Pathophysiology of Pneumonia

A. Description: Acute infection of the lung varying in severity and causing fluid accumulation.B. Etiology: causative organisms include bacteria, viruses, fungi, and protozoan.C. Pathophysiologic process and manifestations.

1. Organisms may enter the respiratory tract through inspiration or aspiration of oral secretions; staphylococcus and Gram-negative bacilli may reach the lungs through circulation in the bloodstream.

2. Normal pulmonary defense mechanisms (cough reflex, mucocilliary transport, and pulmonary macrophages) usually protect against infection. However, in susceptible hosts, these defenses are either suppressed or overwhelmed by the invading organism.

3. The invading organism multiplies and releases damaging toxins, causing inflammation and edema of the lung parenchyma; this results in accumulation of cellular debris and exudates.

4. Lung tissue fills with exudates and fluid, changing from an airless state to consolidated state.

5. In viral pneumonia, the ciliated epithelial cells become damaged.6. Severity of symptoms depends on the extent of pneumonia present (e.g., partial lobe,

full lobe [lobar pneumonia], or diffuse [broncho pneumonia]).7. Symptoms include:

i. Feverii. Chills

iii. Malaiseiv. Coughv. Pleuritic pain

vi. Increased tactile fremitus on palpitationvii. Rales and ronchi on auscultation

viii. DyspneaD. Overview of nursing interventions

1. Administer antibiotics specific for the causative organism, as prescribed and confirmed by culture and sensitivity.

2. Control fever with acetaminophen as ordered.3. Assess vital signs, monitor respiratory status.4. Monitor pulse oximetry.5. Monitor exercise tolerance.6. Monitor breath sounds note changes in sputum production.7. Encourage adequate fluid intake.8. Provide bronchial hygiene.9. Maintain adequate fluid intake.10. Perform chest physiotherapy (CPT) as indicated.11. Administer O2 therapy as ordered.12. Attempt to prevent pneumonia in susceptible hosts. For example:

i. Frequent positioning, deep breathing and coughing exercises in the post-op patient.

ii. Chest PTiii. Avoid contact with persons who have respiratory infections, crowds, malls and

shopping center.