PNEUMONIA

DEFINITION:

An inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid. OTHER NAME: Pneumonitis

CAUSATIVE AGENT:

Streptococcus Pneumoniae Staphylococcus Aureus Haemophilus Influenzae Klebsiella Pneumoniae (Friedlanders Bacilli)

ETIOLOGY
Bacteria Viruses Mycoplasmas Fungal Agents Protozoa Others: Aspiration of Foods, Fluids, or vomitus or from inhalation of toxic or caustic chemicals, smoke, dusts or gases.

RISK FACTORS

Advanced age History of Smoking Upper Respiratory Infection Tracheal Intubation Prolonged immobility Immunosuppresive Therapy Non-functional Immune system Malnutrition Dehydration Homelessness Chronic disease States (e.g. Diabetes and Heart Disease)

ANATOMICAL CLASSIFICATION OF PNEUMONIA: (base on location and radiologic

appearance)

Bronchopneumonia (Bronchial Pneumonia) Interstitial Pneumonia (Reticular Pneumonia) Alveolar Pneumonia (Acinar Pneumonia)

Necrotizing Pneumonia

Bronchopneumonia vs. Lobar Pneumonia

Microorganism inhaled to alveoli

infect type II Alveolar cells

multiply in the alveolus and invade alveolar epithelium through the pores of the Kohn.

producing inflammation and consolidation along lobar compartments

inflamed and fluid/ pus filled alveolar sacs cannot exchange Oxygen and Carbon Dioxide effectively

alveolar exudate tends to consolidate

difficulty to expectorate exudates

signs and symptoms: Sudden onset of chills with rising fever Rusty/ prune juice like color sputum Labored respiration and dyspnea increased sputum production Cough Wheezing/ rales/ Rhonchi consolidation Hypoxemia chest pain dullness

Nursing Diagnosis And Interventions

IMPAIRED GAS EXCHANGE

Titrate

Oxygen delivery rates to maintain oxygen saturation above 92% OUTCOME:

Improved

gas exchange, as evidenced by maintained oxygen saturation over 92% on decreasing amounts of inspired oxygen, having no manifestations of pallor or cyanosis retaining baseline mental status.

Nursing Interventions

INEFFECTIVE AIRWAY CLEARANCE

Increase fluid intake, teaching and encouraging effective cough and breathing techniques and frequent turning. Use incentive spirometer every 2 hours while awake. Clients w/ altered level of consciousness should be turned at least every 2 hours and should be placed in side lying position. Only thickened liquids should be given Bronchodilators OUTCOMES:

Maintain effective airway clearance as evidenced by keeping a patent airway and clearing secretions

Nursing Interventions

INEFFECTIVE BREATHING PATTERN

Raise

head of bed at 45 degree Teach patient to splint the chest wall with pillow Administer cough suppressants and analgesics CAUSIOUSLY. OUTCOMES;
Improved

breathing pattern as evidenced by 1 respiratory rate within normal 2adequate chest expansion 3clear breath sounds 4 decreased dyspnea

Nursing Interventions

ACTIVITY TOLERANCE
Teach

client to avoid conditions that increase oxygen demand, such as smoking, temperature extremes, weight gain, and stress. Pursed-Lip and diaphragmatic breathing, which improve airflow, as well as techniques to lower energy use, should be reinforced. Activities that are tiring should be interpersed with rest OUTCOMES:
Improved

activity tolerance as evidenced by ability to perform activities of daily living and a progressive increase in physical activity without dyspnea and fatigue.