Eleazar, Elysa Mae S. 302N/Grp.

1B

Nov. 28, 2011 Mrs. Chan

Pneumonia

I.

Overview/ Definition/ Description

Pneumonia is a general term that means inflammation of the lungs. It can affect one or both of the lungs. If bacteria, a virus, a fungus, or other foreign matter enters the lungs, the bodys natural immune response produces inflammation in the affected area. When inflammation occurs in the lungs, fluid and pus (destroyed white blood cells) can collect and interfere with normal lung function, which is to provide oxygen to and remove carbon dioxide from the bloodstream. Pneumonia ranges in severity from mild to severe, and it can be fatal. Very young children, adults over 65, and patients who have a chronic illness are particularly vulnerable to pneumonia. In patients who are at increased risk for this condition, learning about pneumonia prevention and talking with a qualified health care provider about precautions can help reduce the risk. Description

Anatomy of the lung To better understand pneumonia, it is important to understand the basic anatomic features of the respiratory system. The human respiratory system begins at the nose and mouth, where air is breathed in (inspired) and out (expired). The air tube extending from the nose is called the nasopharynx. The tube carrying air breathed in through the mouth is called the oropharynx. The nasopharynx and the oropharynx merge into the larynx. The oropharynx also carries swallowed substances, including food, water, and salivary secretion, which must pass into the esophagus and then the stomach. The larynx is protected by a trap door called the epiglottis. The epiglottis prevents substances that have been swallowed, as well as substances that have been regurgitated (thrown up), from heading down into the larynx and toward the lungs. A useful method of picturing the respiratory system is to imagine an upside-down tree. The larynx flows into the trachea, which is the tree trunk, and thus the broadest part of the respiratory tree. The trachea divides into two tree limbs, the right and left bronchi. Each one of these branches off into multiple smaller bronchi, which course through the tissue of the lung. Each bronchus divides into tubes of smaller and smaller diameter, finally ending in the terminal bronchioles. The air sacs of the lung, in which oxygen-carbon dioxide exchange actually takes place, are clustered at the ends of the bronchioles like the leaves of a tree. They are called alveoli. The tissue of the lung which serves only a supportive role for the bronchi, bronchioles, and alveoli is called the lung stroma. Function of the respiratory system The main function of the respiratory system is to provide oxygen, the most important energy source for the body's cells. Inspired air (the air you breath in) contains the oxygen, and travels down the respiratory tree to the alveoli. The oxygen moves out of the alveoli and is sent into circulation throughout the body as part of the red blood cells. The oxygen in the inspired air is exchanged within the alveoli for the waste product of human metabolism, carbon dioxide. The air you breathe out contains the gas called carbon dioxide. This gas leaves the alveoli during expiration. To restate this exchange of gases simply, you breathe in oxygen, you breathe out carbon dioxide Respiratory system defences The healthy human lung is sterile. There are no normally resident bacteria or viruses (unlike the upper respiratory system and parts of the gastrointestinal system, where bacteria dwell even in a healthy state). There are multiple safeguards along the path of the respiratory system. These are designed to keep invading organisms from leading to infection. The first line of defense includes the hair in the nostrils, which serves as a filter for large particles. The epiglottis is a trap door of sorts; designed to prevent food and other swallowed substances from entering the larynx and then trachea. Sneezing and coughing, both provoked by the presence of irritants within the respiratory system, help to clear such irritants from the respiratory tract.

Mucus, produced through the respiratory system, also serves to trap dust and infectious organisms. Tiny hair like projections (cilia) from cells lining the respiratory tract beat constantly. They move debris trapped by mucus upwards and out of the respiratory tract. This mechanism of protection is referred to as the mucociliary escalator. Cells lining the respiratory tract produce several types of immune substances which protect against various organisms. Other cells (called macrophages) along the respiratory tract actually ingest and kill invading organisms. The organisms that cause pneumonia, then, are usually carefully kept from entering the lungs by virtue of these host defenses. However, when an individual encounters a large number of organisms at once, the usual defenses may be overwhelmed, and infection may occur. This can happen either by inhaling contaminated air droplets, or by aspiration of organisms inhabiting the upper airways. II. Etiology/ Predisposing Factor

In addition to exposure to sufficient quantities of causative organisms, certain conditions may make an individual more likely to become ill with pneumonia. Certainly, the lack of normal anatomical structure could result in an increased risk of pneumonia. For example, there are certain inherited defects of cilia which result in less effective protection. Cigarette smoke, inhaled directly by a smoker or second-hand by a innocent bystander, interferes significantly with ciliary function, as well as inhibiting macrophage function. Stroke, seizures, alcohol, and various drugs interfere with the function of the epiglottis. This leads to a leaky seal on the trap door, with possible contamination by swallowed substances and/or regurgitated stomach contents. Alcohol and drugs also interfere with the normal cough reflex. This further decreases the chance of clearing unwanted debris from the respiratory tract. Viruses may interfere with ciliary function, allowing themselves or other microorganism invaders (such as bacteria) access to the lower respiratory tract. One of the most important viruses is HIV (HumanImmunodeficiency virus), the causative virus in AIDS (acquired immunodeficiency syndrome). In recent years this virus has resulted in a huge increase in the incidence of pneumonia. Because AIDS results in a general decreased effectiveness of many aspects of the host's immune system, a patient with AIDS is susceptible to all kinds of pneumonia. This includes some previously rare parasitic types which would be unable to cause illness in an individual possessing a normal immune system. The elderly have a less effective mucociliary escalator, as well as changes in their immune system. This causes this age group to be more at risk for the development of pneumonia. Various chronic conditions predispose a person to infection with pneumonia. These include asthma, cystic fibrosis, and neuromuscular diseases which may interfere with the seal of the epiglottis. Esophageal disorders may result in stomach contents passing upwards into the esophagus. This increases the risk of aspiration into the lungs of those stomach contents with their resident bacteria. Diabetes, sickle cell anemia, lymphoma, leukemia, and emphysema also predispose a person to pneumonia. Genetic factors also appear to be involved in susceptibility to pneumonia. Certain changes in DNA appear to affect some patients' risk of developing such complications of pneumonia as septic shock. Pneumonia is also one of the most frequent infectious complications of all types of surgery. Many drugs used during and after surgery may increase the risk of aspiration, impair the cough reflex, and cause a patient to underfill their lungs with air. Pain after surgery also discourages a patient from breathing deeply enough, and from coughing effectively. Radiation treatment for breast cancer increases the risk of pneumonia in some patients by weakening lung tissue. III. Clinical Manifestation

General Symptoms. The symptoms of some bacterial pneumonias, such as pneumococcal pneumonia, develop very quickly and typically include: A single episode of shaking chills followed by fever Chest pain on the side of the infected lung. Severe abdominal pain sometimes occurs in people with pneumonia in the
lower lobes of the lung

Cough, which may be dry at first, but eventually produces phlegm (sputum) Nausea, vomiting, and muscle aches Rapid breathing and heartbeat Shortness of breath Emergency Symptoms. Symptoms of pneumonia indicating a medical emergency include the following: Blood in sputum Bluish-toned (cyanotic) skin

 High fever Labored and heavy breathing Mental confusion or reduced mental function in the elderly Rapid heart rate Weight loss Symptoms in the Elderly. It is important to note that older people may have fewer or different symptoms than younger people. Symptoms may come on much more slowly. An elderly person who experiences even a minor cough and weakness for more than a day should seek medical help. Some elderly people may be confused, lethargic, and show general deterioration. Symptoms of Atypical Pneumonia General Symptoms of Atypical Pneumonias. Atypical pneumonia is most commonly caused by mycoplasma, Legionnaires' disease, or chlamydia and usually appears in children and young adults. The disease progresses gradually: General flu-like symptoms often occur first. They may include fatigue, fever, weakness, headache, nasal discharge, sore throat, earache, and stomach and intestinal distress. Vague pain under and around the breastbone may occur, but the severe chest pain associated with typical bacterial pneumonia is uncommon. Patients may have a severe hacking cough, but it usually does not produce sputum. IV. Pathophysiology
entry of microorganism to nasal passages

invasion of the respiratory system

Activation of Immune response (mucus production) Ineffective immune response results to overwhelming Infection Invading lung parenchyma Release of endotoxins and exotoxins Continuous mucus production Hazy portion of the chest pain Massive inflammation (pneumonia)

Cough

Dyspnea

Altered gas exchange

Consolidation

V.

Laboratory or Diagnostic Test Physical exam. During the exam, your doctor listens to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid. Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the infection. Blood and mucus tests. You may have a blood test to measure your white cell count and look for the presence of viruses, bacteria or other organisms. Your doctor also may examine a sample of your mucus or your blood to help identify the particular microorganism that's causing your illness. Management Medical

VI.

Prior to the discovery of penicillin antibiotics, bacterial pneumonia was almost always fatal. Today, antibiotics, especially given early in the course of the disease, are very effective against bacterial causes of pneumonia. Erythromycin and tetracycline improve recovery time for symptoms of mycoplasma pneumonia. They, do not, however, eradicate the organisms. Amantadine and acyclovir may be helpful against certain viral pneumonias. A newer antibiotic named linezolid (Zyvox) is being used to treat penicillin-resistant organisms that cause pneumonia. Linezolid is the first of a new line of antibiotics known as oxazolidinones. Another new drug known as ertapenem (Invanz) is reported to be effective in treating bacterial pneumonia. Nursing Management 1. 2. Monitoring vital signs Oxygen level Monitoring lung sounds Watch for edema Feeling of shortness of breath If the patient is immobile it is imperative that the patient be turned every two hours

Instruct patient to do deep breathing exercise. Continue light activities as tolerated by the patient such as: Going a short walk. Assisted if necessary Light housework if tolerated Tell the patient to avoid the following: Alcohol Caffeine Spicy foods Cheese Fatty Hot liquid Tea Soft drinks

3.