PNEUMONIA

 Inflammation of the pulmonary parenchyma

 An acute respiratory disorder characterized by inflammation of lung tissue and alveoli
filled with exudate.
o Classification of Pneumonia
 Community-acquired pneumonia
 CAP S. pneumonia, H influenza
 Hospital-acquired (nosocomial) pneumonia (HAP) Escherichia coli, H.
influenza, klebsiella species
 Pneumonia in the immune compromised host
 Aspiration pneumonia
o Predisposing factors
 Conditions that produced mucus or bronchial obstruction
 Immunosuppressed patient
 Smoking
 Prolonged immobility
 Nothing-by-mouth NPO status
 Respiratory therapy with improperly cleaned equipment
 Advanced age
o Pathophysiology
 Bacterial pneumonia (Mycoplasma pneumonia) is transmitted by infected
respiratory droplets through person-to-person contact
 ↓
 Acute stage of respiratory infection occurs within the ciliated cells the airways
 Infiltration of the tracheobronchial tree
 ↓
 Inflammatory process extends into the alveolar area, resulting in edema and
exudation
 ↓
 An inflammatory reaction can occur in the alveoli, producing an exudate that
interferes with the diffusion of oxygen and carbon dioxide
 ↓
 Blood by passes the alveoli without gas exchange occurring. This is seen with
obstruction of the distal airways PNEUMONIA
 ↓
 A ventilation- perfusion mismatch occurs in the affected area of the lungs
o Signs and Symptoms
 FEVER AND CHILLS
 FAST BRETHING (tachypnea), NASAL FLARING AND DYSPNEA
 INTERCOSTAL RETRACTIONS (chest indrawing)
 PRODUCTIVE COUGH (with greenish and rusty sputum)
 PLEURITIC CHEST PAIN
 DULLNESS OVER AREA OF CONSOLIDATION
 Anorexia, nausea, vomiting, fatigue, malaise
 FLUSHED FACE AND DILATED PUPILS
 RELATIVELY LOW PULSE
 RUSTY SPUTUM WITH HACKING PAROXYMAL COUGH
 DIMINISHED CHEST MOVEMENT ON AFFECTED SIDE
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o Diagnostic Procedures
 CHEST X-RAY (confirmatory test)
 SPUTIM GRAM STAIN (gram negative or gram positive)
 SPUTUM CULTURE- to specify the bacterial agents
 COMPLETE BLOOD COUNT –leukocytosis
 ARTERIAL BLOOD GASES- hypoxemia
o Treatment
 Antibiotic:
 Penicillin G (drug of choice)
 Ampicillin, amoxicillin
 Cephalosporin’s (keflin)
 Aminoglycoside (Gentamycin)
 Non antibiotic Drug
 Bronchodilators (THEOPHYLLINE)
 Expectorants (GUAIFENESIN)
 Symptomatic Treatment
 Absolute bed rest
 Position change every 2 hours
 Fluids
 Oxygen mist or mechanical ventilation for respiratory failure
 Pain relievers for pleurisy pain
 Expectorants
o Nursing Management
 Provide rest in the proper position (semi-fowler’s) and change position
 Maintain a patient airway (suctioning of secretion if needed) (coughing)
 Administer oxygen as indicated
 Monitor vital signs (respirations, rr, temperature , ABGs)
 INCREASE FLUID UNLESS CONTRAINDICATED (npo), I&O monitoring
and observe for dehydration:
o Sunken fontanels
o Thirst
o Dry skin and mucous membrane
o Poor skin turgor or non-elastic skin
o Rapid thread pulse
o Dehydration fever
o Lethargy
 PROVIDE A BLANCE DIET- (high in calories, proteins, vitamins.)
o Gradually progressing from liquids to solids for infants shift from
diluted to full strength formula
 PROMOTE COMFORT BY cool baths, skin care, analgesics if ordered,
calm environment

Prevention and Control

 PREVENT COMMON COLDS, INFLUENZA, OTHER RESPIRATORY
INFECTIONS
 Hib (anti haemophilus influenza B)
 Immunization with pneumonia vaccine
 Avoid exposure to environmental, physical conditions and contributory
factors.
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4 STAGES OF PNEUMONIA
1. LUNG ENGORGEMENT
Heavy lung
Dark red in color
Exuding a bubbly, blood tinged froth
2. RED HEPATIZATION
Lung is still heavy
Sinks in water
Looks like a piece of red granite
3. GREY HEPATIZATION
Red color changes to gray
Looks like ordinary granite
Softer and tears more easily
When pressed, exudates a purulent fluid
4. STAGE OF RESOLUTION
Inflammatory exudates is either absorbed by the blood stream or
Expectorated

LOBAR PNEMONIA- if a substantial portion of one or more lobes is involved

BRONCHOPNEUMONIA- describes a pneumonia that is distributed in a patchy fashion,
START FROM THE BRONCHUS, BRONCHIOLES AND SPREAD TO THE ALVEOLI

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