Pneumonia: Causes, Symptoms, Treatment, and Nursing Care

What is Pneumonia

It is inflammation of the lung parenchyma, causing impaired gas exchange. It is usually caused by microorganisms which damage the lungs and cause fluid and blood cells to leak into the alveoli.

Causes of Pneumonia

• Bacteria: Common bacteria include: Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter species, Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus especially methicillin-resistant Staphylococcus aureus(MRSA)
• Viruses : Adenoviruses, rhinovirus, influenza virus (flu), Respiratory Syncytial Virus(RSV)
• Fungi : Histoplasma capsulatum, candida species, Aspergillus
• Protozoa and other microbes can cause pneumonia

Classification of Pneumonia

• By etiology - bacterial, viral, fungal, and protozoal
• By where the infection was acquired - community acquired infection, and hospital acquired infection
• Location - lobar pneumonia, and bronchopneumonia
• Other classifications - aspiration pneumonia, primary pneumonia, secondary pneumonia

Community acquired pneumonia:It occurs in the community setting or within the first 48 hours after hospitalization.

Hospital acquired pneumonia:It is also known as nosocomial pneumonia. It occurs more than 48 hours after admission in patients with no evidence of infection at the time of admission.

Clinically, pneumonia is classified into two types:

• Lobar Pneumonia - it affects one or more lobes.
• Bronchopneumonia - it involves the bronchi and bronchioles. It occurs mostly in children.

Aspiration Pneumonia:It results from aspiration of gastric secretion, food particles, and foreign matter such as vomitus in the lower airway. It is more likely to occur in the elderly, unconscious patients, patients who are unable to swallow their oral secretions amongst others.

Primary Pneumonia:This results from direct inhalation of pneumonia-causing pathogens.

Secondary Pneumonia:This is the type of pneumonia that develops by prolonged lung damage from irritants or through hematogenous spread from distant areas to the lungs.

Pathophysiology of Pneumonia

The disease process begins with an infection in the alveolar spaces. As the organism multiplies, the alveolar spaces fill with fluid, white blood cells, and cellular debris. The infection spreads from the alveoli and can involve the distal airways (bronchopneumonia) or one or more of the lobes of the lungs (lobar pneumonia).
The inflammatory process causes the lung tissue to stiffen, thus resulting in a decrease in lung compliance and an increase in the work of breathing. Diseased areas of the lungs are not adequately ventilated because of secretions and mucosal edema that causes partial occlusion of the bronchioles or alveoli with resultant decrease in alveolar oxygen tension. Venous blood therefore passes by unventilated portions of lung tissue and returns to the left atrium unoxygenated. As the arterial oxygen tension falls, the patient begins to exhibit the signs and symptoms of hypoxemia.
In addition to hypoxemia, pneumonia can lead to respiratory failure and septic shock. Infection may spread via the bloodstream and cause endocarditis, pericarditis, meningitis, or bacteraemia.

Signs & Symptoms of Pneumonia

• Pyrexia
• Chills
• Pleuritic chest pain
• Malaise, fatigue
• Shortness of breath
• Cough - may be copious, white, yellowish, green or blood-stained
• Use of accessory muscles for respiration
• Tachypnea
• Tachycardia
• Headache
• Anorexia

Bronchopneumonia

It is inflammation of the lung tissues and bronchioles, especially the terminal bronchioles. It may be caused by microorganisms, aspiration of irritants or foreign bodies. It may also occur due to precipitating factors such as pertussis, measles, malnutrition and gastroenteritis

Clinical Features of Bronchopneumonia

• Fever
• Productive cough with purulent sputum usually yellow or green in colour
• Dyspnoea
• Cyanosis
• Tachycardia
• Tachypnoea
• Loss of appetite
• Fatigue
• Nasal flaring
• Crackles and wheezes
• Vomiting
• Diarrhea

Lobar Pneumonia

It is an acute inflammation characterized by toxaemia and consolidation (solid or airless) of one or more lobes of the lungs. Changes that occur in the lobes of the lungs as a result of lobar pneumonia include: red hepatization, gray hepatization, and resolution.

Red hepatization:During this initial stage, the diseased lobe looks like a liver and is airless due to pathogen invasion. There is also an outpouring of blood from the alveoli.

Gray hepatization:Here, the diseased lung later looks grayish and the alveoli become packed with red blood cells, white blood cells, and serous fluids.

Resolution:Here, the pathogen may disappear as phagocytosis and destruction occur. Purulent secretions also develop which may be absorbed or coughed out.

Medical Management of Pneumonia

• Antibiotics
• Antivirals
• Analgesics
• Antipyretics
• Bronchodilators
• Cough mixtures or antitussives
• Oxygen therapy

Nursing Management of Pneumonia

The following are the measures to put in place in the care of a hospitalized person diagnosed of Pneumonia

1. Provide psychological support to patient and caregiver to relieve fear and anxiety
2. Put patient in a sitting up or fowler`s position
3. Maintain patent airway
4. Administer prescribed oxygen
5. Instruct patient to cover mouth and nostrils when coughing
6. Monitor vital signs especially respiratory difficulty and report
7. Ensure intake of adequate fluids to liquefy secretion
8. Encourage patient to cough out the secretions
9. Monitor fluid intake and output
10. Tepid sponge patient
11. Serve high caloric, nutritious, light, and easily digestible diet
12. Administer prescribed medications and observe for their therapeutic and side effects.
13. Provide sputum mug and ensure adequate mouth care
14. Nurse patient in a well ventilated room
15. Ensure adequate rest and sleep
16. Assist patient with activities of daily living
17. Patient should cover nose and mouth with a tissue paper when coughing or sneezing and discard the used tissue paper appropriately.

Complications of Pneumonia

1. Empyema
2. Pleural effusion
3. Lung cancer
4. Pericarditis
5. Lung abscess
6. Pneumothorax
7. Endocarditis