Pneumonia Notes

Topics: Pneumonia, Immune system, Pulmonology Pages: 5 (1460 words) Published: November 19, 2013

Pneumonia is a lower respiratory problem. It is an acute inflammation of the lung, caused by viral, chemical, bacterial, fungal agents. Usually happens in people with compromised immune systems, or people who have compromise to the structures that protect the airway (i.e. the nares dry up and can't humdify air anymore, bronchioles shrivel and can't filter the air) If anything occurs with the mucocilliary system, the epiglottis, or the nares, we are inviting pneumonia into our bodies. Aging also causes a huge predisposition for pnuemonia because lungs are smaller, it's harder to expel air because the shape of the thoracic cage changes, and the immune system is less efficient.

4 ways that you can acquire pneumonia
(1) Aspiration: suction isn't done correctly or the epiglottis dysfunctions and food or fluid is introduced into the lungs, where it will sit and grow bacteria. To prevent this, STOP the tube feeding before you lay the patient flat or turn them. If patient is nauseous put them on their L side because aspiration is most likely in the R lung. Check for placement after you put in an NG tube to avoid putting tube feeding into the lungs. (2) Inhalation of microbes: microbes like mycoplasma pneumoniae exist in the air and you can breathe them in. (3) Blood: pneumonia can get into your blood and spread to your lungs. (4) Pneumo/Hemothorax: the lung is introduced to the outside air and outside bacterias.

*it is super important that we encourage our patients to ambulate, cough and deep breathe, IS, and walk so they don't get pneumonia*

5 types of pneumonia
(1) Community acquired: lower respiratory infection resulting from smoking and being in a community infected with pneumonia. Smoking ruins your mucocilliary tract and makes it easy for an infection to nest there. Usually symptoms occur while in the infected community or 2 days after admittance to the hospital. (2) Hospital acquired: Strains like *pseudomonas, enterobacter, staph aureus, and strep pneumonia* (3) Fungal pneumonia: patients are not isolated because this doesn't pass from patient to patient. Usually occurs in people with suppressed immune systems as an opportunistic infection. Most common in AIDS/transplant or transfusion patients. (4) Aspiration pneumonia: again, you aspirate fluid, food, or the mycoplasm into your lungs and the bacteria or virus multiplies. This usually occurs from Dobhoff tubes, aspiration, vomiting, tube feeding. Follow tube feeding aspiration precautions, place pt on L side. (5) Opportunistic pneumonia: Caused by PCP, and doesn't bother a healthy person at all. This is what kills AIDS patients. Patients at risk are those who have really bad nutritional malnutrition, people who consistently feel full, organ donor recipients, chemo patients, and transplant patients.

PATHOPHYSIOLOGY
Stage 1: Congestion: the patient starts to feel the clinical signs and symptoms of pneumonia. The S/S of pneumonia occur as congestion,which is when fluid covers the alveoli and exchange can't occur. Stage 2: Red hepatization: this occurs as a reaction of the lungs to the inflammation caused by pneumonia when RBCs, fibrin, and neutrophils fill the lungs. The lung begins to look red and ruddy like the liver on an x-ray. Stage 3: Gray hepatization: the downslope of red hepatization where the body kicks in and tries to control the immune response. The blood flow is decreased, the leukocytes and fibrin consolidate in areas that are affected. This is where we get bronchial sounds in the areas of consolidation -- usually crackles. Stage 4: Resolution: immunosuppressed patients never get to this stage. COPD'ers, smokers and the elderly have a hard time recovering from the congestion and red hepatization. Usually the exudate is lysed and considered not harmful. It's processed by macrophages and healing is complete.

*most cases of pneumonia are in the R middle lobe. Remember that the R lobe is the most common for aspiration, so it's common for...
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