Pneumonia

Ventilation Disorders

  • Definition: Disorders affecting air movement in and out of the lungs through the alveoli, impacting oxygen intake and carbon dioxide expulsion.

Pneumonia

  • Definition: An acute infection of the pulmonary tissues leading to inflammation and edema in the lungs.

  • Pathophysiology:

    • Edema and inflammation cause exudates to fill the alveoli, hindering oxygen and carbon dioxide transfer.

  • Types of Pneumonia:

    • Community-acquired pneumonia (CAP): Spread within the community.

    • Healthcare-acquired pneumonia (HAP): Occurs 48 hours after hospital admission or post-operation.

    • Bacterial pneumonia: Common pathogens include Streptococcus and Staphylococcus aureus.

    • Viral pneumonia: Caused by viruses like influenza, COVID-19, or RSV.

    • Aspiration pneumonia: Results from inhalation of food or gastric contents.

Clinical Manifestations

  • Symptoms may include:

    • Cough (productive or non-productive)

    • Fever

    • Malaise/Fatigue

    • Lung sounds: Crackles due to fluid in alveoli (like blowing through a straw).

    • Elevated white blood cell count

    • Pleuritic pain

    • Diaphoresis

    • Shortness of breath (dyspnea)

    • Weakness

    • Increased heart rate

Diagnostics

  • Key diagnostic tools:

    • Chest X-ray: Reveals infiltrates or consolidation in the affected lobe.

    • Sputum Culture: Identifies bacteria or the type of pneumonia.

Treatment

  • Treatment is based on the pneumonia type:

    • Bacterial pneumonia: Administer antibiotics.

    • Viral pneumonia: No antibiotics; symptomatic treatment.

    • Aspiration pneumonia: Prophylactic antibiotics due to foreign objects.

    • Supportive treatments:

      • Antipyretics: Manage fever.

      • Analgesics: Alleviate pleuritic pain.

      • Bronchodilators: Open bronchi and assist sputum clearance.

      • Steroids: Increase airway patency.

      • Cough suppressants: Especially at night for rest.

      • Expectorants (Mucinex/Guaifenesin): Promote sputum liquefaction for easier expelling.

    • Bronchoscopy:

      • Performed for aspiration pneumonia to remove mucus or food particles; requires monitoring for bronchospasms & gag reflex post-procedure.

Respiratory Support

  • Ensuring airway support includes:

    • Rest for the patient.

    • Oxygen therapy if oxygen saturation is <90%.

    • Humidified air to prevent drying nasal passages.

    • High-volume IV fluids (3000-4000 mL) within the first 24-48 hours to loosen secretions.

    • Turn, cough, and deep breathe to facilitate lung expansion and secretion clearance.

    • Positioning:

      • High Fowler's position for optimal breathing.

Nursing Management

  • Focus on continuous assessment of:

    • Lung sounds

    • Oxygen saturation

    • Skin color

    • Cough and sputum production

  • Encourage patients to:

    • Cough into their elbow, wash hands frequently, and stay home when sick to prevent spreading pneumonia.

    • Seniors (60+) and high-risk individuals should receive pneumonia vaccinations to prevent infection.