Pneumonia

Welcome, and thank you for joining me for this review of Pneumonia. In this video, we will cover the definition and different kinds of pneumonia, how it affects the body, and treatment options.

The word “pneumonia” comes from the Greek word for “lung”. The term pneumonia refers to an infection of the lung tissue that leads to inflammation. Pneumonia can be caused by various microorganisms, including viruses, bacteria, and fungi.

Categorization of Pneumonia

Pneumonia is often categorized by the organisms that cause it. Viral pneumonia is caused by viruses such as influenza, cytomegalovirus, and respiratory syncytial virus, or RSV. Bacterial pneumonia is most commonly caused by the bacteria Streptococcus pneumoniae, but can also be caused by other bacteria like Staphylococcus aureus. Atypical pneumonia is caused by certain kinds of bacteria such as Mycoplasma pneumoniae, and results in a slightly different diagnosis and treatment from other types of pneumonia. Atypical pneumonia can be known as “walking pneumonia” when symptoms are less severe. Other kinds of pneumonia that do not fit into any of the previous categories are less common, and include infections caused by fungi.

Pneumonia can also be classified by the setting or environment in which it occurs. There is some overlap between these categories because some types of pneumonia can happen in multiple settings, but knowing how the pneumonia was acquired can be helpful for making a diagnosis and determining treatment. Hospital-acquired, or nosocomial pneumonia occurs at least 48 hours after a patient was admitted to the hospital. The broader term “healthcare-acquired pneumonia” is sometimes used to include pneumonia that is contracted in other care settings, such as nursing homes. Community-acquired pneumonia occurs in the general population outside of healthcare settings.

In addition to these categories, immunocompromised patients are especially vulnerable to infections of any kind because of the body’s decreased ability to fight off disease. Pneumonia in immunocompromised patients may be caused by pathogens that do not normally cause disease in healthy people.

Aspiration of foreign substances, such as stomach contents or saliva, can introduce organisms into the lower airway and cause inflammation and infection. Strictly speaking, pneumonitis is an inflammation of the lungs without a microorganism present. Chemical pneumonitis results from inhalation of toxic substances when irritation to the lung tissue alone is enough to cause an inflammatory response. Pneumonia may then occur if the aspirated substance contained pathogens, or if the damaged tissue were more susceptible to infection.

Impact on the Respiratory System

Because pneumonia is an infection in the lung tissue, its effects are primarily in the respiratory system, although there may be widespread effects as well. In normal, spontaneous breathing, air is inspired through the upper respiratory tract, where it is warmed and filtered before it reaches the lungs. Air travels through the trachea, bronchi, and bronchioles before it reaches the alveoli, where gas exchange occurs. Oxygen from the air in the alveolar sacs is exchanged for carbon dioxide in the bloodstream at the alveolar or pulmonary capillary wall. Oxygen moves into the bloodstream, and carbon dioxide exits the bloodstream. Carbon dioxide is then exhaled, and the blood delivers oxygen to the cells of the body.

Microorganisms can invade the lungs through the upper respiratory tract if filtering defenses are diminished, such as during the presence of an upper respiratory tract infection, or through aspiration. If pathogens are present in the bloodstream, as in sepsis, they may also enter the pulmonary capillaries.

The presence of organisms in the normally-sterile lower respiratory tract, in addition to potentially causing irritation to the tissue, triggers an inflammatory immune response as the body attacks the invaders. This inflammation can cause the alveolar sacs to fill with fluid, including white blood cells, or pus. Alveoli that are already filled with liquid are then unable to fill with air during inspiration, which subsequently impairs gas exchange.

Symptoms of Pneumonia

Infection, inflammation, fluid in the lungs, and impaired gas exchange are responsible for most of the signs and symptoms of pneumonia. Mild to high fever, sweating, and chills may be present as the body tries to fight infection. Fluid and infection may cause chest or pleuritic pain and shortness of breath, especially with exertion. Cough is often present and possibly productive as the patient tries to clear the airway. Other possible symptoms include fatigue, headache, body aches, decreased appetite, nausea, and vomiting. Confusion or other changes in mental status may also occur with pneumonia, usually in older adults.

Other objective signs of pneumonia include changes in respiratory status. The patient may be tachypneic, or have a higher than normal breathing rate, as the body tries to compensate for decreased gas exchange. Shortness of breath may be present, and increased work of breathing may also be evident in accessory muscle use. Pulse oximetry may reveal a decreased saturation of oxygen (or spO2) in the blood. Decreased oxygen in the blood is sometimes visible as cyanosis, or a bluish tinge to the skin. Common locations for cyanosis to occur are the nail beds or around the mouth and lips, which is called circumoral cyanosis.

Adventitious breath sounds may be auscultated in patients with pneumonia. Pneumonia can affect just one section, or lobe, of one lung, or multiple lobes of one or both lungs. Lung sounds may be diminished in the affected area, or coarse crackles or rhonchi may be heard. Bronchial breath sounds are normally auscultated over large areas like the trachea, but may be heard in the peripheral lung fields in patients with pneumonia. Consolidation refers to solid or dense tissue that occurs with pneumonia as a result of fluid filling alveolar sacs, which then conducts sound better than air, leading to bronchial breath sounds.

People at increased risk for developing pneumonia include those with an existing infection, especially upper respiratory infections, and those with existing lung diseases, such as asthma or chronic obstructive pulmonary disease (COPD). Immobility can also increase the risk for pneumonia, as it can begin with atelectasis or aspiration. Mechanically ventilated patients are at risk for pneumonia due to the invasive nature of this intervention. Pneumonia is more common, and often more severe, in patients under 2 years of age or over age 65.

Prevention and Treatment

Vaccines can help prevent certain types of pneumonia. The pneumococcal vaccine, recommended for patients age 65 and older, protects against Streptococcus pneumoniae. The influenza vaccine reduces the risk of pneumonia due to the influenza virus. As with any infectious disease, good hygiene, including hand hygiene, helps reduce transmission of organisms. Infection prevention precautions must be observed in healthcare settings to help prevent hospital-acquired pneumonia.

Diagnosis of pneumonia is made based on the patient’s history, physical exam, and diagnostic tests, including chest x-ray, sputum culture, and blood culture. The sputum sample is frequently collected by having the patient breathe deeply and cough into a sterile container, and the culture is used to identify the specific organism present in the lungs that is causing the infection.

Treatment of pneumonia is based on each case’s causative agents and symptoms. Bacterial pneumonia may be treated by an appropriate antibiotic or combination of antibiotics, and viral pneumonia is sometimes treated with antiviral medication. Educating patients to complete prescribed antibiotic doses even if their symptoms have resolved can help alleviate the likelihood of developing antibiotic resistance.

Supportive care is important for all types of pneumonia. Monitoring oxygen saturation is essential, as administration of supplemental oxygen may be required. Monitoring hydration status is also significant, as a patient may require IV fluids if unable to maintain adequate hydration by mouth. Medications such as acetaminophen or ibuprofen can be used to treat fever or mild pain and body aches. Incentive spirometry can encourage patients to cough and breathe deeply. Oropharyngeal suctioning is sometimes necessary for patients who are unable to clear their own secretions. Chest physiotherapy is occasionally prescribed to help loosen secretions.

Now let’s go over a few practice questions to review.

Review Questions

1. The nurse is reviewing discharge instructions with a patient who was admitted for pneumonia. Which of the following statements made by the patient indicate the need for further education?

1. “I should take the rest of my antibiotic medicine on schedule until it is all gone.”
2. “I do not need to worry about getting pneumonia again since I have had it already.”
3. “I will continue to drink plenty of water at home.”
4. “My grandchildren are traveling to come visit me in 3 weeks.”

2. Which of the following patients are at increased risk for developing pneumonia? Choose all that apply.

1. A 36-year-old mother of 3 young children.
2. A 70-year-old male with a history of COPD.
3. A 25-year-old receiving chemotherapy for breast cancer.
4. A 22-year-old college student who lives with a roommate.

An 84-year-old female who is on bedrest after a hip fracture.

3. Which of the following are appropriate nursing interventions for a patient with pneumonia? Select all that apply.

1. Raise the head of the bed at the patient’s request while resting.
2. Collect a sputum specimen and send to the lab for analysis per physician’s order.
3. Monitor the patient’s fluid intake and output.
4. Auscultate for adventitious lung sounds.

Thanks for watching, and happy studying.