PNEUMONIA

 a lower respiratory tract infection that causes inflammation of the alveoli sacs
 an inflammation of the lungs caused by infectious agent in which the air sacs are
filled with pus or exudate and the air is excluded and the lungs becomes solid.

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 cell RBCs and WBCs, and bacteria. This causes the sac to lose the ability to
inflate and deflate which allows proper gas exchange. Therefore, the patient will start to
experience HYPOXEMIA (low oxygen in the blood) because oxygen cannot transfer
across capillary wall to attach to RBCs to supply the body with oxygen and the body
keeps the CO2 (carbon dioxide) which leads to RESPIRATORY ACIDOSIS!

Arterial Blood Gase Values due to Respiratory Acidosis:

 ABGs: PO2: <90 mmHg

 pH: lower 7.35 mmHg
 PCO2: higher than 45 mmHg
 **To compensate for this the Kidneys start to conserve bicarbonate (HCO3)
to hopefully increase the blood’s pH back to normal…..so HCO3 becomes
>26 mEq/L
Further look at the Germs that Cause Pneumonia:

 Bacteria: most common cause of pneumonia especially in community-

acquired is caused by Streptococcus pneumoniae
 Atypical Bacteria: Mycoplasma pneumoniae 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 common causes of PNA in children
 Fungi: least common…most likely to affect people with severe suppressed
immune system and typically is contracted from outside in nature from
plants, animals etc.

Types of Pneumonia
 Community-acquired Pneumonia (most occurring): patient obtains the
germs that causes the pneumonia OUTSIDE of the healthcare system hence
in the community.
 Hospital-acquired Pneumonia: patients who are on mechanical ventilation
at major risk…it is hard to treat because the bacteria tend to be resistant to
antibiotics and more likely a bacteria 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 Frequently 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….watch for HEARING LOSS “ototoxicity”

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

References 
1. Help Prevent Pneumonia. Centers for Disease Control and Prevention. Retrieved 24 October 2016, from
https://www.cdc.gov/pneumonia/

2. Pneumonia – NHLBI, NIH. (2016). Nhlbi.nih.gov. Retrieved 25 October 2016, from

https://www.nhlbi.nih.gov/health/health-topics/topics/pnu

3. Treatment – NHLBI, NIH. Nhlbi.nih.gov. Retrieved 23 October 2016, from

https://www.nhlbi.nih.gov/health/health-topics/topics/pnu/treatment