PNEUMONIA

An inflammation of the lung parenchyma caused by various microorganisms, including bacteria,

mycobacteria, fungi and viruses.

CLASSIFICATIONS:
I. Community Acquired Pneumonia - Occurs in the community or within the first 48 hours
after hospitalization or institutionalization.

TYPES:

1. Streptococcal pneumonia : A gram positive organism that resides naturally in the upper
respiratory tract; colonizes the upper respiratory tract and can cause disseminated invasive
infections, pneumonia and other lower respiratory tract infections and upper respiratory
tract infections, such as otitis media and rhinosinusitis. It may occur as a lobar or
bronchopneumonic form in patients with any age and may follow a recent respiration
illness

Risk Factors:
Younger than 60 years of age without comorbidity
60 years and older with comorbidity
Clinical Manifestation:
Abrupt onset
Toxic appearance
Pleuric chest pain :usually involves one or more lobes
Lobar infiltrate :common in chest x-ray or bronchopneumonia pattern
Diagnostic Findings:
Lobar infiltrate common on Chest x-ray or bronchopneumonia pattern

Treatment:
Medicatons: Penicillin non-resistant penicillin G, amoxicillin
Penicillin Resistant cefotaxime, ceftriaxone, fluoroquinolone

2. H. Influenzae: The presentation is indistinguishable from that of other forms of bacterial CAP
and may be subacute, with cough or low-grade fever for weeks before diagnosis.
Risk Factors:
Alcoholics
Elderly patients in long term care facilities & nursing homes
Patients w/ diabetes or COPD
Children <5 yr. of age

Clinical Manifestations:
Frequent insidious onset associated w/ Upper respiratory tract infection 2-6 wk before onset of
illess
Fever, Chills
Productive cough
Diagnostic Findings:
Bacteremia is common. Infiltrate, occasional bronchopneumonia pattern on chest x-ray
Treatment:
Non-beta lactamase producingamoxicillin, beta-lactamase producingsecond or third
generation cephalosporin, amoxicillin-clavulanate

3. Legionnaires disease (Legionella pneumophila): Highest occurrence in summer & fall. May
cause disease sporadically or as part of an epidemic.

Risk Factors:
Middle-Aged & Older men
Smokers
Patients with chronic diseases
Receiving immunosuppressive therapy
Close proximity to excavation sites
Clinical Manifestations:
Flulike symptoms
High fever
Mental confusion
Headache
Pleuritic pain
Myalgias
Dyspnea
Productive cough
Diagnostic Findings:
Hemoptysis
Leukocytosis
Bronchopneumonia, unilateral or bilateral disease
Lobar consolidation

Treatment:
Fluoroquinolone, Azithromycin

4. Mycoplasma Pnemoniae: Increase in fall and winter.
- Responsible for epidemics of respiratory illness
- Most common type of atypical pneumonia
- Accounts 20% of CAP
Risk Factors:
Children & Young Adult
During fall & winter seasons
Clinical Manifestations:
Onset is usually insidious
Patient is no usually ill
Sore throat
Nasal congestion
Headache
Low-grade fever
Pleuritic pain
Myalgias
Diarrhea
Erythematous rash

Diagnostic Findings:
Pharyngitis
Interstitial infiltrates on chest x-ray
Treatment:
Macrolide, A tetracycline

5. Viral Pneumonia (influenza viruses types A,B adenovirus, parainfluenza, cytomegalovirus,
coronavirus, varicellazoster) :
- Incidence greatest during winter and cold seasons
- Epidemics occur every 2-3 years
Risk Factors:
Most common causative agents: ADULTS
Other organisms: CHILDREN (e.g., cytomegalovirus, respiratory syncytial virus)
Cold season
Clinical Manifestations:
Gastrointestinal symptoms
Edema
Exudation
Acute upper respiratory infection (influenza)
Bronchitis
Pleurisy

Diagnostic Findings:
Patchy Infiltrate
Small pleural effusion on chest x-ray
Acute upper respiratory infection (influenza)
Treatment:
Oseltamivir or zanamivir
Treated symptomatically
Does not respond to treatment w/ currently available antimicrobials


6. Chlamydial Pneumonia : Common cause of CAP or observed in combination w/ other
pathogens.
- Mortality rate is low because the majority of cases are relatively mild.
Risk Factors:
College Students
Military recruits
Elderly
Clinical Manifestations:
Hoarseness
Fever, Chills
Pharyngitis
Rhinitis
Nonproductive cough
Myalgias
Arthalgias
Diagnostic Findings:
Single infiltrate on chest x-ray
Pleural effusion possible
Treatment:
Fluoroquinolone



II. Hospital Acquired Pneumonia Also known as nosocomial pneumonia, defined as the
onset of pneumonia symptoms more than 48 hours after admission.

TYPES:

1. Pseudomonas pneumonia (Pseudomonas aeruginosa) :Incidence greatest in those with
preexisting lung disease, cancer
-almost always of nosocomial origin
Risk Factors:
Patient who are debilitated
Altered mental status
Prolonged intubation or
With tracheostomy
Clinical Manifestation:
Toxic appearance: fever, chills, productive cough, relative bradycardia, leukocytosis
Diagnostic Findings:
Diffuse consolidation on chest x-ray
Medical or Surgical intervention or indication:
Medications: antipseudomonal betalactam plus ciprofloxacin
Levofloxacin or aminoglycoside

2. Staphylococcal pneumonia (Staphylococcal aureus) :can occur through inhalation of the
organism or spread to hematogenous route

Risk Factors:
Immunocompromised patients
IV drug users
Complication of epidemic influenza
Clinical Manifestation:
Severe hypoxemia
Cyanosis
Necrotizing infection
Diagnosis Findings:
Bacteremia is common.
Medical or Surgical intervention or indication:
Methicillin susceptible antistaphylococcal penicillin
Methicillin resistant vancomycin or linezolid

3. Klebsiella pneumonia: encapsulated gram negative aerobic bacillus

Risk Factors:
Elderly
Alcoholics
Patient with chronic disease: diabetes, heart failure,
COPD
Clinical manifestation:
Toxc apprearance: fever, cough, sputum production, bronchopneumonia, lung abscess

Diagnostic fndings:
Lobar consolidation
Bronchopneumonia pattern on chest x-ray
Medical or surgical intervention or indication:
Meropenem or levofloxacin
Piperacillin/tazobactam plus amikacin

Pneumonia in the Immunocompromised host the use corticosteroids or other
immunosuppressive agents
-increasing numbers of patient with impaired
defenses develop HAP from gram-negative bacilli

TYPES
1. Pneumocystis pneumonia
Risk factors:
Patient with AIDS
Patient receiving immunosuppressive therapy for cancer
Organ transplantation
Clinical manifestation:
Nonproductive cough
Fever
Dyspnea
Diagnostic findings:
Pulmonary infiltration on chest x-ray
Medical or surgical intervention or indication:
Trimethoprim/sulfamethoxazole (TMP-SMZ)

2. Fungal pneumonia (Aspergillus fumigatus)

Risk factors:
Immunocompromised and
Neutropenic patients
Clinical Manifestation:
Cough
Hemoptysis

Diagnostic findings:
Infiltrates
Fungus ball on chest x-ray
Medical or surgical intervention or indication:
Voriconazole or
Anidulafungin
Caspofungin
Lobectomy for fungus ball

3. Tuberculosis (mycobacterium tuberculosis)
Risk factors:
Increased in indigent
Immigrant
Prison population
People with AIDS
Homeless
Clinical Manifestation:
Weight loss
Fever
Night sweats
Cough
Sputum production
Hemoptysis


Diagnostic findings:
Nonspecific infiltrate (lower lobe)
Hilar node enlargement
Pleural effusion on chest x-ray

Medical or surgical intervention or indication:
Isoniazid plus
rifampin plus
ethambutol plus
Pyrazinamide

Pneumonia from Aspiration refers to pulmonary consequences resulting from entry of
endogenous or exogenous substances to lower airway

TYPES
1. Bacterial infection/Anerobic bacteria
(S. pneumonia, H. influenza, S. aureus) - most common form of aspiration pneumonia occur in
the community or hospital setting

Risk factors:
Dysphagia
Disorders of upper GI tract
Clinical Manifestation:
Abrupt onset of dyspnea
Low-grade fever
Cough
Diagnostic findings:
Predisposing condition for aspiration
Medical or surgical intervention or indication:
Clindamycin or
Betalactam antibiotics






NURSING DIAGNOSIS

Ineffective airway clearance related to copious tracheobronchial secretions
Activity Intolerance related to impaired respiratory function
Risk for deficient fluid volume related to fever and a rapid respiratory rate
Imbalanced Nutrition: less than body requirements
Deficient knowledge about the treatment regimen and preventive health measures


NURSNG INTERVENTIONS

Improve airway patency
Promote rest and conserving energy
Promoting fluid intake
Maintaining nutrition
Promoting patients knowledge
Monitoring and managing potential complications
Promoting Home and Community-based Care