at the carina and enters into the lungs
at the hilum and branches into the
• Secondary Bronchi (also
called Lobar Bronchi)
• Tertiary Bronchi (also
called Segmental Bronchi)
then into smaller branches
called bronchioles to the alveolar
ducts to the alveolar sacs which inflate
and deflate to allow gas exchange.
During this process, there is the
transfer of oxygen from inhalation into
the bloodstream and transfer of carbon
dioxide out of the blood through the
lungs which is exhaled. This happens in
the alveoli capillary wall. Then the fresh
oxygenated blood is taken back to
the heart through the pulmonary vein
and is pumped through the heart to the
body.
How does Pneumonia develop?
Normally, the respiratory system can
“fight off” these type of germs by
filtering the air taken in through the
nose and airway BUT certain conditions
can damage the body’s ability to do
this and make the body more
susceptible to developing PNA.
These risk factors include:
• Prior infection: flu or cold
• Weak immune system:
Elderly, infants, HIV,
autoimmune medications
• Immobile: strokes or any
other condition that
causes decrease mental
awareness or restrict
ability to move
• Lung problems: COPD,
asthma, smokers
• Post-opt patient: not
coughing deep breathing
These germs get into the lungs
by inhalation, aspiration, or from the
blood and attack the alveoli sacs.
These sacs become very inflamed and
fill with fluid, body’s immune defense Further look at the Germs that Cause
cell RBCs and WBCs, and bacteria. Pneumonia:

• Bacteria: most common

cause of pneumonia
especially in community-
acquired is caused
by Streptococcus pneumo
niae
• Atypical
Bacteria: Mycoplasma pne
umoniae that causes
“walking pneumonia”
which is a milder form of
pneumonia that isn’t
severe enough to require
complete bed rest
• Virus: influenza, RSV most
This causes the sac to lose the ability common causes of PNA in
to inflate and deflate which allows children
proper gas exchange. Therefore, the
patient will start to • Fungi: least
experience HYPOXEMIA (low oxygen common…most likely to
in the blood) because oxygen cannot affect people with severe
transfer across capillary wall to attach suppressed immune
to RBCs to supply the body with system and typically is
oxygen and the body keeps the CO2 contracted from outside in
(carbon dioxide) which leads nature from plants,
to RESPIRATORY ACIDOSIS! animals etc.

Types of Pneumonia
• Community-acquired
Arterial Blood Gase Values due to
Pneumonia (most
Respiratory Acidosis:
occurring): patient obtains
the germs that causes the
• ABGs: PO2: <90 mmHg
pneumonia OUTSIDE of
• pH: lower 7.35 mmHg the healthcare system
hence in the community.
• PCO2: higher than 45
mmHg • Hospital-acquired
Pneumonia: patients who
• **To compensate for this
are on mechanical
the Kidneys start to
ventilation at major risk…it
conserve bicarbonate
is hard to treat because
(HCO3) to hopefully
the bacteria tend to be
increase the blood’s pH
resistant to antibiotics and
back to normal…..so HCO3
more likely a bacteria
becomes >26 mEq/L
 cause. Criteria: patient
must have developed 48-
72 hours after admission
Diagnosed:
• Notice: abnormal lungs
sound when auscultating
with stethoscope may
hear coarse crackles,
rhonchi (type of wheezing)
or bronchial breath sounds
which should be noted
only in the tracheal area
and this represents lung
consolidation.
• Chest x-ray, sputum
culture
Signs & Symptoms of
Pneumonia
Remember the word: PNEUMONIA
Productive cough, Pleuritic pain (chest
pain that is caused by coughing,
breathing etc.)
Neuro changes (especially ELDERLY
patients…may not even have a fever
but fatigue and increased respiratory
rate)
Elevated labs: PCO2 >45 (retaining
carbon dioxide because it can’t pass
capillary of alveoli sac), increased WBC
(represents infection…body is trying to
fight infection off)
Unusual breath sounds: coarse
crackles, rhonchi, or bronchial in the
peripheral lung fields
Mild to high Fever (bacteria cause
produces highest fever….. greater than
104’F)
Oxygen saturation decreased (want
>90%) will need supplementary oxygen
Nausea and vomiting (won’t feel like
eating)
Increase heart rate and respirations
Aching all over with joint pain, Activity
intolerance with shortness of breath
Nursing Interventions for
Pneumonia
Monitor respiratory system:
• Lung Sounds
• Respiratory rate/vital signs
• Oxygen Saturation >95%
• ABGS (if ordered)
• Sputum (collect for
culture)
• Suction as needed
Encourage usage of incentive
spirometer for deep breathing and
encourage coughing and deep
breathing
Encourage 2-3 L of fluid (unless on
fluid restriction as with patients who
have heart failure)…fever causes
dehydration, lose water through
breathing (300-400 mL), and patient is
too sick to have the urge to drink
Education on prevention: Up-to-date
Vaccinations (Pneumovax every 5
years for patients 65+ and 19-64 years
old with risk factors and annual flu
shot)
Education about stop smoking, avoid
people who are sick, hand-washing
Keeping head of bed elevated greater
than 30 degree for immobile patients
to prevent aspiration especially while
eating and after meals along with
frequent turning.
Breathing treatments and other
respiratory therapy treatments (usually
by respiratory therapy department).
These will be schedule or PRN (as
needed).
Treatments include: Bronchodilators,
chest percussion etc.
Medications:
Administering per doctor’s order:
fluids, antipyretics, antivirals (if a viral
cause), and antibiotics (if a bacterial
cause)
Antibiotics Groups for
BACTERIAL Pneumonia
Remember the
mnemonic: Various Medications Frequ
ently Treat Pneumonia Cases
Antibiotics used depend on the
bacteria type that is causing the
infection, the patient’s ability to
tolerate etc.
Vancomycin: used to treat severe cases
and is one of the few that can treat
bacteria that may be resistant to other
antibiotics.
Macrolides: “Zithromax (Z-Pak)” used
in patients with Penicillin
allergy….narrow-spectrum targets
mainly gram positive bacteria
Tetracylines: “Doxycycline” broad-
spectrum that targets gram positive
and negative bacteria. Side effects: not
for pregnant women or 8 years or
younger due to growth retardation and
teeth discoloration, photosensitivity of
the skin and decreases effectiveness of
birth control, no antacids or milk
product while taking this medication
because it affects absorption.
Fluroquinolones: “Levaquin” broad-
spectrum (targets gram-negative and
positive)…treatment for severe
infection that are found in the hospital
that are resistant. Side effects: c. diff
infection, tendon rupture, cardiac
arrhythmias such as QT interval
prolonged
Cephalosporins: “Keflex, Rocephin”
watch with patients who are allergic to
penicillin (can also be allergic to
cephalosporin)…great for community
acquired pneumonia… ( 3rd and 4th
generations of cephalosporins broad-
spectrum)
Penicillin: “Penicillin G”…narrow-
spectrum…target gram positive
bacteria…. monitor if patient is allergic
to cephalosporins, decreases
effectiveness of birth control
Education about antibiotics: Take
medications as prescribed and don’t
stop in the middle of treatment….even
if feeling better which helps decrease
resistance
Viral Cases: May be prescribed an
antiviral of the virus that is causing the
pneumonia ex: Tamiflu