Sunday, January 15, 2006

pneumonia

Pneumonia is an acute illness caused by inflammation or infection of the lungs. It can occur in any season but is most common during winter and early spring. People of any age are susceptible, but it is more common among infants and the elderly. Pneumonia is often caused by aspiration of infected materials into the distal bronchioles and alveoli. People who are highly susceptible include those whose respiratory defense mechanisms are damaged, those with chronic obstructive lung disease, influenza, and tracheostomy (opening through the neck into the windpipe) patients who have recently had anesthesia, and alcoholics. Nasocomial pneumonia (acquired in the hospital) increasingly is a cause of mortality due to an increase in the number of patients with impaired defenses resulting from certain types of therapy and an increase in the number of patients on respirators.
Pneumonia is a communicable disease. The mode of transmission is dependent on the infecting organism. Pneumonia is classified according to the offending organism rather than anatomic location. Typical or classic pneumonia is found in those with diminished defense mechanisms, recent respiratory tract infection or viral influenza. Symptoms include sudden onset with a shaking chill, fever, pleuritic chest pain, and productive cough. Sputum is greenish and purulent (pus-like) and may be blood tinged. Respirations are rapid and shallow with fine inspiratory crackling rales (abnormal breathing sounds).
Diagnosis is made by physical examination, sputum culture and sensitivity studies, chest x-ray, and complete blood count. Treatment is primarily supportive. It includes bed rest and fluids in large quantities. If the patient is unable to tolerate oral fluids, intravenous fluids are given. Humidification, by a cool-mist vaporizer, of inspired air is usually helpful in liquifying secretions. Oxygen may be administered by nasal prong or mask to relieve dyspnea (shortness of breath). Coughing and deep breathing are encouraged to expand the lungs and raise sputum. Analgesics are given to reduce temperature. Codeine may be given for chest pain.
Atypical pneumonia is most commonly caused by mycoplasma pneumoniae. Legionella pneumophila, the organism causing Legionnaire's disease, occurs most commonly in older adults and in people who smoke. Predisposing conditions include chronic renal disease, chronic bronchitis, emphysema, diabetes, cancer, immunosuppressive medications, and smoking. About 25,000 cases of Legionnaires' disease occur annually.
Onset of symptoms is gradual. The patient experiences malaise, headache, sore throat, dry cough, and soreness of the chest wall. Patients with Legionella infections may also have abdominal pain, diarrhea, and respiratory distress. Increased temperature and shaking chills are also common. Treatment for infection by mycoplasma pneumoniae and Legionella pneumophila is erythromycin or rifampin.
Aspiration pneumonia is caused by the aspiration of material into the airways. Non- infectious aspiration pneumonia is caused by aspiration of gastric acid; even a small amount can cause severe respiratory distress. If a bacterial infection occurs it usually manifests itself in 48 to 72 hours. Aspiration of large quantities of inert substances such as water, barium, and tube-feeding liquids obstruct the airway and cause respiratory distress. A secondary infection may occur in obstructed airways.
Bacterial aspiration pneumonia occurs in patients who have consciousness disorders such as anesthesia, coma, seizures, or excessive alcoholism. It occurs in other patients who also have a poor cough mechanism. The clinical course is mild and gradual in early stages. Symptoms include a cough and low-grade fever over several days or weeks, progressing to expectoration of large amounts of foul-smelling sputum.
Aspiration pneumonia acquired in the hospital may be insidious in onset. Early symptoms may be fever and mild tachypnea. Treatment is symptomatic and includes measures used in the treatment of classic pneumonia.
Two vaccines are available to prevent respiratory infections. They should be given to people with a high risk of developing complications of pneumonia, those with chronic heart or lung disease and people 65 or older. Strict adherence to handwashing is a major preventive measure.
Scherer, J. C. Introductory Medical-Surgical Nursing. 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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