pneumonia

1. CARE OF CLIENT WITH
RESPIRATORY INFECTIONS
BY: HASNAH ZANI
101

2. PNEUMONIA
LUNG ABSCESS
PLEURAL EFFUSION
2

3. LEARNING OBJECTIVES
1. Define pneumonia, lung abscess, pleural
effusion.
2. State cause, pathophysiology, clinical
manifestations, diagnosis, and treatment of
each condition.
3

4. PNEUMONIA
DEFINITION:
• Is an acute inflammation of the lung
parenchyma (lung tissues) often caused by micro
organism (& occasionally inhaled irritant).
• Is a lower respiratory tract infection.
4

5. PNEUMONIA
5

6. PNEUMONIA
6

7. TYPE OF PNEUMONIA
1. Community-Acquired Pneumonia (CAP)
– Occurs in community & during < 48 hours of
hospitalization.
– Is the most common type of pneumonia.
2. Hospital-Acquired Pneumonia (HAP)
- Pneumonia occurring 48 hours or more
during a hospital stay for another illness.
Higher risk client on a mechanical ventilator eg.
Ventilator-associated pneumonia (VAP).
7

8. CONTD.
3. Health Care-associated Pneumonia (HCP)
– Pneumonia in other health care settings, such as
nursing homes, dialysis centers, and outpatient
clinics.
4. Aspiration Pneumonia
- Due to inhale foreign body, food, drink, vomit, or
saliva from your mouth into lungs that occur in
condition of poor gag reflex eg. Brain injury,
dysphagia, or excessive use of alcohol or drugs.
8

9. CONTD.
5. Atypical Pneumonia
- Is most commonly caused by mycoplasma.
Legionnaires’ disease or chlamydia and
usually appears in children and young
adults.
6. Hypostatic pneumonia
- Results from the collection of fluid in the dorsal
region of the lungs and occurs especially in those
(as the bedridden or elderly, etc).
9

10. QUESTION
State 6 types of pneumonia?
ANSWER:
1. …………………………………
2. …………………………………
3. …………………………………
4. …………………………………
5. …………………………………
6. …………………………………
10

11. CAUSES
1. Infection to the lung
– Virus, bacteria
– Fungi, protozoa (if immunity very low)
• Mode: droplets & airborne (commonest), via
blood stream.
2. Non-infectious
- Aspiration of gastric contents
- Inhalation of toxic / irritant gases.
11

12. PATHOPHYSIOLOGY
Infection to the lung (eg. bacteria, virus)
▼
Inflammatory response initiated
▼
Alveolar edema + exudate formation
▼
Alveoli & respiratory bronchioles fill with serous
exudate, blood cells, fibrin, bacteria
▼
Consolidation of lung tissues
12

13. CLINICAL MANIFESTATION
1. Flu-like symptom: malaise with anorexia
2. Sudden feeling of worsening ill health after a
flu.
3. Fever – could be very high.
4. Chills & rigors
5. Prolonged/worsening cough
6. Sputum (containing greenish / yellowish /
blood tinged if bacterial pneumonia)
13

14. CONTD.
7. Dyspnea
– Pleuritic chest pain (pain when deep breathe or
cough)
– Confusion esp in elderly.
– Anorexia
– Nausea
– Vomiting
– Diarrhea
14

15. COMPLICATION
1. Pleuritis - inflammation of the pleural.
2. Lung abscess
3. Pleural effusion
4. Empyema - pus in the lung
5. Septicemia – systemic infection
6. Respiratory failure
15

16. DIAGNOSIS
1. History – s/s of suggestive pneumonia.
2. Abnormal lung sound by auscultation.
3. Chest X Ray
4. Sputum
1. Culture & sensitivity (C&S)
2. Full examination microscopy examination (FEME)
3. Serology
4. Acid fast bacilli (AFB)
16

17. CONTD.
5. Blood test:
1. Culture & sensitivity
2. Full blood count (raised WBC)
5. Bronchoscopy
6. Thoracentesis
7. CT thorax
17

18. HEALTH EDUCATION
1. Limit infection spread by:
 Staying at home for first 2-3 days.
 Covering mouth, nose when cough & sneeze.
 Wearing mask if in public.
 Washing hand frequently.
2. Complete antibiotic course if prescribed to
prevent resistance.
3. Drink plenty of water to liquefy & mobilize
secretion.
18

19. CONTD.
4. Eat balance nutrition diet & plenty of rest to
boost immunity.
 Prevent upper respiratory infection.
 Avoid overcrowding & keep a distance with person
with upper respiratory infection.
19

20. LUNG ABSCESS
20

21. LUNG ABCESS
DEFINITION:
• Lung abscess is a localized area of lung
necrosis (destructions) and pus formation.
21

22. LUNG ABCESS
22

23. CAUSES
1. Foreign body (eg. Denture, gastric content)
2. Pneumonia
3. Tuberculosis
4. Lung wound
23

24. PATHOPHYSIOLOGY
Alveoli that are filled with fluid, pus & microbes
become consolidated (solid)
▼
Consolidated tissue becomes necrotic tissue
called abscess
▼
Necrotic process can spread & abscess can rupture to
empty its content into bronchus (or pleural cavity)
▼
Form cavity filled with air & fluid (cavitations)
24

25. CLINICAL MANIFESTATION
• Occurs after 2 weeks after the precipitating
event.
• Early manifestation – same as pneumonia.
• When abscess rupture:
(a) Large amount foul smelling, purulent, blood
streaked sputum
(b) Abnormal breath sound e.g crackles in the
region of the abscess.
(c) Chest percussion – dull tone
25

26. DIAGNOSIS
1. Chest X Ray
2. Sputum culture & sensitivity
3. Bronchoscopy
26

27. TREATMENT
1. Antibiotic IV
2. Postural drainage to promote drainage from
the lungs.
3. Bronchoscopy (if indicated)
(a) Drainage of abscess
(b) Resection
4. Chest tube insertion (if pleural space
involved)
27

28. COMPLICATION
1. Pleurisy
– Inflammation of the pleura.
2. Septicemia if not treated
- Systemic infection caused by multiplication of
microorganisms in circulating blood.
28

29. PLEURAL
EFFUSION
29

30. PLEURAL EFFUSION
DEFINITION:
• Is a collection of excess fluid in the pleural
space.
• Note: Large pleural effusion compresses
adjacent lung tissue, thus, impair lung
expansion.
30

31. PLEURAL EFFUSION
31

32. CAUSES
1. Transudative pleural effusions.
– Caused by fluid leaking into the pleural space.
– This is caused by elevated pressure in, or low
protein content in, the blood vessels.
– Congestive heart failure is the most common
cause.
32

33. CONTD.
2.Exudative pleural effusions.
- Result from leaky blood vessels caused by
inflammation (irritation and swelling) of the
pleura.
- This is often caused by lung disease eg. Lung
cancer, lung infections (TB, pneumonia, drug
reactions)
33

34. PATHOPHYSIOLOGY
Aspiration of gastric content or bacteria enter the lung
▼
Inflammatory response
▼
Cavity extend to bronchus
▼
Abscess become encapsulated
▼
Tissues necrotize
▼
Increase production of sputum
▼
Purulent sputum
34

35. CLINICAL MANIFESTATION
1. Dyspnea
2. Chest pain
3. Auscultation – dull tone
4. Limited chest movement
5. Fever & malaise (infection)
6. CXR – pleural effusion
35

36. DIAGNOSIS
1. Chest X Ray
2. Pleural fluid analysis (look for bacteria,
amount of protein, cancerous cell)
3. Sputum culture & sensitivity
4. Bronchoscopy
5. Thoracentesis (a sample of fluid is removed
with a needle inserted between the ribs)
6. Thoracic CT
7. Ultrasound of the chest
36

37. TREATMENT
1. Chest drainage
2. Thoracentesis
3. Antibiotic (if infection)
4. Chemotherapy (if cancer)
5. Radiation therapy
37

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