This lecture is all about Pneumonia | Lecture notes Nursing

PNEUMONIA

Definition:a lower respiratory tract

infection that causes inflammation of the

alveoli sacs

Key Players:

Germs:Bacteria, Virus, Fungi

Lung Parenchyma: Alveoli, Alveolar

Ducts, and Bronchioles (the trio in gas

exchange)

Process of normal gas exchange: oxygen is

inhaled through theupper respiratory

systemdown throughtrachea,

the"bronchus (right and left primary

bronchi)which splits at thecarinaand

enters into the lungs at thehilum"and

branchesinto the

Secondary Bronchi (also called

Lobar Bronchi)

Tertiary Bronchi (also called

Segmental Bronchi)

then into smaller branches

called"bronchiolesto thealveolar ductsto

thealveolar sacswhich inflate and deflate

to allow gas exchange.

During this process, there is the transfer

of oxygen from inhalation into the

bloodstream and transfer of carbon dioxide

out of the blood through the lungs which is

exhaled. This happens in the alveoli

capillary wall. Then the fresh oxygenated

blood is taken back to theheartthrough the

pulmonary vein and is pumped through the

heart to the body.

How does Pneumonia develop?

Normally, the respiratory system can “fight

off” these type of germs by filtering the air

taken in through the nose and

airwayBUTcertain conditions can damage

the body’s ability to do this and make the

body more susceptible to developing PNA.

These risk factors include:

Prior infection: flu or cold

Weak immune system: Elderly, infants,

HIV, autoimmune medications

Immobile: strokes or any other

condition that causes decrease mental

awareness or restrict ability to move

Lung problems: COPD, asthma,

smokers

Post-opt patient: not coughing deep

breathing

These germs get into the lungs

byinhalation, aspiration, or from the

blood and attack the alveoli sacs. These

sacs become very inflamed and fill with

fluid, body’s immune defense cell RBCs and

WBCs, and bacteria.

This causes the sac to lose the ability to

inflate and deflate which allows proper gas

exchange. Therefore, the patient will start to

experienceHYPOXEMIA (low oxygen in

the blood)because oxygen cannot transfer

across capillary wall to attach to RBCs to

supply the body with oxygen and the body

keeps the CO2 (carbon dioxide) which leads

toRESPIRATORY ACIDOSIS!

Arterial Blood Gase Values due to

Respiratory Acidosis:

ABGs: PO2: <90 mmHg

pH: lower 7.35 mmHg

PCO2: higher than 45 mmHg

**To compensate for this the Kidneys

start to conserve bicarbonate (HCO3)

to hopefully increase the blood’s pH

back to normal…..so HCO3 becomes

>26 mEq/L

Germs that Cause Pneumonia:

Bacteria: most common cause of

pneumonia especially in community-

acquired is caused

by"Streptococcus"pneumoniae

Atypical Bacteria:

Mycoplasma"pneumoniaethat

causes “walking pneumonia” which is

a milder form of pneumonia that isn’t

severe enough to require complete

bed rest

Virus: influenza, RSV most common

causes of PNA in children

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PNEUMONIA

Definition: a lower respiratory tract infection that causes inflammation of the alveoli sacs Key Players:  Germs: Bacteria, Virus, Fungi  Lung Parenchyma: Alveoli , Alveolar Ducts , and Bronchioles (the trio in gas exchange) Process of normal gas exchange: oxygen is inhaled through the upper respiratory system down through trachea , the bronchus (right and left primary bronchi) which splits at the carina and enters into the lungs at the hilum and branches into the  Secondary Bronchi (also called Lobar Bronchi)  Tertiary Bronchi (also called Segmental Bronchi) then into smaller branches called bronchioles to the alveolar ducts to the alveolar sacs which inflate and deflate to allow gas exchange. During this process , there is the transfer of oxygen from inhalation into the bloodstream and transfer of carbon dioxide out of the blood through the lungs which is exhaled. This happens in the alveoli capillary wall. Then the fresh oxygenated blood is taken back to the heart through the pulmonary vein and is pumped through the heart to the body. How does Pneumonia develop? Normally, the respiratory system can “fight off” these type of germs by filtering the air taken in through the nose and airway BUT certain conditions can damage the body’s ability to do this and make the body more susceptible to developing PNA. These risk factors include:  Prior infection: flu or cold  Weak immune system: Elderly, infants, HIV, autoimmune medications  Immobile: strokes or any other condition that causes decrease mental awareness or restrict ability to move  Lung problems: COPD, asthma, smokers  Post-opt patient: not coughing deep breathing These germs get into the lungs by inhalation, aspiration, or from the blood and attack the alveoli sacs. These sacs become very inflamed and fill with fluid, body’s immune defense cell RBCs and WBCs, and bacteria. This causes the sac to lose the ability to inflate and deflate which allows proper gas exchange. Therefore, the patient will start to experience HYPOXEMIA (low oxygen in the blood) because oxygen cannot transfer across capillary wall to attach to RBCs to supply the body with oxygen and the body keeps the CO2 (carbon dioxide) which leads to RESPIRATORY ACIDOSIS! Arterial Blood Gase Values due to Respiratory Acidosis:  ABGs: PO2: <90 mmHg  pH: lower 7.35 mmHg  PCO2: higher than 45 mmHg  **To compensate for this the Kidneys start to conserve bicarbonate (HCO3) to hopefully increase the blood’s pH back to normal…..so HCO3 becomes

26 mEq/L Germs that Cause Pneumonia:  Bacteria : most common cause of pneumonia especially in community- acquired is caused by Streptococcus pneumoniae  Atypical Bacteria: Mycoplasma pneumoniae that causes “walking pneumonia” which is a milder form of pneumonia that isn’t severe enough to require complete bed rest  Virus : influenza, RSV most common causes of PNA in children

 Fungi : least common…most likely to affect people with severe suppressed immune system and typically is contracted from outside in nature from plants, animals etc. Types of Pneumonia  Community-acquired Pneumonia (most occurring): patient obtains the germs that causes the pneumonia OUTSIDE of the healthcare system hence in the community.  Hospital-acquired Pneumonia : patients who are on mechanical ventilation at major risk… it is hard to treat because the bacteria tend to be resistant to antibiotics and more likely a bacteria cause. Criteria: patient must have developed 48-72 hours after admission Diagnosed:  Notice: abnormal lungs sound when auscultating with stethoscope may hear coarse crackles, rhonchi (type of wheezing) or bronchial breath sounds which should be noted only in the tracheal area and this represents lung consolidation.  Chest x-ray, sputum culture Signs & Symptoms of Pneumonia Nmemonic: PNEUMONIA P roductive cough, P leuritic pain (chest pain that is caused by coughing, breathing etc.) N euro changes (especially ELDERLY patients… may not even have a fever but fatigue and increased respiratory rate) E levated labs : PCO2 >45 (retaining carbon dioxide because it can’t pass capillary of alveoli sac), increased WBC (represents infection…body is trying to fight infection off) U nusual breath sounds: coarse crackles, rhonchi, or bronchial in the peripheral lung fields M ild to high Fever (bacteria cause produces highest fever ….. greater than 104’F) O xygen saturation decreased (want >90%) will need supplementary oxygen N ausea and vomiting (won’t feel like eating) I ncrease heart rate and respirations A ching all over with joint pain , A ctivity intolerance with shortness of breath Nursing Interventions for Pneumonia Monitor respiratory system:  Lung Sounds  Respiratory rate/vital signs  Oxygen Saturation >95%  ABGS (if ordered)  Sputum (collect for culture)  Suction as needed  Encourage usage of incentive spirometer for deep breathing and encourage coughing and deep breathing  Encourage 2-3 L of fluid (unless on fluid restriction as with patients who have heart failure)…fever causes dehydration, lose water through breathing (300-400 mL), and patient is too sick to have the urge to drink  Education on prevention: Up-to-date Vaccinations (Pneumovax every 5 years for patients 65+ and 19-64 years old with risk factors and annual flu shot)  Education about stop smoking , avoid people who are sick, hand-washing  Keeping head of bed elevated greater than 30 degree for immobile patients to prevent aspiration especially while eating and after meals along with frequent turning.  Breathing treatments and other respiratory therapy treatments

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PNEUMONIA