II.
PATHOPHYSIOLOGY AND MANAGEMENT
ETIOLOGY
SIGNS & SYMPTOMS
Typical pathogen that cause community-acquired
pneumonia (CAP) include Streptococcus pneumoniae and
atypical bacteria (possibly from exposure due to Blood-tinged productive cough
DISEASE PROCESS
traveling). Sudden onset of chills
Predisposing: age of 40 yo, history of diabetes, travel Shortness of breath
history
Most CAPs(Great Britain), insustained
are bacterial back
origin and injury
often from
follow pastviral
brief Intractable back pain
vehicle
upper accidenttract infection.
respiratory Nasal congestion
Precipitating: airborne pathogenic Sore throat
Inhalation, aspiration of oropharyngeal flora, contiguous Chest pain with inspiration
Cough-associated emesis
Proliferation of microbes in the lower airways & alveoli
Rusty sputum production
Local response of alveolar epithelial cells
Inflammatory response
MANAGEMENT TO THE SPECIFIC S&S
Accumulation of neutrophils & infiltrates on the infection site
DIAGNOSTIC
Medical: OxygenEVALUATION / TOOLS
therapy, IV therapy (0.9 normal saline),
Fluid accumulation evaluation & monitoring of patient response to medications
Phsyical Respiratory Assesment: SpO2, lung auscultation,
RR,and
sputuminterventions
inspection, capillary refill
Irritation of alveolar walls with trigger cough reflex Medical Diagnostics: chest x-ray, CBC, biopsy of lung
tissues/percutaneous aspiration, sputum
Pharma: administration culture & anti-tussives,
of antibiotics,
sensitivity, sputum gram stains
Thickening of alveolar walls antipyretics
Nursing and analgesics
Diagnosis (NANDA): Ineffective Airway Clearance
r/t bronchial inflammation and increased sputum
Low exchange of CO2 and O2 Nursing:
production assesstoand
secondary CAP monitor VS,byhealth
as evidenced dyspnea,teaching on deep
chest pain, lung crackles, and purulent sputum
Hypoxia and CO2 retention breathing & cough exercises, tepid sponge bath for fever,
promote adequate fluid intake (2-3L per day) for hydration
Manifestation of clinical symptoms
MANAGEMENT
Medical:
Take medications exactly as presicribed;
- Broad spectrum antibiotics
- Ceftriaxone (1g every 12hrs for 7 days)
- Azithromycin (500mg daily for 3 days)
- Cephalosporin
- Hydrocodone/acetaminophen (5/325mg q4 PRN)
- Regular insulin
IV therapy (0.9% normal saline)
If treated:
If not treated: Oxygen therapy
Surgical:
Thoracostomy/pleurodesis, lobectomy, thoracotomy
PROGNOSIS
Nursing:
If left untreated, pneumonia can lead to serious
complications, including an increased risk of re-infection,
- Assess and monitor vital signs,
and possible permanent damage to your lungs. One
especially respiratory rate, rhythm,
complication from bacterial pneumonia is the infection
oxygen saturation (every 4hrs or as
can enter your blood stream and infect other systems in
needed).
your body.
- Provide patient with health teaching
on non-pharmacological methods to
manage symptoms including deep
breathing exercises and coughing
exercises.
- Provide and assist patient on tepid
PROGNOSIS
Improved airway patency and gas exhange
No signs or symptoms of disease progression
and further complications
Gradual recovery
Resolution
B. NARRATIVE DISCUSSION
Since the advent of antibiotics, the etiology of community-acquired
pneumonia (CAP) has evolved. Streptococcus pneumoniae, however,
continues to be the most typical reason for community-acquired
pneumonia (CAP).
It has long been believed that CAP is a lung parenchyma infection largely
brought on by bacterial or viral respiratory pathogens. In this theory,
respiratory infections spread from person to person through inhaling
aerosols or, less frequently, droplets (eg, as with Legionella or Coxiella
species). The pathogen is inhaled, colonizes the nasopharynx, and then
travels through the microaspiration to the lung alveoli. Infection happens
when there is a large enough inoculum or when the host's immune system
is weak. Inflammation and damage to the lung parenchyma are caused by
the pathogen's replication, the creation of virulence factors, and the host
immune response, which results in pneumonia.
The clinical presentation of CAP varies widely, ranging from mild
pneumonia characterized by;
- Fever
- Cough
- Shortness of breath
to severe pneumonia characterized by;
- sepsis and respiratory distress
Symptom severity is directly related to the intensity of the local and
systemic immune response in each patient. Although certain signs and
symptom such as fever, cough, tachycardia, and rales are common among
patients with CAP, these features are ultimately nonspecific and are shared
among many respiratory din. No individual symptom or constellation of
symptoms is adequate for diagnosis without chest imaging.
For the clinical evaluation and diagnostic testing of community-acquired
pneumonia, the following tools are used:
Physical Respiratory Assessment
Auscultation of lung sounds (presence of crackles)
Respiratory rate (abnormal: rales, labored)
Inspection of sputum color and consistency
Capillary refill (abnormal: more than 3 seconds)
Oxygen saturation (abnormal: 88%)
Medical Diagnostics
Complete Blood Count (CBC) – abnormal WBC count (elevated)
Chest X-ray
Biopsy of lung tissues / percutaneous aspiration
Sputum culture and sensitivity test
Gram stain of sputum
Nursing Diagnosis
Ineffective Airway Clearance related to bronchial inflammation
and increased sputum production secondary to CAP as evidenced
by dyspnea, chest pain, lung crackles, and purulent sputum
For the management of of the specific signs and symptoms of CAP; see the
following.
Medical Management:
- Conduct of oxygen therapy
- IV therapy of 0.9% normal saline
Pharmacological Management:
- Administration of medications such as
Antibiotics to kill bacteria and prevent the growth or spread to
other body areas of the body.
Antitussives to help treat coughs and congestion and provide
respiratory relief.
Antipyretics/Analgesics to help manage fever and pain.
Nursing Management:
- Assess and monitor vital signs
- Health teaching on deep breathing & cough exercises
- Tepid sponge bath for fever
- Promote adequate fluid intake (2-3L per day) for hydration
If left untreated, pneumonia can lead to serious complications, including an
increased risk of re-infection, and possible permanent damage to your lungs. One
complication from bacterial pneumonia is the infection can enter your blood
stream and infect other systems in your body.
Vice versa, if treated properly, prognosis includes Improved airway patency and
gas exhange, absence of signs or symptoms of disease progression and further
complications, gradual recovery, and resolution.
III. DISCHARGE PLANNING
DISCHARGE INSTRUCTIONS
1. Breathing warm, moist air helps loosen the sticky mucus that may make
you feel like you are choking. Other things that may also help include:
- Placing a warm, wet washcloth loosely near your nose and mouth.
- Filling a humidifier with warm water and breathing in the warm
mist.
-
2. Coughing helps clear your airways. Take a couple of deep breaths, 2 to 3
times every hour. Deep breaths help open up your lungs.
3. While lying down, tap your chest gently a few times a day. This helps bring
up mucus from the lungs.
4. Avoid smoking as well as exposure to second-hand smoke.
5. Drink plenty of liquids, as long as recommended by the health provider.
6. Get plenty of rest when you go home. If you have trouble sleeping at night,
take naps during the day.
7. Comply with the medication regimen prescribed by the health provider.
8. Do not take cough or cold medicines unless the physician says it is okay.
Coughing helps your body get rid of mucus from your lungs.
9. To prevent pneumonia in the future:
- Get a flu (influenza) shot every year.
- Ask your provider if you need to get the pneumonia vaccine.
- Wash your hands often.
References:
Matt Vera, B. S. N. (2022, June 5). Pneumonia nursing care plans and nursing
diagnosis. Nurseslabs. Retrieved November 3, 2022, from
https://nurseslabs.com/pneumonia-nursing-care-plans/
Metlay JP;Waterer GW;Long AC;Anzueto A;Brozek J;Crothers K;Cooley LA;Dean
NC;Fine MJ;Flanders SA;Griffin MR;Metersky ML;Musher DM;Restrepo
MI;Whitney CG; (n.d.). Diagnosis and treatment of adults with community-
acquired pneumonia. an official clinical practice guideline of the American
Thoracic Society and Infectious Diseases Society of America. American journal of
respiratory and critical care medicine. Retrieved November 3, 2022, from
https://pubmed.ncbi.nlm.nih.gov/31573350
Sethi, S. (2022, October 20). Community-acquired pneumonia - lung and airway
disorders. Merck Manuals Consumer Version. Retrieved November 3, 2022, from
https://www.merckmanuals.com/home/lung-and-airway-disorders/pneumonia/
community-acquired-pneumonia
Sethi, S. (2022, October 20). Community-acquired pneumonia - pulmonary
disorders. MSD Manual Professional Edition. Retrieved November 3, 2022, from
https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/
community-acquired-pneumonia
