PNEUMONIA
Pneumonia is an inflammatory process of the lung substance, caused by infectious agents
Etiology and Pathophysiology
1. The organism gains access to the lungs through aspiration of oropharyngeal contents/ by inhalation of respiratory secretions from infected individuals, by way of bloodstream, or from direct spread to the lungs as a result of surgery or trauma
2. When bacterial pneumonia, occurs in a healthy person, there is usually a history of preceding viral illness.
3. Predisposing factors include conditions interfering with the normal drainage of the lungs such as tumours, general anaesthesia and post-operative immobility, depression of the CNS from drugs, neurologic disorders or other conditions and intubation or respiratory instrumentation.
4. Pneumonia may be divided into 3 groups.
a. Community acquired, due to a number of organisms.
b. Hospital acquired, due to a gram-negative bacilli and staphylococci.
c. Pneumonia in the immuno compromised person
5. Patients with bacterial pneumonia may have underlying diseases that impairs host defense.
a. Immuno compromised persons patients received corticosteroids or immunosuppressants, those with cancer, those being treated with chemotherapy or radiotherapy, those undergoing organ transplantation, alcoholics, IV drugs abusers, those with HIV and AIDS.)
b. These people have increased chance of developing overwhelming infections. Infectious agents include aerobic and anaerobic gram negative bacilli, staphylococcus, Nicardia, fungi, Candida, viruses such as cytomegalo virus (CMV), Penumocystis carinij, reactivation of tuberculosis and others.
Pathophysiology - Bacterial Pneumonia
Etiological factors, (Entry of organisms)
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Inflammatory reaction
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Production of exudates (pours into air spaces)
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WBC, mostly neutrophils migrate into the alveoli
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Lung segment-forms a more solid structure as the air-containing spaces become filled.
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Areas of the lungs are not adequately ventilated.
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Partial occlusion of the bronchi or alveoli.
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Drop in alveolar Oxygen tension
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Venous blood coming into the lung pass through the under ventilated area and goes out of the lung to the left side of the heart without being oxygenated.
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Mixing of oxygenated and unoxygenated blood
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Arterial hypoxemia.
Clinical Manifestations
- Sudden onset, shaking chill, rapidly rising fever of 101-105°F,
- Productive cough with purulent sputum
- Pleuritic chest pain aggravated by respiration/coughing
- Dyspnoea, tachypnoea accompanied by respiratory grunting, nasal flaring/use accessory muscles of respiration, fatigue.
- Rapid bounding pulse
Diagnostic Evaluation
History and Physical Examination (of recent Respiratory Tract Infection)
1. Chest X-ray shows presence/extent of pulmonary disease.
2. Gram's stain, culture and sensitivity of sputum
3. Blood culture-detect bacteremia.
4. Immunologic test for detecting microbial antigens in serum, sputum and urine.
Medical Management
1. Antimicrobial therapy depends on laboratory identification of causative organism and sensitivity to specific antimicrobial
2. Oxygen therapy if patient has inadequate gas exchange
3. Respiratory support measures Endotracheal intubation, high inspiratory oxygen concentration, mechanical ventilation and positive end (PEEP) may be required for some patients. expiratory pressure
Nursing Management
1.Encourage a high level of fluid intake (2-3 litres/day) thins and loosens pulmonary secretions and replaces fluid loss. Humidify oxygen in order to loosen secretion and improve ventilation.
2. Encourage the patient to cough.
3. Chest physiotherapy - helps to loosen and mobilize secretion.
4. The patient is placed in a proper position drain the involved lung, then the chest is vibrated and percussed. After the lung has drained for 10-20 minutes, the patient is encourage to deep breathe and cough. If he is too weak to cough effectively, the mucus may be removed by nasotracheal suctioning of by bronchoscopic aspiration as determined by the physician
5. Administer oxygen and monitor the effectiveness of oxygen concentration by assessing for clinical manifestation of hypoxia.
6. Encourage rest and avoidance of over exertion.
7. Usually a comfortable position (semifowler's) for resting and breathing.
8. Encourage to change position frequently.
9. Evaluate for altered sensorium (restlessness, confusion and aggression due to cerebral hypoxemia), if sedatives or tranquilizers are prescribed.
10. Advise the patient to stop cigarette smoking - since it destroys tracheobronchial ciliary action and smoking irritates mucous cells of bronchi and inhibits the function of alveolar and macrophages cells.
11. Instruct to avoid fatigue, sudden change of temperature and excessive alcohol intake which lowers resistance to pneumonia.
12. Encourage the patient to obtain influenza vaccine and pneumococcal vaccine at prescribed times.
13. Report signs and symptoms of respiratory tract infection to a physician.
