Medical Surgical Respiratory System: Pneumonia

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Risk Factor:

Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (eg, cancer, cigarette smoking, chronic obstructive pulmonary disease). Immunosuppressed patients and those with a low neutrophil count (neutropenic). Smoking; cigarette smoke disrupts both mucociliary and macrophage Activity. Prolonged immobility and shallow breathing pattern. Depressed cough reflex (due to medications, a debilitated state, or weak respiratory muscles); aspiration of foreign material into the lungs during a period of unconsciousness (head injury, anesthesia, depressed level of consciousness), or abnormal swallowing mechanism. Nothing-by-mouth (NPO) status; placement of nasogastric, orogastric, or endotracheal tube. Supine positioning in patients unable to protect their airway. Antibiotic therapy (in very ill people, the oropharynx is likely to be colonized by gram-negative bacteria). Alcohol intoxication (because alcohol suppresses the body’s reflexes, may be associated with aspiration, and decreases white cell mobilization and tracheobronchial ciliary motion). General anesthetic, sedative, or opioid preparations that promote respiratory depression, which causes a shallow breathing pattern and predisposes to the pooling of bronchial secretions and potential development of pneumonia. Advanced age, because of possible depressed cough and glottic reflexes and nutritional depletion. Respiratory therapy with improperly cleaned equipment. Transmission of organisms from health care providers.

Preventive Measures:

Promote coughing and expectoration of secretions. Encourage smoking cessation. Initiate special precautions against infection. Initiate suctioning and chest physical therapy if indicated. Reposition frequently to prevent aspiration and administer medications. Promote frequent oral hygiene. Minimize risk for aspiration by checking placement of tube and proper positioning of patient. Elevate head of bed at least 30 degrees. Monitor patients receiving antibiotic therapy for signs and symptoms of pneumonia. Encourage reduced or moderate alcohol intake. Observe the respiratory rate and depth during recovery from general anesthesia and before giving medications. If respiratory depression is apparent, withhold the medication and contact the physician. Promote frequent turning, early ambulation and mobilization, effective coughing, breathing exercises, and nutritious diet. Make sure that respiratory equipment is cleaned properly; participate in continuous quality improvement monitoring with the respiratory care department. Use strict hand hygiene and gloves. Implement health care provider education.

Treatment for Pneumonia Complications:

A vasopressor agent may be administered by continuous IV infusion and at a rate adjusted in accordance with the pressure response. Corticosteroids may be administered parenterally to combat shock and toxicity in patients who are extremely ill with pneumonia and at apparent risk for death from the infection. Patients may require endotracheal intubation and mechanical ventilation.

Patho:

Normally, the upper airway prevents potentially infectious particles from reaching the sterile lower respiratory tract. Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx; patients often have an acute or chronic underlying disease that impairs host defenses. Pneumonia may also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Pneumonia affects both ventilation and diffusion. An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air-filled spaces. Areas of the lung are not adequately ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease in alveolar oxygen tension. Bronchospasm may also occur in patients with reactive airway disease. Because of hypoventilation, a ventilation–perfusion mismatch occurs in the affected area of the lung. Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated. The mixing of oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial hypoxemia. If a substantial portion of one or more lobes is involved, the disease is referred to as lobar pneumonia. The term bronchopneumonia is used to describe pneumonia that is distributed in a patchy fashion, having originated in one or more localized areas within the bronchi and extending to the adjacent surrounding lung parenchyma. Bronchopneumonia is more common than lobar pneumonia

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