How Pneumonia is Serious condition and what is Management of pneumonia
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. Pneumonias are classified as community acquired pneumonia (CAP), hospital-acquired (nosocomial) pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Pathophysiology of pneumonia
An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide; bronchospasm may also occur if the patient has reactive airway disease. Bronchopneumonia, the most common form, is distributed in a patchy fashion extending from the bronchi to surrounding lung parenchyma. Lobar pneumonia is the term used if a substantial part of one or more lobes is involved.
Pneumonias are caused by a variety of microbial agents in the various settings. Common organisms include Pseudomonas aeruginosa and Klebsiella species; Staphylococcus aureus; Haemophilus influenzae; Staphylococcus pneumoniae; and enteric Gram-negative bacilli, fungi, and viruses (most common in children).
Clinical Manifestations of Pneumonia.
Clinical features vary depending on the causative organism and the patient’s disease.
• Sudden chills and rapidly rising fever (38.50C to 40.50C [101F to 105F]).
• Pleuritic chest pain aggravated by respiration and coughing.
• Severely ill patient has marked tachypnea (25 to 45 breaths/min) and dyspnea; orthopnea when not propped up.
• Pulse rapid and bounding; may increase 10 beats/min per degree of temperature elevation (Celsius).
• A relative bradycardia for the amount of fever suggests viral infection, mycoplasma infection, or infection with a Legionella organism.
• Other signs: upper respiratory tract infection, headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis; after a few days, mucoid or mucopurulent sputum is expectorated.
• Severe pneumonia: flushed cheeks; lips and nail beds demonstrating central cyanosis.
• Sputum purulent, rusty, blood-tinged, viscous, or green depending on etiologic agent.
• Appetite is poor, and the patient is diaphoretic and tires easily.
• Signs and symptoms of pneumonia may also depend on a patient’s underlying condition (example, different signs occur in patients with conditions such as cancer, and in those who are undergoing treatment with immunosuppressants, which decrease the resistance to infection).
Assessment and Diagnostic Methods
• Primarily history, physical examination
• Chest x-rays, blood and sputum cultures, Gram stain
Medical Management
• Antibiotics are prescribed on the basis of Gram stain results and antibiotic guidelines (resistance patterns, risk factors, etiology must be considered). Combination therapy may also be used.• Supportive treatment includes hydration, antipyretics, antitussive medications, antihistamines, or nasal decongestants.
• Bed rest is recommended until infection shows signs of clearing.
• Oxygen therapy is given for hypoxemia.
• Respiratory support includes high inspiratory oxygen concentrations, endotracheal intubation, and mechanical ventilation.
• Treatment of atelectasis, pleural effusion, shock, respiratory failure, or superinfection is instituted, if needed.
• For groups at high risk for CAP, pneumococcal vaccination is advised.
Pneumothorax and Hemothorax.
Pneumothorax occurs when the parietal or visceral pleura is breached and the pleural space is exposed to positive atmospheric pressure. Normally the pressure in the pleural space is negative or sub atmospheric; this negative pressure is required to maintain lung inflation.
Hemothorax is the collection of blood in the chest cavity because of torn intercostal vessels or laceration of the lungs injured through trauma. Often both blood and air are found in the chest cavity (hemopneumothorax).
Hemothorax is the collection of blood in the chest cavity because of torn intercostal vessels or laceration of the lungs injured through trauma. Often both blood and air are found in the chest cavity (hemopneumothorax).
Types of Pneumothorax
Simple Pneumothorax
A simple, or spontaneous, pneumothorax occurs when air enters the pleural space through a breach of either the parietal or visceral pleura.
Traumatic Pneumothorax
A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or from a wound in the chest wall. A traumatic pneumothorax resulting from major injury to the chest is often accompanied by hemothorax. Open pneumothorax is one form of traumatic pneumothorax. It occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration.
A simple, or spontaneous, pneumothorax occurs when air enters the pleural space through a breach of either the parietal or visceral pleura.
Traumatic Pneumothorax
A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or from a wound in the chest wall. A traumatic pneumothorax resulting from major injury to the chest is often accompanied by hemothorax. Open pneumothorax is one form of traumatic pneumothorax. It occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration.
Tension Pneumothorax
A tension pneumothorax occurs when air is drawn into the pleural space and is trapped with each breath. Tension builds up in the pleural space, causing lung collapse.
Clinical Manifestations
Signs and symptoms associated with pneumothorax depend on its size and cause:• Pleuritic pain of sudden onset.
• Minimal respiratory distress with small pneumothorax; acute respiratory distress if large.
• Anxiety, dyspnea, air hunger, use of accessory muscles, and central cyanosis (with severe hypoxemia).
• In a simple pneumothorax, the trachea is midline, expansion of the chest is decreased, breath sounds may be diminished, and percussion of the chest may reveal normal sounds or hyper resonance depending on the size of the pneumothorax.
• In a tension pneumothorax, the trachea is shifted away from the affected side, chest expansion may be decreased or fixed in a hyper expansion state, breath sounds are diminished or absent, and percussion to the affected side is hyper resonant.
Medical Management
The goal is evacuation of air or blood from the pleural space.
• A small chest tube is inserted near the second intercostal space for a pneumothorax.
• A large-diameter chest tube is inserted, usually in the fourth or fifth intercostal space, for hemothorax.
• Autotransfusion is begun if excessive bleeding from chest tube occurs.
• Traumatic open pneumothorax is plugged (petroleum gauze); patient is asked to inhale and strain against a closed glottis to eject air from the thorax until the chest tube is inserted, with water-seal drainage.
• Antibiotics are usually prescribed to combat infection from contamination.
• The chest wall is opened surgically (thoracotomy) if more than 1,500 mL of blood is aspirated initially by thoracentesis (or is the initial chest tube output) or if chest tube out put continues at greater than 200 mL/h. Urgency is determined by the degree of respiratory compromise.• An emergency thoracotomy may also be performed in the emergency department if a cardiovascular injury secondary to chest or penetrating trauma is suspected.
The goal is evacuation of air or blood from the pleural space.
• A small chest tube is inserted near the second intercostal space for a pneumothorax.
• A large-diameter chest tube is inserted, usually in the fourth or fifth intercostal space, for hemothorax.
• Autotransfusion is begun if excessive bleeding from chest tube occurs.
• Traumatic open pneumothorax is plugged (petroleum gauze); patient is asked to inhale and strain against a closed glottis to eject air from the thorax until the chest tube is inserted, with water-seal drainage.
• Antibiotics are usually prescribed to combat infection from contamination.
• The chest wall is opened surgically (thoracotomy) if more than 1,500 mL of blood is aspirated initially by thoracentesis (or is the initial chest tube output) or if chest tube out put continues at greater than 200 mL/h. Urgency is determined by the degree of respiratory compromise.
• An emergency thoracotomy may also be performed in the emergency department if a cardiovascular injury secondary to chest or penetrating trauma is suspected.
• The patient with a possible tension pneumothorax should immediately be given a high concentration of supplemental oxygen to treat the hypoxemia, and pulse oximetry should be used to monitor oxygen saturation.
• In an emergency situation, a tension pneumothorax can be decompressed or quickly converted to a simple pneumothorax by inserting a large-bore needle (14-gauge) at the second intercostal space, midclavicular line on the affected side. A chest tube is then inserted and connected to suction to remove the remaining air and fluid, reestablish the negative pressure, and re expand the lung.
Nursing Management
• Promote early detection through assessment and identification of high risk population; report symptoms.
• Assist in chest tube insertion; maintain chest drainage or water-seal.
• Monitor respiratory status and re expansion of lung, with interventions (pulmonary support) performed in collaboration with other health care professionals (eg, physician, respiratory therapist, physical therapist).
• Provide information and emotional support to patient and family.
• Assist in chest tube insertion; maintain chest drainage or water-seal.
• Monitor respiratory status and re expansion of lung, with interventions (pulmonary support) performed in collaboration with other health care professionals (eg, physician, respiratory therapist, physical therapist).
• Provide information and emotional support to patient and family.