Pneumonia

Definition
Pneumonia is a form of acute respiratory infection that
affects the lungs. The lungs are made up of small sacs called
alveoli, which fill with air when a healthy person breathes.
When an individual has pneumonia, the alveoli are filled
with pus and fluid, which makes breathing painful and
limits oxygen intake. (WHO, 2021)
Clinical Presentation
Pneumonia is an infection of the lung tissue caused by a
number of different bacteria, viruses, and fungi, resulting
in inflammation of the lung parenchyma and accumulation
of an inflammatory exudate in the airways. Infection
typically begins in the alveoli, with secondary spread to the
interstitium, resulting in consolidation and impaired gas
exchange.
Infection can also extend to the pleural space, causing pleuritis
(inflammation of the pleura, characterized by pain on
inspiration). The exudative inflammatory response of the pleura
to pneumonia is termed a parapneumonic effusion; when
bacterial infection is present in the pleura, this is termed
empyema.
Etiology
Despite technologic advances in diagnosis, no causative
agent is identified in more than 50% of cases of
community-acquired pneumonia. Even in cases in which
a microbiologic diagnosis is made, there is usually a delay
of several days before the pathogen can be identified and
antibiotic susceptibility determined. Symptoms are
nonspecific and do not reliably differentiate the various
causes of pneumonia. Therefore, knowledge of the most
common etiologic organisms is crucial in determining
rational empiric antibiotic regimens.
Etiology
Most common etiologic organism causing pneumonia:
1. Streptococcus pneumoniae
2. Mycoplasma pneumoniae
3. Chlamydia pneumoniae
4. Haemophilus influenzae
5. Respiratory viruses
6. Legionella pneumophila
7. Gram-negative bacteria
8. Anaerobes
9. Staphylococcus aureus
Pathogenesis

Pneumonia is disproportionally a disease of the elderly and

impaired host. This can be attributed to the effectiveness of
host defenses, including anatomic barriers and cleansing
mechanisms in the nasopharynx and upper airways and
local humoral and cellular factors in the alveoli.
Pathogenesis
The respiratory tract is the most common site of infection
by pathogenic microorganisms. The lung is constantly
exposed to a mixture of particulate matter and microbes that
are present in inspired air. Pulmonary pathogens reach the
lungs by one of three routes:
● (1) direct inhalation of infectious respiratory droplets into
the lower airways;
● (2) aspiration of oropharyngeal contents; or
● (3) hematogenous spread.
Defenses of The Respiratory Epithelium
Against Infection:

The respiratory epithelium that lines the airways and alveoli is an

important component of the host defense against respiratory
pathogens. Epithelial cells are covered with beating cilia
blanketed by a layer of mucus. Each cell has about 200 cilia that
beat up to 500 times/min, moving the mucus layer upward
toward the larynx. The mucus itself contains antimicrobial
compounds such as lysozyme and lactoferrin.
Lungs
● Most bacteria are 0.5–2 μm in
Bronchioles
size and can reach the terminal
Alveoli bronchioles, alveolar ducts, and
alveoli.
● Upon their arrival, they are
opsonized by surfactant,
complement, and antibodies

● Macrophages recognize the

● This signaling cascade recruits neutrophils and,
ultimately, antigen-specific T and B
lymphocytes into the area. Lymphocytes
produce antibody and have cytotoxic ability to
further defend against ongoing infection
pathogen via pattern recognition
receptors such as Toll-like
receptors, which leads to
generation of inflammatory
cytokines such as TNF-α and IL-
1.
Diagnosis
How is pneumonia diagnosed?

1. Medical History
● Any recent travel?
● Occupation
● Contact with animals
● Exposure to other infected people at home, work, or
school
● Recent illness
Diagnosis
2. Physical Exam

Auscultation. If the client has pneumonia, their lungs

make crackling, bubbling, and rumbling sounds when
they inhale.

3. Diagnostic Tests

● Blood tests – to confirm the infection and to try to

identify the microorganism that is causing the illness.
Diagnosis
● Chest X-ray – to look for the location and extent of inflammation
in the lungs.
● Pulse oximetry – to measure the oxygen level in the blood.
Pneumonia prevents the lungs from moving enough oxygen into
your bloodstream.
● Sputum test – it requires a sample of sputum (mucus that the client
coughs up). Culture of sputum is used to identify the
microorganism that caused the pneumonia and can help determine
which antibiotic is best to use.
● Urine testing — Urine tests can be helpful for diagnosing
pneumonia caused by two bacteria, Streptococcus pneumoniae and
Legionella pneumophila. These tests can be done easily by a lab
technician and provide immediate results.
Symptoms

The signs and symptoms of pneumonia vary from mild

to severe, depending on:

● Type of microorganism causing the infection

● Age
● Overall Health
Symptoms
Signs and symptoms of pneumonia may include:
● Fever (102 F/ 39 C or higher)
● Dyspnea (shortness of breath)
● Chest pain with breathing
● Rapid heart and breathing rate
● Nausea
● Vomiting
● Cough
● Cough that produces green or yellow sputum (mucus from the lungs)
● Shaking chills (rigors)
● Change in mental status (Confusion, Unclear thinking)
● Anorexia (loss of appetite)
● Fatigue
● Cyanosis (Lips and fingernails turning blue)
 Types of
Pneumonia
Walking Pneumonia
● Anyone can get it. Walking pneumonia from mycoplasma is most
common in children, military recruits, and adults younger than
40.
● Live and work in crowded places.
● Late summer and fall are the most common times of year for
walking pneumonia.

Is It Contagious?
● Walking pneumonia spreads through sneezes or coughs.
● If you get it, you could be contagious (which means you could
spread it to other people) for up to 10 days.
Walking Pneumonia
Symptoms:
● Chest pain when you take a deep breath
● A cough that may come in violent spasms
● Mild flu-like symptoms such as fever and chills
● Sore throat
● Headache
● Tiredness
● Weakness that may last after other symptoms go away
● Ear infection
● Anemia
● Skin rash
Treatment:
● Antibiotics
Walking Pneumonia
Prevention:
● There’s no vaccine for mycoplasma infection, so you can’t
completely prevent it.

But you can take some steps to lower your chances of getting it
through:
● Exercise
● Balance Diet
● Get enough sleep
● Hand hygiene
● Avoid smoking and vaping
● Cover your mouth with a tissue or your sleeve when you cough
or sneeze
Viral Pneumonia
Diagnosis:
● Bronchoscopy – a procedure used to look into the lung’s
airways. We can also take fluid samples or a biopsy of lung
tissue.
● Pleural fluid culture – which removes a small amount of
fluid from around tissues that surround the lung, to analyze
and identify bacteria causing the pneumonia.
● Arterial blood gas test – to measure the amount of oxygen
in a blood sample taken from an artery, usually in your
wrist.
Viral Pneumonia
Causes:
● Viruses that can lead to pneumonia include:
● Influenza (flu) A and B viruses (most common causes in
adults)
● Respiratory syncytial virus (RSV), (more common in
infants and children than in adults)
● Coronaviruses, including SARS-CoV-2.
● Rhinoviruses, parainfluenza viruses, and adenoviruses
(can cause pinkeye)
Viral Pneumonia
Symptoms:
● Dry cough
● Fever
● Chills
● Shortness of breath
● Pain in your chest when you cough or breathe
● Rapid breathing
How it spreads:
● Can travel through the air in droplets of fluid after someone
sneezes or coughs. These fluids can get into your body through
your nose or mouth.
● Can also acquire viral pneumonia after touching a virus-covered
doorknob or keyboard and then touching your mouth or nose.
Viral Pneumonia
Treatment:
● If a virus is causing your pneumonia, antibiotics won’t
help.
● Influenza virus: oseltamivir (Tamiflu), zanamivir
(Relenza), or peramivir (Rapivab).
● If RSV is the cause of your pneumonia: ribavirin
(Virazole).
Prevention:
● Hand hygiene
● Flu vaccination (each year at the beginning of flu season).
● Avoid to people who cough or sneeze.
● Try not to touch your eyes, ears, nose, and mouth.
Community-Acquired Pneumonia

● can be caused by bacteria, viruses, and fungi. Vaccines can

help protect against the flu virus and certain bacteria that
can also cause pneumonia.
● Also includes aspiration pneumonia (which happens when
you breathe food, fluid, or vomit into your lungs).
● It’s likely if you have problems swallowing or coughing. If
you can't cough up the material you took in, bacteria can
multiply in your lungs.
Hospital-Acquired Pneumonia
● You catch this type during a stay in a hospital. It can be
serious because the bacteria causing the pneumonia can be
resistant to antibiotics.

You're more likely to get this type if:

● You're on a breathing machine
● You can't cough strongly enough to clear your lungs
● You have a tracheostomy (trach) tube to help you breathe
● Your immune system -- your body's defense against germs
-- is weak from a disease or treatment
Bacterial Pneumonia
● Is an infection of your lungs caused by certain bacteria.
● The most common one is Streptococcus (pneumococcus).
● These bacteria can live in your throat without causing any
trouble. But if your body’s defenses (immune system) become
weak for some reason, the bacteria can go down into your lungs.
● The air sacs in your lungs get infected and inflamed. They fill up
with fluid, and that causes pneumonia.
● People who have a weakened immune system also have an
increased risk for bacterial pneumonia, HIV positive, leukemia,
lymphoma, or severe kidney disease.
Bacterial Pneumonia
Diagnosis:
● Pulse oximetry.
● Blood tests.
● Tests of the gunk you cough up.
● CT scan.

Symptoms:
● Fever (up to 105 F)
● Coughing out greenish, yellow, or bloody mucus
● Chills
● Feeling like you can’t catch your breath, especially when you
move around a lot
● Feeling very tired
Bacterial Pneumonia
Symptoms:
● Anorexia
● Sharp or stabby chest pain, especially when you cough or take a deep
breath
● Sweating a lot
● Fast breathing and heartbeat
● Lips and fingernails turning blue
● Confusion, especially if you’re older

Prevention:
● Two kinds of shots for bacterial pneumonia:
● PCV13 (Prevnar 13)
● People 65 or older
● Kids under 5 years
● People who have a high risk of bacterial pneumonia
Bacterial Pneumonia
PPSV23 (Pneumovax)
● People 65 or older
● Children older than 2 who have a high risk of bacterial
pneumonia
● People between 19 and 64 who smoke or have asthma
● Practice Hand Hygiene
● Eat right, with plenty of fruits and vegetables.
● Exercise.
● Get enough sleep.
● Quit smoking.
● Stay away from sick people, if possible.
Bacterial Pneumonia
Treatment:
● Prescribed antibiotics
● Get lots of rest.
● Drink plenty of fluids
● Use a humidifier or take a warm bath.
● Don’t smoke.
● Stay home until your fever goes down and you aren’t coughing
anything out.
● Oxygen treatment & treatments to help loosen the gunk.
Fungal Pneumonia
● Are a less common cause of pneumonia.
● You get fungal pneumonia by breathing in tiny particles called
fungal spores.
● Such as:
● Farmers who work around bird, bat, or rodent droppings
● Landscapers and gardeners who work with the soil
● Members of the military or construction workers who are around
a lot of dust
Symptoms:
● Fever
● Cough
Nursing Care
● Control your fever with aspirin, nonsteroidal anti-
inflammatory drugs (NSAIDs, such as ibuprofen or naproxen),
or acetaminophen. DO NOT give aspirin to children.
● Drink plenty of fluids (to help loosen secretions and bring up
phlegm).
● Do not take cough medicines without first talking to your
doctor (Coughing is one way your body works to get rid of an
infection).
● Drink warm beverages.
● Stay away from smoke. (Smoking, secondhand smoke, and
wood smoke)
● Get lots of rest.
Thank you.