Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Respiratory Module:Respiratory Module:

PneumoniaPneumonia

Respiratory Infection: Respiratory Infection: ClassificationClassification

Upper respiratory infection:Upper respiratory infection:Affects nasopharynx, larynx, trachea: Affects nasopharynx, larynx, trachea: Common cold (rhinitis), pharyngitis, Common cold (rhinitis), pharyngitis, laryngitis, tracheitislaryngitis, tracheitis

Lower respiratory infectionLower respiratory infection: : Affects the bronchi and lungs: Affects the bronchi and lungs: Bronchitis, bronchiolitis, pneumonia Bronchitis, bronchiolitis, pneumonia

PneumoniaPneumonia

Pneumonia: DescriptionPneumonia: Description

Inflammation of the lung alveoliInflammation of the lung alveoliBroncho-pneumoniaBroncho-pneumonia::Infection / inflammation around the Infection / inflammation around the terminal bronchi and bronchioles (more terminal bronchi and bronchioles (more prevalent in infants and the elderly due to prevalent in infants and the elderly due to ineffective cough)ineffective cough)LobarLobar PneumoniaPneumonia: : Infection/ inflammation consolidates one or Infection/ inflammation consolidates one or more whole lobes of the lungmore whole lobes of the lung

Pneumonia: ClassificationPneumonia: Classification

Community-acquiredCommunity-acquired

Hospital-acquired (nosocomial) Hospital-acquired (nosocomial)

Pneumonia in an immuno-compromised Pneumonia in an immuno-compromised hosthost

Aspiration PneumoniaAspiration Pneumonia

Pneumonia: Aetiology/ Pneumonia: Aetiology/ Most Common Pathogens Most Common Pathogens

Community-acquiredCommunity-acquired::

Pneumococcus (Strep Pneumoniae)Pneumococcus (Strep Pneumoniae)

Haemophylus Influenzae (HIB)Haemophylus Influenzae (HIB)

Hospital-acquiredHospital-acquired ( (NosocomialNosocomial):):

PseudomonasPseudomonas

Staphylococcus Aureus (MRSA)Staphylococcus Aureus (MRSA)

Pneumonia: Aetiology/Pneumonia: Aetiology/Most Common Pathogens Most Common Pathogens

Immuno-compromisedImmuno-compromised hosthost (AIDS (AIDS patient, patient undergoing chemotherapy, patient, patient undergoing chemotherapy, radiation, post-transplant): radiation, post-transplant): Tuberculosis (TB) Tuberculosis (TB) Pneumocystis Carinii Pneumocystis Carinii AspirationAspiration Pneumonia Pneumonia (secretions from (secretions from upper respiratory tract infection or inhaled upper respiratory tract infection or inhaled vomit (acid/ chemical pneumonia) or FB:vomit (acid/ chemical pneumonia) or FB:Pneumococcus, HIB, Staph Aureus Pneumococcus, HIB, Staph Aureus

Pneumonia: Aetiology/Pneumonia: Aetiology/Pre-disposing Risk FactorsPre-disposing Risk Factors

ImmobilityImmobilityPost-operative atelectasis and super-Post-operative atelectasis and super-imposed infectionimposed infectionUpper respiratory infectionUpper respiratory infectionOld age (and infancy)Old age (and infancy)SmokingSmokingCompromised immune responseCompromised immune responseChronic Obstructive Airways DiseaseChronic Obstructive Airways Disease

Pneumonia: Pneumonia: Clinical ManifestationsClinical Manifestations

Dyspnoea, tachypnoea, orthopnoeaDyspnoea, tachypnoea, orthopnoeaCough (productive but may be dry if the Cough (productive but may be dry if the patient is dehydrated: requires hydration to patient is dehydrated: requires hydration to loosen and expectorate viscous sputum)loosen and expectorate viscous sputum)Purulent sputum may be tinged with bloodPurulent sputum may be tinged with bloodCyanosisCyanosisPyrexia, tachycardia, rigors, sweatingPyrexia, tachycardia, rigors, sweatingPain especially with lobar, over affected Pain especially with lobar, over affected lobe and also pleuritic pain on inspiration lobe and also pleuritic pain on inspiration

Pneumonia: DiagnosisPneumonia: Diagnosis

Chest Xray: AP and lateralChest Xray: AP and lateral

Sputum sample for culture and sensitivitySputum sample for culture and sensitivity

Blood cultureBlood culture

CBC (WCC ↑ if normal immune response)CBC (WCC ↑ if normal immune response)

ABG ABG

Pulse oximetryPulse oximetry

Pneumonia: ManagementPneumonia: Management

Bed rest, upright position (lung expansion) Bed rest, upright position (lung expansion) Humidified O2Humidified O2Bronchodilator via nebuliserBronchodilator via nebuliserMucosolvantMucosolvantIV fluidsIV fluidsIV antibioticsIV antibioticsAnti-pyreticsAnti-pyreticsAdequate pain relief (especially with lobar) Adequate pain relief (especially with lobar) Chest physio (includes postural drainage)Chest physio (includes postural drainage)

Pneumonia: Pneumonia: Nursing ConsiderationsNursing Considerations

O2 and bronchodilator via nebuliserO2 and bronchodilator via nebuliserAssist chest physio Assist chest physio IV fluids (oral as tolerated) IV fluids (oral as tolerated) IV antibiotics/ antipyretics (tepid sponging)IV antibiotics/ antipyretics (tepid sponging)Emotional supportEmotional supportAdequate pain relief Adequate pain relief Frequent mouth care, change positionFrequent mouth care, change positionMonitor vital signs, fluid balance, pulse Monitor vital signs, fluid balance, pulse oximetry, ABGoximetry, ABG

Pneumonia: PreventionPneumonia: Prevention

Adequate restAdequate restHealthy diet including vitamin CHealthy diet including vitamin CAvoid smokingAvoid smokingAvoid crowded places Avoid crowded places Avoid droplet spread of pathogensAvoid droplet spread of pathogensIsolation of immuno-compromised patientsIsolation of immuno-compromised patientsIf immobile deep breathing exercisesIf immobile deep breathing exercisesVaccination of the vulnerable in population Vaccination of the vulnerable in population (HIB, Pneumococcus)(HIB, Pneumococcus)