Lower Airway Restrictive Disorders

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Lower Airway Restrictive Disorders

• Pneumonia

The leading cause of death in infectious diseases
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Pneumonia

• Inflammation of lung tissue resulting from
  infectious organism.

• Classified according to
• Location bronchi, lobar pneumonia
• Origin viral, fungal, bacterial
• Type Typical / atypical
• primary or secondary origin

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Lung involvement
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Types of pneumonia
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Etiology
Community Acquired Pneumonia
Nosocomial - Hospital acquired Pneumonia
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Community Acquired Pneumonia

• Elderly

• No history of pneumococcal vaccination

• No influenza vaccine in the previous year

• Chronic other co-existing condition

• Recent history of /exposure to viral/influenza
  infection

• History of tobacco / Alcohol use

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INCIDENCE of CAP
Tends to be mostly gram-positive
Streptococcus Pneumoniae 60 Mycoplasma
pneumoniae 10 Haemophilus influenzae 10 Viru
ses 10
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Nosocomial Pneumonias

• Elderly

• Chronic lung disease

• Gram negative colonization of the oropharnyx
  stomach

• Altered level of consciousness

• Aspiration

• Endotracheal, tracheostomy, Nasogastic tubes

• Poor nutritional status

• Immunocompromised status ( from disease/
  medications)

• Medications that increase gastric pH

• Mechanical ventilation

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Incidence - HAP
Gram - negative bacteria (i.e. Pseudomonas
aerginosa, Escherichia coli)
50 Staphylococcus aureus
20 Streptococcus pneumoniae
15 Anaerobes and fungi
10 Others 5
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Hospital acquired infections tend to be more
virulent and are associated with a high mortality
rate since the invading microorganisms are more
virulent
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Chances of getting depend on

• Resistance
• pathogens
• pathogen virulence

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Routes

• Aspiration ? bacteria hospital acquired
• - organism from oropharynx GI tract
• - i.e. Trach tube, NG tube

• Inhalation ? usually viral

• Circulatory ? to lungs via circulation
• - i.e.. Endocarditis, septicemia

• Direct contact ? through health carers
• - contaminated equipment such as suction
  catheters, improper hand washing

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Path physiology

• Inflammation lung tissue
• ?
• production of exudate
• ?
• shunting (? ventilation)
• ?
• consolidates lungs
• ?
• hypoxemia

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Assessment
History consider risk factors

• Physical assessment

• flushed cheeks , bright eyes anxious expression

• Fever

• vital signs

• Cough

• Sputum production

• Pleuritic chest discomfort

• auscultation

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Clinical Manifestations

• Elderly usually exhibit with weakness, fatigue,
  lethargy, confusion and poor appetite
• Fever and Cough may be absent but respiratory
  rate is high and PO2 is low

Infants poor feeding, lethargy, fever, resp.
distress
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Complications

• Hypoxemia
• Ventilatory failure
• Atelactasis
• Pleural effusion
• Pleurisy
• Septicemia
• Super infection

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TESTS

• Chest X rays

• Sputum specimen

• WBC

• Blood cultures

• ABGs

• Bronchoscopy or tracheal aspiration

• pulse oxymetry

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Nursing Diagnosis

• Ineffective airway clearance related to retained
  secretions
• Activity intolerance related to inflammatory
  process
• Pain related to continued coughing
• Knowledge deficit related to proper management of
  symptoms
• Risk of fluid volume deficit related to tachypnoea

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Nursing Management

• Promote adequate ventilation
• Control infection
• Provide rest and comfort
• Prevent potential complications
• Health teaching