Purpose
To provide a thorough review of a disease process at the cellular or organ level Link essential assessments and nursing care priorities to the client’s response to their disease process.
Pathophysiology at the Cellular or Organ Level
Pneumonia is described in Tabers cyclopedia medical dictionary, “as inflammation of the lungs, usually due to an infection with bacteria, viruses, or other pathogenic organisms” (p.1833) The pathophysiology of pneumonia is broken down in four stages cough, red hepatization, gray hepatization, and resolution. The first stage is congestion. This happens once the organism reaches the alveoli, which results in fluid entering the alveoli. Inside the alveoli there is fluid called serous.
Once the organism reaches the serous fluid it multiplies and spreads to the adjacent alveoli (Lewis, Dirksen, Heitkemper, Bucher, Camera, 2011). Serous fluid acts as a lubricant and reduces friction from muscle movement (2011. Pneumonia). When the organism interrupts the serous fluid it then interferes with gas exchange. The second stage is referred to as red hepatization.
The lungs turn red and granular, which is caused by massive dilation of the capillaries. At this stage the alveoli are filled with organisms, neutrophils, red blood cells, and fibrin. The third stage of pathophysiology of pneumonia is gray hepatization. In this process the blood decreases and red blood cells start breaking down. Then the fibrin and leukocytes surround the affected lungs.
The final stage is called the resolution. The fluid breaks down and is processed by macrophages. Macrophages have antigen receptors on their surface that can identify foreign antigens and can activate immune response. During the healing process normal lung tissue comes back and the patient’s gas exchange with the alveoli returns to normal (Lewis et al., 2011). Signs and Symptoms
The signs and symptoms of pneumonia vary from mild to severe cases. Each case can be different depending on the type of organism, a person’s age, or the overall health of the patient. (2011. Pneumonia).
Signs and symptoms for pneumonia from Tabers cyclopedia medical dictionary include:
- Fever, sweating, and Chills
- Cough
- Mucus from lungs. Color can be rusty or green. Mucus can also have blood mixed in.
- Chest pain that sometimes results from coughing or breathing in. Fatigue and body aches
- Nausea and vomiting
- Diarrhea
- Headache
All of these symptoms can contribute to pneumonia. The most common symptoms are cough, fever, and shortness of breath (P.1834).
Diagnostic Tests and Results
When diagnosing pneumonia your physician usually will start by obtaining medical history and perform a physical examination. If the physician suspects pneumonia then he might recommend other diagnostic test, which include: Chest x-ray will confirm whether you have pneumonia and show the location of the infection. Blood test which can show elevated leukocytes.
Pulse oximetry is used to measure the level of oxygen. The lack of gas exchange can prevent movement of oxygen in the blood stream and cause a poor pulse oximetry levels. Sputum test which can determine what kind of infection. A sample fluid can be obtained from a deep cough. Test and results vary depending on the infection. Most cases of pneumonia can be determined by history, physical examination, and a chest x-ray (Lewis et al., 2011).
Medications Prescribed for the Disease Process
Most physicians prescribe antibiotics for pneumonia. In most cases they prescribe medication without even knowing what kind organism that has infected the lungs. Antibiotics stated on webmd.com include:
- Macrolides: azithromycin, clarithromycin, erythromycin.
- Tetracycline: doxycycline
- Fluoroquinolones: gemifloxacin, levefloxacin, moxifloxacin
- Cephalosporins: cefaclor, cefadroxil, cefprozil, cefuroxime, cephalexin Penicillins: amoxicillin, amoxicillin with clarulanate, ampicillin, piperacillin, ticarcillin with carulanate
- Vancomycin: vancomycin
- OTC: Acetaminophen (Tylenol) or aspirin can be used for pain and body aches.
Physicians usually prescribe one antibiotic that treats a wide range of organisms. If the first does not work they will prescribe another antibiotic that fights a different range of organisms. If severe symptoms they will sometimes start with two antibiotics and do a culture that would show what antibiotics the organism would be resistant to. (2011. Pneumonia)
Two Applicable Nursing Diagnoses:
- Patient has an ineffective airway clearance r/t excessive mucus aeb crackles in the lower lobe.
- Patient is experiencing acute pain r/t coughing and deep breathing aeb wheezing in the right and left upper lobes of the lungs. (Ackley &Ladwig,2011)
Priority Areas for Client Teaching
These areas are important for patients being treated for pneumonia. Client education should include: Finish all antibiotics and the importance of finishing the medication. If patient stop taking their medication in the middle of treatment the infection can come back. Report any signs of symptoms of allergy reactions to the medication. Hydration is important and drinking fluids will help from getting dehydrated. Tylenol and Aspirin can be used for pain or fever. Note you should not give Aspirin to anyone under the age of 20. Rest is important in helping the body recover
Coughing is ok as long as it’s not affecting your sleep. A cough is one way for the body to get rid of the infection. If the cough interferes with sleep to contact your physician. (Lewis et al., 2011)
Priority Nursing
Some pneumonia cases need further treatment besides medication. If a patient has trouble breathing or other lung problems they may require oxygen or medicines you breathe using an inhaler or nebulizer. These help with shortness of breath and wheezing symptoms. For more severe patients hospital treatments may be required they include: Antibiotics through IV, Fluids for hydration, and respiratory therapy to remove mucus from the lungs (2011. Pneumonia).
Health promotion is a way to help reduce the risk of pneumonia returning. Teaching the patient that hand washing, eating a well-balanced diet, exercise, and rest are ways to practice good help habits. Help with providing information about social workers that may be able to set up care at home if patient has no one at home to give support. Promote education on the available vaccines that may help prevent some of the serious complications of pneumonia. Giving information on all the available treatments like medication (antibiotics or OTC), and therapies that help with pneumonia (Lewis et al., 2011).
Resources
- Ackley, MSN,EdS, RN, B.J., & Ladwig, MSN,RN, G.B. (2011). Nursing Diagnosis Handbook-An evidence guide to planning care (Tenth Edition). Maryland Heights, Missouri: Elsevier Mosby.
- Lewis, RN, PhD, FAAN, S. L., Ruff Dirksen, RN, PhD, S., McLean Heitkemper, RN, PhD, CEN, M., Bucher, RN, PhD, CEN, L., & Camera, RN, MSN, ND, I. M. (2011). Medical surgical nursing- assessment and management of clinical problems (Eighth edition). St Louis, Missouri:
- Elsevier Mosby. (2011, March 17). Pneumonia. Retrieved from Webmd, Better information, Better Health. website: www.webmd.com (2009). Pneumonia. Taber’s cyclopedic medical dictionary (22 edition). Philadelphia: F.a. Davis Company.
