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.

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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; Ventilator associated 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. Older than 65 years.

B. Become confused.

C. Breathing is rapid.

D. Blood pressure drops.

E. 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.