Pneumonia

What is Pneumonia?
Pneumonia is a lung infection that can be caused by different types of microorganisms, including bacteria, viruses, and fungi.

What are the causes of pneumonia?

Some cases of pneumonia are contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs cough or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep, it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and their immune system will prevent the aspirated organisms from causing pneumonia. However, if a person is in a weakened condition from another illness, a severe pneumonia can develop. People with recent viral infections, lung diseases heart diseases, and swallowing problem, as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population. As we age, our swallowing mechanism can become impaired as does our immune system. These factors, along with some of the negative side effects of medications, increase the risk for pneumonia in the elderly. Once organisms enter the lungs, they usually settle in the air sacs and passages of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus (the body's inflammatory cells) as the body attempts to fight off the infection.

What are pneumonia symptoms and signs?

Most people who develop pneumonia initially have symptoms of a cold (upper respiratory infection, for example, sneezing, sore throat, cough), which are then followed by a high fever (sometimes as high as 104 F), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Depending on the location of the infection, certain symptoms are more likely to develop. When the infection settles in the air passages, cough and sputum tend to predominate the symptoms. In some, the spongy tissue of the lungs that contain the air sacs is more involved. In this case, oxygenation of the blood can be impaired, along with stiffening of the lung, which results in shortness of breath. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated. The only pain fibers in the lung are on the surface of the lung, in the area known as the pleura. Chest pain may develop if the outer aspects of the lung close to the pleura are involved in the infection. This pain is usually sharp and worsens when taking a deep breath and is known as pleuritic pain or pleurisy. In other cases of pneumonia, depending on the causative organism, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms. Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia.

What are the treatments of pneumonia?

Antibiotics are used to treat bacterial pneumonia. In contrast, antibiotics are not useful for viral pneumonia, although they sometimes are used to treat or prevent bacterial infections that can occur in lungs damaged by a viral pneumonia. The antibiotic choice depends on the nature of the pneumonia, the most common microorganisms causing pneumonia in the local geographic area, and the immune status and underlying health of the individual. Treatment for pneumonia should ideally be based on the causative microorganism and its known antibiotic sensitivity. Because treatment should generally not be delayed in any person with a serious pneumonia, empiric treatment is usually started well before laboratory reports are available. - The duration of treatment has traditionally been seven to ten days, but there is increasing evidence that shorter courses (as short as three days) are sufficient. Antibiotics for hospital-acquired pneumonia include third- and fourth-generation aminoglycosides, and vancomycin. These antibiotics are usually given intravenously. Multiple antibiotics may be administered in combination in an attempt to treat all of the possible causative microorganisms. People who have difficulty breathing due to pneumonia may require extra oxygen. Extremely sick individuals may require intensive care, often including end tracheal intubation and artificial ventilation.

What are the nursing responsibilities?

Observe and report signs of pain. Tell the nurse if a person tells you that they are in pain or if you see an unconscious person with a look of pain on their face. Pain is now called the 5th vital sign. Patients should be checked for pain often. Provide a quiet room, a backrub and even soothing music to patients that are in pain. Allow the person in pain to speak to you. Spend quiet time with them when that is what they want.

Give the person their bath and provide very good skin care. Keep them clean and dry at all times.

Turn and position the patient at least every 2 hours. Many dying patients are at risk for pressure ulcers.

Provide very good mouth care. The patient may be dehydrated and have a dry mouth. Use mouth swabs for unconscious patients that have a dry mouth. Give sips of water to patients that are conscious and able to swallow safely.

Keep the bed and the room neat. Adjust the temperature in the room if the person is too warm or too cold. Give them lighter clothing to wear if they are hot. Give them a sweater or blankets if they are cold.

Emphysema
What is Emphysema?
Emphysema is a destructive disease of the lung in which the alveoli (small sacs) that promote oxygen exchange between the air and the bloodstream are destroyed.

What are the Symptoms?

Each of the subtypes has characteristic symptoms; those primarily associated with emphysema are shortness of breath and wheezing. Initially the shortness of breath (dyspnea) occurs with activity; as time continues and the disease progresses, the episodes of dyspnea occur more frequently eventually occurring at rest.

What are the causes for emphysema?

The main risk factor for emphysema is smoking, which activates inflammatory cells in the lung. This inflammation causes; 1) swelling within the bronchioles, and 2) activation of enzymes called proteases which attack and destroy lung tissue (the alveolar wall structures). This leads to centriacinar emphysema, which begins in the bronchioles and gradually spreads peripherally to the far reaches of the lung. There may be a genetic contribution to the development of emphysema, since not all people who smoke suffer from emphysema.

There is also an inherited form of emphysema. The relatively rare condition known as Alpha 1-antitrypsin deficiency is the genetic deficiency of a chemical that protects the lung from damage by proteases. This results in panacinar emphysema, which destroys the alveoli throughout the lung uniformly.

Emphysema is also a component of aging. As the lungs get older, the elastic properties decrease, and the tensions that develop can result in small areas of emphysema.

Treatment for Emphysema?

Emphysema is not a curable disease, once lung damage has occurred it cannot be reversed. The goal of treatment is to stop further lung destruction and preserve lung function. The patient needs to know that the focus is on improving quality of life and limiting the intrusion of emphysema on daily activities. Emphysema tends not to be the primary cause of death, but can be a contributing factor to other organ failure.

What are the stages of emphysema?

Emphysema staging helps determine how much lung damage is present and how severe it is. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses FEV1 measurements to help with this determination: Stage I = mild II = moderate III = severe IV = very severe FEV1 greater than or equal to 80% predicted less than 80%, greater than 50% predicted Less than 50%, greater than 30% predicted Less than 30% predicted, or less than 50% in chronic respiratory failure

What are the nursing responsibilities?

Always encourage proper hygiene and proper nutrition. Increase fluid intake.

Proper positioning and frequent changing of positions to allow better lung expansion and air and fluid movement.

Teach the client proper breathing techniques for better air exchange.

Encourage the client to eat more frequent, smaller meals to decrease gastric distention, which can cause pressure on the diaphragm.