 Pneumonia is an acute infectious

disease caused by pneumococcus,

associated by general toxemia and a
consolidation of one or more lobes of
either one or both lungs. It is an
inflammation of the lungs caused by
infectious agent in which air sacs are
filled with pus or exudates so that air
is excluded and the lungs become
solid.
 Bacteriacommonly enter the lower airway but
do not cause pneumonia in the presence of
intact host defense mechanism (Smeltzer &
Bare, 2005). Often pneumonia begins after an
upper respiratory tract infection (an infection of
the nose and throat). The incubation period
ranges from one to three days with sudden
onset of shaking chills, rapidly rising fever and
stabbing chest pains aggravated by coughing
and respiration. The disease is transmitted
through droplet infection or through indirect
contact.
 It is also called Pneumonitis or
Bronchopneumonia. Pneumonia can be a
serious threat to our health. Although
pneumonia is a special concern for older
adults and those with chronic illnesses, it can
also strike young, healthy people as well. It
is a common illness that affects thousands of
people each year in the Philippines, thus, it
remains an important cause of morbidity and
mortality in the country. Worldwide, it's a
leading cause of death in children, many of
them younger than a year old.
 There are many kinds of pneumonia that range
in seriousness from mild to life-threatening. In
infectious pneumonia, bacteria, viruses, fungi
or other organisms attack your lungs, leading to
inflammation that makes it hard to breathe.
Pneumonia can affect one or both lungs. In the
young and healthy, early treatment with
antibiotics can cure bacterial pneumonia. The
drugs used to fight pneumonia are determined
by the germ causing the pneumonia and the
judgment of the doctor. It’s best to do
everything we can to prevent pneumonia, but if
one do get sick, recognizing and treating the
disease early offers the best chance for a full
recovery.
 Pneumonia is not a single disease. It can
have over 30 different causes. There are five
main causes of pneumonia:
Bacteria
Viruses
Mycoplasmas
Other infectious agents, such as fungi
Various chemicals
 Classically, pneumonia has been
categorized into one to four categories:
bacterial or typical, atypical,
anaerobic/cavitary, and opportunistic.
However, there is overlap in the
microorganisms thought to be
responsible for typical and atypical
pneumonia.
 Pneumonia is sometimes classified
according to where and how the client s
exposed to the disease:
COMMUNITY ACQUIRED PNUEMONIA

HOSPTAL- ACQUIRED PNUEMONIA

PNEUMONIA IN THE
IMMUNOCOMPROMISED HOST

ASPIRATION PNEUMONIA
A case with a diagnosis of Pneumonia
may catch one’s attention, though the
disease is just like an ordinary cough and
fever, it can lead to death especially when
no intervention or care is done. Treating
patients with pneumonia is necessary to
prevent its spread to others and make
them as another victim of this illness.
Anatomy and
Physiology
 and
Pathoph
ysiology
 -
Pathophysiology o
-pathology
Streptococcus pneumoniae
 Physical
Assessmen
t and
Review of
Systems
P.A & R.S
Diagnost
ic Test
DT-1

DT-2
Pharmacol
ogy/
Medication
Drug study
 Nursing
Care Plan
NCP's
 Medical-
Surgical
Manageme
nt
Discharge
Plan and
Health
Education
Plan
Medication
 Exercise
 Deep breathing exercises and therapy to
clean secretions help prevent the occurrence
of pneumonia in people at high risk, such as
those who have chest or abdominal surgery
and those immune suppressed. People with
pneumonia also need to clear secretions and
benefit from deep breathing exercises and
therapy as well. Instruct patient to inhale
through nose and exhale through mouth.
Advice them to exercise frequently especially
every morning.
Deep Breathing Exercise
 Instruct the client to assume sitting position.
 Place the client’s palm on the border of the
client’s rib cage to assess respiratory depth.
 Ask the client to inhale slowly and evenly through
the nose until the greatest chest expansion is
achieved.
 Instruct the client to hold his/her breath for 2 – 3
seconds.
 Then instruct the client to exhale slowly through
the mouth.
 Instruct the client to continue exhalation until
maximum chest contraction has been achieved.
Coughing Exercise
 Instruct the client to cough voluntarily after
a few deep inhalations.
 Ask the client to inhale deeply, hold the
breath for a few seconds, and then cough,
once or twice.
 Ensure that the client coughs deeply and
does not just clear the throat.
Early Ambulation
 Encourage the client to have walking as
an exercise since it improves circulation.
 Walking should be done as it is tolerated
by the client.
 Therapy
 If people with pneumonia are short of breath or
their blood is low in oxygen, supplemental
oxygen or oxygen therapy is provided. Monitor
the effectiveness of oxygen therapy (e.g. pulse
oximetry, ABGs) as appropriate. Although rest
is an important part of treatment, moving often
and getting out of bed and into a chair are
encouraged. Another is included is anti-
infective therapy instruct patient to continue
taking the drug as prescribed even he/she feels
better.
Hydration
 Necessary since fever and tachypnea
results to insensible fluid losses.
 Instruct the client to increase fluid intake to
3000 ml/day (if the pt. has no
contraindications) since it facilitates mucous
secretion.
Steam Inhalation (a method of administering drugs for
local or systemic effects through the respiratory tract
by use of steam as a medium; it loosens secretions
and relieve coughing and also softens thick, tenacious
mucus)
 This is done by the health care provider with the
doctor’s order.
 Prepare the equipments & fill the water jar from ½ to
2/3 full and place the prescribed drug.
 Cover the eyes of client with face or bath towel.
 Connect the inhaler cone to the steam outlet of the
apparatus and convey steam from the free and of the
cone to the client’s nose, instructing to inhale vapors
until the prescribed time.
 Disconnect the plug and removed and then document
the time and treatment given as well as the patient’s
reaction.
Percussion (forceful striking of the skin with cupped
hands)
 Cover the area with a towel or gown to reduce
discomfort.
 Ask the client to inhale deep slowly and deeply
exhale to promote relaxation.
 Alternate flex and extend the wrist rapidly to slap
the chest.
 Percuss each affected lung segment for 1 to 2
minutes
 Avoid percussion on the breasts, sternum, spinal
column, & kidneys.
Vibration (a series of vigorous quivering
produced by hands that is placed flat against
the client’s chest wall; used after percussion
to increase the turbulence of the exhaled air
& thus, loosen thick secretion)
 Place hand, palms down, on the chest area to be
drained, one hands over the other with the fingers
together and extended. Alternatively, the hands may
be placed side by side.
 Ask the client to inhale deeply and exhale slowly
through the nose or pursed lips.
 During the exhalation, tense all the hands and arm
muscles, and using mostly the heel of the hand,
vibrate (shake) the hands, moving then downward.
Stop the vibrating when the client inhales.
 Vibrate during five exhalations over one affected lung
segment.
 After each vibration, encourage the client to cough
and expectorate secretions into the sputum container.
Postural Drainage (drainage by gravity of
secretions from various lung segments)
 Before postural drainage, the client may be
given a bronchodilator medication or
nebulization therapy to loosen secretion
 The best times include before breakfast,
before lunch, in the late afternoon, and
before bedtime.
 Assess the patient’s vital signs first.
 The sequence of PVD is usually as follows:
Positioning, Percussion, Vibration, &
Removal of secretions by coughing or
suction.
 Each position is usually assumed 10 – 15
minutes.
 Following PVD, the nurse should
auscultate the client’s lungs. Compare the
findings to baseline data, and document
the amount, color, and character of
expectorated secretions.
Oxygen Therapy at Home
 For home oxygen use, teach the family
members and roommates to smoke only
outside or provided smoking rooms away from
the client.
 Place cautionary signs reading “No Smoking:
Oxygen in Use” on the client’s door, at the foot
or head of the bed, and on the oxygen
equipment.
 Instruct the client and visitors about the hazard
of smoking with oxygen use.
 Make sure that electric devices are in good
working order to prevent the occurrence of
short-circuit sparks.
 Avoid materials that generate electricity, such
as woolen blankets and synthetic fibers.
Cotton blankets should be used, and clients
and caregivers should be advised to wear
cotton fabrics.
 Avoid the use of volatile, flammable,
materials, such as oils, greases, alcohol,
acetone near clients receiving oxygen.
Health Teaching
 Educate the client and family the
avoidance of upper respiratory tract
infections and viruses. Instruct the client to
avoid crowds (especially in the fall and
winter when viruses are prevalent),
people who have a cold or flu, and
exposuse to irritants such as smoke. An
annual influenza vaccine is recommended,
one every five years.
 To continue the proper administration of
antibiotics
 Teach patient about side effects of drugs
 Encourage patient breathing exercise to promote
secretion clearance and volume expansion
 Instruct patient to avoid stress, fatigue, sudden
changes in temperature, and excessive intake of
alcohol, all of which lower resistance to
pneumonia
 Instruct patient to have adequate nutrition and
rest
Vaccination

-The vaccine for older adults is called

pneumococcal polysaccharide (PPV).
 Pneumococcal vaccine (Pneumovax,
Prevnar) prevents Streptococcus
pneumoniae.

-Vaccination with the chickenpox vaccine

(varicella-zoster vaccine) can prevent most
cases of pneumonia caused by the virus that
causes chickenpox.
 Vaccination of children for measles can prevent
most cases of measles. Adults may need to be
vaccinated against measles if they have not
had the disease or were not vaccinated during
childhood.
 Flu vaccine prevents pneumonia and other
problems caused by the influenza virus. It
must be given yearly to protect against new
viral strains.
 Hib vaccine prevents pneumonia in children
from Haemophilus influenzae type b.
Promoting Healthy Breathing (Instruct the
client to practice the following)
 Sit straight and stand erect to permit full
lung expansion.
 Exercise regularly.
 Breathe through the nose.
 Breathe in to expand the chest fully.
 Do not smoke cigarettes, cigars, pipes.
 Eliminate or reduce the use of household
pesticides and irritating chemical agents.
 Do not incinerate garbage in the house.
 Avoid exposure o second-hand smoke.
 Make sure furnaces, ovens, and wood
stoves are correctly ventilated.
 Support pollution-free environment.
Controlled and Huff Coughing
 After using a bronchodilator, treatments (if
prescribed) instruct the client to inhale deeply
and hold his/her breath for a few seconds.
 Cough twice. The first cough loosens the
mucus, the second expels the secretions.
 For huff coughing, lean forward and exhale
sharply with a “huff” sound. This technique
helps keep your airways open while moving
secretions up and out of the lungs.
 Inhale by taking rapid short breaths in
succession (“sniffing”) to prevent mucus
from moving back into smaller airways.
 Rest.
 Try to avoid prolonged episodes of
coughing because these may cause fatigue
and hypoxia.
 Using Cough Medications

 Use of metered-dose inhaler

 OPD Visit
 Review all drugs with the client or family
and emphasize completing anti-infective
therapy. Instruct the client to notify the
health care provider if chills, fever, cough,
dyspnea, wheezing, hemoptysis,
increased sputum production, chest
discomfort or ireversing fatigue recurs or if
symptoms fail to resolve.
 Instruct the patient to return to the clinic or
caregiver’s office for a follow-up chest x-
ray and physical examination
 Young infants and 12 months to 5 years-
follow up after 2 days
 Diet
 Encouraged to drink fluids, aids in the liquefaction
or respiratory secretions.
 Small, frequent, nutritionally balanced meals.
 Respiratory treatment that promotes coughing
should be avoided immediately before and after
meals to prevent nausea and vomiting associated
with vigorous coughing.
 Encourage intake of fruits rich in Vitamin C such as
citrus & oranges.
 The mineral zinc may help reduce the risk
of pneumonia in children. Zinc can be
found in certain foods (lean red meats,
seafood, beans, and cereals) or added to
the diet in supplements. Studies in
developing countries found that the
incidence of pneumonia in children
dropped when zinc was added to the diet.
 Spirituality
 Encourage patient to have spiritual
enhancement such as meditation, singing
and prayer. Before the patient will be
discharged pray for them. And provide
spiritual emphasise such as bible
passages found in Jeremiah 33:3.
Prognosis
 Most pneumonias are treated successfully,
especially if antibiotics are started early.
Pneumonia can be fatal; the very old and frail,
especially those with multiple other medical
conditions, are most vulnerable. With
treatment, most types of bacterial pneumonia
can be cleared within two to four weeks. Viral
pneumonia may last longer, and mycoplasmal
pneumonia may take four to six weeks to
resolve completely. In cases where the
pneumonia progresses to blood poisoning (
bacteremia), just over 20% of sufferers will die.
The death rate (or mortality) also depends on
the underlying cause of the pneumonia.
 Pneumonia caused by Mycoplasma, for
instance, is associated with little mortality.
However, about half of the people who
develop methicillin-resistant Staphylococcus
aureus (MRSA) pneumonia while on a
ventilator will die.In regions of the world
without advanced health care systems,
pneumonia is even deadlier. Limited access to
clinics and hospitals, limited access to x-rays,
limited antibiotic choices, and inability to treat
underlying conditions inevitably leads to
higher rates of death from pneumonia.