Introduction to pneumonia Acute, lower respiratory tract infection.inflammation in terminal airways & alveoli- impairing gas exchange.Caused by Bacteria, viruses, fungi, protozoa and parasites.6th leading cause of death in US- more prominent in immunodeficient patients.Higher in elderly and babiesdifferent organisms present different S/Sx and dif. treatment.Commom Organisms:(Gram-negative) Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aerugimose, Klebsiella pneumoniae, Escherichia coli.

Pathophysiology Bacterial pneumonia: This infecition triggers alveolar inflammtion and edema.Viral pneumonia: This virus first attacks bronchiolar epithelial cells and causes interstitial inflammation and dequamation. Aspirations pneumonia: INhalation of gastric juices or hydrocarbon inflammatory changes and in activates surfactant over a large area.

Aspirations pneumonia Decreased surfactantleads to alveolarcollapse. Acidic gastricjuices may damage theairflow , leading to secondary bacterialpneumonia.

Signs and SymptomsCoughing- can be dry and persistent or it may be productiveSputum productionPleuric chest painShaking/ chillsFeverWide range of physical signs:From diffuse, fine cracklesTo sings of localized or extensive consolidation and pleural effusionDyspneaTachypneaMalaiseDecreased breath sounds

Laboratory & Diagnosticagnostics Chest X- rays are used to confirm the diagnosis.Sputum speciman, Gram stain, and culture and sensitivity tests differentiate the type of infection.WBC count indicates leukocytosis in bacterial pneumonia.Normal or low WBC count for viral or mycoplasmal pneumonia.

Risks Factors

Long TermHospitalization withVentilator

Smoking

Not Being Able to Coughor Hsving Difficulty WhileSwallowing

Chronic Disease

Age

Weakended or Supressed Immune System

HIV/AIDS organ Transplant Chemotherapy Long Term Steroid Use

2 Years Old or Younger 65 Years Old or Older

Asthma COPD CFibrosisystic Heart Disease

Introduction to pneumonia Acute, lower respiratory tract infection.inflammation in terminal airways & alveoli- impairing gas exchange.Caused by Bacteria, viruses, fungi, protozoa and parasites.6th leading cause of death in US- more prominent in immunodeficient patients.Higher in elderly and babiesdifferent organisms present different S/Sx and dif. treatment.Commom Organisms:(Gram-negative) Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aerugimose, Klebsiella pneumoniae, Escherichia coli.

Bacterial Pneumonia There is lowAcute, lowventilation withnormal perfusion.Capillaries becomeengored with blood,causing stasis. Asthe alveolocapillarymembrane breaksdown, alveoli fill withblood and exudate,resulting inatelectasis

Viral Pneumonia The virus also invadesbronchial mucousglands and gobletcells. It then spreads to the alveoli, which fillwith blood and fiuid . Inadvanced infection, a hyaline membranemay form .

Nursing & Medical InterventionsTreatments:Antimicrobial TherapyHumidified oxygen therapyMechanical VentilationHigh- calorie dietAdequate fluid intakeBed RestAnalgesicsPositive end - expiratory pressure (to facilitate adeqate oxygenation in patients on mechanical ventilation for severe pneumonia)

Nursing Interventions:''The incidences of ventilator-associated pneumonia wassignificantly reduced using''bundles'' of care intervention.These bundiles... include thefollowing nursing interventions:(a)elevate the patient, and (b)mobilize the patient, and (c)implement comprehensive oralcare.''

Additional Nursing Interventions:Auscultate lung fields every 1-2 hourAuscultate lung sounds every 1-2 hourIncentive Spirometer''A' back to basics'approach to nursingcare can halp to preventunnecessareycomplications duringhospitalization.''

Medications Used to Treat Pneumonia:Ceftriaxone(Broad spectrum antibiotic)Cefotaxime (Broad Spectrum antibioticLevofloxacin (Anti- infective)Moxifloxacin (Anti-infective)Ampicillin/Sulbactam (Anti -infective, broad spectrum) Ertapenem (anti- infective) other Medications:Doripenem (anti- infective)Tigecycline(Broad spectrum, anti- infective) These medications are currently being tested as additional treatments for pneumonia.

Signs and SymptomsDifferences with Age Adults:in previously healthyindividual adults,pneumonia may presentwith a 1 to 2 day historyof cough, fatigue, rigorsand pleuritic pain

Signs and SymptomsDifferences with Age On examination respiratoryreat is likely to be repid, crackles may be audible oninspiration and there may beevidence of pleural effusion(dullness on auscultation orobvious lack of expansion ofthe ribcage on inspiration)

Signs and SymptomsUpon Examination Subjective Data:Sudden onset of feveraccompanied by convulsionsComplaints of being weakShortness of breathComplaining of being tired on the move Insomnia or can't fall or stay asleepCoughing with phlegmNausea, vomiting, no appetiteSometimes diarrheaWeight loss

Laboratory & Diagnosticagnostics Blood cultures reflect bacteremia.Arterial blood gas levels vary.Bronchoscopy or trensteacheal aspiration allows Collection of material for culture.Pulse oximetry Shows a reduced oxygen saturation level.