Pneumonia
An inflammation
of the lung parenchyma, associated with alveolar edema and congestion that
impair gas exchange due to virus (more common in children) or bacteria
(especially Streptococcus pneumonia) and rarely fungi with symptoms including high
fever (over 1020 F), chills, headaches, muscle aches, shortness of
breath, coughing that produces phlegm (discolored yellowish or greenish or some
blood spot), increased breathing rate, and sharp chest pain is the pneumonia. During pneumonia the air sacs may be filled
with fluid or pus (purulent material), causing cough with phlegm or pus, fever,
chills, and difficulty breathing. Pneumonia
is a sixth leading cause of death overall.
When a person breathes in small droplets that contain pneumonia-causing
organisms and or when bacteria or viruses that are normally present in the
mouth, nose and throat, enter the lungs, pneumonia can occur. Viral pneumonia tends to develop slowly over
a number of days, whereas bacterial pneumonia usually develops quickly, often
over a day. With the use of antibiotics
pneumonia can usually be treated successfully at home but in some cases, it may
require hospitalization and can result in loss of life. Pneumonia vaccines are available against some
of the more common infectious agents.
Some other symptoms would also be seen in the skin, lips and
nail beds where they become dusky or bluish which indicates lungs not being
able to deliver enough oxygen to the body which is vital situation and required
urgent medical assistance.
In babies and children, symptoms may be less specific and
they may not show clear signs of a chest infection. Commonly they will have a
high fever, appear very unwell, and become lethargic. they may also have noisy
or rattly breathing, have difficulty with feeding and make a grunting sound
with breathing.
Right lung has three lobes while as the left one has two
lobes only. Pneumonia can affect all the
lungs or only one lobe and the condition are classified by the area of the lung
affected and by the cause of the infection.
Anyone can develop pneumonia, but certain groups are with
higher risk which include babies and toddlers (particularly those born
prematurely), people with recent viral infection, asthma, bronchitis,
bronchiectasis, immunocompromised, swallowing, or coughing problem following
stroke or brain injury, smokers, drinkers, people aged above 65, etcetera.
Diagnosis
Upon suspicion of pneumonia the doctor will take a medical
history and will conduct a physical examination. During the examination the
doctor will listen to the chest with a stethoscope. Coarse breathing, crackling
sounds, wheezing and reduced breath sounds in a particular part of the lungs
can indicate pneumonia.
Confirmed diagnosis is made via chest x-ray where the affected
lung area by the pneumonia can be seen.
Blood
tests along with the sputum sample be tested in laboratory.
Pathophysiology of pneumonia
Pneumonia can be transmitted with inhalation of airborne microbe from
an infected individual. However, in many cases, pneumonia are attributable to
self-infection with one or more types of microbes that are present in the nose
and mouth. In healthy people, typical upper airway there is a presence of
bacteria such as Streptococcus pneumoniae (“pneumococcus”) and Hemophilus influenzae
which are culprit for most common bacteria causing community-acquired
pneumonia. Hospital-acquired pneumonia is usually caused by more resistant
bacteria, such as Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas
aeruginosa, and Escherichia coli.
Individuals with an extreme low immune system become susceptible to
pneumonia caused by so-called “opportunistic” microbes, such as certain fungi,
viruses, and bacteria related to tuberculosis (mycobacteria), that would not
ordinarily cause disease in normal individuals.
To cope with its constant exposure to potentially infectious microbes,
the lung depends on a hierarchy of defense mechanisms. Physical mechanisms that
can prevent microbes from reaching the alveoli include the structure of the
upper airway, the branching of the bronchial tree, the sticky mucus layer
lining the airways, the hair-like cilia that propel mucus upward, and the cough
reflex. The microbes that do manage to reach the alveoli are usually destroyed
by a variety of immune cells, which is why most pneumonias occur in people with
one or more deficiencies in either their mechanical or immune defense
mechanisms.
Treatment
Most cases of pneumonia can be treated at home but untreated
pneumonia could complicate to
hypoxemia, respiratory failure, pleural effusion, empyema, lung abscess, and
bacteremia. However, babies,
children, elderly people, and people with severe pneumonia may need hospital
admit. Pneumonia is usually treated with
antibiotics, irrespective of viral pneumonia as there might be a degree of
bacterial infection. The type of antibiotic used and the way it is given will
be determined by the severity and cause of the pneumonia. Mostly, azithromycin and cefixime is
antibiotic of choice. Home treatment
would include antibiotics by mouth, pain killer, paracetamol and proper rest
while as hospital treatment would use IV antibiotics, oxygen therapy (in case
of low O2), intravenous fluid (to hydrate in case of dysphagia) and
physiotherapy (to clear sputum from lungs).
Recovery
Severe weeks is required for full recovery from Pneumonia
for clearance of sputum from lung. Some
fatigue and reduced exercise tolerance may also be experienced. In case of worsened cough and fever lasting
several weeks a doctor consultation is required and smokers should to have a
chest x-ray after six weeks to confirm complete clearance of the lungs.
Prevention
Prevention is always better than cure as, person cured are not healthy as
person prevented. Breastfeeding baby (bossing
immune system), smoking cessation, making home warm and well-ventilated,
vaccination for pneumococcal disease, whooping cough, haemophilus influenza and
influenza, good hand hygiene, avoiding contact with patient with cold and flu
would be some steps that could be taken for prevention from pneumonia.
Nursing
Care Plans
Nursing care for patients with pneumonia should include supportive measures
like humidified oxygen therapy for hypoxemia, mechanical ventilation for respiratory failure, a high calorie diet and adequate
fluid intake. Interventions should include bed rest and analgesic to relieve
pleuritic chest pain.
Nursing care plan for pneumonia
should include these major eight issues:
- Ineffective Airway Clearance. Inability to clear secretions or obstructions from the
respiratory tract to maintain a clear airway.
- Ineffective Breathing Pattern/ Impaired Gas Exchange
- Risk for Deficient Fluid Volume
- Risk for Imbalanced Nutrition: Less Than
Body Requirements
- Acute Pain
- Activity Intolerance
- Risk for Infection
Nursing
Interventions
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Rationale
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Assess the rate and depth of
respirations and chest movement.
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Tachypnea, shallow respirations,
and asymmetric chest movement are frequently present because of discomfort of
moving chest wall and/or fluid in lung.
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Auscultate lung fields, noting
areas of decreased or absent airflow and adventitious breath sounds:
crackles, wheezes.
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Decreased airflow occurs in areas
with consolidated fluid. Bronchial breath sounds can also occur in these
consolidated areas. Crackles, rhonchi, and wheezes are heard on inspiration
and/or expiration in response to fluid accumulation, thick secretions, and
airway spasms and obstruction.
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Elevate head of bed, change
position frequently.
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Doing so would lower the diaphragm
and promote chest expansion, aeration of lung segments, mobilization and
expectoration of secretions.
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Teach and assist patient with
proper deep-breathing exercises. Demonstrate proper splinting of chest and
effective coughing while in upright position. Encourage him to do so often.
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Deep breathing exercises
facilitates maximum expansion of the lungs
and smaller airways. Coughing is a reflex and a natural self-cleaning
mechanism that assists the cilia to maintain patent airways. Splinting
reduces chest discomfort and an upright position favors deeper and more
forceful cough effort.
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Suction as indicated: frequent
coughing, adventitious breath sounds, desaturation related to airway
secretions.
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Stimulates cough or mechanically
clears airway in patient who is unable to do so because of ineffective cough
or decreased level of consciousness.
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Force fluids to at least 3000
mL/day (unless contraindicated, as in heart failure).
Offer warm, rather than cold, fluids.
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Fluids, especially warm liquids,
aid in mobilization and expectoration of secretions.
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Assist and monitor effects of
nebulizer treatment and other respiratory physiotherapy: incentive spirometer,
IPPB, percussion, postural drainage. Perform treatments between meals and
limit fluids when appropriate.
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Nebulizers and other respiratory
therapy facilitates liquefaction and expectoration of secretions. Postural
drainage may not be as effective in interstitial pneumonias or those causing
alveolar exudate or destruction. Coordination of treatments and oral intake
reduces likelihood of vomiting with coughing, expectorations.
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Administer medications as
indicated: mucolytics, expectorants, bronchodilators, analgesics.
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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 and depress respirations.
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Provide supplemental fluids: IV.
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Room humidification has been found to provide minimal benefit and is thought to increase the
risk of transmitting infection.
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Monitor serial chest x-rays, ABGs,
pulse oximetry readings.
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Followers progress and effects of
the disease process, therapeutic regimen, and may facilitate necessary
alterations in therapy.
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Assist with bronchoscopy and/or
thoracentesis, if indicated.
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Occasionally needed to remove
mucous plugs, drain purulent secretions, and/or prevent atelectasis.
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Urge all bedridden and
postoperative patients to perform deep breathing and coughing exercises
frequently.
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To promote full aeration and
drainage of secretions.
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