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Pneumonia, causes, risk factors, treatment.pdf
- 1. Pneumonia Phelan Coy, CharleneFerguson & Devika Gill
- 2. At the endof this presentation, students will be able to: Give a basic overview of Pneumonia. Define the classifications of Pneumonia. State the etiology of Pneumonia. Describe the pathophysiology of Pneumonia. List the clinical manifestations of Pneumonia. State the diagnostic tests for Pneumonia. Describe the medical management for Pneumonia. Discuss the nursing management for Pneumonia. Review a nursing care plan for a patient with Pneumonia. State possible complications of Pneumonia. Objectives
- 3. Inflammation ofthe lung parenchyma. Classified according to morphology, etiologic agent or clinical form Clinical manifestations vary on the: Etiologic agent Age Person’s systemic reaction to the infection Degree of bronchiolar obstruction Overview of Pneumonia
- 4. Occurs in differentsettings: Community-acquired pneumonia (CAP) –occurs within 48 hours after hospitalization. Hospital-acquired (nosocomial) pneumonia (HAP) – onset of symptoms more then 48 hours after admission in patients with no evidence of infection at the time of admission Pneumonia in the immuno-compromised host – caused by organism in CAP OR HAP; can also occur in immuno- competent people Aspiration pneumonia – occurs from entry of endogenous or exogenous substances into the lower airway. Occurs in community or hospital setting. Classifications of Pneumonia
- 5. Pneumonia affects yourlungs in two ways. According to areas involved : Lobar pneumonia : affects a section (lobe) of a lung. Bronchial pneumonia (Bronchopneumonia) : affects patches throughout both lungs. TYPES OF PNEUMONIA
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- 8. S. pnuemoniae( s. pneumococcus), gram positive most common young people & elderly with comorbidity. H. influenza affects elderly & those with comorbidity such as COPD, DM & alcoholism. Its subacute with cough & low grade fever. Mycoplasma pneumonia spreads by person-to person contact through air droplets & spread to the entire respiratory system. Virus – cytomegalovirus is common in immunocomprised adults. Inflammation extends to alveolar area resulting in edema & exudation Etiology - CAP causative agents:
- 9. Bacteria pneumonia-associated with mechanical ventilator or endotracheal intubation. This type is known as nosocomial pneumonia & causes the air sacs to become inflamed and filled with pus Staphylococcal pneumonia occurs through inhalation of organism or spread through hematogenous route. Overuse of antimicrobial agents should be noted Etiology - HAP causative agents
- 10. Pneumonia in immunocomprisedhost: Fungal pneumonia & mycobacterium tuberculosis can affect those on chemotherapy, nutritional depletion, use of broad spectrum antimicrobial agents, AIDS, long term MV & genetic immune disorder. Aspiration Pneumonia: Entry of endogenous or exogenous substances into lower airway e.g. bacterial infection of natural bacteria of the upper airways. Other substances can aspirated into the lungs such as gastric contents, irritating gases.
- 11. Invasion andovergrowth of microorganisms in the lung parenchyma Provokes intra-alveolar exudates Pathogen has to reach the alveoli so defenses become overwhelmed. WBC’s, mainly neutrophils fill the normally air-filled spaces. Small blood vessels of the lungs becomes leaky with protein rich fluid seeping into the alveoli. Results in a less functional area for gas exchange. It affects both ventilation and diffusion. Pathophysiology
- 12. High fever,Shaking Chills Shortness of breath (Dyspnoea) Increased breathing rate (Tachypnea) Chest pain when you breathe deeply or cough Dusky or purplish skin colour (cyanosis) from poorly oxygenated blood Fatigue and muscle aches Nausea, vomiting or diarrhoea Cough, particularly cough productive of sputum Clinical manifestations
- 13. Streptococcus pneumoniae:Rust-colored sputum. Pseudomonas, Haemophilus, and pneumococcal species: May produce green sputum. Klebsiella species pneumonia: Red currant- jelly sputum. Anaerobic infections: Often produce foul- smelling or bad-tasting sputum. Older people who have pneumonia sometimes have sudden changes in mental awareness. Clinical manifestations
- 14. History taking Physical examination Chest x-rays Blood and sputum cultures Gram stain Diagnostic tests
- 15. Most peoplecan be treated at home. If pneumonia becomes so severe that treatment is in the hospital, you may receive fluids and antibiotics, oxygen therapy, and possibly breathing treatments. Viral Pneumonia: Anti-virals like Oseltamivir (Tamiflu) and zanamivir (Relenza) Bacterial pneumonia: Patients with mild pneumonia who are otherwise healthy are treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin). Medical management
- 16. Patients withother serious illnesses, such as heart disease, chronic obstructive pulmonary disease, or emphysema, kidney disease, or diabetes are often given more powerful and/or higher dose antibiotics. Don't smoke. Practice good hygiene. Stay rested and fit. Medical management
- 17. Appropriately treatingunderlying illnesses (such as HIV/AIDS, diabetes mellitus, and malnutrition) can decrease the risk of pneumonia. Get a Pneumonia Vaccination. Medical management con’t
- 18. Conserve strength. Encourage rest to prevent exhaustion Turn and reposition frequently IV therapy Provide humidified oxygen Check SpO2 regularly Encourage chest physiotherapy Give frequent small feedings Stay hydrated. Drink plenty of fluids, especially water, to help loosen mucus in your lungs. Educate about medication adherence Nursing management
- 19. Nursing Care Plan Assessme nt DiagnosisPlanning / Goals Interventio ns Rationale Evaluatio n 25 year old male with chest pain, cough, crackles and malaise Ineffective airway clearance related to immobile mucous secretion AEB consistent coughing & pleuritic pain. Patient will be able to demonstra te effective coughing technique. Monitor patient’s vital signs, respiratory status and breath sounds. To compare base line measurem ents to maintain homeostas is. To assess for tachypnea or adventitio us sounds The patient was able to effectively demonstrat e proper coughing technique
- 20. Administer bronchoacti ve medications as ordered 0.5cc ventolin and 2.5cc normal saline. Elevate head of bed Medication aids in the dilation of the bronchiole s. For lungs expansion, mobilizati on & to relieve chest pain & provide comfort
- 21. Encourage fluid intake of 3-4L/day or warm fluidsto drink. Teach deep breathing exercises & coughing technique. To help thinning & mobilize secretion for expectoratio n To help with mobilize secretion for expectoratio n.
- 22. Assessme nt Diagnosis Plannin g / Goals Interventio ns RationaleEvaluatio n Risk for infection related to stasis of secretion. The patient will be able to prevent and reduce risks for infection. Encourage the patient to drink plenty of water to keep hydrated. Frequent hand washing or use of alcohol base hand rubs. Thorough education patient will understand that fluid helps thinning secretion for expectorati on and replace lost during fever. To prevent the spread of infection. Patient practices technique to prevent the spread of infection.
- 23. Encourage the patient to cover mouthwhile expectoratin g secretion. Explain the need to adhere to medication prescription, especially antibiotics. To help contain the mucous secretion prevent spreading infection. Noncomplian ce of antibiotic and lead to developing resistance to specific antibiotic.
- 24. Shock &respiratory failure Pleural Effusion Complications
- 25. Bono, M. (2014).Medscape. Retrieved 16 February, 2016, from http:// emedicine.medscape.com/article/1941994- medication#2 Oba, Y . (2015). Medscapecom. Retrieved 16 February, 2016, from http://emedicine.medscape.com/article/297351-overview Mosenifar, Z. (2015). Medscapecom. Retrieved 16 February, 2016, from http ://emedicine.medscape.com/article/300455-treatment Kamangar, N. (2015). Medscapecom. Retrieved 16 February, 2016, from http:// emedicine.medscape.com/article/300157-treatment Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2012). Brunner & Suddraths Textbook of Medical-Surgical Nursing (12th ed., Vol. 1). Wolters Kluwer Health References