PNEUMONIA

PNEUMONIA

- inflammation of lung parenchyma leading to pulmonary consolidation as alveoli is filled with exudates.

Etiologic agents:

1. Streptococcus pneumoniae (pnemococcal pneumonia)
2. Hemophilus pneumoniae(Bronchopneumonia)
3. Escherichia coli
4. Klebsiella P.
5. Diplococcus P.

High risk elderly & children below 5 yo

Predisposing factors:

1. Smoking
2. Air pollution
3. Immuno-compromised
1. AIDS – PLP
2. Bronchogenic CA - Non-productive to productive cough

4. Prolonged immobility – CVA- hypostatic pneumonia

5. Aspiration of food

6. Over fatigue

S/Sx:

1. Productive cough – pathognomonic: greenish to rusty sputum
2. Dyspnea with prolonged respiratory grunt
3. Fever, chills, anorexia, gen body malaise
4. Wt loss
5. Pleuritic friction rub
6. Rales/ crackles
7. Cyanosis
8. Abdominal distension leading to paralytic ileus

Sputum exam – could confirm presence of TB & pneumonia

Dx:

1. Sputum GSCS- gram staining & culture sensitivity - Reveals (+) cultured microorganism.
2. CXR – pulmo consolidation
3. CBC – increase WBC

Erythrocyte sedimentation rate

4. ABG – PO2 decrease

Nsg Mgt:

1. Enforce CBR

2. Strict respiratory isolation

3. Meds:

- Broad spectrum antibiotics

Penicillin or tetracycline

Macrolides – ex azythromycin (zythromax)

- Anti pyretics

- Mucolytics or expectorants

4. Force fluids – 2 to 3 L/day

5. Institute pulmonary toilet-

- Deep breathing exercise

- Coughing exercise

- Chest physiotherapy – cupping

- Turning & reposition - Promote expectoration of secretions

6. Semi-fowler

7. Nebulize & suction

8. Comfy & humid environment

9. Diet: increase CHO or calories, CHON & vit C

10. Postural drainage - To drain secretions using gravity

Mgt for postural drainage:

a.) Best done before meals or 2 – 4 hrs after meals to prevent Gastroesophageal Reflux

b.) Monitor VS & breath sounds

Normal breath sound – bronchovesicular

c.) Deep breathing exercises

d.) Adm bronchodilators 15 – 30 min before procedure

e.) Stop if pt can’t tolerate procedure

f.) Provide oral care – it may alter taste sensation

g.) C/I – pt with unstable VS & hemoptysis, increase ICP, increase IOP (glaucoma)

Normal IOP – 12 – 21 mmHg

11. HT:

a.) Avoidance of precipitating factors

b.) Complication: Atelectacies & meningitis

c.) Compliance to meds