It is defined as “an inflammatory process of the lung and its parenchyma, usually in the bronchioles, alveoli, and alveolar sacs.” It is characterized by marked congestion and edema of alveolar spaces. It is the seventh leading cause of death in the united-state. (King & Pippin, 1997).
It is called primary if it occurs in previously healthy patients and secondary Pneumonia if it occurs in patients with previous lungs abnormality, e.g., COPD.
Causes of Pneumonia:
Pneumonia can be caused by bacteria, viruses, fungi, parasites, aspiration of gastric contents, or fluid accumulation in the lungs.
Bacterial Pneumonia is caused by:
- Streptococcus pneumonia
- Mycoplasma pneumoniae
- Haemophilus influenzae
- Legionella pneumophila
Viral Pneumonia is due to:
- influenza (flu)
- respiratory syncytial virus (RSV)
- rhinoviruses (common cold)
Fungal Pneumonia is due to:
- Pneumocystis jirovecii
- Cryptococcus species
- Histoplasmosis species
Types of Pneumonia
Classification of Pneumonia is following:
Hospital-acquired Pneumonia (HAP)
Pneumonia that develops in the hospital in a patient admitted for more than 48 hours is considered hospital-acquired Pneumonia. Organisms involved are: gram-negative bacilli, Staphylococcus aureus, and Streptococcus pneumoniae. It can be more serious than other types, as the bacteria may be more resistant to antibiotics.
Community-acquired Pneumonia (CAP)
It occurs in previously healthy individuals outside of a medical or institutional setting.
Ventilator-associated Pneumonia (VAP)
Pneumonia occurring in patients who are on the ventilator is called ventilator-associated Pneumonia.
Aspiration pneumonia
Aspiration of gastric contents during seizures, coma, anesthesia, and other conditions may lead to Pneumonia, called aspiration pneumonia. The organisms involved are mixed aerobic-anaerobic bacteria.
Pathophysiology of Pneumonia:
Bacteria, viruses, fungi, parasites, chemical inhalation, aspiration of gastric contents, or fluid accumulation in the lung.
The decrease in the number of RBCs in the exudates is replaced by neutrophils.
Consolidation of alveolar spaces with fluid and hemorrhagic exudate occurs. There is a rapid proliferation of organisms in the lungs.
RBCs, fibrin, and polymorphonuclear leukocytes infiltrate in the alveoli.
Signs and Symptoms of Pneumonia:
They can include:
- Productive or non-productive cough with sputum
- High-grade fever
- sweating or chills
- shortness of breath (dyspnea)
- chest pain
- fatigue
- loss of appetite
- nausea or vomiting
- headaches
Diagnostic Test:
- ABGs analysis
- Serological test
- Sputum culture/gram staining
- Erythrocyte sedimentation rate
- Complete blood count
- Chest X-ray
- Pulse oximeter
Medication:
- Antibiotics as prescribed based on gram stain results. Macrolide antibiotics such as azithromycin and clarithromycin are commonly used as first-line drugs for Pneumonia.
- Cough suppressants to alleviate cough
- Opioids such as paracetamol, ibuprofen.
- Supportive treatment includes hydration, antipyretics, antihistamines, or nasal congestion.
- Oxygen therapy for hypoxemia
Complications Due To Pneumonia:
- Suppuration (Abscess formation)
- Bacteriemia
- Empyema
- Lung fibrosis
- Disturbances of ventilation and perfusion
A nursing care plan for Pneumonia involves assessing the respiratory system after every four hours, ABGs measurement, oxygen saturation, etc.
Diagnosis:
- Ineffective Airway clearance
- Impaired gas exchange
- Ineffective breathing pattern
- Activity intolerance
- Risk for imbalanced nutrition: less than body requirements
- Deficient fluid volume
Assessment:
Closely monitor high risk individual, monitor vital signs heart rate> 140 beats/min, respiratory rate > 30 breaths/min, oxygen saturation < 60 mmHg.
To evaluate for signs of hypoxemia
Assess cough effectiveness and productivity
Pneumonia causes a dry, hacking cough, which interferes with sleep and saps energy. Coughing is the most effective of removing secretions
Obtain sputum for gram stain and blood cultures
Cultures help to identify specific organisms and sensitive or resistant antibiotics.
Assess the patient’s hydration status.
Airway clearance is hindered by inadequate hydration and thickening of secretions.
Nursing intervention:
- Position the client, elevate their head, and frequently change position.
- It will promote chest expansion, mobilization, and expectoration of secretions.
- Teach and assist the patient in deep breathing exercises. Encourage the patient to do it multiple times
- Exercises allow more expansion of the lungs, most helpful in removing secretions by productive cough.
- Do suction as indicated.
- Suction improves cough reflex and helps in improving cough reflex.
- Maintain hydration, and provide fluids according to the need.
- Fluids aid in the expectoration of secretions. Help in maintaining saturation
- Administer oxygen according to the needs and monitor its effectiveness.
- Increased humidity will decrease the viscosity of secretions. It will reduce the patient’s restlessness and reduce pulmonary edema.
- Administer cough suppressants or expectorants, as ordered by the physician
- A dry, hacking cough interferes with sleep and saps energy.
Evaluation:
Evaluate the patient to check for the effectiveness of the nursing care plan:
- Maintenance of patent airway with breath sounds clearing
- Absence of dyspnea
- Patent airway and effectively clearing secretions.Copyright of www.TheNursesBrain.com
Copyright of www.TheNursesBrain.com
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