Introduction:

Pneumonia is an inflammation of the lung parenchyma characterized by consolidation of the affected part, the alveolar air spaces being filled with exudate, inflammatory cells, and fibrin. Pneumonia is due to infection by bacteria or viruses, inhalation of chemicals, trauma to the cell wall, and at least to fungi, rickettsiae, yeast, and helminths. The distribution of pneumonia may be lobar, segmental, or lobular when lobular and associated with bronchitis, it is called bronchopneumonia.

Definition:

Pneumonia is an inflammation of lung parenchyma which is associated with a marked increase in interstitial and alveolar fluid.

Causes of Pneumonia:

1: Bacterial Infection

Gram +ve

Streptococcal pneumonia 

Streptococcal aurious

Gram -ve

H.influenza 

Anaerobic bacteria 

Pseudomonas

2:Viral infection

Influenza virus

Adenovirus 

Parainfluenza virus 

3:Fungus infection

Candidiasis 

Histoplasmosis

4:Mycoplasma and protozoa in AIDS

Classification of Pneumnonia:

1:Communityy Acquired Pneumonia

It occurs in normal healthy persons

Bacterial infection

Viral infection 

2:Hospital Acquired Pneumonia

It occurs either when immunity is weak or in lung disorders or anatomical abnormal lungs.

Types Of Pneumonia:

1:Segmental Pneumonia:

Only in one small segmental lobes of lungi

2:Bilateral Pneumonia:

Both side segmental lobes of the lungs are affected

3:Lobar Pneumonia:

Complete lobe affected.

4:Bronochopneumonia:

Patchy-like formation in the lungs.

Risk Factors:

Continuous smoking 

Cold weather

URI(upper respiratory infection)

AIDS(Acquired Immuno Deficiency Syndrome)

Malnutrition and dehydration

Aspiration of food, fluid, vomitus.

Inhalation of toxic, Chemicals, gases

Chronic diseases:

Diabetes mellitus

Lung diseases 

Cancer 

Heart diseases

Renal diseases

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Altered consciousness level

Alcoholism

Head injury

Seizures disorders

Drug overdose

General anesthesia 

Immune suppressive therapy, e.g, Corticosteroid.

Signs and Symptoms of Pneumonia:

Chills

Sweating

Cough

Cyanosis

Dyspnoea

Rapid pulse 

Haemoptysis 

Pallor skin 

Hot skin

Sputum production 

Pleuritic pain 

Increase respiratory rate

Low oxygen saturation

Headache

Fatigue

Fever(high in bacterial infection)

Dull sound produce on percussion

Diagnostic Evaluation of Pneumonia:

Sputum for culture and sensitivity

Chest x-ray 

Bronchoscopy

Cracked sound 

Mantoux test

ABG analysis

Complications of Pneumonia:

Atelectasis(due to mucous plugs)

Pleural effusion 

Superinfection (pericarditis, meningitis)

Medical Management of Pneumonia:

Prevention of pneumonia by vaccination 

Use of antibiotic therapy for treatment e.g,

Erythromycin

Cephalosporin

Amikacin 

Ampicillin

Ceftriaxone

Bronchodilators are used 

Analgesics for chest pain ,e.g,nimuslide, paracetamol.

Nursing management of pneumonia:

We should encourage the patient to take plenty of fluid provide warm liquids.

Provide drugs as prescribed bronchodilators, anticholinergics, leukotriene, antagonists, methylxanthines, and inflammatory.

Provide humidification, room humidifier.

Monitor ABGs pulse oximetry to detect hypoxia.

Provide humidification,(room humidifier)

Monitor ABGs, pulse oximetry to detect hypoxia

Provide fowlers or semi fowler position to expand lung properly and relieve dyspnea.

Assess the color of the mucus membrane or skin to detect cyanosis.

Administer supplemental O2 as indicated.

Maintain adequate hydration and nutrition to improve resistance to disease and reduce the risk of infection.

Administer antimicrobials agents as prescribed.

Nursing Diagnosis of Pneumonia:

• Ineffective airway clearance related to alveolar inflammation, edema formation, sputum production, pleuritic pain.
• Impaired gas exchange related to hypoventilation(altered O2 supply), inflammation of alveoli.
• Risk for infection related to immunosuppression, chronic disease, inadequate ciliary action to defenses.
• Activity intolerance related to hypoxia, or imbalance O2 supply and demands, fatigue.
• Acute pleuritic pain related to inflammatory process in lung parenchyma, chronic and persistent coughing.
• Imbalance nutrition less than body requirements related to anorexia, sputum production, fever, bronchodilators treatment, odor, and taste of sputum.
• Risk for deficient fluid volume related to increased fluid loss due to fever diaphoresis, mouth breathing.
• Deficient knowledge related to a disease condition.
• Ineffective breathing pattern related to decreasing lung expansion (fluid accumulation lungs) and inflammatory process.
• Anxiety-related to disease.

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