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PNEUMONIA

BY: BERNALYN MACARAEG

PNEUMONIA -An acute inflammatory process of the lung parenchyma, resulting in lung consolidation as the alveoli and bronchioles fill with exudates. A. Assess for type of pneumonia (classification) 1. Community acquired pneumonia (CAP)- acquired outside the hospital; lower respiratory tract infection. Typical i. Streptococcus pneumonia and Haemophilus influenza ii. Communicable disease

iii. Clinical manifestations:

Rapid onset, severe chills, high temperature Tachypnea, rapid pulse Productive cough with purulent sputum Pleuritic pain Anxiety Dyspnea Bronchial breath sounds, crackles

b. Atypical i. Legionella, Mycoplasma, Chlamydia ii.Clinical manifestations More gradual onset Dry cough Headache, fatigue, sore throat Nausea &vomiting Crackles

2. Hospital acquired pneumonia (HAP)- leading cause of mortality stemming from nosocomial Infections. Occurs 48 hours after hospitalization a. Pseudomonas, Enterobacter, staphylococcus, Stroptoccocus pneumonia which enter lungs after aspiration of particles from clients own pharynx. b. Risk factors Aspiration Abdominal Surgery Immunosuppresant therapy Prolonged mechanical ventilation Structural lung disease

c. Clinical manifestations: Fever, chills, diaphoresis Wheezing, inspiratory rales Productive cough, increase pulmonary secretions Fatigue, pallor, malaise Tachypnea, tachycardia 3. Aspiration Pneumonia- aspiration of material in mouth into trachea and lungs. Aspirate can be food, water, vomitus chemicals. a. Secondary to other conditions such as age, debilitations, stasis, loss of consciousness

b. Onset insidious-initial manifestations may be airway obstructions 4. Opportunistic pneumonia- client with altered immune response very susceptible to respiratory infections. a. At risk individuals include those with malnutrition, HIV/AIDS, transplants, cancer, and immune deficiencies. b. Pneomocystic carinii, cytomegalovirus and fungi

c. Clinical manifestations: fever chills dry cough, non productive malaise fatigue B. Observe for an increase in the amount of sputum 1. Change in character of sputum (particularly color-yellow to green) 2. Onset of malaise or fever

IMPLEMENTATION: a. If possible, keep client ambulatory or change position frequently b. Elevate head of bed 30 degrees c. Encourage fluids to 3000ml or more d. Observe and record type and amount of sputum e. Administer antibiotics as ordered 1. Given for period of 10-14 days 2. Penicillin G IV, ampicillin, vancomycin (staph pneumonia) and cephalosporins f. Provide physiotherapy as ordered

g. Obtain throat sputum and blood cultures for specific organisms h. Administer antipyretic drugs and analgesics as needed i. Administer oxygen as indicated.

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