Causes of Pneumonia

Pneumonia An infection and/or inflammation of the interstitial tissues of the lung in which fluid, white blood cells, and cellular debris from phagocytosis of the infectious agent accumulate in the alveoli.

Incidence: Approximately 50% of all pneumonia cases are bacterial with pneumococcal pneumonia accounting for 25%–35% of all community-acquired pneumonia and approximately 40,000 deaths annually. Mycoplasma accounts for 20% of all cases of pneumonia.

Onset: Varies according to type of pneumonia.

Etiology: Causes include viruses, bacteria, fungi, and the inhalation of vomitus, food, liquid, or gases. TB and other respiratory diseases can also secondarily cause pneumonia.

Clinical Findings: Fever, productive cough, substernal pain and discomfort, shortness of breath, crackles on auscultation, increased fremitus, and dullness on percussion over affected lobe(s).

Three Types of Pneumonia
■ Primary pneumonia: Caused by inhalation or aspiration of a bacterial or viral pathogen into the lower respiratory tract.
■ Secondary pneumonia: Results from lung injury that was caused by the spread of bacteria from an infection elsewhere in the body or by inhalation of a noxious chemical, which can precipitate acquired respiratory distress syndrome (ARDS).
■ Aspiration Pneumonia: Caused by aspiration of foreign matter such as food, vomitus, or secretions into the bronchial tree. Risk factors include old age, decreased gag reflex, anesthesia and sedation, debilitation, and ALOC.

Nursing Focus
■ Position Pt to facilitate an open airway and ease breathing (HOB 30–45).
■ Encourage coughing and deep breathing every 2 hours.
■ Suction the airway to clear secretions as needed.
■ Encourage fluids as ordered.
■ If antibiotic therapy is started, closely monitor routine peak and trough levels.

Patient Teaching
■ Provide Pt and family with literature on pneumonia.
■ Explain the dosages, route, actions, and adverse reactions of meds.
■ Stress the importance of limiting activity and resting frequently to avoid fatigue.
■ Explain that combined fluid intake (liquid, soup, Jello, etc.) should be at least 3 L/day.
■ Teach Pt to eat small, frequent meals to maintain adequate nutrition.
■ Explain that prescribed coughing, deep breathing, and incentive spirometry promote healing and help prevent recurrence.
■ Provide literature on smoking cessation to Pts who smoke.
■ Advise Pts over age 65 and those in high-risk groups to receive the pneumonia vaccine.