Pneumonia

Friday, December 30,

Structures and Functions of the
Respiratory System

Friday, December 30,

Objectives:
 At the end of the unit, students will be able to:
 Pneumonia
 Integrate pathophysiology and pharmacology concepts of
respiratory disease
 Apply nursing process with support on Evidence-Based Nursing
(EBN) to provide to the clients with respiratory disorders
 Discuss the holistic approach for nursing management of the
patient with respiratory diseases
 Develop a teaching plan for a client experiencing disorders of the
respiratory disorders.
  

Friday, December 30,

 HAP- pneumonia occurring 48 hours or longer after
admission
 VAP- pneumonia occurring 48-72 hours after ET
intubation
 HCAP- hospitalized for 2 or more days within 90 days
of infection; resided in LTC facility; received IV
therapy or wound care within past 30 days of current
infection; attended a hospital or dialysis clinic
 Aspiration pneumonia- abnormal entry of secretions
into lower airway
Friday, December 30,
 Pneumonia
Pathophysiology
 Congestion
 Fluid enters alveoli; organisms multiply & infection spreads
 Red hapatization
 Massive capillary vasodilation; alveoli filled with organisms,
neutrophils, RBCs, & fibrin
 Gray hepatization
 Blood flow decreases & leukocytes & fibrin consolidate in affected
part
 Resolution
 Resolution & healing; exudate processed by macrophages
5
 Pneumonia
 Risk Factors
Aging
 Air pollution
 Altered LOC
 Altered oral normal flora
secondary to antibiotics
 Prolonged immobility
 Chronic diseases
 Debilitating illness
 Immunocompromised
state
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 Inhalation or aspiration of
noxious substances
 NG tube feedings
 Malnutrition
 Resident of Long-term care
 Smoking
 Tracheal intubation
 Upper respiratory tract
infection
Assessment and Diagnostic
Methods

 CXR
 Sputum C&S
 Blood cultures
 ABGs
 Leukocytosis

1
Friday, December 30,
Friday, December 30, 8
 Clinical Manifestations
 Clinical features vary depending on the causative organism and the
patient’s disease.
 • Sudden chills and rapidly rising fever (38.5C to 40.5C
 [101F to 105F]).
 Pleuritic chest pain aggravated by respiration and coughing.
 Severely ill patient has marked tachypnea (25 to 45 breaths/min) and
dyspnea; orthopnea when not propped up.
 Pulse rapid and bounding; may increase 10 beats/min per
 degree of temperature elevation (Celsius).
 A relative bradycardia for the amount of fever suggests viral
 infection, mycoplasma infection, or infection with a Legionella
 organism.

Friday, December 30,

 Cont…
 Signs and symptoms of pneumonia may also depend
on a patient’s underlying condition (eg, different
signs occur in patients with conditions such as
cancer, and in those who are undergoing treatment
with immuno suppressants, which decrease the
resistance to infection).

Friday, December 30,

 Pneumonia- Complications
 Pleuritis
 Pleural effusion- 40% of hospitalized patients
 Atelectasis
 Bacteremia
 Lung abscess
 Empyema
 Pericarditis
Friday, December 30,
 Medical Management
 Antibiotics are prescribed on the basis of Gram stain
results and antibiotic guidelines (resistance patterns,
risk factors, etiology must be considered).
Combination therapy may also be used.
 Supportive treatment includes hydration, antipyretics,
antitussive medications, antihistamines, or nasal
decongestants.
 Bed rest is recommended until infection shows signs
of clearing.

Friday, December 30,

 Cont…
 Oxygen therapy is given for hypoxemia.
 Respiratory support includes high inspiratory oxygen
concentrations, endotracheal intubation, and
mechanical ventilation.
 Treatment of atelectasis, pleural effusion, shock,
respiratory failure, or superinfection is instituted, if
needed.
 For groups at high risk for CAP, pneumococcal
vaccination is advised.

Friday, December 30,

Pneumonia
Collaborative Care

 Prompt treatment with antibiotics

 Oxygen, analgesics, antipyretics
 Influenza vaccine
 Pneumococcal vaccine
 Nutrition
 PSI – Pneumonia Patient Outcomes Research
Team Severity Index
 Determine whether to treat at home or in
hospital

Friday, December 30,

 Pneumonia
Nursing Assessment
 Fever in any hospitalized patient
 Pain

 Tachypnea

 Use of accessory muscles

 Rapid, bounding pulse
 Relative bradycardia
 Coughing

 Purulent sputum
Friday, December 30,
 Pneumonia
Nursing Assessment
 Consolidation
 Auscultation
 Bronchial breathing
 Bronchovesicular rhonchi

 Crackles

 Fremetis
 Egophony
 Whispered pectroloquy

Friday, December 30,

 Pneumonia
Nursing Diagnoses
 Ineffective airway clearance RT copious
tracheobronchial secretions
 Activity intolerance RT altered respiratory
function
 Risk for fluid volume deficit RT fever and
dyspnea
 Knowledge deficit about the treatment regimen
and preventive health measures

Friday, December 30,

 Pneumonia
Potential Problems
 Hypotension and shock
 Respiratory failure
 Atelectasis
 Pleural effusion
 Delerium
 Superinfection

Friday, December 30,

 Pneumonia
Nursing Goals
 Improving airway patency
 Conserving energy – rest
 Maintaining proper fluid balance
 Patient understanding of treatment and
prevention
 Prevention of complications

Friday, December 30,

Pneumonia
Nursing Interventions

 Improving airway patency

 Removing secretions – coughing vs. suctioning
 Adequate hydration loosens secretions
 Air humidification to loosen secretions and improve
ventilation
 Chest physiotherapy – loosens and mobilizes
secretions

Friday, December 30,

 Pneumonia
Nursing Interventions
 Promoting rest and conserving energy
 Bedrest with frequent changes of position
 Energy conservation
 Sedatives to decrease work of breathing and energy
expenditure unless contraindicated
 Promoting fluid intake
 Dehydration is possible RT insensible fluid losses
through respiratory tract
 If not contraindicated, increase fluid intake to 2
liters/day
Friday, December 30,
 Pneumonia
Nursing Interventions
 Patient education and home care considerations
 Increase activities as tolerated – fatigue and
weakness may be prolonged
 Breathing exercises to clear the lungs should be
taught
 Smoking cessation if indicated – smoking destroys
tracheobronchial ciliary action, which is the first line
of defense for the lungs. Smoking also irritates the
mucus cells of the bronchi and inhibits the function
of alvolar macrophages
Friday, December 30,
Cont…
 Patient is encouraged to get influenza vaccine
because influenza increases risk for secondary
bacterial infections
 Staphylococcus

 H. influenzae

 S. pneumonae

 Encouraged to get Pneumovax against S.

pneumonae

Friday, December 30,

 TEACHING PATIENTS
SELF-CARE

 Instruct patient to continue taking full course of

antibiotics as prescribed; teach the patient about their
proper administration and potential side effects.
 Instruct patient about symptoms that require contacting
the health care provider: difficulty breathing, worsening
cough, recurrent/increasing fever, and medication
intolerance.

Friday, December 30,

 Cont…
 Advise patient to increase activities gradually after
fever subsides.
 Advise patient that fatigue and weakness may linger.
 Encourage breathing exercises to promote lung
expansion and clearing.
 Encourage follow-up chest x-rays.
 Encourage patient to stop smoking.

Friday, December 30,

 Cont…
 Instruct patient to avoid stress, fatigue, sudden
changes in temperature, and excessive alcohol intake,
all of which lower resistance to pneumonia.
 Review principles of adequate nutrition and rest.
 Recommend influenza vaccine (Pneumovax) to all
patients at risk.
 Refer patient for home care to facilitate adherence to
therapeutic regimen, as indicated.

Friday, December 30,

 Pneumonia- Core Measures
 Oxygenation assessment (ABGs, oximetry)
 Pneumococcal vaccine (>65yo; prior to DC)
 BC performed within 24h prior to after hospital
arrival
 BC before first antibiotic
 Adult smoking cessation advice
 Antibiotic timing- within 4 hours of arriving to
hospital
 Influenza vaccine
Friday, December 30,
 Reference:
Smeltzer, C. S. Bare, B. Hinkle, L. J. Cheever, H. K. (2010). Brunner &
Suddath’s Textbook of Medical & Surrgical Nursing, vol. 1&2. chap 24
(12th ed.). Lippincot: Willium Wilkins.
Herdman, H. T. Kamitsuru, S. (2015-2017). Nursing Diagnosis: Definitions
and Classifications. (2010). WILEY Blackwell.
Carpenito. J. L. (2017). Nursing Diagnosis: Application to Clinical Practice.
(15th ed.). Philadelphia: Waltter Kluwer.
Berman, A, T. Snyder, S. Frandsen. (2008). Fundamentals of Nursing:
Concepts, Process, and Practice (10th ed.). Pearson, USA.
Jacob, A. R. R, Tarachand. S. J. (2011). Clinical Nursing Procedures: The Art
of Nursing Practice (2nd ed.) JAYPEE: New Delhi.
Jacob. A; R. R; Tarachand. S. J. (2010). Clinical Nursing Procedures: The Art
of Nursing Practice (2nd ed.) JAYPEE: New Delhi.

Friday, December 30,

Friday, December 30,