Pneumonia

Pneumonia

Definition: Infection and/or inflammation of interstitial lung tissues in which fluid, white blood cells, and cellular debris from phagocytosis of infectious agent accumulate in alveoli. Incidence: Approximately 50% of all pneumonia cases are bacterial; pneumococcal pneumonia accounts for 25%–35% of all community-acquired pneumonia cases and ~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 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 bacterial or viral pathogen into lower respiratory tract. ■ Secondary Pneumonia: Results from lung injury caused by spread of bacteria from infection elsewhere in body or by inhalation of noxious chemical, which can precipitate ARDS. ■ Aspiration Pneumonia: Caused by aspiration of foreign matter such as food, vomitus, or secretions into 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 degrees). ■ Encourage coughing and deep breathing every 2 hours. ■ Suction 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 dosages, route, actions, and adverse reactions of meds. ■ Stress the importance of limiting activity and of resting frequently to avoid fatigue. ■ Explain that combined fluid intake (liquid, soup, Jell-O, 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 _65 years old and those in high-risk groups to receive the pneumonia vaccine.