PNEUMONIA
Ns. Vika Endria, M.Kep
OBJECTIVE
1.Recall the signs and symptoms of pneumonia
2.Describe the management of bacterial and Viral pneumonia
3.Summarize the nursing diagnosis of pneumonia
4.Discuss the prevention of bacterial pneumonia
PNEUMONIA
ü Inflammation of one or both lung's
parenchyma that is more often caused by
infections.
ü Decrease respiratory tract defence
mechanisms
Bacteria
Viruses
Fungi
parasites
RESPIRATORY TRACT DEFENCE
RISK FACTOR
Certain people are more likely to get pneumonia:
• Adults 65 years or older
• Children younger than 5 years old
• People who have ongoing medical conditions
• People who smoke cigarettes
TYPE S PNEUMONIA
CAUSE
The most common causes of community- The most common causes of HCAP and HAP are MRSA
acquired pneumonia (CAP) is S. pneumoniae (methicillin-resistant Staphylococcus aureus) and
followed by Klebsiella pneumoniae, S. aureus, Pseudomonas aeruginosa respectively.
and Pseudomonas aeruginosa.
HAP
ASSESSMENT AND DIAGNOSTIC
• Clinical : It includes taking a careful patient history and performing a thorough physical examination to
judge the clinical signs and symptoms mentioned above.
• Laboratory : This includes lab values such as complete blood count with differentials, inflammatory
biomarkers like ESR and C-reactive protein, blood cultures, sputum analysis or Gram staining and/or
urine antigen testing or polymerase chain reaction for nucleic acid detection of certain bacteria.
• Radiological : It includes chest x-ray as an initial imaging test and the finding of pulmonary infiltrates
on plain film is considered as a gold standard for diagnosis when the lab and clinical features are
supportive
Physical findings vary from patient to patient and mainly
depend on the severity of lung consolidation and existence
or nonexistence of pleural effusion.
CLINICAL
Major history findings:
Major clinical findings:
• Fever with tachycardia and/or chills and sweats.
• Increased respiratory rate.
• The cough may be either nonproductive or
productive with mucoid, purulent or blood- • Percussion sounds vary from flat to dull.
tinged sputum. • Tactile fremitus.
• Pleuritic chest pain, if the pleura is involved.
• Crackles, rales, and bronchial breath sounds are heard on
• Shortness of breath with normal daily routine
work. auscultation.
Other symptoms include fatigue, headache,
myalgia, and arthralgia.
Terdapat Infiltrat baru atau
infiltrat progresif ditambah
dengan 2 atau lebih gejala di
bawah ini :
• Batuk-batuk bertambah
• Perubahan karakteristik dahak / purulen
• Suhu tubuh > 380C (aksila) / riwayat demam
• Pemeriksaan fisis : ditemukan tanda-tanda
konsolidasi, suara napas bronkial dan ronki
• Leukosit > 10.000 atau < 4500
CURB-65
If the total of the score is 2 or more than 2, it
indicates hospital admission. If the total is 4 or
more than 4, it indicates ICU admission.
Recommended therapy for different settings
are as follows:
Outpatient Setting: For patients having comorbid
conditions ( e.g., diabetes, malignancy, etc.) the
regimen is "fluoroquinolone" or "beta-lactams +
macrolide." For patients with no comorbid
conditions, we can use "macrolide" or
"doxycycline" empirically. Testing is usually not
performed as the empiric regimen is almost always
successful.
Inpatient Setting (non-ICU): Recommended
therapy is fluoroquinolone or macrolide + beta-
lactam.
Inpatient setting (ICU): Recommended therapy is
beta-lactam + macrolide or beta-lactam +
fluoroquinolone.
Pneumonia Severity Index
MANAGEMENT
üWhen a pneumonia is left untreated, it carries a mortality in excess of
25%.
üPneumonia can also lead to extensive lung damage and lead to
residual impairment in lung function.
üOther reported complications of pneumonia that occur in 1-5% of
patients include lung abscess, empyema, and bronchiectasis
MEDICAL
MANAGEMENT
Penatalaksanaan berupa terapi antibiotik dan suportif.
ü Terapi suportif dengan pemberian cairan untuk mencegah
dehidrasi serta elektrolit dan nutrisi. Selain itu juga dapat
diberikan anti piretik jika dibutuhkan serta mukolitik.
ü Pemberian antibiotik diberikan secara empirik dan harus
diberikan dalam waktu kurang dari 8 jam.
ü Alasan pemberian terapi awal dengan antibiotik empirik adalah
karena keadaan penyakit yang berat dan dapat mengancam
jiwa, membutuhkan waktu yang lama jika harus menunggu
kultur untuk identifikasi kuman penyebab serta belum dapat
dipastikan hasil kultur kuman merupakan kuman penyebab
CAP.
VIRAL PENUMONIA
The cornerstone of treatment of viral pneumonia consists of the following: Supportive Care
• The first priority of supportive care is to maintain oxygenation as needed. This may entail nasal
cannula, noninvasive airway, or mechanical ventilation.
• The second priority of supportive care is to maintain hydration either via supervised oral intake or
intravenous fluids.
• The third priority of supportive care is to maintain rest and decrease oxygen demand.
• A final priority of supportive care is to meet the increased calorie needs of the patient, secondary
to the increased respiratory effort.
NURSING MANAGEMENT
Nursing priorities for patients with pneumonia:
üIImproving airway patency
ümproving tolerance to activity
üMaintaining proper fluid volume
üMeasures to prevent complications
Assess for subjective and Assess for factors related to the Management
objective data: cause of pneumonia:
ü Obtain blood work and check
ü Changes in rate, depth of ü Alteration of patient’s cultures
respirations O2/CO2 ratio and hypoxia
ü Abnormal breath sounds ü Decreased lung expansion ü Hydrate the patient
(rhonchi, bronchial lung and fluid-filled alveoli Administer antibiotics as ordered
sounds, egophony) ü Inflammatory process, ü Keep patient comfortable and warm
ü Use of accessory muscles tracheal and bronchial ü Perform suction as required
ü Dyspnea, tachypnea inflammation, edema
ü Cough, effective or ineffective; formation, increased sputum ü Measure ins and out
with/without sputum production Manage pain and cough
production ü Pleuritic pain and alveolar- ü Promote nutrition
ü Cyanosis capillary membrane changes Administer oxygen as needed
ü Decreased breath sounds over ü Altered oxygen-carrying ü Provide rest
affected lung areas capacity of blood/release at
ü Teach patient hand washing
ü Ineffective cough cellular level
ü Purulent sputum ü Altered delivery of oxygen
ü Hypoxemia and hypoventilation
ü Infiltrates seen on chest x-ray ü Collection of mucus in
film airways
ü Reduced vital capacity
NURSING GOAL
Goals and expected outcomes may include:
ü Patient will demonstrate improved ventilation and oxygenation of tissues by ABGs within the patient’s
acceptable range and absence of symptoms of respiratory distress.
ü Patient will maintain optimal gas exchange.
ü Patient will participate in actions to maximize oxygenation.
ü Patient will identify/demonstrate behaviors to achieve airway clearance
ü Patient will display/maintain a patent airway with breath sounds clearing; absence of dyspnea cyanosis, as
evidenced by keeping a patent airway and effectively clearing secretions.
• Lama pemberian antibiotik secara oral maupun intravena minimal 5 hari dan tidak terdapat demam selama
48-72 jam.
• Sebelum terapi dihentikan pasien dalam keadaan sebagai berikut: tidak memerlukan suplemen oksigen
(kecuali untuk penyakit dasarnya) dan tidak memiliki lebih dari satu tanda-tanda ketidakstabilan klinik
seperti: Frekuensi nadi > 100 x/menit Frekuensi napas > 24 x/menitTekanan darah sistolik ≤ 90 mmHg
• Setelah mendapatkan perbaikan dengan antibiotik intravena pada pasien rawat inap maka jika terapi
secepatnya diganti ke oral dengan syarat; hemodinamik stabil, gejala klinis membaik, dapat minum obat per
oral dan fungsi gastrointestinal baik
• Pasien akan dipulangkan jika dalam waktu 24 jam tidak ditemukan salah satu dibawah ini :
Suhu>37,80C
Nadi > 100 menit
Frekuensi napas > 24/ minute
Distolik < 90 mmHg
saturasi oksigen < 90%
tidak dapat makan per oral
DISCHARGE PLANNING
• Get vaccinated against pneumococcus and influenza
• Eat healthy
• Ambulate
• Wash hands
• Follow up with a clinician Exercise regularly
Prevention
CONCLUSION
ü The management of pneumonia is with an interprofessional team. The reason is that most patients are
managed as outpatients but if not properly treated, the morbidity and mortality are high.
ü Besides the administration of antibiotics, these patients often require chest physical therapy, a dietary
consult, physical therapy to help regain muscle mass and a dental consult. The key is to educate the patient
on the discontinuation of smoking and abstaining from alcohol.
REFERENCE
• Ashurst JV, Dawson A. 2023.StatPearls Publishing; Treasure Island (FL): Jan 30, 2023. Klebsiella Pneumonia. [PubMed: 30085546]
• Bin, S., Sattar, A., Sharma, S., Headley, A., & Hosp, J. (2023). Bacterial Pneumonia ( Nursing ).
• Bozoky, G., & Ruby, E. (2019). Community-acquired pneumonia as a cause of sepsis. Trends in Medicine, 19(3), 1–4.
https://doi.org/10.15761/tim.1000185
• CDC. (2023). An infection of lungs, acsess https://www.cdc.gov/pneumonia/
• Free, R. C., Richardson, M., Pillay, C., Hawkes, K., Skeemer, J., Broughton, R., Haldar, P., & Woltmann, G. (2021). Specialist pneumonia
intervention nurse service improves pneumonia care and outcome. BMJ Open Respiratory Research, 8(1), 1–6.
https://doi.org/10.1136/bmjresp-2020-000863
• Grief SN, Loza JK.(2018) Guidelines for the Evaluation and Treatment of Pneumonia. Prim Care. Sep;45(3):485- 503. [PMC free article:
PMC7112285] [PubMed: 30115336]
• Martin-Loeches, I., Torres, A., Nagavci, B., Aliberti, S., Antonelli, M., Bassetti, M., Bos, L., Chalmers, J., Derde, L., de Waele, J., Garnacho-
Montero, J., Kollef, M., Luna, C., Menendez, R., Niederman, M., Ponomarev, D., Restrepo, M., Rigau, D., Schultz, M., … Wunderink, R. (2023).
ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Medicine, 49(6), 615–
632. https://doi.org/10.1007/s00134-023-07033-8
• Yasuhiro Yamaguchi. (2023). Pneumoni in elder people. The university of Tokyo hospital. https://www.h.u-tokyo.ac.jp/english/about-us/news-
letter/details/1187757_1993.html
