Pneumonia Presentation PDF

Pneumonia Presented by : Dr. Heba Abd El Reheem Lecturer of Medical –Surgical Nursing  Pneumonia Objectives : –Define pneumonia. –Classify pneumonia : According to causes. According to area involved. According to location of illness onset. –Identify mode...

Pneumonia Presented by : Dr. Heba Abd El Reheem Lecturer of Medical –Surgical Nursing  Pneumonia Objectives : –Define pneumonia. –Classify pneumonia : According to causes. According to area involved. According to location of illness onset. –Identify mode of transmission –List predisposing factors of pneumonia –Pathophysiology of pneumonia –Describe clinical manifestations of pneumonia –State diagnostic evaluation of pneumonia –State complications of pneumonia –Explain management of pneumonia Medical management of pneumonia Nursing intervention of pneumonia –Preventive measures of pneumonia –Prognosis of pneumonia  Definition of pneumonia Pneumonia is an inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) that is commonly caused by infectious agents. (various microorganisms, including bacteria, mycobacteria, fungi, parasites and viruses).  Inflammatory infiltrate in alveoli ( = consolidation) occurs when the right sided normally air-filled alveoli become consolidation filled with fluid and debris. consolidation is a pathological process in which the alveoli are filed with a mixture of inflammatory exudate, bacteria and white blood cell  Classification of pneumonia (cont…) According to causes: Bacterial (the most common cause of pneumonia) Viral pneumonia Fungal pneumonia Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance) – Tuberculosis Inhalation pneumonia (aspiration pneumonia)  BACTERIAL PNEUMONIA: The most common cause of community-acquired bacterial pneumonias is Streptococcus pneumoniae, also called pneumococcal pneumonia. VIRAL PNEUMONIA: Influenza viruses are the most common cause of viral pneumonia. FUNGAL PNEUMONIA: Candida and Aspergillus are two types of fungi that can cause pneumonia. pneumonia related to tuberculosis: Mycobacterium tuberculosis also may cause pneumonia.  ASPIRATION PNEUMONIA: results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. The aspirated material (food, water, vomitus, or oropharyngeal secretions) triggers an inflammatory response. The most common form of aspiration pneumonia is bacterial infection from aspiration of bacteria that normally reside in the upper airways.  This most often occurs in patients with decreased levels of consciousness or an impaired cough or gag reflex. These conditions can occur with alcohol ingestion, stroke, general anesthesia, seizures, gastrointestinal reflux disease (GERD), or other serious illness.  VENTILATOR-ASSOCIATED PNEUMONIA: A type of aspiration pneumonia, ventilator-associated pneumonia (VAP), develops in patients who are intubated and mechanically ventilated. The endotracheal tube keeps the glottis open, so secretions can be easily aspirated into the lungs.  CHEMICAL PNEUMONIA: * Inhalation of toxic chemicals can cause inflammation and tissue damage, which can lead to chemical pneumonia. *This increases the risk for subsequent bacterial infection. *Chemical pneumonia results from ingestion of kerosene or inhalation of volatile hydrocarbons (kerosene, gasoline, or other chemicals), which may occur in industrial settings.  Radiation pneumonia: results from damage to the normal lung mucosa during radiation therapy for breast or lung cancer.  HYPOSTATIC PNEUMONIA: Hypoventilation of lung tissue over a prolonged period can occur when a client is bedridden and breathing with only part of the lungs. Bronchial secretions subsequently accumulate, (Secretions pool in dependent areas of the lungs and can lead to inflammation and infection), which may lead to hypostatic pneumonia.  Classification of pneumonia (cont…) According to areas involved: Lobar pneumonia; means that the inflammation is confined to one or more lobes of the lung. Broncho-pneumonia; means that the infection is patchy, diffuse, and scattered throughout both lungs, the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue. Bronchopneumonia is more common than lobar pneumonia Interstitial; Interstitial Pneumonia  Classification of pneumonia (cont…): According to location of illness onset : 1-Hospital-acquired pneumonia (HAP): also known as nosocomial pneumonia : is defined as the onset of pneumonia symptoms more than 48 hours after a hospital admission in patients with no evidence of infection at the time of admission. - Ventilator-associated pneumonia: is considered one type of HAP( nosocomial) pneumonia that is associated with endotracheal intubation and mechanical ventilation. - Health care–associated pneumonia (HCAP): is pneumonia that develops in outpatient settings or nursing homes.  2- community-acquired pneumonia (CAP) is an acute infection of the lung occurring in patients who have not been hospitalized. (CAP) develops either in the community setting or within the first 48 hours after hospitalization. and is usually less serious than other forms.  3-pneumonia in the immunocompromised host : Pneumonia in the immunocompromised host occurs with use of corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, use of broad spectrum antimicrobial agents, acquire immunodeficiency syndrome (AIDS), genetic immune disorders, and long term advanced life-support technology (mechanical ventilation).  Mode of transmission Ways you can get pneumonia include: Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs. You may breathe some of these germs directly into your lungs (droplets infection). You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).  Organisms that cause pneumonia reach the lung by three methods: 1. Aspiration of normal flora from the nasopharynx or oropharynx. Many of the organisms that cause pneumonia are normal inhabitants of the pharynx in healthy adults. 2. Inhalation of microbes present in the air. Examples include Mycoplasma pneumoniae and fungal pneumonias. 3. Hematogenous spread from a primary infection elsewhere in the body. An example is Staphylococcus aureus.  Pathophysiology The streptococci reach the alveoli and lead to inflammation and pouring of an exudates into the air spaces. WBCs migrates to alveoli, the alveoli become more thick due to its filling consolidation, involved areas by inflammation are not adequately ventilated, due to secretion and edema. This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content.  Venous blood that goes to affected areas without being oxygenated and returns to the heart. This will lead to arterial hypoxemia and even death due to interference with ventilation.  Predisposing factors Immunosuppressed patients, A weakened immune system, as HIV/AIDS or cancer, or to medications that suppress immune function; Cigarette smoking Difficult swallowing or coughing problem (due to stroke, dementia, parkinsons disease, or other neurological conditions) Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)  Predisposing factors(cont…) Chronic lung disease (COPD, bronchostasis, cystic fibrosiscystic fibrosis, asthma) Frequent suction Other serious illness such as heart disease, liver cirrhosis, and DM Recent cold, laryngitis or flu Infants and children 2 years of age or younger; Age 65 and older;( Advanced age) Tracheal intubation or tracheostomy. Nasogastric tube (feeding).  Clinical manifestations Shaking chills Rapidly rising fever ( 39.5 to 40.5 degree) Stabbing chest pain aggravated by respiration and coughing Tachypnea(25 to 45 breaths/min), nasal flaring Patient is very ill and lies on the affected side to decrease pain Use of accessory muscles of respiration e.g. abdomen and intercostals muscles Cough with purulent, blood tinged, rusty sputum Shortness of breath Flushed cheeks Loss of appetite, low energy, and fatigue Cyanosed lips and nail beds Crackles and wheezes may be heard on lung auscultation because of the exudate in the alveoli and airways.  Diagnostic evaluations of pneumonia The diagnosis of pneumonia is made by history (particularly of a recent respiratory tract infection), Physical examination: a chest X-ray Looking at sputum under a microscope Pulse oximetry Arterial Blood Gas Complete blood count Sputum culture Bronchoscopy  Diagnostic Tools History Physical Exam Cough (>90%), sputum (66%), Temperature, RR, intercostal dyspnea (66%), chest pain and accessory muscle use, (50%), fever & chills, myalgias, rales, wheezes, rhonchi, diarrhea, headache, sore throat, pleural rubs rhinitis Overall state of health (age), Rate of onset, season, location, BP, RR, Pulse, O2 saturation travel, exposure to ill persons, (Vital Signs) Provide decision animals, environment, and making and prognostic immunosuppressive conditions information  Diagnostic investigation of pneumonia Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. X-ray can also show pleural effusions. Pulse oximetry. This measures the oxygen level in your blood Arterial blood gases (ABGs): may be obtained to assess for hypoxemia(partial pressure of oxygen in arterial blood [PaO ] less than 2 80 mm Hg), hypercapnia (partial pressure of carbon dioxide in arterial blood [PaCO ] greater than 45 mm Hg), and acidosis. 2 Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection a sputum specimen for culture and Gram stain to identify the organism is obtained before beginning antibiotic therapy. Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection Leukocytosis occurs in the majority of patients with bacterial pneumonia; the white blood cell (WBC) count is usually greater than 15,000/μL (15 × 109/L) with the presence of bands (immature neutrophils).  Diagnostic investigation of pneumonia (cont..) The doctor might order additional tests if patients are older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include: CT scan. If pneumonia isn't clearing as quickly as expected Pleural fluid culture. A fluid sample is taken by putting a needle between ribs from the pleural area and analyzed to help determine the type of infection. (A thoracentesis)  Sputum culture Blood tests Diagnostics: Bronchoscopy  Complications Pleurisy: (inflammation of the pleura) is relatively common. Pleural effusion : (fluid in the pleural space) can occur. In most cases, the effusion is sterile and is reabsorbed in1 to 2 weeks. Occasionally, effusions require aspiration by thoracentesis.  Atelectasis (collapsed, airless alveoli) of one or part of one lobe may occur. These areas usually clear with effective coughing and deep breathing. Empyma (accomulation of purulent exudate in the pleural cavity). occurs in less than 5% of cases and requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage. Lung abcess:is not a common complication of pneumonia. However, it may occur with pneumonia caused by Staphylococcus aureus and gram-negative organisms.  Complications (cont….) Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury. This clinical syndrome is characterized by a sudden and progressive pulmonary edema. Sepsis,(septicemia):can occur when bacteria within alveoli enter the bloodstream. Severe sepsis can lead to shock and multisystem organ dysfunction syndrome (MODS) such as: endocarditis(inflammation of the endocardium), pericarditis (inflammation of the pericardium), results from spread of the infecting organism from infected pleura or via a hematogenous route to the pericardium and purulent arthritis.  Otitis media(infection of the middle ear), bronchitis, or sinusitis also may complicate recovery, especially from atypical pneumonia Respiratory failure: is one of the leading causes of death in patients with severe pneumonia. Failure occurs when pneumonia damages the lungs’ ability to exchange oxygen for carbon dioxide. (which requires mechanical ventilator)  Medical management initiation of antibiotic therapy for bacterial pneumonia ,and depending on sputum and blood culture Antivira therapy may be used to treat pneumonia caused by influenza or anti fungal. hydration to thin secretions supplemental oxygen to treat hypoxemia, Individualize bed rest, and activity to the patient’s tolerance. Benefits of mobility include improved diaphragm movement and chest expansion, mobilization of secretions, and prevention of venous stasis.  chest physical therapy and postural drainage (techniques that involve manual pounding or clapping to loosen secretions and positioning of the client to drain and remove secretions from specific areas of the lungs), bronchodilators, and corticosteroids are often prescribed cough expectorants (mucolytics) or suppressants, depending on the nature of the client’s cough. analgesics, to relieve chest pain, antipyretics, such as aspirin or acetaminophen for significantly elevated temperature.  If a client is hospitalized, treatment is more vigorous, depending on the potential or actual complications. Fluid and electrolyte replacement sometimes is necessary secondary to fever, dehydration, and inadequate nutrition. If the client experiences severe respiratory difficulty and thick, copious secretions, he or she may require intubation along with mechanical ventilation.  Emergency and Long term care Maintain a patent airway and adequate oxygenation. IV access Positioning (upright, side lying, semi-Fowler’s position (45 degree) Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours. Monitor the patient’s ABG levels Activity (limite or decrease activity) Nutrition: Provide a high calorie, high protein diet of soft foods (small frequent meals,......) Increase fluid intake if not contraindicated (intake and output).  Nursing intervention Maintain a patent airway and adequate oxygenation. Obtain sputum specimens as needed. Use suction if the patient can’t produce a specimen. perform chest physiotherapy.  Nursing intervention (cont…) Provide a high calorie, high protein diet of soft foods. To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly. To control the spread of infection, dispose secretions properly.  Nursing intervention (cont…) Provide a quiet, calm environment, with frequent rest periods. Monitor the patient’s ABG levels, especially if he’s hypoxic. Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours.  Nursing intervention (cont…) Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. Monitor fluid intake and output, skin turgor, vital signs, serum electrolytes. Evaluate the effectiveness of administered medications. Explain all procedures to the patient and family.  Preventive measures Promote coughing and expectoration of secretions if client experiences increased mucus production. Change position frequently if client is immobilized for any reason. Encourage deep-breathing and coughing exercises at least every 2 hours. Administer chest physical therapy as indicated. Suction client if he or she cannot expectorate.  Prevent aspiration in clients at risk. Prevent infections. Cleanse respiratory equipment on a routine basis. Promote frequent oral hygiene. Administer sedatives and opioids carefully to avoid respiratory depression. Encourage client to stop smoking and reduce alcohol intake.  Prevention 1. A vaccine against some of the common types of S. pneumoniae. - The pneumococcal conjugate vaccine (PCV13) is given to children in the first two years of life, to all adults 65 years or older, and to younger adults with certain conditions that weaken their immune system. - The pneumococcal polysaccharide vaccine (PPSV23) is given to adults 65 years or older, as well as children and younger adults with certain high-risk conditions. 2. Seasonal influenza vaccines  Prognosis With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.  NURSING DIAGNOSES Based on the assessment data, the patient’s major nursing diagnoses may include: 1-Ineffective airway clearance related to copious tracheobronchial secretions 2- Activity intolerance related to impaired respiratory function  NURSING DIAGNOSES (cont…) 3- Imbalanced nutrition: less than body requirements 4- Deficient knowledge about the treatment regimen and preventive health measures 5-Risk for deficient fluid volume related to fever and dyspnea Any Questions?