Pneumonia is an inflammation of the lung parenchyma that can be caused by various microorganisms including bacteria, mycobacteria, fungi and viruses. It is classified as community acquired pneumonia which occurs outside the hospital or hospital acquired pneumonia which occurs more than 48 hours after admission. Common types of community acquired pneumonia include streptococcal pneumonia, H. influenzae, Legionnaire's disease, Mycoplasma pneumoniae, and viral pneumonia. Common types of hospital acquired pneumonia include Pseudomonas pneumonia, staphylococcal pneumonia, and Klebsiella pneumonia. Nursing interventions include improving airway patency, promoting rest, maintaining fluid and nutrition intake, educating the patient, and monitoring for complications.
Pneumonia is an inflammation of the lung parenchyma that can be caused by various microorganisms including bacteria, mycobacteria, fungi and viruses. It is classified as community acquired pneumonia which occurs outside the hospital or hospital acquired pneumonia which occurs more than 48 hours after admission. Common types of community acquired pneumonia include streptococcal pneumonia, H. influenzae, Legionnaire's disease, Mycoplasma pneumoniae, and viral pneumonia. Common types of hospital acquired pneumonia include Pseudomonas pneumonia, staphylococcal pneumonia, and Klebsiella pneumonia. Nursing interventions include improving airway patency, promoting rest, maintaining fluid and nutrition intake, educating the patient, and monitoring for complications.
Pneumonia is an inflammation of the lung parenchyma that can be caused by various microorganisms including bacteria, mycobacteria, fungi and viruses. It is classified as community acquired pneumonia which occurs outside the hospital or hospital acquired pneumonia which occurs more than 48 hours after admission. Common types of community acquired pneumonia include streptococcal pneumonia, H. influenzae, Legionnaire's disease, Mycoplasma pneumoniae, and viral pneumonia. Common types of hospital acquired pneumonia include Pseudomonas pneumonia, staphylococcal pneumonia, and Klebsiella pneumonia. Nursing interventions include improving airway patency, promoting rest, maintaining fluid and nutrition intake, educating the patient, and monitoring for complications.
Pneumonia is an inflammation of the lung parenchyma that can be caused by various microorganisms including bacteria, mycobacteria, fungi and viruses. It is classified as community acquired pneumonia which occurs outside the hospital or hospital acquired pneumonia which occurs more than 48 hours after admission. Common types of community acquired pneumonia include streptococcal pneumonia, H. influenzae, Legionnaire's disease, Mycoplasma pneumoniae, and viral pneumonia. Common types of hospital acquired pneumonia include Pseudomonas pneumonia, staphylococcal pneumonia, and Klebsiella pneumonia. Nursing interventions include improving airway patency, promoting rest, maintaining fluid and nutrition intake, educating the patient, and monitoring for complications.
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PNEUMONIA
An inflammation of the lung parenchyma caused by various microorganisms, including bacteria,
mycobacteria, fungi and viruses.
CLASSIFICATIONS: I. Community Acquired Pneumonia - Occurs in the community or within the first 48 hours after hospitalization or institutionalization.
TYPES:
1. Streptococcal pneumonia : A gram positive organism that resides naturally in the upper respiratory tract; colonizes the upper respiratory tract and can cause disseminated invasive infections, pneumonia and other lower respiratory tract infections and upper respiratory tract infections, such as otitis media and rhinosinusitis. It may occur as a lobar or bronchopneumonic form in patients with any age and may follow a recent respiration illness
Risk Factors: Younger than 60 years of age without comorbidity 60 years and older with comorbidity Clinical Manifestation: Abrupt onset Toxic appearance Pleuric chest pain :usually involves one or more lobes Lobar infiltrate :common in chest x-ray or bronchopneumonia pattern Diagnostic Findings: Lobar infiltrate common on Chest x-ray or bronchopneumonia pattern
2. H. Influenzae: The presentation is indistinguishable from that of other forms of bacterial CAP and may be subacute, with cough or low-grade fever for weeks before diagnosis. Risk Factors: Alcoholics Elderly patients in long term care facilities & nursing homes Patients w/ diabetes or COPD Children <5 yr. of age
Clinical Manifestations: Frequent insidious onset associated w/ Upper respiratory tract infection 2-6 wk before onset of illess Fever, Chills Productive cough Diagnostic Findings: Bacteremia is common. Infiltrate, occasional bronchopneumonia pattern on chest x-ray Treatment: Non-beta lactamase producingamoxicillin, beta-lactamase producingsecond or third generation cephalosporin, amoxicillin-clavulanate
3. Legionnaires disease (Legionella pneumophila): Highest occurrence in summer & fall. May cause disease sporadically or as part of an epidemic.
Risk Factors: Middle-Aged & Older men Smokers Patients with chronic diseases Receiving immunosuppressive therapy Close proximity to excavation sites Clinical Manifestations: Flulike symptoms High fever Mental confusion Headache Pleuritic pain Myalgias Dyspnea Productive cough Diagnostic Findings: Hemoptysis Leukocytosis Bronchopneumonia, unilateral or bilateral disease Lobar consolidation
Treatment: Fluoroquinolone, Azithromycin
4. Mycoplasma Pnemoniae: Increase in fall and winter. - Responsible for epidemics of respiratory illness - Most common type of atypical pneumonia - Accounts 20% of CAP Risk Factors: Children & Young Adult During fall & winter seasons Clinical Manifestations: Onset is usually insidious Patient is no usually ill Sore throat Nasal congestion Headache Low-grade fever Pleuritic pain Myalgias Diarrhea Erythematous rash
Diagnostic Findings: Pharyngitis Interstitial infiltrates on chest x-ray Treatment: Macrolide, A tetracycline
5. Viral Pneumonia (influenza viruses types A,B adenovirus, parainfluenza, cytomegalovirus, coronavirus, varicellazoster) : - Incidence greatest during winter and cold seasons - Epidemics occur every 2-3 years Risk Factors: Most common causative agents: ADULTS Other organisms: CHILDREN (e.g., cytomegalovirus, respiratory syncytial virus) Cold season Clinical Manifestations: Gastrointestinal symptoms Edema Exudation Acute upper respiratory infection (influenza) Bronchitis Pleurisy
Diagnostic Findings: Patchy Infiltrate Small pleural effusion on chest x-ray Acute upper respiratory infection (influenza) Treatment: Oseltamivir or zanamivir Treated symptomatically Does not respond to treatment w/ currently available antimicrobials
6. Chlamydial Pneumonia : Common cause of CAP or observed in combination w/ other pathogens. - Mortality rate is low because the majority of cases are relatively mild. Risk Factors: College Students Military recruits Elderly Clinical Manifestations: Hoarseness Fever, Chills Pharyngitis Rhinitis Nonproductive cough Myalgias Arthalgias Diagnostic Findings: Single infiltrate on chest x-ray Pleural effusion possible Treatment: Fluoroquinolone
II. Hospital Acquired Pneumonia Also known as nosocomial pneumonia, defined as the onset of pneumonia symptoms more than 48 hours after admission.
TYPES:
1. Pseudomonas pneumonia (Pseudomonas aeruginosa) :Incidence greatest in those with preexisting lung disease, cancer -almost always of nosocomial origin Risk Factors: Patient who are debilitated Altered mental status Prolonged intubation or With tracheostomy Clinical Manifestation: Toxic appearance: fever, chills, productive cough, relative bradycardia, leukocytosis Diagnostic Findings: Diffuse consolidation on chest x-ray Medical or Surgical intervention or indication: Medications: antipseudomonal betalactam plus ciprofloxacin Levofloxacin or aminoglycoside
2. Staphylococcal pneumonia (Staphylococcal aureus) :can occur through inhalation of the organism or spread to hematogenous route
Risk Factors: Immunocompromised patients IV drug users Complication of epidemic influenza Clinical Manifestation: Severe hypoxemia Cyanosis Necrotizing infection Diagnosis Findings: Bacteremia is common. Medical or Surgical intervention or indication: Methicillin susceptible antistaphylococcal penicillin Methicillin resistant vancomycin or linezolid
Diagnostic fndings: Lobar consolidation Bronchopneumonia pattern on chest x-ray Medical or surgical intervention or indication: Meropenem or levofloxacin Piperacillin/tazobactam plus amikacin
Pneumonia in the Immunocompromised host the use corticosteroids or other immunosuppressive agents -increasing numbers of patient with impaired defenses develop HAP from gram-negative bacilli
TYPES 1. Pneumocystis pneumonia Risk factors: Patient with AIDS Patient receiving immunosuppressive therapy for cancer Organ transplantation Clinical manifestation: Nonproductive cough Fever Dyspnea Diagnostic findings: Pulmonary infiltration on chest x-ray Medical or surgical intervention or indication: Trimethoprim/sulfamethoxazole (TMP-SMZ)
2. Fungal pneumonia (Aspergillus fumigatus)
Risk factors: Immunocompromised and Neutropenic patients Clinical Manifestation: Cough Hemoptysis
Diagnostic findings: Infiltrates Fungus ball on chest x-ray Medical or surgical intervention or indication: Voriconazole or Anidulafungin Caspofungin Lobectomy for fungus ball
3. Tuberculosis (mycobacterium tuberculosis) Risk factors: Increased in indigent Immigrant Prison population People with AIDS Homeless Clinical Manifestation: Weight loss Fever Night sweats Cough Sputum production Hemoptysis
Medical or surgical intervention or indication: Isoniazid plus rifampin plus ethambutol plus Pyrazinamide
Pneumonia from Aspiration refers to pulmonary consequences resulting from entry of endogenous or exogenous substances to lower airway
TYPES 1. Bacterial infection/Anerobic bacteria (S. pneumonia, H. influenza, S. aureus) - most common form of aspiration pneumonia occur in the community or hospital setting
Risk factors: Dysphagia Disorders of upper GI tract Clinical Manifestation: Abrupt onset of dyspnea Low-grade fever Cough Diagnostic findings: Predisposing condition for aspiration Medical or surgical intervention or indication: Clindamycin or Betalactam antibiotics
NURSING DIAGNOSIS
Ineffective airway clearance related to copious tracheobronchial secretions Activity Intolerance related to impaired respiratory function Risk for deficient fluid volume related to fever and a rapid respiratory rate Imbalanced Nutrition: less than body requirements Deficient knowledge about the treatment regimen and preventive health measures
NURSNG INTERVENTIONS
Improve airway patency Promote rest and conserving energy Promoting fluid intake Maintaining nutrition Promoting patients knowledge Monitoring and managing potential complications Promoting Home and Community-based Care