Pneumonia Presentation PDF

PNEUMONIA PRESENTED BY MRS CHULU  OBJECTIVES By the end of the lecture/discussion, students should be able to: Define pneumonia List the causative organisms of pneumonia Mention the predisposing factors of pneumonia Describe the types of pneumonia Discuss the pathoph...

PNEUMONIA PRESENTED BY MRS CHULU  OBJECTIVES By the end of the lecture/discussion, students should be able to: Define pneumonia List the causative organisms of pneumonia Mention the predisposing factors of pneumonia Describe the types of pneumonia Discuss the pathophysiology of pneumonia State the signs and symptoms of pneumonia Describe the medical management of pneumonia Describe the nursing management of pneumonia State the complications of pneumonia  definition It is the inflammation of the lung tissue characterized by chest pains, fever, dyspnea. Pneumonia is an acute inflammation of the lung parenchyma. diagram  classification May be classified according to the cause or anatomical structure affected. ACCORDING TO ANATOMICAL STRUCTURE Broncho pneumonia Lobar pneumonia ACCORDING TO CAUSE Aspiration pneumonia - Due to inhaling fluids foods or vomitus into the airway Hypostatic pneumonia - due to immobility Atypical pneumonia caused by less common organism ; Bacterial, viral, fungal pneumonia  Causative organism Bacterial-Haemophilus influenza, Streptococcus pneumonia , Staphylococcus aureas Viruses- Adeno virus, influenza virus Fungi- pneumocystis carini Protozoa- mycoplasm pneumonia  Predisposing factors Existing chest infection e.g. bronchitis Aspiration of gastric secretions Aspiration of infected mucus following Upper Respiratory tract infection Unconsciousness- impaired cough reflex Smoking - damage of the epithelial lining of the respiratory tract. Old age and children- due to lowered immune system  types Aspiration pneumonia Results from entry of endogenous or exogenous substances into the lower respiratory tract: Bacteria that normally resides in the upper respiratory tract. Gastric contents, irritating gases or exogenous chemicals - Impair lung defenses causing inflammatory changes leading to growth of bacteria.  TYPES CONT.. HYPOSTATIC PNEUMONIA Portions of the lungs not well ventilated develop the infection. Occurs primarily in the aged or those debilitated by disease who lie in the same position.  TYPES CONT.. LOBAR PNEUMONIA Acute bacterial infection of a single lobe or part of the lobe of the lung. Congestion - the affected lobe is heavy, red and oedematous. This is due to the outpouring of exudates in the alveolar(a mass of cell and fluids seep out of blood vessels into the alveolar) Red hepatisation - Within a few days the lung assumes a liver like appearance. The alveolar spaces are filled with neutrophils, red cells and fibrin.  TYPES CONT.. Grey hepatisation - the lung is now dry, gray and firm because the red blood cells are lysed and accumulation of fibrin (break down of cells caused by damage to its plasma membrane) Resolution this follows in uncomplicated cases as the exudates are enzymatically digested and reabsorbed by the macrophages or coughed up  TYPES CONT.. BRONCHOPNEUMONIA It is the commonest form of pneumonia affecting mainly the very young, the elderly and the immunosuppressed. The infection affects the terminal bronchioles and alveoli. Patchy consolidation involving one or several lobes  TYPES CONT.. PNEUMOCYSTIS CARINII PNEUMONIA Now called Jerovecii (PJP) This type of pneumonia occurs in people with compromised immunity. Major opportunistic infections in HIV/AIDS. Fever, Shortness of breath and Dry cough are the common manifestations.  PATHOPHYSIOLOGY The causative organism is inhaled or spread from upper respiratory tract infection. It lodges in the alveoli where it multiplies. The organisms trigger the inflammatory process and aggregation of white blood cells. This will cause local capillary leak, oedema and watery exudates First 12-48 hours the alveoli appears reddish and lungs consolidate due to wide spread dilatation of pulmonary blood vessels. The fluids which collect in and around the alveoli causing the walls to thicken and the patient will start coughing trying to clear the airway.  PATHOPYSIOLOGY CONT.. The capillary leak and watery exudates will overflow and spread the infection to other areas of the lung. If the organisms get into the blood stream, then sepsis results causing fever. When organism enters the pleural cavity, empyema comes in leading to pleurisy. Red blood cells and fibrin also move into the alveoli. These events reduce gas exchange; reduce the vital capacity and alveoli collapse leading to hypoxemia  CLINICAL MAINFESTATION Fever up to 39 to 40˚C accompanied with rigors and delirium. Severe chest pains – over the affected lobe due to the inflammatory process and rubbing of the pleura against each other. Rapid respirations of 25-45 per minute as a compensatory mechanism to the impaired gaseous exchange. Dry cough which becomes productive after 24-48 hours with typical rusty sputum especially in lobar pneumonia. This is due to massive exudation and erosion of alveolar blood vessels. The sputum is thick and tenacious and often adheres to the side of the sputum mug Chest in drawing commonly seen in children resulting from pleural rub  CLINICAL MANIFESTATIONS CONT.. Tachycardia - As a compensatory mechanism by the body to increase oxygen supply in the blood and tissues. Restless - Due to reduced oxygen perfusion to the tissues. Dyspnoea due to impaired gas exchange related to consolidation of the lung. Cyanosis in severe cases due to impaired tissue perfusion. Crepitations with suppressed breath sounds are heard over the affected area due to consolidation Joint and muscle pains due to tissue hypoxia Anorexia due to inflammatory process General body malaise due to tissue hypoxia Intercoastal retraction due to impaired ventilation  MANAGEMENT AIM Relieve pain Promote healing Prevent complications  DIAGNOSTIC TESTS History from the patient may review stabbing chest pains which is made worse by breathing or cough. On auscultation there will be reduced air entry and cracking sound (rales) in the affected lung. On percussion there will be dullness on the affected side due to consolidation of the underlying lung. Blood culture to isolate the causative organism Blood for FBC shows high white blood cell and neutrophil count. Blood gas analysis to rule out any reduction in PO2 in arterial blood X-ray - The area affected on X-Ray appears as an area of increased density. Pleural effusion can also be detected. Sputum for M/C/S  MEDICAL MANAGEMENT Antibiotics based on culture e.g. Benzyl penicillin 2-4 mega IU in qid IV/IM for 7days Gentamycin 80mg iv bd It is antibacterial in nature. S/E – allergic reactions, GIT disturbances. Implications – don’t administer to penicillin allergic patients. Ceftriaxone-Dose –Adult; 1-2g as a single dose or in 2 divided doses. It is bactericidal. Side effects; headache, leucopoenia tenderness at injection site. Nursing implications; use cautiously in patients allergic to penicillin  TREATMENT CONT.. Antipyretics - Acetylsalicylic acid 300- 600mg tds x 3/7. Oxygen therapy is also administered in cases of dyspnea that is 2-5 litres per minute. Give a lot of fluids to loosen the secretion Balanced diet to boost the immunity thereby promote quick recovery  NURSING MANAGEMENT Aims To establish a normal breathing pattern To improve the nutrition status To relieve the pain To prevent complications To allay anxiety  NURSING MGT ENVIRONMENT Patient will be nursed in a general ward but reverse barrier nursing will be used to prevent acquisition of nosocomial infection Patient should be nursed in a clean, warm well-ventilated environment to prevent secondary infection. Patient will be nursed in a well lit room for easy observation POSITION Nurse the patient in a semi fowler’s position to promote lung expansion and increase gaseous exchange. Encourage frequent change of position to promote drainage of secretions.  NURSING MGT CONT.. OBSERVATIONS Acute phase 4 hourly observations of vital signs progressing to 12 hourly as the condition stabilizes. Respirations for depth, rate and rhythm so as to rule out dyspnoea and tachypnea. Temperature for fever, pulse for tachycardia. Vitals will help check if patient is improving. Signs of confusion indicative of hypoxia  NURSING MGT CONT.. Obverse for cyanosis, if it is improving or getting worse and give oxygen therapy when necessary Observe sputum for color amount and consistency to detect hemoptysis and report to the physician Observe the feeding pattern and take measures  NURSING MGT CONT.. PSYCHOLOGICAL CARE Explain the disease process to the patient, significant others and involve spiritual provider if available. Allow patient and relatives to verbalize their concerns then answer them appropriately to alley anxiety MEDICATION Give oxygen via a correct mask or nasal cannulae so as to prevent dyspnoea and improve the respirations. Administer prescribed antibiotics as well as prescribed analgesics.  CONT.. NUTRITION Encourage hourly oral fluids according to patient’s preference this will help liquefy the secretions aiding their expectoration. IV fluids could be given to promote hydration. Give protein and calorie to promote healing and provide energy. HYGIENE Hygiene is important to promote comfort of the patient. Bed bath if the patient is very sick and a big bath if the patient is stable. Oral toilet is encouraged to prevent halitosis. Change linen whenever soiled especially that the patient will be having fevers which cause increased perspiration.  CONT.. EXERCISE Exercises are encouraged if the condition of the patient allows to promote blood circulation and recovery. Passive exercises in the acute stage such as sitting in bed. Patient is taught and encouraged to be doing breathing exercises to promote lung expansion  IEC Minimizing factors that can cause reinfection, including close living conditions, poor nutrition and poorly ventilated living houses or working environment. Patient is taught and encouraged to continue doing breathing exercises at home. Adherence to treatment – it has been observed that the highest cause of readmissions to hospital is poor adherence to treatment after discharge. The patient and his family will be told to continue with the prescribed medication even as they will be at home. This will help with completely clearing the infection, hence promoting complete recovery and avoid recurrences of the illness.  IEC CONT.. Nutrition - An emphasis will be placed on the importance of continued good nutrition with the locally available foods such as nshima with vegetables and kapenta. This will enhance quick recovery and boost the immunity, henceforth, preventing other illnesses from setting in. Review dates - Importance of review dates is explained to both the patient and his family. They are told that they need to follow these appointments with the doctor as it serves as follow up on his condition. This will also help the doctor assess his discharge plan and see if it will need adjustments or not.  IEC CONT.. He is also informed on significant changes in signs such as fever, increasing chest pains and hemoptysis, and that he should seek quick medical advice should these signs appear. The client and his family are taught on the importance of rest and gradual resumption of activities  COMPLICATIONS Atelectasis - decreased or absent air in the entire or part of the lung. This is due to growth of fibroblasts from the alveolar septa resulting in fibrosed, tough, airless leathery lung tissue. Pleural effusion- increased fluid in the pleural space. This is usually as a result of the exudation following the inflammation of the lung parenchyma. It can cause shortness of breath by compressing the lung. Empyema - presence of pus within the pleural cavity. This usually arises from bacterial spread from a severe pneumonia. Lung abscess – is a localized area of suppuration within a lung tissue that leads to parenchymal destruction.  COMPLICATIONS CONT.. Metastatic infection - occasionally infection in the lungs and pleural cavity in lobar pneumonia may extend into pericardium and the heart causing pericarditis, endocarditis and myocarditis. Haematogenous (septicemia) spread to cause; Meningitis, Acute Otitis media and Arthritis