BRONCHOPNEUMONIA

BRONCHOPNEUMONIA

Pneumonia is an English word derived from the Greek word “Pneumon” which means lungs. According to the Bailliérés Nurses Dictionary, pneumonia is the inflammation of the lungs with consolidation and exudation. It is therefore defined as an inflammation of the lungs parenchyma characterized by consolidation of the affected lung which impairs gaseous exchange. Pneumonitis is generally used to mean an infection and inflammation of the lung tissue. However, pneumonia is commonly used in terms of inflammation of the lung.

INCIDENCE 

It is estimated that pneumonia is the most common cause of death in the United State of America (Brunner and Suddarth 13th edition). It occurs in all age groups but commonly the elderly and children. Incidence is very high during the harmattan season. 

MODE OF TRANSMISSION 

Pneumonia may be transmitted through coughing, sneezing of infected patients. It sometimes arises from aspiration of endogenous fluid by patient whose resistance is low. It can also be spread through blood stream that is when infections are carried to the lungs by the blood.

AETIOLOGY

The common etiological types are the bacteria pneumonia of which the following agents are the common causative organism;

• Streptococcal pneumonia also called pneumococcus. This causes 80% of all bacteria Staphylococcal pneumonia
• Tuberculus pneumonia
• Haemophillus influenza
• Legionella pneumophilia: This causes Legionnaire disease, a form of pneumonia which generally occurs among those whose immunity is low.
• Mycoplasma pneumonia causes 20% of all pneumonia
• Adenovirus causes viral pneumonia

Other pathogenic causes are;

• Aspiration of gastric secretions, food or fluids which occur frequently in the immobile patient
• The elderly who is mobile but debilitated. 

PREDISPOSING FACTORS 

• Chronic diseases such as bronchitis
• Systemic diseases such as diabetes mellitus
• Unconscious patients
• Excessive smoking
• Excessive alcohol intake
• Elderly and infants due to low immunity
• Common cold and other viral respiratory tract infections
• Exposure to cold
• Hypoventilation

PATHOPHYSIOLOGY

Pathogenesis describes the origin and development of a particular disease. Pneumonia interferes with ventilation and diffusion. An inflammatory reaction initiated by pneumococci occurs in the alveoli (air sac) and produce exudates. These exudates in turn interfere with both movement and diffusion of oxygen and carbon dioxide. The alveoli exudates consist of neutrophils with a small amount of fibrin. There is interstitial oedema wall and compensatory emphysema around the collapsed alveoli. Areas of the lungs are not adequately ventilated because of secretions, mucosal oedema and Bronchospasm. These conditions cause partial occlusion of the bronchio alveoli, producing a drop in the alveoli oxygen tension. Venous blood coming into the lungs passes through the under ventilated area and goes out of the lungs to the left side of the heart without being oxygenated. This mixing of oxygenated and deoxygenated blood eventually results in hypoxemia. The stages of pneumonia are;

• Congestion in which the blood vessels are engorged and exudates appears in the alveoli and increase in amount.
• Red hepatization in which the lung becomes solid and the alveoli are filled with Fibrous clots containing red blood cells. This makes the lung reddish like the liver.
• Grey hepatization in which the capillaries are obliterated by the presence of the exudates and alveoli are packed with polymorph nuclear cells and disintegrating red cell.
• Resolution in which there is absorption of the exudates and the lungs are restored to normal. 

TYPES OF PNEUMONIA

Pneumonia can be grouped in several ways; it may be grouped according to microbial aetiology, location of the lesion and means of infection:

1. MICROBIAL AETIOLOGY 

• Viral pneumonia
• Bacterial pneumonia
• Fungi pneumonia
• Protozoa pneumonia
• Mycoplasma pneumonia

2. LOCATION OF LESION OR STRUCTURE;

• Lobar pneumonia: There is an inflammation and consolidation of one or more lobes of the lung.
• Bronchopneumonia: This implies that the pneumonic process is distributed in a patchy fashion having originated in one or more localized areas within the bronchi and extended to the adjacent surrounding parenchyma. It is inflammation of the terminal bronchioles of the lungs. The bronchioles become clogged with mucopurulent exudates and form consolidated patches in nearby lobules. This type of pneumonia is common among infants less than two years of age.
• Lobular pneumonia; It affects part of the lobe

3. MEANS OF INFECTION 

• Primary pneumonia: This results from inhalation or aspiration of pathogens such as bacteria.
• Secondary pneumonia: This is due to initial damage of the lungs from poisonous chemicals or pathogenous spread of bacterial from one part to the other.
• Aspiration pneumonia: It is an inflammatory response in the lungs resulting from the aspiration of foreign substance such as vomitus or food into the bronchi, smoke inhalation etc. This type is often seen in infants who have gastro esophageal reflux or trachea esophageal reflux.
• Hypostatic pneumonia:This results from retention of secretions which occur most frequently in immobilized elderly or debilitated individuals. It can also occur in anaesthetized patient with inadequate lung expansion.

CLINICAL FEATURES

1. There is increased pulse and respiratory rate
2. There is difficulty in breathing
3. here is painful productive cough
4. There is general malaise
5. There is increased in body temperature
6. There is cyanosis
7. Nostrils are flared on inspiration
8. In pneumococcal pneumonia, sputum is usually rusty colored and becomes purulent as resolution takes place.
9. There is an elevation of white blood cells
10. Rhinorrhea

DIAGNOSTIC INVESTIGATIONS

1. Chest X – ray discloses infiltration of the lung.
2. Blood culture reveals causative organism
3. Sputum culture and sensitivity to isolate the causative organism
4. Chest auscultation and percussion to reveal dullness and decreased breath sound
5. White blood cell count is elevated
6. History and clinical features manifested by child. 

MEDICAL TREATMENT

1. Antibiotics: This is given to treat infections and inhibit the growth of the specific organism eg;

• Streptococcus pneumonia is treated with penicillin G.
• Klebsiella pneumonia is treated with cephalosporin. Example ceftriaxone.
• Pneumocystis carinii pneumonia is treated with pentamidine methane sulfonate and trimethoprim – sulfamethoxazole. Other antimicrobials used include erythromycin, clindamycin and other penicillin’s.

2.  Analgesics: It is administered to relieve pain example, paracetamol.

3. Cough Suppressants: They are administered to suppress cough example sedalyn.

4. Mixture of Expectorate: They are served as sedative and facilitate the removal of sputum.

5.  Haematinic: They are administered to prevent or combat anemia. E.g. oradex

6. Antipyretics: They are administered to reduce or bring temperature to normal.

7. Intravenous therapy: They are administered to prevent dehydration and restore energy. E.g. Dextrose Saline.

8. Oxygen therapy: They are administered to enhance aspiration and prevent cyanosis as well as nourishing body tissues.

PREVENTION OF INFECTION

1. Open windows for proper ventilation to minimize air contamination.
2. Encourage patient to cover his mouth and nose when coughing.
3. All secretions should be disinfected before discarding.
4. People with respiratory tract infection should not care for patient or visit patients with pneumonia.
5. The nurse should wash hands before and after attending to patient and after each procedure to prevent cross infection.

COMPLICATIONS

• Pleural effusion
• Respiratory failure
• Lung abscess
• Meningitis
• Septicemia
• Empyema
• Pneumothorax
• Pulmonary edema
• Hypoxemia