pneumonia

Prepared by-:Dr / amany lotfy

Definition :- Asthma is an intermittent, reversible, obstructive airway disease, it ismanifested by a narrowing of airway resulting in dyspnea, cough and wheezing.

Asthma can begin at any age about half of the cases develop in childhood and anther third before age 40.

Asthma is often characterized as allergic, idiopathic Or mixed

The Patient with Asthma & Status Asthmaticus

ExerciseStress or emotional upset

Medications Aspirin and non steroid anti-inflammatory chugs

(NSAlDs), beta-blockers (including eye drops), cholinergic drugs (to promote bladder contraction and as eye drops for glaucoma). Enzymes- including those in laundry detergents..

'Chemicals- toluene and others used in solvents, paints, and plastics

Common factors triggering asthmatic attacks

The common symptoms of asthma are cough, dyspnea & wheezing.

Asthma attacks frequently occur at night.

Attacks starts suddenly with coughing & a sensation of tightness in thechest.

Cyanosis secondary to sever hypoxia.Symptoms of carbon dioxide retention

- sweating, tachycardia.

Clinical manifestations

Un Status asthmatics occurs in which therapeutic measures fail &thepatient has repeated attacks or continuous asthma.

Allergic reaction eczema, urticaria, edema.

Clinical manifestations

1-Acomplete history. 2 -Reaction skin test.

3-Assessment of environmental factors, including seasonal changes, mold and pollens. Climate changes.

4-Occupation- related chemicals & compounds (metal salts, wood & vegetable dust, pharmacological a gents, industrial chemicals, biologic enzymes - including laundry detergents 5-

5-Chest X-ray .6 -Sputum examination.' Pulmonary function

studies

Diagnostic evaluation

There are five categories of drugs used in the treatment of asthma:

Beta antagonist brortchodilatots:eg pinephrine .Methylxanthines - bronchodilator e.g aminophylline

Ant cholinergic - broncho-dilatition effect e.g. tropine.Corticosteroids - reduce inflammation & broncho-

constrictione.g. hydrocortisone prednisone.5- Mast cell inhibitors: broncho-dilatition g.cromolyn sodium.

Drug therapy

Assessment :-ASSESS THE PATIENT RFOR-: History of asthma onset & duration

Precipitating factorsCurrent medications

Medications used to relieve asthma symptomsAny recent changes in medication regimen,

Self-care methods used to relieve symptoms:Assess General appearance.

Assess vital signs.Assess laboratory findings.

Nursing Process.

Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid

Pneumonia

Classification according to the causative agent:

*1 '-Bacterial pneumonia (common streptococcus;)

Viral Pneumonia2 -Mycoplasma Pneumonia3 -

4-Aspiration pneumonia's syndrome

5-Chemical pneumonia, after ingestion of kerosene or irritation gases

Pneumonia

Risk factor/groups :Patients with conditions that produce

bronchial obstruction - cancer

Immunosuppressed patients Smokers

Bed ridden patientsVery ill patients who are on nothing by

mouth ,Over dose of sedatives- respiratory depression

Associated with congestive heart failure diabetes, alcoholism

Classification ◦1.1 Early classification schemes◦1.2 Combined clinical classification 1.2.1 Community-acquired pneumonia

1.2.2 Hospital-acquired pneumonia

Pneumonia

A lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Lobar pneumonia is often due to Streptococcus pneumonia (though Klebsiella pneumonia is also possible.)

Multilobar pneumonia involves more than one lobe, and it often causes a more severe illness.

Early classification schemes-:

pneumonia by clinical characteristics, dividing :them into

1"-acute" (less than three weeks duration)

Streptococcus pneumonia2" -chronic" pneumonias.

Combined clinical classification

is infectious pneumonia in a person who has not recently been hospitalized.

Streptococcus pneumonia is the most common cause of community-acquired pneumonia

Community-acquired pneumonia

called Nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission.

Hospital-acquired pneumonia

risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances.

Hospital-acquired pneumonia

1 -Pneumonia arises from aspiration of flora present in the oropharynx. & blood borne organisms that enter the pulmonary circulation

2-An inflammatory reaction can occur in the alveoli, producing exudates that affect on ventilation 3-White blood cells, mostly neutrophils, migrate into the alveoli. Areas of the lung are not adequately ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli

Pathophysiology :

4 -Venous blood entering the pulmonary circulation to the left side of the heart poorly oxygenated. The mixing of oxygenated and unoxygenated blood eventually results in arterial hypoxemia.

Pathophysiology:

PneumoniaClinical manifestations:

1-Cough producing greenish or yellow sputum, 2- high fever that may be accompanied by shaking chills. 3- Shortness of breath4- pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by them .

5 - cough up blood ,6-headaches ,or develop sweaty and clammy skin.7- Other symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood

swings, and joint pains or muscle aches .

1-Medical interventionDiagnosis:- patient's symptoms and

findings from physical examination, chest X-ray and blood tests are helpful, and sputum cultures chest CT scan or other tests may be needed to distinguish pneumonia from other illnesses. A complete blood count indicating the presence of an infection or inflammation, in some people with

immune system problems

Management:

1-Administration of appropriate antibiotics as Penicillin

Typically, oral antibiotics, rest, fluids, and home care

2-people with other medical problems and the elderly may need

treatment that is more advanced. 3-If the symptoms worse, the pneumonia

does not improve with home treatment, or complications occur, the person will often have to be hospitalized.

Pneumonia

Prevention 1-treating underlying illnesses (such as AIDS) 2-Smoking cessation 3-Testing pregnant women for

Group B Streptococcus and Chlamydia trachomatis, and then giving antibiotic treatment

4 Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia.

5-Vaccination is important for preventing pneumonia in both children and adults. Vaccinations against Haemophilus influenza and Streptococcus pneumonia in the first year of life.

Assessment:.

- The nurse should monitor the following:

• Changes in temperature and pulse • Amount, odor, and color of secretions • Frequency and severity of cough • Degree of Tachypnea or shortness of breath • Changes in physical assessment findings

(primarily assessed by inspecting and auscultation the chest)

•Changes in the chest x-ray findings

Nursing Process:

NURSING DIAGNOSES Based on the assessment data, the patient’s

major nursing diagnose smay include: - •1- Ineffective airway clearance related to

copious tracheobronchial secretions •2- Activity intolerance related to impaired

respiratory function • 3-Risk for deficient fluid volume related to

fever and dyspnea • 4-Imbalanced nutrition: less than body

requirements •5-Deficient knowledge about the treatment

regimen and preventive health

Planning and Goals :-The major goals for the patient may

include 1- improved airway patency, rest to conserve energy,

2- maintenance of proper fluid volume, maintenance of adequate nutrition, 3- an understanding treatment protocol and preventive measures, 4- absence of complications.

Nursing Interventions:-   1- IMPROVING AIRWAY PATENCY 2- PROMOTING REST AND CONSERVING

ENERGY. 3- PROMOTING FLUID INTAKE 4- MAINTAINING NUTRITION 5- PROMOTING THE PATIENT’S

KNOWLEDGE 6- MONITORING AND MANAGING

POTENTIAL COMPLICATIONS 7 -PROMOTING HOME AND COMMUNITY-

BASED CARE &Teaching Patients Self-Care.

EXPECTED PATIENT OUTCOMES a -Has normal vital signs, pulse oximetry,

and arterial blood gas measurements b. Reports productive cough that

diminishes over time c. Has absence of signs or

symptoms of shock, respiratory failure, or pleural effusion

d. Remains oriented and aware of surroundings

e. Maintains or increases weight 8. Complies with treatment protocol and

prevention strategies.