 Pneumonia

is an acute infectious disease caused by pneumococcus, associated by general toxemia and a consolidation of one or more lobes of either one or both lungs. It is an inflammation of the lungs caused by infectious agent in which air sacs are filled with pus or exudates so that air is excluded and the lungs become solid.

 Bacteria

commonly enter the lower airway but do not cause pneumonia in the presence of intact host defense mechanism (Smeltzer & Bare, 2005). Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). The incubation period ranges from one to three days with sudden onset of shaking chills, rapidly rising fever and stabbing chest pains aggravated by coughing and respiration. The disease is transmitted through droplet infection or through indirect contact.

 It

is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. Worldwide, it's a leading cause of death in children, many of them younger than a year old.

 There

are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery.

 Pneumonia is not a single disease. It can

have over 30 different causes. There are five main causes of pneumonia: Bacteria Viruses Mycoplasmas Other infectious agents, such as fungi Various chemicals

 Classically,

pneumonia has been categorized into one to four categories: bacterial or typical, atypical, anaerobic/cavitary, and opportunistic. However, there is overlap in the microorganisms thought to be responsible for typical and atypical pneumonia.

 Pneumonia is sometimes classified

according to where and how the client s exposed to the disease: COMMUNITY ACQUIRED PNUEMONIA HOSPTAL- ACQUIRED PNUEMONIA PNEUMONIA IN THE IMMUNOCOMPROMISED HOST ASPIRATION PNEUMONIA

A

case with a diagnosis of Pneumonia may catch one’s attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness.

Anatomy and Physiology

and Pathoph ysiology

Pathophysiology o -pathology

Streptococcus pneumoniae

Physical Assessmen t and Review of Systems

P.A & R.S

Diagnost ic Test

DT-1 DT-2

Pharmacol ogy/ Medication

Drug

study

Nursing Care Plan

NCP's

MedicalSurgical Manageme nt

Discharge Plan and Health Education Plan

Medication

 Deep

breathing exercises and therapy to clean secretions help prevent the occurrence of pneumonia in people at high risk, such as those who have chest or abdominal surgery and those immune suppressed. People with pneumonia also need to clear secretions and benefit from deep breathing exercises and therapy as well. Instruct patient to inhale through nose and exhale through mouth. Advice them to exercise frequently especially every morning.

Exercise

Deep Breathing Exercise  Instruct the client to assume sitting position.  Place the client’s palm on the border of the client’s rib cage to assess respiratory depth.  Ask the client to inhale slowly and evenly through the nose until the greatest chest expansion is achieved.  Instruct the client to hold his/her breath for 2 – 3 seconds.  Then instruct the client to exhale slowly through the mouth.  Instruct the client to continue exhalation until maximum chest contraction has been achieved.

Coughing Exercise  Instruct the client to cough voluntarily after a few deep inhalations.  Ask the client to inhale deeply, hold the breath for a few seconds, and then cough, once or twice.  Ensure that the client coughs deeply and does not just clear the throat.

Early Ambulation  Encourage the client to have walking as an exercise since it improves circulation.  Walking should be done as it is tolerated by the client.

Therapy
 If people with pneumonia are short of breath or

their blood is low in oxygen, supplemental oxygen or oxygen therapy is provided. Monitor the effectiveness of oxygen therapy (e.g. pulse oximetry, ABGs) as appropriate. Although rest is an important part of treatment, moving often and getting out of bed and into a chair are encouraged. Another is included is antiinfective therapy instruct patient to continue taking the drug as prescribed even he/she feels better.

Hydration  Necessary since fever and tachypnea results to insensible fluid losses.  Instruct the client to increase fluid intake to 3000 ml/day (if the pt. has no contraindications) since it facilitates mucous secretion.

Steam Inhalation (a method of administering drugs for local or systemic effects through the respiratory tract by use of steam as a medium; it loosens secretions and relieve coughing and also softens thick, tenacious mucus)  This is done by the health care provider with the doctor’s order.  Prepare the equipments & fill the water jar from ½ to 2/3 full and place the prescribed drug.  Cover the eyes of client with face or bath towel.  Connect the inhaler cone to the steam outlet of the apparatus and convey steam from the free and of the cone to the client’s nose, instructing to inhale vapors until the prescribed time.  Disconnect the plug and removed and then document the time and treatment given as well as the patient’s reaction.

Percussion (forceful striking of the skin with cupped hands)  Cover the area with a towel or gown to reduce discomfort.  Ask the client to inhale deep slowly and deeply exhale to promote relaxation.  Alternate flex and extend the wrist rapidly to slap the chest.  Percuss each affected lung segment for 1 to 2 minutes  Avoid percussion on the breasts, sternum, spinal column, & kidneys.

Vibration (a series of vigorous quivering produced by hands that is placed flat against the client’s chest wall; used after percussion to increase the turbulence of the exhaled air & thus, loosen thick secretion)

 

 

Place hand, palms down, on the chest area to be drained, one hands over the other with the fingers together and extended. Alternatively, the hands may be placed side by side. Ask the client to inhale deeply and exhale slowly through the nose or pursed lips. During the exhalation, tense all the hands and arm muscles, and using mostly the heel of the hand, vibrate (shake) the hands, moving then downward. Stop the vibrating when the client inhales. Vibrate during five exhalations over one affected lung segment. After each vibration, encourage the client to cough and expectorate secretions into the sputum container.

Postural Drainage (drainage by gravity of secretions from various lung segments)  Before postural drainage, the client may be given a bronchodilator medication or nebulization therapy to loosen secretion  The best times include before breakfast, before lunch, in the late afternoon, and before bedtime.  Assess the patient’s vital signs first.

 The sequence of PVD is usually as follows:

Positioning, Percussion, Vibration, & Removal of secretions by coughing or suction.  Each position is usually assumed 10 – 15 minutes.  Following PVD, the nurse should auscultate the client’s lungs. Compare the findings to baseline data, and document the amount, color, and character of expectorated secretions.

Oxygen Therapy at Home  For home oxygen use, teach the family members and roommates to smoke only outside or provided smoking rooms away from the client.  Place cautionary signs reading “No Smoking: Oxygen in Use” on the client’s door, at the foot or head of the bed, and on the oxygen equipment.  Instruct the client and visitors about the hazard of smoking with oxygen use.

 Make sure that electric devices are in good

working order to prevent the occurrence of short-circuit sparks.  Avoid materials that generate electricity, such as woolen blankets and synthetic fibers. Cotton blankets should be used, and clients and caregivers should be advised to wear cotton fabrics.  Avoid the use of volatile, flammable, materials, such as oils, greases, alcohol, acetone near clients receiving oxygen.

Health Teaching
 Educate the client and family the

avoidance of upper respiratory tract infections and viruses. Instruct the client to avoid crowds (especially in the fall and winter when viruses are prevalent), people who have a cold or flu, and exposuse to irritants such as smoke. An annual influenza vaccine is recommended, one every five years.

 To continue the proper administration of

antibiotics  Teach patient about side effects of drugs  Encourage patient breathing exercise to promote secretion clearance and volume expansion  Instruct patient to avoid stress, fatigue, sudden changes in temperature, and excessive intake of alcohol, all of which lower resistance to pneumonia  Instruct patient to have adequate nutrition and rest

Vaccination -The vaccine for older adults is called pneumococcal polysaccharide (PPV).  Pneumococcal vaccine (Pneumovax, Prevnar) prevents Streptococcus pneumoniae. -Vaccination with the chickenpox vaccine (varicella-zoster vaccine) can prevent most cases of pneumonia caused by the virus that causes chickenpox.

 Vaccination of children for measles can prevent

most cases of measles. Adults may need to be vaccinated against measles if they have not had the disease or were not vaccinated during childhood.  Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given yearly to protect against new viral strains.  Hib vaccine prevents pneumonia in children from Haemophilus influenzae type b.

Promoting Healthy Breathing (Instruct the client to practice the following)  Sit straight and stand erect to permit full lung expansion.  Exercise regularly.  Breathe through the nose.  Breathe in to expand the chest fully.  Do not smoke cigarettes, cigars, pipes.

 Eliminate or reduce the use of household

pesticides and irritating chemical agents.  Do not incinerate garbage in the house.  Avoid exposure o second-hand smoke.  Make sure furnaces, ovens, and wood stoves are correctly ventilated.  Support pollution-free environment.

Controlled and Huff Coughing  After using a bronchodilator, treatments (if prescribed) instruct the client to inhale deeply and hold his/her breath for a few seconds.  Cough twice. The first cough loosens the mucus, the second expels the secretions.  For huff coughing, lean forward and exhale sharply with a “huff” sound. This technique helps keep your airways open while moving secretions up and out of the lungs.

 Inhale by taking rapid short breaths in

succession (“sniffing”) to prevent mucus from moving back into smaller airways.  Rest.  Try to avoid prolonged episodes of coughing because these may cause fatigue and hypoxia.

 Using Cough Medications  Use of metered-dose inhaler

OPD Visit
 Review all drugs with the client or family

and emphasize completing anti-infective therapy. Instruct the client to notify the health care provider if chills, fever, cough, dyspnea, wheezing, hemoptysis, increased sputum production, chest discomfort or ireversing fatigue recurs or if symptoms fail to resolve.

 Instruct the patient to return to the clinic or

caregiver’s office for a follow-up chest xray and physical examination  Young infants and 12 months to 5 yearsfollow up after 2 days

Diet
Encouraged to drink fluids, aids in the liquefaction or respiratory secretions.  Small, frequent, nutritionally balanced meals.  Respiratory treatment that promotes coughing should be avoided immediately before and after meals to prevent nausea and vomiting associated with vigorous coughing.  Encourage intake of fruits rich in Vitamin C such as citrus & oranges.

 The mineral zinc may help reduce the risk

of pneumonia in children. Zinc can be found in certain foods (lean red meats, seafood, beans, and cereals) or added to the diet in supplements. Studies in developing countries found that the incidence of pneumonia in children dropped when zinc was added to the diet.

Spirituality
 Encourage patient to have spiritual

enhancement such as meditation, singing and prayer. Before the patient will be discharged pray for them. And provide spiritual emphasise such as bible passages found in Jeremiah 33:3.

Prognosis

 Most

pneumonias are treated successfully, especially if antibiotics are started early. Pneumonia can be fatal; the very old and frail, especially those with multiple other medical conditions, are most vulnerable. With treatment, most types of bacterial pneumonia can be cleared within two to four weeks. Viral pneumonia may last longer, and mycoplasmal pneumonia may take four to six weeks to resolve completely. In cases where the pneumonia progresses to blood poisoning ( bacteremia), just over 20% of sufferers will die. The death rate (or mortality) also depends on the underlying cause of the pneumonia.

 Pneumonia

caused by Mycoplasma, for instance, is associated with little mortality. However, about half of the people who develop methicillin-resistant Staphylococcus aureus (MRSA) pneumonia while on a ventilator will die.In regions of the world without advanced health care systems, pneumonia is even deadlier. Limited access to clinics and hospitals, limited access to x-rays, limited antibiotic choices, and inability to treat underlying conditions inevitably leads to higher rates of death from pneumonia.

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