Transcript PNEUMONIA - IMET2000-Pal

PNEUMONIA
Fadi J. Zaben RN MSN
Definition:
• Pneumonia is an inflammatory process,
involving the terminal airways and alveoli of the
lung, caused by infectious agents.
• The most common pneumonia-causing germ in
adults is Streptococcus pneumonia
(pneumococcus).
• Viruses are also a common cause of pneumonia,
especially in infants and young children.
Pneumonia and lungs
Pathophysiology and Etiology:
The organism gains access to the lungs through
aspiration of oropharyngeal contents, by
inhalation of respiratory secretions from infected
individuals, by way of the bloodstream, or from
direct spread to the lungs as a result of surgery or
trauma.
Types of Pneumonia:
Types according to organism causes:
Bacterial:
Streptococcus pneumonia, Staphylococcus
aureus, Klebsiella species, Legionella
pneumophila, and H. influenzae.
Atypical and Non-bacterial:
Mycoplasma pneumonia, Chlamydia trachomatis.
Viral pneumonia (Influenza viruses, Parainfluenza
viruses, Respiratory syncytial viruses, Rhinoviruses,
Adenovirus, Varicella, rubella, rubeola, herpes simplex,
cytomegalovirus, and Epstein-Barr virus).
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Fungal pneumonia.
Pneumocystis pneumonia(PCP).
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 Types according to source of cause:
 Community-acquired pneumonia (CAP):
It refers to pneumonia in people who have not recently
been in the hospital or another health care facility
(nursing home, rehabilitation facility).
 Hospital-acquired pneumonia(HAP):
It is an infection of the lungs contracted during a
hospital stay.
It called also, Nosocomial pneumonia; Ventilatorassociated pneumonia.
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 Inhalation or aspiration pneumonia:
Aspiration pneumonia occurs when breathe foreign
matter into your lungs.
Opportunistic viral, bacterial and fungal
pneumonias.
Note:
People over age 65 have a high mortality, even with
appropriate antimicrobial therapy.
Recurring pneumonia commonly indicates underlying
disease, such as cancer of the lung, multiple myeloma,
or COPD.
Risk Factors:
• Age (age 65 or older and very young children
with immune systems aren't fully).
• Certain diseases ( immune deficiency diseases
such as HIV/AIDS and chronic illnesses such as
heart disease, emphysema and other lung
diseases).
• Smoking.
• Having chronic obstructive pulmonary disease
(COPD) and using inhaled corticosteroids for
more than 24 weeks.
• Exposure to certain chemicals or pollutants.
Clinical Manifestations:
• The most common symptoms of pneumonia are:
Cough (with some pneumonias you may cough up
greenish or yellow mucus, or even bloody mucus).
Fever, which may be mild or high.
Shaking chills.
Shortness of breath (may only occur when you climb
stairs).
• Additional symptoms include:
Sharp or stabbing chest pain that gets worse when
you breathe deeply or cough.
Headache.
Excessive sweating and clammy skin.
Loss of appetite, low energy, and fatigue.
Confusion, especially in older people.
Diagnostic Evaluation:
History and physical exam.
Chest X-ray: shows presence/extent of
pulmonary disease, typically consolidation.
Gram stain and culture and sensitivity tests of
sputum: may indicate offending organism.
Blood culture: detects bacteremia (bloodstream
invasion) occurring with bacterial pneumonia.
Immunologic test: detects microbial antigens in
serum, sputum, and urine.
Chest X-ray shows an area of lung inflammation
indicating the presence of pneumonia.
Treatment:
The best approach to treating pneumonia
depends on a number of factors, including patient
age and general health, the organism or
organisms involved, and the setting where the
infection developed; community or health care.
Treatment may include:
1. Medications.
2. Admission.
3. Oxygen therapy if patient has inadequate gas
exchange
Medication :
• Antibiotics are used to treat bacterial pneumonia.
• Other medications may help improve breathing
and relieve symptoms in bacterial and viral
pneumonia.
• Medication options include:
 Antibiotics. The decision to treat pneumonia with an
antibiotic isn't always straightforward. Even with a
high likelihood of bacterial infection, it takes time to
identify the bacterium involved and choose the best
antibiotic to wipe it out.
Antivirals. Antibiotics are not effective for treating
viral pneumonia.
 Fever reducers.
 Cough medicine. Coughing helps loosen and get rid of
extra sputum.
Hospital admission :
• Community-acquired pneumonia generally
does not require hospital care.
• Patient may need to be admitted, if have any
two of these indicators of severity:
A.
B.
C.
D.
E.
Older than 65 years.
Become confused.
Breathing is rapid.
Blood pressure drops.
Need breathing assistance, including oxygen or
respiratory therapy.
Complications:
Pleural effusion.
Sustained hypotension and shock, especially in
gram-negative bacterial disease, particularly in
elderly patients.
Superinfection: pericarditis, bacteremia, and
meningitis.
Delirium; this is considered a medical emergency.
Atelectasis; due to mucous plugs.
Delayed resolution.
Lifestyle and Home:
1) Get plenty of rest.
2) Stay home from school or work until after
body temperature returns to normal and you
stop coughing up mucus.
3) Drink plenty of fluids, especially water.
Liquids keep you from becoming dehydrated
and help loosen mucus in the lungs.
4) Take the entire course of any prescribed
medications.
5) Keep all of your follow-up appointments.