PNEUMONIA

WHAT IS IT?

• INFLAMMATION OF LUNG PARENCHYMA (LUNG BRONCHIOLES/ALVEOLI) WITH

INCREASED ALVEOLAR AND INTERSTITIAL FLUID
• 8TH LEADING CAUSE OF DEATH
• ORGANISMS ENTER THE BODY THROUGH CONTAMINATED AIR, SECRETIONS,
ASPIRATION AND BLOODSTREAM OR FROM THE BLOODSTREAM
• HEALTHY PEOPLE CAN GET SICK TOO!!
• GERMS ENTER THROUGH OROPHARYNX (NOSE AND MOUTH),OVERWHELMING
BODY’S DEFENSES BY LARGE NUMBERS OR VIRULENCE (DISEASE CAUSING ABILITY)
 PATHO

• Invading microorganisms
enter lungs
• Microorganisms release
endotoxins that damage lung
tissue.
• Inflammatory and immune
responses continue ALL
causing vascular congestion
and edema
• Alveoli become filled with
fluid or other exudate
 PATTERNS OF PNEUMONIA

• LOBAR PNEUMONIA-BACTERIA DISTRIBUTE EVENLY THROUGHOUT THE LOBE,

CAUSING A CONSOLIDATION OF LUNG TISSUE. ABRUPT ONSET
• BRONCHOPNEUMONIA-VIRUSES CAUSE A PATCHY DISTRIBUTION, USUALLY
ALVEOLI OR BRONCHIOLES (LESS EDEMA AND CONGESTION). SLOWER,
GRADUAL ONSET
• INTERSTITIAL-THE BACTERIA EFFECT THE INTERSTITIAL TISSUES (CONNECTIVE
TISSUES AND OUTSIDE OF ALVEOLI). SLOWER ONSET
• MILIARY PNEUMONIA-BACTERIA TRAVELS THROUGH BLOODSTREAM, USUALLY
IN IMMUNOCOMPROMISED PATIENTS
 OTHER CLASSIFICATIONS

• LEGIONNAIRES DISEASE-TYPE OF BRONCHOPNEUMONIA, CAUSED BY LEGIONELLA BACTERIA.

• PRIMARY ATYPICAL- TYPICALLY CAUSED BY MYCOPLASMA. USUALLY MILD SYMPTOMS
"WALKING PNEUMONIA”.
• VIRAL-USUAL CAUSES ARE H. FLU, ADENOVIRUS AND CMV. USUALLY MORE MILD DISEASE,
BUT CAN BE SUDDEN OR GRADUAL ONSET
• PNEUMOCYSTIS JIROVECI-PARASITIC CAUSE, AFFECTS SEVERELY COMPROMISED (AIDS
OPPORTUNISTIC INFECTION). ABRUPT ONSET, USUALLY VERY SYMPTOMATIC
• ASPIRATION-ENTERING OF FOREIGN CONTENTS INTO THE LUNG, CAUSES A
CHEMICAL/BACTERIAL INFECTION. VOMITING MAY BE PRESENT OR “SILENT ASPIRATION”
 WHERE IT COMES FROM

• COMMUNITY ACQUIRED (CAP)- STREP PNEUMONIAE (PNEUMOCOCCUS) CAUSES

APPROX. 50% OF INFECTION, INFLUENZA, LEGIONELLA, CHLAMYDIA
PNEUMONIAE
• HOSPITAL ACQUIRED (HAP)- S. AUREUS, S. PNEUMONIAE, PSEUDOMONAS, E. COLI
• VENTILATOR ACQUIRED (VAP)- S. AUREUS, PSEUDOMONAS, ACINETOBACTER
• OTHER-USUALLY OPPORTUNISTIC WITH IMMUNOCOMPROMISED PATIENTS AT
GREATEST RISK. PNEUMOCYSTIS, MYCOBACTERIUM TB, CMV, FUNGI
 CLINICAL MANIFESTATIONS

• Fever will vary based

on the causative
agent. Low grade-
very high
• Cough: dry and
hacking versus wet
and purulent
• Breathing
pattern/oxygenation
may change very
quickly: crackles,
wheezes and/or dull
percussion
 DIAGNOSTICS AND LABS

• CHEST X-RAY-HELPS TO DETERMINE PATTERN OF INFECTION. HELPS TO IDENTIFY

DISEASE ESPECIALLY IN ELDERLY CLIENT WITH VAGUE COMPLAINTS.
• CT SCAN-WILL FURTHER EVALUATE PATTERNS/CHARACTERISTICS
• PULSE OXIMETRY-LESS THAN 95% MAY INDICATE IMPAIRED GAS EXCHANGE
• SPUTUM TESTING-GRAM STAIN(QUICKER) AND C/S.
• CBC WITH DIFFERENTIAL, ABG’S, BLOOD CULTURES, ELECTROLYTES
• OTHER BLOOD TESTS FOR SPECIFIC PATHOGENS SUCH AS LEGIONELLA, PJP
 NURSING DIAGNOSES

• INEFFECTIVE AIRWAY CLEARANCE

*INCREASED AIRWAY EDEMA AND INFLAMMATION, INCREASED SPUTUM AND INABILITY
TO CLEAR
ASSESS RESP STATUS, BREATH SOUNDS COUGH, SPUTUM PRODUCTION, LABS/ABG’S
HIGH FOWLER’S POSITION, SUCTION IF NEEDED, MONITOR I/O, AMBULATE PT (IF ABLE)
TEACH COUGH/DEEP BREATHING, INCREASING FLUIDS, CHEST PT
 NURSING DIAGNOSES

• IMPAIRED GAS EXCHANGE-

*POOR DELIVERY OF OXYGEN(POOR PERFUSION), INFLAMMATION, INCREASED MUCUS,
HYPOVENTILATION
ASSESS RESP STATUS, **VITAL SIGNS, BREATHING PATTERNS, ABG’S, PULSE OX, PAIN STATUS, MENTAL
STATUS, LEVEL OF ANXIETY
GIVE O2, CONTROL FEVER, PROMOTE POSITION OF COMFORT AND REASSURE PT WHICH HELPS TO
DECREASE ANXIETY
TEACH PT SLOW, ABDOMINAL BREATHING; SPLINTING OF THE CHEST, BEDREST AND INCREASING
ACTIVITY AS TOLERATED, MAINTAIN ADEQUATE NUTRITION
 ADDITIONAL DIAGNOSES

• ACTIVITY INTOLERANCE
• HYPERTHERMIA
• ANXIETY
• NUTRITION: LESS THAN

This Photo by Unknown Author is licensed under

CC BY-NC-ND
 COMMON MEDICATIONS

• ANTIBIOTICS-PENICILLIN/CEPHALOSPORINS (ROCEPHIN), MACROLIDES (Z-PACK)

• BRONCHODILATORS-HELP TO RELAX SMOOTH MUSCLE BY DECREASING
BRONCHOSPASM AND CONSTRICTION. SHORT ACTING/LONG ACTING, THEOPHYLLINE
AND AMINOPHYLLINE INCLUDED
• MUCOLYTICS-HELP TO THIN OR BREAK UP SECRETIONS (GUAIFENESIN)
• ANTI-INFLAMMATORIES- DECREASE AIRWAY INFLAMMATION
• ANTIPYRETICS-DECREASE FEVER
• OXYGEN
 LIFESPAN CONSIDERATIONS

• YOUNGER IN AGE: INFANTS AND CHILDREN-IMMATURE AIRWAY MAKES CHILD

MORE SUSCEPTIBLE. CONDITION DETERIORATES VERY QUICKLY
• PREGNANT WOMEN: BASED ON SMOKING STATUS AND/OR HISTORY OF RECENT
RESP ILLNESS
• OLDER ADULTS*: D/T AGING, COUGH AND GAG REFLEXES WEAKEN; CILIA GET
DESTROYED, IMMOBILITY, PRE-EXISTING MEDICAL PROBLEMS (COPD, KIDNEY
DAMAGE). THEY USUALLY DON’T FOLLOW THE “RULES”
 PREVENTION

• HAND HYGIENE
• AVOID CROWDED AREAS AT TIMES KNOWN FOR HIGH INFECTION (FLU ETC)
• VACCINE: 2 SEPARATE SHOTS THAT PROTECT AGAINST DIFFERENT STRAINS
 IMPORTANT TERMS

• PLEURAL EFFUSION-ACCUMULATION OF EXCESS FLUID IN THE LUNG CAVITY

• EMPYEMA-PURULENT EXUDATE IN THE LUNG CAVITY
• PLEURITIC PAIN-SHARP, LOCAL CHEST PAIN; WORSENS WITH BREATHING
• ATELECTASIS-LUNG/ALVEOLAR COLLAPSE
• RETRACTIONS-VISIBLE APPEARANCE OF CHEST BEING DRAWN IN ON
INSPIRATION