Pneumonia Nursing Notes PDF

Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses PNEUMONIA Nur Eldeen M. Echeverria, MAN  Brent Hospital and Colleges Incorporated | College of Nursing...

Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses PNEUMONIA Nur Eldeen M. Echeverria, MAN  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Definition: PNEUMONIA Infection of the pulmonary parenchyma. Caused by an microorganisms.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Mode of Transmission: PNEUMONIA Bacteria and viruses living in the nose, sinuses, or mouth may spread to the lungs. One may breathe some of these germs directly into your lungs (droplets infection). Inhalation of food, liquids, vomit, or fluids from the mouth into the lungs (aspiration pneumonia).  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Risk Factors: PNEUMONIA Immuno-suppressed patients Cigarette smoking Difficulty in swallowing (due to stroke, dementia, Parkinson’s diseases, other neurological conditions). Impaired consciousness (loss of brain function due to dementia, stroke, etc)  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Risk Factors: PNEUMONIA Chronic lung diseases (COPD, Bronchiectasis). Frequent suction Medical comorbidities such as heart disease, liver cirrhosis, and diabetes Recent cold, laryngitis or flu.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA According to According to ETIOLOGY AFFECTED CAUSES Lobar pneumonia Bacterial Community-Acquired Pneumonia Broncho-pneumonia Viral Atypical Pneumonia Fungal Hospital-Acquired Pneumonia Chemical Aspiration Pneumonia Inhalation Opportunistic Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: 1. Lobar pneumonia; if one or more lobe is involved 2. Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: LOBAR PNEUMONIA BRONCHOPNEUMONIA Multiple patches scattered Consolidated in a single Distribution throughout the lungs lobe (bronchi and bronchioles) Stages: Inflammation starts from Congestion bronchi/bronchioles then to Pathology RED Hepatization alveoli. GRAY Hepatization Patchy infiltrates Resolution  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: Continuation… LOBAR PNEUMONIA BRONCHOPNEUMONIA Streptococcus pneumoniae Staphylococcus aureus Causative Klebsiella pneumoniae Pseudomonas aeruginosa Agents Haemophilus influenzae 2o to viral illness: Influenza Insidious onset with less Rapid onset with high fever, severe symptoms, low- Clinical chills, productive cough, grade fever, productive features RUSTY COLORED SPUTUM cough Scattered rales & ronchi  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: Continuation…  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: DRILL… LOBAR PNEUMONIA BRONCHO- PNEUMONIA Multiple Patches throughout the lungs Single lobe only  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: DRILL… LOBAR PNEUMONIA BRONCHO- PNEUMONIA Single lobe only Multiple Patches throughout the lungs Streptococcus pneumoniae Staphylococcus aureus  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: DRILL… LOBAR PNEUMONIA BRONCHO- PNEUMONIA Single lobe only Multiple Patches throughout the lungs Streptococcus pneumoniae Staphylococcus aureus Rapid Onset Insidious / Gradual Onset  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to AREA AFFECTED: DRILL… LOBAR PNEUMONIA BRONCHO- PNEUMONIA Single lobe only Multiple Patches throughout the lungs Streptococcus pneumoniae Staphylococcus aureus Rapid Onset Insidious / Gradual Onset  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: 1. Bacterial (the most common cause of pneumonia) 2. Viral pneumonia 3. Fungal pneumonia 4. Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance) 5. Inhalation pneumonia (aspiration pneumonia)  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: BACTERIAL VIRAL FUNGAL CHEMICAL INHALATION Streptococcus Influenza virus Histoplasma Kerosene Food particles pneumoniae Rhinovirus capsulatum Smoke Saliva Staphylococcus Coronavirus (COVID) Aspergillus species Chlorine gas Gastric contents pneumoniae Respiratory Syncytial Blastomyces Industrial chemical Other bacterial flora Klebsiella pneumonia Virus dermatitidis Haemophilus Adenovirus influenzae  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: BACTERIAL VIRAL FUNGAL CHEMICAL INHALATION Acute inflammation of Invades the Granulomatous Direct chemical injury Aspiration leads to the alveoli → pus respiratory inflammation in to the lung tissue chemical injury accumulation, fluid, epithelial cells → the lungs → → inflammation from gastric acid immune cells diffuse interstitial necrosis and and necrosis of the and bacterial inflammation cavitation bronchioles and infection due to alveoli aspirated material Can predispose to Common among secondary immunocompromi Can lead to bacterial infection sed individuals pulmonary edema and Acute Respiratory Distress Syndrome  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: BACTERIAL VIRAL FUNGAL CHEMICAL INHALATION Can be lobar or Involves both lungs Can be localized or Diffuse involvement, Affects the bronchopneumonia with interstitial disseminated especially in areas of dependent portions pattern Nodules, cavitations, the lung exposed to of the lungs (right or masses on imaging chemical agents lower lobe) Sudden or gradual Gradual onset with Varying symptoms Rapid onset of Symptoms may onset of high fever, low-grade fever, non- including chronic symptoms after include a cough with chills, productive productive cough, cough, weight loss, exposure, including foul-smelling sputum, cough with purulent fatigue, myalgia, and night sweats, fever, cough, wheezing, fever, pleuritic chest sputum headache and hemoptysis dyspnea, chest pain pain, and empyema. Mimic Tuberculosis and cyanosis.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 35-year-old male presents to the clinic with fever, non-productive cough, and general malaise after spending time in a crowded setting during a flu outbreak. His symptoms have been worsening over the last few days, and a chest X-ray reveals diffuse interstitial infiltrates. What is the most likely cause of his pneumonia? A) Inhalation B) Bacterial C) Viral D) Fungal  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 40-year-old immunocompromised patient presents with a prolonged cough, fever, and fatigue. The patient reports living in an area endemic to Histoplasma capsulatum. A chest X-ray shows multiple nodular lesions. What is the most likely cause of the pneumonia? A) Fungal B) Bacterial C) Chemical D) Viral  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 70-year-old woman with a history of stroke and dysphagia presents with a cough, fever, and foul-smelling sputum. She often chokes on her food and has had multiple episodes of aspiration. A chest X-ray reveals consolidation in the right lower lobe. What is the most likely cause of her pneumonia? A) Fungal B) Inhalation C) Viral D) Chemical  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 45-year-old industrial worker presents to the emergency department with severe dyspnea, cough, and chest pain after accidentally inhaling chlorine gas at work. His symptoms developed rapidly, and he is now hypoxic. What is the most likely cause of his pneumonia? A) Bacterial B) Chemical C) Inhalation D) Fungal  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) and long-term corticosteroid use presents with a chronic cough, weight loss, and night sweats. He has been experiencing hemoptysis and a chest X-ray shows cavitary lesions in the upper lobes. Which type of pneumonia is most likely based on the cause? A) Chemical B) Bacterial C) Fungal D) Viral  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 30-year-old woman presents with a dry cough, low-grade fever, headache, and myalgia that developed over the past week. She works in a daycare and mentions that several children have had similar symptoms. Her chest X-ray shows bilateral diffuse interstitial infiltrates. What is the most likely cause of her pneumonia? A) Fungal B) Viral C) Bacterial D) Inhalation  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to CAUSES: DRILL… A 50-year-old man presents with a sudden onset of high fever, chills, and a productive cough with thick, greenish sputum. Physical examination reveals dullness to percussion and crackles in the right lower lobe. A chest X-ray shows lobar consolidation. Which type of pneumonia is most likely based on the cause? A) Viral B) Fungal C) Bacterial D) Chemical  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: 1. Community Acquired Pneumonia (CAP) 2. Atypical Pneumonia 3. Hospital Acquired Pneumonia (Nosocomial Pneumonia) 4. Aspiration Pneumonia 5. Opportunistic Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: COMMUNITY-ACQUIRED PNEUMONIA This occurs out of hospital or within 48h of admission and may be primary or secondary to existing disease. ✓ Streptococcus pneumoniae (most common), Haemophilus influenzae and Staphylococcus aureus. ✓ Viruses are implicated in approximately 10% of cases. ✓ In pre-existing lung disease (e.g.COPD/bronchiectasis), organisms such as Pseudomonas aeruginosa and Moraxella catarrhalis are more common.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: ATYPICAL PNEUMONIA ✓ They can be acquired in the community or in institutions. ✓ This is caused by organisms such as Mycoplasma, Legionella and Chlamydia species.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: HOSPITAL-ACQUIRED PNEUMONIA ✓ This is new-onset pneumonia occurring at or more than 48 h after admission to hospital. ✓ Gram-negative organisms such as Pseudomonas and Klebsiella are much more common causes.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: ASPIRATION PNEUMONIA ✓ This occurs as a result of the aspiration of gastrointestinal contents because of an inability to protect the airway such as after a cerebral vascular event or with a decreased consciousness level. ✓ Anaerobic organisms may be implicated. ✓ Stroke patients are at particular risk of aspiration pneumonia.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: OPPORTUNISTIC PNEUMONIA ✓ Individuals with cystic fibrosis are at increased risk of Pseudomonas pneumonia due to changes in the composition of airway surface mucus. ✓ Patients with impaired immune system (e.g. HIV+) are at increased risk of fungal (e.g. Aspergillus), Pneumocystis jiroveci or viral (e.g. CMV, HSV) pneumonia. ✓ Patients on respiratory support (e.g. ventilated in intensive care) are at increased risk of ventilator-associated pneumonia (VAP) commonly caused by Pseudomonas or Klebsiella.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Clinical Features `TYPICAL’: PNEUMONIA ✓ Fever (rapidly rising 39.5 – 40.5) ✓ Shaking chills ✓ Tachypnoea ✓ Dyspnea ✓ RUSTY SPUTUM (Productive Cough) ✓ Pleuritic chest pain (aggravated by respiration and coughing)  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Clinical Features `TYPICAL’: PNEUMONIA ✓ Tachypnea – nasal flaring ✓ Pt is very ill and lies on the affected side to reduce pain ✓ Use of accessory muscles of respiration ✓ Flushed cheeks ✓ Loss of appetite, lethargy and fatigue ✓ Cyanosed lips and nail beds  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Clinical Features `TYPICAL’: PNEUMONIA ✓ Signs of pulmonary consolidation (dullness, increased vocal resonance, bronchial breath sounds and coarse crepitations) may be found on physical examination and coincide with abnormalities on the CXR.  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Clinical Features `ATYPICAL’: PNEUMONIA ✓ ‘Atypical’ pneumonia has a more gradual onset ✓ Dry cough ✓ Extrapulmonary symptoms (headache, muscle aching, fatigue, sore throat, nausea, vomiting and diarrhoea).  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 40-year-old woman with systemic lupus erythematosus on long-term corticosteroids presents with fever, dry cough, and malaise. Chest X-ray shows bilateral patchy infiltrates. She is not recently hospitalized but has a history of recurrent respiratory infections. Which type of pneumonia is most likely? A) Opportunistic Pneumonia B) Hospital-Acquired Pneumonia C) Community-Acquired Pneumonia D) Aspiration Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 35-year-old man with HIV/AIDS presents with a non-productive cough, fever, and progressive shortness of breath over several weeks. He has a CD4 count of 50 cells/mm³. Chest X-ray shows diffuse bilateral interstitial infiltrates. What type of pneumonia is this most likely? A) Hospital-Acquired Pneumonia B) Opportunistic Pneumonia C) Community-Acquired Pneumonia D) Atypical Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 64-year-old woman presents with a productive cough, high fever, pleuritic chest pain, and dyspnea. She has no significant medical history and lives independently at home. On examination, she has dullness to percussion and crackles in the right lower lobe. Chest X-ray shows consolidation in the right lower lobe. Which type of pneumonia is most likely? A) Atypical Pneumonia B) Hospital-Acquired Pneumonia C) Community-Acquired Pneumonia D) Opportunistic Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD) has been hospitalized for three days for a urinary tract infection. He now develops a new fever, increased sputum production, and shortness of breath. A chest X-ray reveals new infiltrates in the right upper lobe. Which type of pneumonia is most likely? A) Community-Acquired Pneumonia B) Atypical Pneumonia C) Hospital-Acquired Pneumonia D) Aspiration Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 28-year-old previously healthy man presents with a gradual onset of low-grade fever, myalgia, headache, and a dry cough. He mentions working in a crowded office where several colleagues have been sick with similar symptoms. His chest X-ray shows a diffuse interstitial pattern with no significant consolidation. Which type of pneumonia is most likely? A) Atypical Pneumonia B) Aspiration Pneumonia C) Hospital-Acquired Pneumonia D) Opportunistic Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Classification: PNEUMONIA According to ETIOLOGY: DRILL… A 60-year-old male with a history of alcohol abuse is found unresponsive at home after vomiting. He is now febrile and coughing up foul-smelling sputum. Chest X-ray shows consolidation in the right lower lobe. What type of pneumonia is this most likely? A) Atypical Pneumonia B) Hospital-Acquired Pneumonia C) Community-Acquired Pneumonia D) Aspiration Pneumonia  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Diagnosis: PNEUMONIA History Taking Physical Examination Instrumental Diagnostics  Brent Hospital and Colleges Incorporated | College of Nursing NCM 112 – Infectious and Inflammatory Responses Physical Examination: PNEUMONIA Examination may reveal coarse inspiratory crepitations. Bronchial breathing with a dull percussion note is present in