Pneumonia Overview Quiz

The Concept of Pneumonia

• Pneumonia is inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) due to infection.
• Key types of pathogens that cause pneumonia include bacteria, viruses, fungi, and protozoa.
• Streptococcus pneumoniae is a leading cause of pneumonia, accounting for roughly 50% of cases.
• Issues impacting the lower respiratory system can lead to pneumonia, affecting ventilation, respiration, and airway maintenance.

Course Student Learning Outcomes

• The first outcome is providing safe, patient-centered care based on evidence and the Caritas philosophy.
• The second outcome involves demonstrating intermediate levels of critical thinking and clinical reasoning in patient care.
• The third outcome relates quality improvement measures to improved patient care.
• The fourth outcome involves explaining management of care concepts for adults.

The Chain of Infection

• The chain of infection includes the etiologic agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
• Respiratory, gastrointestinal, and urinary tracts can serve as reservoirs for infection.
• Portals of exit for infectious agents include tissue, blood, and reproductive tracts.
• Transmission can occur directly or indirectly (e.g., airborne).
• Inhalation and cuts in the skin are common portals of entry.
• Susceptible hosts are those at risk of infection.

Overview and Pathophysiology of Pneumonia

• What types of Pathogens Can Invade the Lungs and Cause Pneumonia?
• Bacteria, viruses, fungi, protozoa
• What Pathogen Causes Roughly 50% of Pneumonia Cases?
• Streptococcus pneumoniae
• Disorders affecting the lower respiratory system can lead to pneumonia, affecting ventilation, respiration, and airway maintenance.

Pathophysiology and Etiology (Pneumonia)

• What happens when pneumonia occurs?
• Organisms enter lungs (inhalation or bloodstream)
• Organisms colonize alveoli, triggering inflammatory/immune responses.
• Lung tissue inflammation/congestion, exudate(fluid/pus) filling alveoli.
• Fluid accumulation, leakage, and infiltration (fluid, pus).
• Consolidation (solidification/hardening of lung tissue).

Pathophysiology and Etiology- Various Causes of Pneumonia

• Infectious causes: bacteria, viruses, fungi, protozoa
• Noninfectious causes: aspiration of gastric/stomach contents; inhalation of irritating gases
• Viral pneumonia typically follows a mild disease pattern, often affecting older adults or those with chronic conditions.
• Bacterial pneumonia usually involves one or more lobes in a single lung, potentially leading to a condition called unilateral lobar pneumonia, a severe lung infection.
• Aspiration pneumonia results from aspiration of food, fluids, or other foreign material, often triggering an inflammatory response.

Etiology- Types of Pneumonia

• Community-acquired pneumonia (CAP)
• Healthcare-associated pneumonia (HCAP)
• Hospital-acquired pneumonia (HAP)
• Ventilator-associated pneumonia (VAP)
• Opportunistic pneumonia, mainly affecting those with compromised immune systems (e.g., HIV/AIDS, patients undergoing cancer treatments).
• Pneumococcal pneumonia is a common form of CAP, caused by Streptococcus pneumoniae.

Etiology- Community Acquired Pneumonia

• Acute bacterial pneumonia, often due to Streptococcus pneumoniae.
• Infections are usually spread by droplets or aspiration of bacteria.

Etiology- Primary Atypical Pneumonia

• Typically caused by Mycoplasma pneumoniae
• Presentation, course differs from bacterial pneumonia
• Exudate and consolidation of lung tissue not found, instead patchy inflammation, possibly a mild course.
• Often referred to as "walking pneumonia."

Etiology- Viral Pneumonia

• Common organisms include influenza and adenovirus.
• Lung involvement often limited to alveolar septum, with an interstitial pattern
• Often a mild course, frequently in community epidemics.

Etiology- Opportunistic Pneumonia

• Caused by Pneumocystis jiroveci (a common parasite/fungus).
• Common among immunocompromised individuals.
• Alveoli thicken, fill with fluid, causing severe gas exchange impairment.

Etiology- Aspiration Pneumonia

• Aspiration of gastric contents, fluids, or foreign material.
• Chemical injury, inflammatory response.
• Increased risk in certain operations or diseases impeding swallowing or cough mechanism.
• Low pH of material aspirated causes severe inflammatory response that can lead to bacterial invasion.

Risk Factors for Pneumonia

• Advanced age, compromised immune systems (HIV/AIDS, organ transplants, or those undergoing cancer treatments), frequent exposure to cigarette smoke, alcoholism, and drug use, and altered levels of consciousness.

Prevention of Pneumonia

• Identify vulnerable populations
• Implement preventative strategies and measures to reduce mortality and morbidity
• Early identification of infecting organisms
• Vaccination (e.g., pneumococcal vaccine) is often recommended

Clinical Manifestations of Pneumonia

• Fever and chills
• Dyspnea with crackles in lungs
• Productive cough with sputum (possibly purulent/yellow/green/bloody)
• Chest pain
• Confusion
• Headache, fatigue, muscle pain appetite changes,
• Infection can spread to other areas e.g. Meningitis, Endocarditis, Peritonitis, increased risk of mortality associated

Diagnostic Tests for Pneumonia

• Chest X-ray, CT scan, Sputum Culture and Sensitivity, complete blood count (CBC) with WBC differential; looking for a left shift (increase in immature WBCs).
• Pulse oximetry and ABG (arterial blood gas).
• Bronchoscopy and Procalcitonin levels when needed.
• Tests to confirm sepsis; Elevated WBCs and lactate, and metabolic acidosis.

Management/Treatment of Pneumonia

• Antibiotics (usually broad spectrum)
• Oxygen therapy, potentially high-flow oxygen, BiPAP or mechanical ventilation, as needed.
• Fluids
• Bronchodilators
• Mucolytics (to thin secretions).
• Antipyretics, Analgesics for symptom relief
• Nonpharmacological therapy (e.g. airway management and supportive care).
• Physical therapy e.g. percussion, Postural Drainage
• Chest physiotherapy (CPT).

Lifespan Considerations- Older Adult patients

• Increased risk of pulmonary infection, decline in immune function, immobility.
• Multi-drug use frequently resulting in possible malnutrition, impacting the ability to respond effectively to infections.

Implementation Nursing Actions (for Pneumonia Management)

• Patient teaching about medication use (antibiotics).
• Maintain airway patency, monitoring respiratory status (at least every 4 hours).
• Assessing cough, sputum, ABGs, positioning (Fowler).
• Encouraging coughing and deep breathing
• Assistive devices as needed, Endotracheal suctioning as needed.
• Fluid intake (at least 2500 -3000 ml/day), if possible
• Early identification of infections, monitor closely and follow up with lab results.

Implementation Nursing Actions (for Pneumonia Management)- Ventilation

• Ensuring effective ventilation, rest periods
• Comfort measures (e.g., managing pain, discomfort associated with pleuritis)
• Educating patients about cough training and pain management to enhance respiratory support.

Implementation Nursing Actions (for Pneumonia Management)

• Promoting balance between activity and rest, assessing activity tolerance and assistance with self-care activities.
• Provision of assistive devices and involving family members to minimize the stress of caring and anxiety levels.
• Providing emotional support and reassurance to the patient and family.

The Concept of Infection: Nursing Care of the Patient with Tuberculosis (TB)

• This section describes the nursing care for patients with tuberculosis, emphasizing the need for patient-centered care.

Course Student Learning Outcomes (for TB)

• Outcomes related to providing safe, patient-centered care, demonstrating critical thinking and clinical reasoning, relating quality improvement measures, and explaining management of care.

The Chain of Infection (for TB)

• The chain of infection for TB involves similar aspects like reservoir, portal of exit, mode of transmission, and susceptible host to that described before. A person who has developed the disease forms this chain of infection.

Additional Information

• Other sections cover topics such as risk factors, diagnostic tests, and pharmacological therapies related to pneumonia, some with examples listed in more detail of the types of pneumonia. The slide deck also has a specific section on implementation and nursing actions, providing direct guidance on patient care.

Test your knowledge on the concept of pneumonia, its causes, and the pathogens involved. This quiz also covers the chain of infection and its implications for patient care and safety. Perfect for students looking to deepen their understanding of respiratory health.