Causes for the development of pneumonia are intrinsic and extrinsic. Extrinsic factors include exposure to the causative agents and pulmonary injury. Whereas intrinsic factors are related to the host. Bacteria from the upper airways spread into the lung’s parenchyma, thereby invading delicate lung tissues. As a result, air sacs become inflamed, causing coughs, fever, chills, and breathing problems in the host. Because of this, patient immunity is minimized, disabling the system from fighting diseases like HIV. This is why most HIV-positive patients die of pneumonia.
Pneumonia develops in the human system once neutrophils from capillaries find their way into the lung’s air sacs. This leads to the formation of a neutrophil pool, which in turn kills microbes using the reactive oxygen species and antimicrobial proteins. This produces a chromatin meshwork known as a Neutrophil Extracellular Trap, which thereafter traps and kills extracellular bacteria. NET is known as the immune system’s first line of defense against infection. It attacks pathogens through engulfment and the secretion of antimicrobials. Therefore, when it is impaired, pathogen invasion of the host is increased (Centers for Disease Control and Prevention, n.d.).
Bacterial pneumonia is the most common and affects adults the most. It is divided according to anatomic or radiological factors, which include lobar (focal) pneumonia, mechanism of acquisition, and the pathogen present. In adults, however, the main bacterium causing pneumonia is Streptococcus pneumoniae. This bacterial pneumonia can be prevented by Prevnar, a pneumococcal conjugate vaccine.
VIRAL INFECTION: It plays a role in the acquisition of bacterial infection by causing disruption of respiratory epithelium, which provides an opportunistic environment for the bacteria. Another suggestion supporting this is that viral infection reduces host immune defense through the expression of receptors compatible with bacteria, hence the inflammation process. Further, host resistance and inflammatory responses can predispose patients to disease due to reduced neutrophil quantity, deficient neutrophil quality, lack of complement, and deficiencies of immunoglobulin.
Symptoms
Symptoms include persistent cough at night, shortness of breath, chest pain, especially after coughing, loss of appetite, and tiredness. Cough, accompanied by the production of sputum, is considered the most common bacterial symptom. If caused by Streptococcus pneumonia, the sputum is rust-colored; if caused by Pseudomonas, it appears green. If it’s anaerobic, the sputum produces a foul smell. Furthermore, physical findings may include dullness to percussion, breathing sounds such as rales, and tracheal deviation, among others.
Risk Factors
General risk factors include co-infection with H1N1 influenza, which increases the chances of developing secondary bacterial pneumonia, lung pathologies, gingivitis, smoking, alteration of the sensorium, or stroke that reduces the gag reflex, hence aspiration pneumonia.
The Various Pneumonia Types
Community-acquired pneumonia develops in an outpatient setting or within 48 hours of admission to the hospital. Institution-acquired pneumonia includes HCAP and NHAP. HCAP is pneumonia that develops in an outpatient setting. Its risk factors include:
- Being under care in a hospital facility for 90 days.
- Antibiotics and wound care within 30 days.
- Home nursing care and contact with family members infected with MDR bacteria.
Hospital-acquired pneumonia is pneumonia that develops 48 hours after admission. It occurs as a result of increased exposure to MDR organisms. Risk factors are:
- Antibiotic therapy within 90 days.
- Hospitalization for five days or more.
- Immunosuppressive disease or therapy.
- A high frequency of antibiotic resistance in the local area.
Ventilation-associated pneumonia is a condition that develops more than 48 hours after endotracheal intubation. Its risk factors are those applying to HAP (Hospital Acquired Pneumonia).
Aspiration pneumonia is the development of infectious infiltrates in a patient experiencing a high risk of oropharyngeal aspiration. It develops after the inhalation of pharyngeal secretions due to poor cough, increased volume of secretions, and impaired immune response, which form its risk factors.
Diagnosis
While pneumonia is a medical diagnosis, a nursing diagnosis administered to the patient is required since it helps the patient recover beyond treatment. This nursing diagnosis includes:
- Ineffective airway clearance.
- Risk for imbalanced nutrition.
- Risk for infection transmission.
- Activity intolerance.
Nursing Diagnosis One: Deficient Knowledge about the Condition and the Need for Action. This is related to less exposure to information and misinterpretation. It is revealed in the repeated mistakes, requests for information, etc. As a result, expected outcomes include understanding the disease processes and treatment conditions. Nursing intervention can be done first by reviewing normal lung functions, emphasizing the importance of continuing an effective cough, and providing written and verbal information.
Nursing Diagnosis Two: Risk for Deficient Fluid Volume as a result of excessive loss of fluids. The nursing diagnosis’s expected outcome is achieving fluid balance. Nursing interventions, in this case, include noting the color of urine, calculation of fluid balance, provision of additional IV fluids, and assessment of mucous membrane moisture.
The third nursing diagnosis includes acute or chronic pain. This is linked to inflammatory lung parenchyma, and the patient experiences chest pains, headaches, restlessness, etc. Once this nursing diagnosis is made, the pain is expected to disappear or reduce, and the body attains its state of relaxation. For the intervention, one needs to determine the characteristics of pain and teach relaxation techniques that can be used by the patient to control the chest during coughing.
Medication And Treatment
The main drug therapy for bacterial pneumonia is antibiotic treatment. Antibiotics can kill certain forms of bacteria, while vaccination can also prevent some bacterial infections. Antibiotics stop the growth of or kill bacteria, while penicillin antibiotics stop or kill specific bacteria; cough medication is used to calm coughing, and fever reducers (aspirin) are used to reduce fever. Moreover, there are supportive care and other measures as far as treatment is concerned. Supportive care includes (World Health Organization, n.d.) oral rehydration therapy, which involves administering fluid by the mouth to treat dehydration caused by diarrhea. Secondly, oxygen therapy is given to patients experiencing breathing problems, and IV fluids deliver fluids or medication directly into the vein. Additionally, treatment always depends on the type and severity of pneumonia, age, and overall health.
Respiratory Support: Patients with bronchospasm and infection benefit from inhaled bronchodilators. If the patient is experiencing mild shortness of breath, supplemental oxygen with a nasal cannula is recommended. However, if supplemental oxygen seems insufficient, ventilators are used. On the other hand, if it involves moderate dyspnea where a high oxygen concentration is required, the use of a Venturi mask, ventilation, and endotracheal intubation is considered.
Glucocorticoids and Corticosteroids: Community-acquired pneumonia patients can be administered corticosteroids, which are believed to reduce hospitalization time by one day and result in a 5% reduction in risk and mechanical ventilation. Moreover, it is believed that patients with severe pneumonia who used corticosteroids had a mortality advantage over the severe patients who never used this at all. Glucocorticoids reduce pulmonary inflammation; still, it is believed that glucocorticoids can impair the immune system.
Moreover, macrolides are known as effective medications for community-acquired pneumonia. It binds to ribosomes and carries mutations that alter macrolide binding, hence rendering it bacteria-resistant. Nevertheless, the use of macrolides is linked to various serious side effects, which include allergic reactions and cholestatic hepatitis. It has drug interactions and thereby can affect the heart. Other minor effects include nausea, diarrhea, vomiting, and gastrointestinal upset. To determine inpatient care and mortality, one is advised to use the Pneumonia Severity Index (PSI). PSI, however, does overestimate mortality in higher-risk patients.
Patient Education: Patients should be encouraged and warned against smoking and advised to avoid alcohol, and patients at risk should be immunized against influenza and pneumococcal disease. One should seek early vaccination so as to prevent pneumonia. Prevention of pneumonia is better than its cure.
References
Centers for Disease Control and Prevention. (n.d.). About pneumonia. https://www.cdc.gov/pneumonia/about/
World Health Organization. (n.d.). Pneumonia in children. https://www.who.int/news-room/fact-sheets/detail/pneumonia
Academic Master Education Team is a group of academic editors and subject specialists responsible for producing structured, research-backed essays across multiple disciplines. Each article is developed following Academic Master’s Editorial Policy and supported by credible academic references. The team ensures clarity, citation accuracy, and adherence to ethical academic writing standards
Content reviewed under Academic Master Editorial Policy.
