Causes for the development of pneumonia are intrinsic and extrinsic. Extrinsic factors include exposure to causative agent, pulmonary injury. Whereas intrinsic 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 to the host. Because of this, patient immune is minimized, disenabling the system to fight diseases like HIV. This is why, most of the HIV Positive dies of pneumonia.
Pneumonia develops in the human system once neutrophils from capillaries find their way into the lung’s air sacs. This leads to formation of neutrophils pool which in turn kills microbes using the reactive oxygen species; antimicrobial proteins. This produces chromatin meshwork which thereafter traps and kills extracellular bacteria known as Neutrophil Extracellular Trap. NET is known as the immune system’s first line of defense against infection. It invades pathogens through engulfing and secretion of anti-microbial. Therefore, when it is killed, pathogens invasion to the host is maximized.
Bacterial Pneumonia is the most common and always affects adults mostly. It is divided according to anatomic or radiological which includes labor (focal pneumonia), mechanism of acquisition and pathogen present. In adults however, the main bacteria causing pneumonia is Streptococcus Pneumonia. This bacterial pneumonia can be prevented by Prevnar, pneumococcal conjugate vaccines.
VIRAL INFECTION, It plays a role in acquisition of bacterial infection by causing disruption of respiratory epithelium which provides an opportunistic environment for the bacteria. Another suggestion supporting this, viral infection reduces hosting immune defense in expression of receptors compatible to bacteria hence inflammation process. Further, Host Resistance, inflammation responses can dispose patient to diseases early due to, reduced neutrophils quantity, deficit neutrophils quality, and lack of compliment and deficiencies of immune globin.
Symptoms include, Persistent cough at night, Shortness of breathing, Chest pain especially after coughing, loss of appetite and tiredness. Cough, accompanied by production of sputum is considered as the bacterial MOST symptoms. If caused by Streptococcus pneumonia, the sputum is rust colored, if caused by Pseudomonas it appears green, if its anaerobic the sputum produce with itself foul smell. Furthermore, Physical findings may include, dullness to percussion, breathing sounds such as rales, tracheal deviation among others.
General risk factors includes Co-infection with HINI influenza which increases chances of obtaining secondary bacterial pneumonia, lung pathologies, gingivitis, smoking, alteration of sensorium or stroke that do reduce gag reflex hence aspiration pneumonia emerges.
THE VARIOUS PNEUMONIA TYPES
Community Acquired Pneumonia is that which develops in outpatient setting or within 48 hours of admission to the hospital. Institutional-Acquired Pneumonia includes HCAP AND NHAP. HCAP is that which develops in outpatient. Its risk factors includes
- Under care facility for 90days in the hospital.
- Antibiotics and wound care within 30 days
- Home nursing care and Contact with infected family member due to MDR bacteria
Hospital acquired pneumonia, is that which develops 48 hours after admission. Occurs as a result of increased exposure to MDR orgasm. RISK Factors are,
- Antibiotic Therapy within 90 days
- Hospitalization is 5 days or more,
- immunosuppressive disease or therapy,
- High frequency of antibiotics resistance in the local area.
Ventilation Associated Pneumonia is that which develops more than 48 hours after the endotracheal intubation. Its risk factors are those applying to HAP (Hospital Acquired Pneumonia).
Aspiration Pneumonia is the development of infectious infiltrate to the patient experiencing high risk of or pharyngeal aspiration. It develops after the inhalation of pharyngeal secretions due to poor cough, increased volume of secretions and impaired immune response which forms its risk factors.
While pneumonia is a medical diagnosis, nursing diagnosis Administered to the patient is required since it helps the patient recover beyond treatments. 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, request for information and 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 importance of continuing effective cough, provision of written and verbal forms.
Nursing Diagnosis Two, Risk for Deficient Fluid Volume, as a result of excessive loss of fluids. The nursing diagnosis expected outcome is achieving fluid balance. Nursing interventions in this case includes, noting the color of urine, calculation of fluid balance, provision of additional IV fluids and assessor of mucous membrane moisture.
Third Nursing Diagnosis Includes Pain Acute Or Chronic. This is linked to the inflammatory lung parenchyma and patient experiences chest pains, headache, restlessness and etc. Once this nursing diagnosis is done, the pain is expected to disappear or reduce and body attains its state of relaxation. For the intervention, one need to determine the characteristic of pain, teach relaxation techniques which can be used by the patient in control of chest during coughing.
MEDICATION AND TREATEMENT
The main drug therapy done for pneumonia bacteria is Antibiotic treatment. Antibiotics can kill any form of bacteria, though Vaccination can as well kill some bacteria. Antibiotics stops growth or kill bacteria while Penicillin antibiotics stops or kills a specific bacteria, cough medication is used to calm coughing, Fever Reducers(Aspirin) to reduce fever. Moreover, there are supportive care and other measures as far as treatment is concerned. Supportive care includes Oral rehydration therapy which involves giving fluid by the mouth to treat dehydration caused by diarrhea. Secondly, Oxygen therapy done to the patients experiencing breathing problems and IV Fluids, which is delivering 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 with infection benefit from inhaled bronchodilators inhalation. If the patient is experiencing mild breathing shortness, 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 high oxygen concentration is required; use of Vento-mask, Ventilation and endotracheal intubation is considered.
Glucocorticoids And Corticosteroids, Community Acquired pneumonia patients hospitalized, can be administered using corticosteroids which are believed to reduce hospitalization time by one day and 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 immune system. .
Moreover, Macrolide is known as the best medication for Community Acquired Pneumonia. It binds to ribosomes carries mutations that alter macrolide binding hence renders its bacteria resistance. Nevertheless, Use of macrolides is linked to various serious side effects which includes allergic reaction and cholestasis hepatitis .It has a drug interaction 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 pneumonia severity index PSI. PSI however does overestimate mortality in the higher risk patient.
Patient Education; Patients should be encouraged and warned against smoking, avoid taking alcohol and patients at risk should be immunized of influenza and pneumococcal. One should seek early vaccination so as to prevent pneumonia. Prevention for pneumonia is better than its Cure.