The pathophysiology of pneumonia according to Ignatavicius and Workman (2016) “Is excess fluid in the lungs resulting from an inflammatory process. The inflammation is triggered by many infectious organisms and by inhalation of irritating agents. The inflammation occurs in the interstitial space, the alveoli, and often the bronchioles” (Ignatavicius and Workman, 206 p.590). When infectious or irritating agents enter the lungs and begin to multiply in the alveoli, white blood cells go the areas affected triggering the inflammatory response. The inflammatory response leads to local capillary leaks and edema, leading to the alveolar walls to thicken. (Ignatavicius and Workman, 2016, p.590).
Clinical manifestations, according to the National Heart, Lung and Blood Institute (NHLBI), for pneumonia are as follows:
· High Fever
· Shakes and chills
· A cough that produces phlegm that is blood-tinged or rust colored that does not improve or worsen
· Shortness of breath with daily activities
· Pleuritic chest pain, or pain when breathing or coughing
After taking into consideration clinical manifestations, diagnostic testing is needed to confirm a diagnosis of pneumonia. Referring to the Infectious Disease Society of America and American Thoracic Society: Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults (Mandell, Wunderink, Anzueto, Bartlett, Campbell, Dean, Dowell, File, Musher, Niederman, Torres, Whitney, 2007), it is recommended that pretreatment blood samples and cultures be obtained, as well as expectorated sputum for stain and cultures (Mandell et all. 2007). It is also recommended to obtain urine samples to test for Legionella pneumophila and Streptococcus pneumonia (Mandell et all, 2017). Furthermore, arterial blood gasses should be obtained as well as serum lactate levels, serum electrolytes, BUN, and creatinine levels. Management of Community-acquired Pneumonia in Adults (Waterer, Rello, Wunderink, 2010) published by the American Journal of Respiratory and Critical Care Medicine suggested the use of using specific biomarkers to aid in an accurate diagnosis of pneumonia. The specific biomarkers suggested are procalcitonin, c-reactive protein, proadrenomedillin, B-natriuretic peptide, and troponin I. Proadrenomedullin, B-natriuretic peptide, and troponin I are associated with the severity of community-acquired pneumonia (CAP), with troponin specifically correlating with degrees of hypoxia (Waterer, Rello, Wunderrink. 2010).
Treatment of pneumonia involves a combination of different drugs and treatment plans depending on the organism and severity of pneumonia. To begin, patients demonstrating shortness of breath supplemental oxygen via nasal cannula is appropriate to aid in breathing and prevent hypoxemia. According to Bacterial Pneumonia Treatment & Management (Gamache, 2017) “Moderate dyspnea requires high oxygen concentrations, such as those provided by a venti-mask or partial rebreathing face mask. Use theses masks with caution in patients with chronic obstructive pulmonary disease (COPD) and/or hypercarbia. Patients in respiratory failure or those with COPD who need high oxygen concentrations may require endotracheal intubation and ventilation” (Gamache, 2017). Fluid resuscitation, particularly for patients with hypotension, elderly patients, and patients with underlying cardiac diseases can be helping in treatment, taking care to avoid fluid overload. Furthermore, antibiotic treatment is incredibly important, with hospitalized patients be started on a broad spectrum antibiotic quickly after cultures are taken. It is recommended that antibiotic therapy be started within four hours or less from admission (Gamache, 2017). According to Ignatavicius and Workman (2016, p. 593) “Which anti-infective therapy is prescribed is based on how the pneumonia was acquired (i.e. CAP, HAP, or HCAP). The exact drug or drugs and their routes of delivery are determined by the severity of the infection, the organism suspected or identified, and whether the patient has other conditions or factors that increase the risk for complications. Drug therapy choices must reflect the degree resistance in the specific geographic area and in that hospital setting” (p. 593). It is suggested that antibiotic therapy regimes for uncomplicated CAP be used for 5-7 days, and for patients who are immunocompromised or who have HAP to be on a regime for up to 21 days (Ignatavicius and Workman, 2016, p.593).
Common antimicrobials used to treat pneumonia are:
· Penicillin G
Nursing interventions associated with caring for the patient with pneumonia involve, improving gas exchange, thorough respiratory assessments, frequent vital sign assessments, promoting breathing and adequate fluid intake, diagnostic testing, and minimizing anxiety.
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