Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent. place the patient at risk for microbial invasion. Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.

1. PNEUMONIA

2. • Pneumonia is an inflammation of the
lung parenchyma caused by various
microorganisms, including bacteria,
mycobacteria, fungi, and viruses.
• Pneumonitis is a more general term that
describes the inflammatory process in
the lung tissue that may predispose and
place the patient at risk for microbial
invasion.

3. Classifications
• Pneumonia is classified into four:
community-acquired pneumonia
(CAP) and hospital-acquired
pneumonia (HAP), pneumonia in
the immunocompromised host, and
aspiration pneumonia.

4. Community-Acquired Pneumonia
( CAP )
• CAP occurs either in the community setting or
within the first 48 hours after
hospitalization.
• The causative agents for CAP that needs
hospitalization include
streptococcus pneumoniae, H. influenza,
Legionella, and Pseudomonas aeruginosa.
• Only in 50% of the cases does the specific
etiologic agent become identified.
• Pneumonia is the most common cause of
CAP in people younger than 60 years of age.

5. Hospital-Acquired Pneumonia
(HAP)
• HAP is also called nosocomial pneumonia and
is defined as the onset of pneumonia symptoms
more than 48 hours after admission in patients
with no evidence of infection at the time of
admission.
• HAP is the most lethal nosocomial infection
and the leading cause of death in patients with
such infections.

6. Hospital-Acquired Pneumonia
(HAP)
• Common microorganisms that are
responsible for HAP include
Enterobacter species, Escherichia coli,
influenza, Klebsiella species, Proteus,
Serratia marcescens, S. aureus, and S.
pneumonia.
• The usual presentation of HAP is a new
pulmonary infiltrate on chest x-ray
combined with evidence of infection.

7. Pneumonia in the
Immunocompromised Host
• Pneumonia in immunocompromised
hosts includes Pneumocystis pneumonia,
fungal pneumonias and Mycobacterium
tuberculosis.
• Patients who are immunocompromised
commonly develop pneumonia from
organisms of low virulence.
• Pneumonia in immunocompromised
hosts may be caused by the organisms
also observe in HAP and CAP.

8. Aspiration Pneumonia
• Aspiration pneumonia refers to the
pulmonary consequences resulting from entry
of endogenous or exogenous substances into
the lower airway.
• The most common form of aspiration
pneumonia is a bacterial infection from
aspiration of bacteria that normally reside in
the upper airways.
• Aspiration pneumonia may occur in the
community or hospital setting.
• Common pathogens are S. pneumonia, H.influenza,
and S. aureus.

9. RISK FACTORS FOR PNEUMONIA
1. Conditions that produce mucus or bronchial
obstruction and interfere with normal lung
drainage (e.g., cancer, cigarette smoking,
COPD)
2. Immunosuppressed patients and those with a
low neutrophil count (neutropenic)
3. Smoking; cigarette smoke disrupts both
mucociliary and macrophage activity
Prolonged immobility and shallow breathing
pattern.

10. 1. Depressed cough reflex (due to medications, a
debilitated state, or weak respiratory muscles);
2. aspiration of foreign material into the lungs
during a period of unconsciousness (head
injury, anesthesia, depressed level of
consciousness), or abnormal swallowing
mechanism
3. Nothing-by-mouth (NPO) status; placement of
nasogastric, orogastric, or endotracheal tube
4. Antibiotic therapy (in very ill people, the
oropharynx is likely to be colonized by gram-
negative bacteria)

11. 1. Alcohol intoxication (because alcohol
suppresses the body’s reflexes, may be
associated with aspiration, and decreases
white cell mobilization and tracheobronchial
ciliary motion)
2. General anesthetic, sedative, or opioid
preparations that promote respiratory
depression, which causes a shallow breathing
pattern and predisposes to the pooling of
bronchial secretions and potential
development of pneumonia

12. Clinical Manifestations
• Pneumonia varies in its signs and
symptoms depending on the organism
and the patient’s underlying disease.
• However, regardless of the type of
pneumonia (CAP, HAP,
immunocompromised host aspiration), a
specific type of pneumonia cannot be
diagnosed by clinical manifestations
alone.

13. • For example, the patient with
streptococcal (pneumococcal)
pneumonia usually has a sudden
onset of shaking chills, rapidly
rising fever (38.5°to 40.5°C [101°to
105°F]), and pleuritic chest pain
that is aggravated by deep breathing
and coughing.

14. • Advanced age, because of possible
depressed cough and glottic
reflexes and nutritional depletion
Respiratory therapy with
improperly cleaned equipment

15. Tachypnea
 SOB
 Pleuritic chest pain (Deep breathing and
coughing aggravate the pain in the chest).
 Use of accessory muscles in respiration
 Loss of appetite and fatigue
 Cyanosed lips and nail beds
Purulent sputum. The sputum becomes
purulent because of the infection in the lung
parenchyma which produced sputum-filled
with pus.

17. Prevention
• It is better to prevent the occurrence of
pneumonia instead of treating the disease
itself. Here are several ways that can help
prevent pneumonia.
• Pneumococcal vaccine. This vaccine can
prevent pneumonia in healthy patients with an
efficiency of 65% to 85%.
• Staff education. To help prevent HAP, the
CDC (2004) encouraged staff education and
involvement in infection prevention.

18. Prevention
• Infection and microbiologic
surveillance. It is important to carefully
observe the infection so that there could
be an appropriate application of
prevention techniques.
• Modifying host risk for infection. The
infection should never be allowed to
descend on any host, so the risk must be
decreased before it can affect one.

19. Complications associated with
Pneumonia
• Pneumonia has several
complications if left untreated or
the interventions are inappropriate.
These are the following
complications that may develop in
patients with pneumonia.

20. Complications associated with
Pneumonia
1. SHOCK AND RESPIRATORY
FAILURE (Severe complications
of pneumonia include hypotension
and shock and respiratory failure
(especially with gram-negative
bacterial disease in elderly
patients).

21. Complications associated with
Pneumonia
2. ATELECTASIS AND
PLEURAL EFFUSION
(Atelectasis (from obstruction of
a bronchus by accumulated
secretions) may occur at any
stage of acute pneumonia)

22. SUPERINFECTION
• Superinfection may occur with
the administration of very large
doses of antibiotics, such a
penicillin, or with combinations
of antibiotics.

23. ASESSMENT & DIAGNOSTIC
• Assessment and diagnosis of
pneumonia must be accurate since
there are a lot of respiratory
problems that have similar
manifestations.
• The following are assessments and
diagnostic tests that could
determine pneumonia.

24. ASESSMENT & DIAGNOSTIC
1. History taking. The diagnosis of
pneumonia is made through history
taking, particularly a recent
respiratory tract infection.
2. Physical examination. Mainly, the
number of breaths per minute and
breath sounds is assessed during
physical examination

25. ASESSMENT & DIAGNOSTIC
1. Chest x-ray studies
2. Blood culture (bloodstream
invasion, called bacteremia, occurs
frequently) and
3. Fiberoptic bronchoscopy. May be
both diagnostic (qualitative cultures)
and therapeutic (Reexpansion of lung
segment).

26. • ABGs/pulse oximetry. Abnormalities
may be present, depending on extent of
lung involvement and underlying lung
disease.
• Bronchoscopy : Bronchoscopy is often
used in patients with acute severe
infection, patients with chronic or
refractory infection, or
immunocompromised patients when a
diagnosis cannot be made from an
expectorated or induced specimen.

27. Sputum examination.
• The sputum sample is obtained by having the
patient.
1. Rinse the mouth with water to minimize
contamination by normal oral flora.
2. Breathe deeply several times.
3. Cough deeply and
4. Expectorate the raised sputum into a
sterile container

28. The sputum sample is obtained by
having the patient.

29. Medical management
• The treatment of pneumonia
includes administration of the
appropriate antibiotic as determined
by the results of the Gram stain.

30. The management of pneumonia centers is a step-
by-step process that zeroes on the treatment of
the infection through identification of the
causative agent.
1. Blood culture. Blood culture is performed for
identification of the causal pathogen and
prompt administration of antibiotics in
patients in whom CAP is strongly suspected.
2. Administration of macrolides. Macrolides
are recommended for people with drug-
resistant S. pneumoniae.

31. • Hydration is an important part of the
regimen because fever and tachypnea
may result in insensible fluid losses.
• Administration of antipyretics.
Antipyretics are used to treat fever and
headache.
• Administration of antitussives.
Antitussives are used for treatment of
the associated cough.
• Bed rest. Complete rest is prescribed
until signs of infection are diminished.

32. • Oxygen administration. Oxygen can be
given if hypoxemia develops.
• Pulse oximetry. Pulse oximetry is used
to determine the need for oxygen and to
evaluate the effectiveness of the therapy.
• Aggressive respiratory measures.
Other measures include administration
of high concentrations of oxygen,
endotracheal intubation, and mechanical
ventilation.

34. Nursing Assessment
Nursing assessment is critical in detecting
pneumonia.
• Assess respiratory symptoms. Symptoms of
fever, chills, or night sweats in a patient
should be reported immediately to the nurse
as these can be signs of bacterial pneumonia.
• Assess clinical manifestations. Respiratory
assessment should further identify clinical
manifestations such as pleuritic pain,
bradycardia, tachypnea, and fatigue, use of
accessory muscles for breathing, coughing,
and purulent sputum.

35. • Physical assessment. Assess the changes
in temperature and pulse; amount, odor,
and color of secretions; frequency and
severity of cough; degree of tachypnea or
shortness of breath; and changes in the
chest x-ray findings.
• Assessment in elderly patients. Assess
elderly patients for altered mental status,
dehydration, unusual behavior, excessive
fatigue, and concomitant heart failure.

36. The nurse
should monitor the following:
1. Changes in temperature and pulse
2. 2. Amount, odor, and color of secretions
3. 3. Frequency and severity of cough
4. 4. Degree of tachypnea or shortness of
breath
5. 5. Changes in physical assessment
findings (primarily assessed by
inspecting and auscultating the chest)

37. The nurse
should monitor the following:
1. Changes in the chest x-ray findings
2. In addition, it is important to assess the
elderly patient for unusual behavior,
altered mental status, dehydration,
excessive fatigue, and concomitant
heart failure.

38. Nursing Management
1. Maintain a patent airway and adequate
oxygenation.
2. Obtain sputum specimens as needed.
3. Use suction if the patient can’t produce
a specimen.
4. Perform chest physiotherapy.
5. Provide a high calorie, high protein diet
of soft foods.

39. Nursing Management
1. To prevent aspiration during nasogastric tube
feedings, check the position of tube, and
administer feedings slowly.
2. Provide a quiet, calm environment, with
frequent rest periods.
3. Explain the importance of respiratory exercise
such as spirometry, deep breathing, effective
coughing, and chest physical therapy etc.
4. Monitor the patient’s ABG levels, especially if
he’s hypoxic.
5. Assess the patient’s respiratory status,
auscultate breath sounds at least every 4 hours

40. Nursing Diagnosis
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.

41. 1. Imbalanced nutrition: less than
body requirements
2. 5. Deficient knowledge about the
treatment regimen and preventive
health measure

42. Nursing Interventions
1. Improve airway patency.
2. Rest to conserve energy.
3. Maintenance of proper fluid volume.
4. Maintenance of adequate nutrition.
5. Understanding of treatment protocol and
preventive measures.
6. Absence of complications.