PNEUMONIA

SUBMITTED TO:MS LISETTE CRUZ SUBMITTED BY: MS. MELY ROSE ABANADOR

Definition

Pneumonia - is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm or pus, fever, chills and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to lifethreatening. It is most serious for infants and young children, people older than age 65, and people with underlying health problems or weakened immune systems. Antibiotics and antiviral medications can treat many common forms of pneumonia

Signs and symptoms of pneumonia include:

Fever, sweating and shaking chills Lower than normal body temperature in people older than age 65, and in people with poor overall health or weakened immune systems Cough, which may produce thick, sticky fluid Chest pain when you breathe deeply or cough Shortness of breath Fatigue and muscle aches Nausea, vomiting or diarrhea Headache

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating. Older people who have pneumonia sometimes have sudden changes in mental awareness.

Causes

The most common causes of pneumonia are infections caused by:

bacteria the most common cause of pneumonia in adults

viruses often responsible for pneumonia in children mycoplasma organisms that have characteristics of bacteria and viruses that cause milder infections opportunistic organisms a threat to people with vulnerable immune systems (e.g., Pneumocystis cariniipneumonia in people who have AIDS)

Risk factors
Pneumonia can affect anyone. But the two age groups at highest risk are: Infants and children younger than age 2 years, because their immune systems are still developing People older than age 65 Other risk factors include: Certain chronic diseases, such as asthma, chronic obstructive pulmonary disease and heart disease Weakened or suppressed immune system, due to factors such as HIV/AIDS, organ transplant, chemotherapy for cancer or long-term steroid use Smoking, which damages your body's natural defenses against the bacteria and viruses that cause pneumonia Being placed on a ventilator while hospitalized

Complications
Often, people who have pneumonia can be treated successfully with medication. But some people, especially those in high-risk groups, may experience complications, including: Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure. Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus. Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a mechanical ventilator while your lung heals.

Treatments and drugs

Treatment for pneumonia involves curing the infection and preventing any complications. People who have community-acquired pneumonia usually can be treated at home with medication. Although your symptoms may ease in a few days or weeks, tiredness can persist for a month or more. Your doctor will likely recommend a follow-up chest X-ray to check that the infection is clearing. It may be safe to stop treatment even if your X-ray isn't completely normal. Only about half of chest X-rays in people with community-acquired pneumonia are normal after 28 days of treatment. Specific treatments depend on the type and severity of your pneumonia, and your age and overall health. The options include:

Antibiotics, to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. Symptoms often improve within three days, although improvement usually takes twice as long in smokers. If your symptoms don't improve, your doctor may recommend a different antibiotic. Antiviral medications, to treat viral pneumonia. Symptoms generally improve in one to three weeks. Fever reducers, such as aspirin or ibuprofen. Cough medicine, to calm your cough so you can rest. Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely.

Hospitalization
You may need to be hospitalized if:

You are older than age 65 You become confused about time, people or places Your nausea and vomiting prevent you from keeping down oral antibiotics Your blood pressure drops Your breathing is rapid You need breathing assistance Your temperature is below normal

If you need to be placed on a ventilator or your symptoms are severe, you may need to be admitted to an intensive care unit. Children may be hospitalized if they:

Are younger than age 3 months Are excessively sleepy Have trouble breathing Have low blood oxygen levels Appear dehydrated Have a lower than normal temperature

Tests and diagnosis

Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that indicate the presence of thick liquid. If pneumonia is suspected, your doctor may recommend:

Chest X-rays, to confirm the presence of pneumonia and determine the extent and location of the infection. Blood tests, to confirm the presence of infection and to try to identify the type of organism causing the infection. Precise identification occurs in only about half of people with pneumonia. Pulse oximetry, to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream. Sputum test. A sample of fluid from yours lungs (sputum) is taken after a deep cough, and analyzed to pinpoint the type of infection.

If you are older than age 65, are in the hospital or have serious symptoms or an underlying health condition, your doctor may recommend:

Pleural fluid culture. A fluid sample is taken from the pleural area and analyzed to help determine the type of infection. Bronchoscopy. A thin, flexible tube with a camera is inserted down your throat and through your airways to check whether something is blocking the airways or whether something else is contributing to your pneumonia.

If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs.

Prevention
To help prevent pneumonia:

Get a seasonal flu shot. The influenza virus can be a direct cause of viral pneumonia. Bacterial pneumonia is also a common complication of the flu. A yearly flu shot provides significant protection. Get a pneumonia vaccination. Doctors recommend a one-time vaccine against Streptococcus pneumoniae bacteria (pneumococcus) for everyone older than age 65, as well as for people of any age residing in nursing homes and long-term care facilities, and for smokers. The vaccine is especially recommended for anyone at high risk of pneumococcal pneumonia. Some doctors recommend a booster shot five years after the first dose. Have your child vaccinated. Doctors recommend a different pneumonia vaccine for all children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group day care center should also get the vaccine. Doctors also recommend seasonal flu shots for children older than six months. Practice good hygiene. To protect yourself against ordinary respiratory infections that sometimes lead to pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer. Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections. Stay rested and fit. Proper rest, a healthy diet and moderate exercise can help keep your immune system strong. Set an example. Stay home when you're sick. When you're in public and have a cold, catch your coughs and sneezes in the inner crook of your elbow.

Symptoms and Complications

Symptoms of pneumonia can vary depending on the cause of the pneumonia and the general health of the person who has pneumonia. Pneumonia almost always causes a cough, which often produces sputum. Red-brown, green, or yellow sputum may be a sign of bacterial infection. Thin, whitish sputum is a possible indicator of mycoplasma or viral pneumonia. In bacterial pneumonia, all or part of the lungs slowly fill with liquid in a process called consolidation. Some bacterial lung infections develop over just a few hours. There's usually a high fever, sometimes going up to 105F (40.9C). Other possible symptoms include:

shortness of breath shivering chills headache delirium (confusion) severe bad breath muscle pain weakness chest pain, especially when breathing deeply

blue lips and nail beds from lack of oxygen in the blood

Viral pneumonias don't actually cause the lungs to fill with liquid; instead, they inflame the actual lung tissue itself. They are usually milder than bacterial infections. An exception is the influenza virus, which can be very serious. Typically, viral pneumonia causes these symptoms:

dry cough minimal sputum

headache
muscle pain weakness and fatigue

Nursing Interventions

Rasionale
Tachypnea, shallow respirations, and asymmetric chest movement are frequently present because of discomfort of moving chest wall and/or fluid in lung.

Assess rate/depth of respirations and chest movement.

Auscultate lung fields, noting areas of decreased/absent airflow and adventitious breath sounds, e.g., crackles, wheezes.

Decreased airflow occurs in areas consolidated with fluid. Bronchial breath sounds (normal over bronchus) can also occur in consolidated areas. Crackles, rhonchi, and wheezes are heard on inspiration and/or expiration in response to fluid accumulation, thick secretions, and airway spasm/obstruction.

Elevate head of bed, change position frequently.

Lowers diaphragm, promoting chest expansion, aeration of lung segments, mobilization and expectoration of secretions.

Assist patient with frequent deep-breathing exercises. Demonstrate/help patient learn to perform activity, e.g., splinting chest and effective coughing while in upright position.

Deep breathing facilitates maximum expansion of the lungs/smaller airways. Coughing is a natural self-cleaning mechanism, assisting the cilia to maintain patent airways. Splinting reduces chest discomfort, and an upright position favors deeper, more forceful cough effort.

Suction as indicated (e.g., frequent or sustained cough, adventitious breath sounds, desaturation related to airway secretions).

Stimulates cough or mechanically clears airway in patient who is unable to do so because of ineffective cough or decreased level of consciousness.

Force fluids to at least 3000 mL/day (unless contraindicated, as in heart failure). Offer warm, rather than cold, fluids.

Fluids (especially warm liquids) aid in mobilization and expectoration of secretions.

Assist with/monitor effects of nebulizer treatments and other respiratory physiotherapy, e.g., incentive spirometer, IPPB, percussion, postural drainage. Perform treatments between meals and limit fluids when appropriate.

Facilitates liquefaction and removal of secretions. Postural drainage may not be effective in interstitial pneumonias or those causing alveolar exudate/destruction. Coordination of treatments/schedules and oral intake reduces likelihood of vomiting with coughing, expectorations.

Administer medications as indicated: mucolytics, expectorants, bronchodilators, analgesics.

Aids in reduction of bronchospasm and mobilization of secretions. Analgesics are given to improve cough effort by reducing discomfort, but should be used cautiously because they can decrease cough effort/depress respirations.

Provide supplemental fluids, e.g., IV, humidified oxygen, and room humidification.

Fluids are required to replace losses (including insensible) and aid in mobilization of secretions. Note: Some studies indicate that room humidification has been found to provide minimal benefit and is thought to increase the risk of transmitting infection.

Monitor serial chest x-rays, ABGs, pulse oximetry readings.

Follows progress and effects of disease process/therapeutic regimen, and facilitates necessary alterations in therapy.

Assist with bronchoscopy/thoracentesis, if indicated.

Occasionally needed to remove mucous plugs, drain purulent secretions, and/or prevent atelectasis.

Pneumococci organism This picture shows the organism Pneumococci. These bacteria are usually paired (diplococci) or appear in chains. Pneumococci are typically aThis ssociated with pneumonia, but may cause infection in other organs such as the brain (pneumococcal meningitis) and blood stream (pneumococcal septicemia). (Image courtesy of the Centers for Disease Control and Prevention.)

Lungs

The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged

White nail syndrome

White nail syndrome may also be called leukonychia. Leukonychia can occur with arsenic poisoning, heart disease, renal failure, pneumonia, or hypoalbuminemia.

Pneumococcal pneumonia

This is a photomicrograph of the organism that causes pneumococcal pneumonia. The bacteria are round, but join together to form chains. Frequently, these join together to form pairs and are called diplococci; the prefix di means two.

Respiratory system

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

Bronchitis is the inflammation of the bronchi, the main air passages to the lungs, it generally follows a viral respiratory infection. Symptoms include; coughing, shortness of breath, wheezing and fatigue