LOBAR PNEUMONIA.

CLARKE INTERNATIONAL UNIVERSITY

SURGICAL NURSING 2 ASSIGNMENT.
LECTURER:MS ANYANGO STELLA
NAMUKWAYA LILLIAN
2021BNSTU-A05.
 PRESENTATION OUTLINE
• Introduction
• Definition
• Pathophysiology
• Causes of pneumonia
• Risk factors
• Signs and symptoms
• Complications
• Diagnosis
• Management
• Prevention
• Nursing concerns
• Nursing diagnoses
• Nursing care plan
• References
DEFINITION
• Pneumonia; infection
that inflames the air
sacs in one or both
lungs, causing them to
fill with fluid or pus,
which makes it difficult
to breathe.
• Also defined as an
infection of one or both
of the lungs caused by
bacteria, viruses, or
fungi.
Definition cont’d
• Lobar pneumonia • Bronchial pneumonia
affects one or more affects patches
lobes of the lungs. throughout both
lungs.
 PATHOPHYSIOLOGY
•Entry of pathogens.
Pneumonia is commonly caused by bacteria, viruses, fungi or other micro-
organisms.
These enter the lungs through inhalation of infected droplets, aspiration of oral
or gastric contents or through the bloodstream from another infected site of
the body.
•Inflammatory Response.
When the pathogens reach the alveoli (air sacs) of the lungs, the body's immune
system is activated.
This triggers an inflammatory response; hence release of cytokines, chemokines
and other inflammatory mediators.
•Alveolar Damage and fluid Accumulation.
In response to the inflammation, the alveoli become damaged and leaky.
 Fluid, white blood cells and other inflammatory substances accumulate in the air sacs, leading
to congestion of lung tissue.
 This process impairs gas exchange, resulting in hypoxemia.
 Pathophysiology cont’d
• Consolidation and impaired Gas Exchange. •Resolution or Chronic infection.
• The affected lung becomes consolidated, firm and
With appropriate treatment, the
solid due to the accumulated inflammatory exudate
and cellular debris. body's immune system often clears

• This impairs the gaseous exchange in the lungs, and the infection, leading to resolution of
resultant respiratory distress and hypoxia.
pneumonia.
•Resulting Symptoms and Complications.
However in some cases, particularly
The accumulation of fluid and inflammatory cells in the
lungs leads to; in immunocompromised individuals

 Fever, cough, chest pain, shortness of breath, or with certain pathogens,

Sputum production
pneumonia can become chronic or
In severe cases, pneumonia can lead to complications
recurrent.
such as respiratory failure, sepsis and lung abscesses.
 CAUSES OF PNEUMONIA
• Bacterial pneumonia.
Most commonly caused by; streptococcus pneumoniae.
It sets in when the body is weakened by illness, poor nutrition, old age and impaired immunity.
Other people at risk; alcohol abusers and cigarette smokers, those from recent surgery, and those
with respiratory diseases or viral infection.
 Other causative organisms
Klebsiella pneumoniae, legionella pneumophila, haemophilus influenzae, mycobacterium
tuberculosis.

• Viral pneumonia.
Common viruses include flu(influenza)
• Mycoplasma pneumoniae; commonly causes mild infections of the respiratory system.
Sometimes these bacteria can cause more serious lung infections that require hosptalisation.
• Good hygiene is important to help decrease the spread of M. pneumoniae and other
respiratory germs.
• Other pneumonias; These are caused by other infections including fungi.
Causes cont’d
 RISK FACTORS
• Adults ages 65 and older.
• Children younger than age 5.
• People with an underlying health condition, weakened immune
system, organ transplant
• People who smoke and take alcohol.
• People receiving chemotherapy or taking medication that suppresses
the immune system
 SIGNS AND SYMPTOMS
• When to see a doctor…
• Cyanotic lips and finger nails
• Shortness of breath
• Chest pain when you breathe or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm- green, yellow and bloody mucus.
• Fatigue
• Fever, sweating and shaking chills
• Lower than normal body temperature (in adults older than age 65 and
people with weak immune systems)
• Loss of appetite
• Nausea, vomiting or diarrhea
For some older adults and people with heart failure or chronic lung
problems, pneumonia can quickly become life-threatening.
 COMPLICATIONS
• Pleural effusion; Fever, chest pain, dry cough, shortness of breath, orthopnea

• Acute respiratory distress syndrome (ARDS).

• Lung abscess- Pockets of pus inside or around the lungs (need to be drained with
surgery), fever, chest pain, foul-smelling productive cough that includes green,
brown, or blood-tinged sputum
• Collapsed lungs -commonly known as pneumothorax; Fast breathing, racing
heartbeat, shortness of breath, fatigue, chest pain on deep breathing (usually on
one side of the chest)
• Respiratory failure; extreme fatigue, confusion, feeling like you can’t get enough air,
lips or fingers that turn blue, peripheral pulse-oximety reading consistently lower
than 90%
• Renal failure; studies show that pneumonia increases risk of chronic kidney
disease (CKD), and CKD can cause pneumonia.
 DIAGNOSIS
• Take history and physical examination of the patient (Such as surgery,
a cold or travel exposures).
• Chest X-ray of internal tissues ,bones and lungs.
• CBC for infection, blood cultures and Arterial blood gas to check
amounts of oxygen in the bloodstream.
• Sputum culture.
• Pulse oximetry to check amounts of oxygen in blood.
• Chest CT scan of the lungs.
• Bronchoscopy. Exams the bronchi with a tube called bronchoscope to
assess blockages and take out samples of tissues or fluid for testing.
• Pleural fluid culture.
MEDICAL MANAGEMENT
• 1. Antibiotics includes penicillin derivatives such as Amoxicillin,
macrolides such as Azithromycin or Clarithromycin, Cephalosporins
and fluoroquinolones.
• 2.Supportive Care.
Fluids: Keeping hydrated helps thin mucus and make it easier to cough
up and prevents dehydration, especially if the person has fevers.
Rest: Adequate rest allows the body to focus on infection.
Pain relief: Such as acetaminophen or ibuprofen help reduce fever and
muscle aches.
• Oxygen therapy
• Respiratory support: Such as mechanical ventilation in severe cases.
 Medical management continued
• 3.Supportive Management.
Fever reduction.ie acetaminophen or ibuprofen.
Cough suppression.
Expectorants.To loosen mucus and make coughing more productive.
Bronchodilators:If there is any underlying asthma or COPD,
bronchodilators may be prescribed to open up the airway and ease
breathing.
• 4.Vaccinations with pneumococcal vaccine and influenza(flu)
vaccine.
• 5.Follow-up.It’s essential for patients with pneumonia to follow up
with their health providers.
SURGICAL MANAGEMENT
• Surgical management of lobar pneumonia is usually reserved for
cases where there are complications like lung abscess or empyema
(pus accumulation in the pleural cavity).
• Procedures may include drainage of the abscess or empyema,
decortication (removing the fibrous layer around the lung), or, in
rare cases, lobectomy (removal of the affected lobe). These
interventions are typically done in conjunction with antibiotic
therapy.
PREVENTION
• Vaccination with pneumococcal vaccine to children younger

than 5 and adults ages 65 and older.

• Pneumococcal vaccine is recommended to all children and

adults who are at risk of pneumococcal disease.

NURSING CONCERNS
• Monitoring vital signs, and oxygen saturation.
• Administration of antibiotics, pyretics as prescribed.
• Ensuring adequate hydration.
• Providing respiratory support,such as chest physiotherapy,
nebulization to improve lung function and clearance.
• Nutrition to support the body's immune response and help in
recovery.
• Infection control.For Example hand hygiene and proper disposal of
contaminated materials.
• Monitoring for signs of complications such as sepsis or respiratory
distress.
 NURSING DIAGNOSES
• Ineffective Airway Clearance related to increased sputum production as evidenced by audible rhonchi,
productive cough, and difficulty expectorating sputum.

• Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by altered arterial blood
gases, hypoxemia, and cyanosis.

• Ineffective Breathing Pattern related to respiratory distress as evidenced by use of accessory muscles,
tachypnea, and abnormal breath sounds.

• Risk for infection related to compromised host defenses

• Acute pain related to pleural irritation as evidenced by sharp chest pain that worsens with deep breathing
and coughing.
• Activity Intolerance related to decreased oxygenation and general weakness as evidenced by fatigue, dyspnea
on minimal exertion, and reluctance to engage in physical activities.
• Hyperthermia (related to inflammatory process as evidenced by elevated body temperature, chills, and
diaphoresis).
• Imbalanced Nutrition: Less Than Body Requirements related to increased metabolic demand and decreased
oral intake as evidenced by weight loss, muscle weakness, and reported lack of appetite.
• Deficient knowledge related to pneumonia treatment and prevention as evidenced by patient’s questions
about medication regimen, importance of vaccination, and strategies to prevent future infections.
 Nursing care plan
Assessment Diagnosis Planning Implementation Evaluation
/rationale

Subjective data Ineffective Goals:  Administering

humidified oxygen at 5
 The patient has
Patient reports Airway Short term Ltrs; to improve the improved
blocked nose, Clearance To improve breathing rate within SPO2 saturation while oxygen
difficult in related to 1 hour. helping in liquefying saturation at
breathing. Patient increased To improve SPO2 to 94% within the respiratory
93% within 1
reports shortness 1-2 hours secretions and improve
of breath.
sputum Long term oxygen perfusion. hour.
production due To improve SPO2 to 96-97% with  Position the patient in  Patient has
Objective data to inflammation in 6 hours. a sit-up position to
improved
Patient has To have the patient able to maintain a patent
productive cough, as evidenced by maintain a patent airway within 2 airway. respiratory rate
with a thick audible rhonchi, days  Encourage rehydration at 22 bpm with
sputum. productive Expected outcomes: to promote liquefied
in 1 hour.
Short term secretions.
Audible rhonchi cough, and Patient will have improved  Administer prescribed  Patient is able
Patient is using difficulty breathing rate within 1 hour. medication to treat the to maintain 95%
intercostal muscles causal organism of
expectorating SPO2 will improve to 94% within
pneumonia. oxygen
to breathe sputum. 1-2 hours saturation
Respiratory rate Long term  Help the patient to
25bpm SPO2 will improve to 96-97% perform breathing to within 24 hours
improve exercises
Spo2; 90% with in 6 hours
 Teach the patient the  Patient has
Patient will be able to maintain a improved
patent airway within 2 days breathing exercises
oxygen
saturation at
96-97% within 2
days .
REFERENCES
• CDC, 2022. Pneumonia. National
Center for Immunization and Respiratory Diseases. September
30, 2022Source:
• MATT VERA, 2024. 11 Pneumonia Nursing Care Plans.
UPDATED ON MARCH 5, 2024