PNEUMONIA

PNEUMONIA

DEFINITION:-
It is an inflammation of lung parenchyma which is associated with marked increase interstitial and alveolar fluid.

CAUSES/AETIOLOGY:-

  1. Bacterial infection:
    • Gram +ve:
      • Strep. Pneumonia
      • Strep. aurious.
    • Gram -ve:
      • H. influenza
      • Pseudomonas
      • Anaerobic bacteria
  2. Viral infection:
    • Influenza virus
    • Para influenza virus
    • Adenovirus

  3. Fungus infection:
    • Candidiasis
    • Histoplasmosis

  4. Mycoplasma and protozoa in AIDS.

CLASSIFICATION:-

  1. Community Acquired Pneumonia
    • It occurs in normal healthy persons
    • Bacterial infection
    • Viral infection

  2. Hospital Acquired Pneumonia
    • It occurs either when immunity is week or in lung disorders or anatomical abnormal lungs.


TYPES:-

  1. Segmental Pneumonia: Only in one small segmental lobes of lung.
  2. Bilateral Pneumonia: Both side segmental lobes of lungs are affected.
  3. Lobar Pneumonia: Complete lobe affected.
  4. Broncho Pneumonia: Patchy like formation in the lungs.

RISK FACTORS:-

  • Air pollution/Aspiration
  • Bed rest/prolonged immobility
  • Chronic lung disease
  • Diabetes mellitus
  • Endotracheal incubation
  • Full day smoker
  • General Anaesthesia/Growing malnutrition
  • HIV
  • Immunosuppressive therapy.

CLINICAL MANIFESTATION:-

  • Fever (high in bacterial infection and mild in viral infection)
  • Chills
  • Sweating
  • Pleuritic pain
  • Cough
  • Sputum production
  • Haemoptysis (cough with blood)
  • Dyspnoea
  • Cyanosis
  • Rapid pulse
  • Hot/pallor Skin
  • Increase respiratory rate
  • Low oxygen saturation
  • Headache
  • Dull sound produce on percussion
  • Unequal chest wall expansion.

PATHOPHYSIOLOGY:-

    Due to any cause, e.g., bacteria, viral or other
    ↓
    Inflammation in alveoli
    ↓
    Mast cells activate and release
    • Histamine
    • Cytokinine
    • Leukotrines
    • Prostaglandins
    ↓
    Due to Cytokinine release, fluid shift to extracellular space (capillary permeability)
    ↓
    Alveoli filled with fluid
    ↓
    Decrease oxygen saturation in body
    ↓
    Hypoxemia/Hypoxia

COMPLICATIONS:-

  • Pleural effusion
  • Atelectasis (due to mucous plug)
  • Super infection (Pericarditis, bacteremia, meningitis).

DIAGNOSTIC EVALUATION:-

  • Sputum for culture and sensitivity
  • Chest X-ray
  • Bronchoscopy
  • Cracked sound
  • ABG analysis
  • Mantoux test.

MEDICAL MANAGEMENT:-

  1. Prevention of pneumonia by vaccination
  2. Use of antibiotic therapy for treatment:

    Example:
    • Pencilline
    • Erythromycin
    • Cephalosporin
    • Amikacin (drug of choice)
    • Ampicillin
    • Ceftriaxone
  3. Bronchodilators are used.
  4. Analgesics for chest pain, e.g., Nimuslide, paracetamol


NURSING MANAGEMENT:-

Assessment

  • Assess the patient that he/she made contact with other client like (T.B, or pneumonia patient).
  • Presence, characterstics and nature of any chest pain.
  • Take a history of patients.

Nursing diagnosis with implementation

  1. Ineffective breathing pattern related to decrease metabolic demands or insufficient exchange of oxygen, carbondioxide in alveoli.

    Nursing Intervention:

    • Provide comfortable position to patient.
    • Prescribe cough suppressant and analgesics.
    • Monitor ABG for hypoxemia, hypercapnia and acid base balance.
  2. Ineffective airway clearance-Due to increase secretion and inflammation.

    Nursing Intervention:

    • Give advice to patient to take high fluid diet.
    • Teach and encourage effective cough and deep breathing techniques.
    • Administration of bronchodilators.
    • Give side lying position to the patient with altered level of consciousness.
  3. Activity intolerance due to decrease level of oxygen for metabolic demands.

    Nursing Intervention:

    • At first we have to maintain baseline activities and response to activity of patient.
    • Provide oxygen therapy.
  4. Anxiety related to knowledge deficit

    Nursing Intervention:

    • Give psychological support to the patient.
    • Maintain a peaceful enviroment.
    • Give comfortable rest.
    • Provide knowledge about disease and also give satisfactory answers to the questions of patient.
  5. Altered nutrition and hydration

    Nursing Intervention:

    • Give prescribed diet.
    • Advice to increases high protein in diet.
    • Enccourage for oral fluids.
  6. Promoting comfort

    Nursing Intervention:

    • Provide restful position to patient.
    • Assess nature and location of chest pain.
    • Administer analgesics.
    • Provide frequent mouth care frequently.
    • Give dry and warm condition to the patient.

    7. Health Education:-

    Nursing Intervention:

    • Prevent Transmission of infection.
    • Provide information about collection or handling of secretion.
Previous Year Questions KUHS

1) Mrs. A, 35 years old lady is admitted with pneumonia. Classify the types of
pneumonia with causes. Explain the pathophysiology of pneumonia.
Discuss the management of Mrs. A including nursing management
(4+4+7=15)

2)Pneumonia (5)

3) Mantoux test (5)

4)Give reason - 
Early morning sputum sample collection 

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