1. Prepared by:-
Dr / amany lotfy
pneumonia

2. Definition :- Asthma is an intermittent, reversible, 
obstructive airway disease, it is
manifested by a narrowing of airway resulting in
dyspnea, cough and wheezing.
Asthma can begin at any age about half of the 
cases develop in childhood and anther third
before age 40.
Asthma is often characterized as allergic, 
idiopathic Or mixed

3. Exercise 
Stress or emotional upset 
Medications 
Aspirin and non steroid anti-inflammatory chugs 
(NSAlDs), beta-blockers (including eye drops),
cholinergic drugs (to promote bladder contraction and
as eye drops for glaucoma) .
Enzymes- including those in laundry detergents..
' Chemicals- toluene and others used in solvents, 
paints, and plastics

4. The common symptoms of asthma are cough, 
dyspnea & wheezing.
Asthma attacks frequently occur at 
night.
Attacks starts suddenly with coughing 
& a sensation of tightness in the
chest.
Cyanosis secondary to sever hypoxia. 
Symptoms of carbon dioxide retention 
- sweating, tachycardia.

5. Un Status asthmatics occurs in which therapeutic 
measures fail &the
patient has repeated attacks or continuous asthma.
Allergic reaction eczema, urticaria, edema. 

6. 1-Acomplete history. 
2- Reaction skin test. 
3-Assessment of environmental factors, including 
seasonal changes, mold and pollens. Climate
changes.
4-Occupation- related chemicals & compounds 
(metal salts, wood & vegetable dust,
pharmacological a gents, industrial chemicals,
biologic enzymes - including laundry detergents 5-
5-Chest X-ray.
6- Sputum examination.' Pulmonary function 
studies

7. There are five categories of drugs used in the 
treatment of asthma:
Beta antagonist brortchodilatots:eg pinephrine. 
Methylxanthines - bronchodilator e.g aminophylline 
Ant cholinergic - broncho-dilatition effect e.g. tropine. 
Corticosteroids - reduce inflammation & broncho- 
constrictione.g. hydrocortisone prednisone.5- Mast
cell inhibitors: broncho-dilatition g.cromolyn sodium.

8. Assessment :-ASSESS THE PATIENT RFOR :- 
History of asthma onset & duration 
Precipitating factors 
Current medications 
Medications used to relieve asthma symptoms 
Any recent changes in medication regimen , 
Self-care methods used to relieve symptoms: 
Assess General appearance. 
Assess vital signs. 
Assess laboratory findings. 



9. Pneumonia is an inflammatory 
illness of the lung. Frequently,
it is described as lung
parenchyma/alveolar
inflammation and abnormal
alveolar filling with fluid

10. Classification according to the causative 
agent:
1-' Bacterial pneumonia (common * 
streptococcus;)
2- Viral Pneumonia 
3- Mycoplasma Pneumonia 
4-Aspiration pneumonia's syndrome 
5-Chemical pneumonia, after ingestion 
of kerosene or irritation gases

11. Risk factor/groups: 
Patients with conditions that produce 
bronchial obstruction -
cancer 
Immunosuppressed patients 
Smokers 
Bed ridden patients 
Very ill patients who are on nothing by 
mouth ,Over dose of sedatives- respiratory
depression
Associated with congestive heart failure 
diabetes, alcoholism

12.  Classification
◦ 1.1 Early classification schemes
◦ 1.2 Combined clinical classification
 1.2.1 Community-acquired
pneumonia
 1.2.2 Hospital-acquired pneumonia

13.  A lobar pneumonia is an infection that
only involves a single lobe, or section, of a
lung. Lobar pneumonia is often due to
Streptococcus pneumonia (though
Klebsiella pneumonia is also possible.)
 Multilobar pneumonia involves more
than one lobe, and it often causes a more
severe illness.

14. pneumonia by clinical 
them into characteristics, dividing
1-"acute" (less than three weeks 
duration) Streptococcus
pneumonia
2- "chronic" pneumonias. 

15. is infectious pneumonia in a person who 
has not recently been hospitalized.
Streptococcus pneumonia is 
the most common cause of
community-acquired
pneumonia

16. called Nosocomial 
pneumonia, is pneumonia
acquired during or after
hospitalization for another
illness or procedure with
onset at least 72 hrs after
admission.

17. risk factors for pneumonia, 
including mechanical ventilation,
prolonged malnutrition, underlying
heart and lung diseases,
decreased amounts of stomach
acid, and immune disturbances.

18. 1- Pneumonia arises from aspiration of 
flora present in the oropharynx. &
blood borne organisms that enter the
pulmonary circulation
2-An inflammatory reaction can occur 
alveoli, producing exudates that in the
affect on ventilation 3-White blood
cells, mostly neutrophils, migrate into
the alveoli. Areas of the lung are not
adequately ventilated because of
secretions and mucosal edema that
cause partial occlusion of the bronchi

19. 4- Venous blood entering the 
pulmonary circulation to the
left side of the heart poorly
oxygenated. The mixing of
oxygenated and unoxygenated
blood eventually results in
arterial hypoxemia.

20. Pneumonia 
Clinical manifestations: 
1-Cough producing greenish or yellow sputum, 
2- high fever that may be accompanied by
shaking chills. 3- Shortness of breath4-
pleuritic chest pain, a sharp or stabbing pain,
either experienced during deep breaths or
coughs or worsened by them.
5- cough up blood, 6-headaches, or develop 
sweaty and clammy skin.7- Other symptoms
are loss of appetite, fatigue, blueness of the
skin, nausea, vomiting, mood swings, and joint
pains or muscle aches.

21.  1-Medical intervention
Diagnosis:- patient's symptoms and 
findings from physical examination,
chest X-ray and blood tests are
helpful, and sputum cultures chest CT
scan or other tests may be needed to
distinguish pneumonia from other
illnesses. A complete blood count
indicating the presence of an infection
or inflammation, in some people with
immune system problems

22. Management: 
1-Administration of appropriate 
antibiotics as Penicillin
Typically, oral antibiotics, rest, 
fluids, and home care
2-people with other medical 
problems and the elderly may need
treatment that is more advanced. 
3-If the symptoms worse, the 
pneumonia does not improve with
home treatment, or complications
occur, the person will often have to
be hospitalized.


23.  Prevention
 1-treating underlying illnesses (such as
AIDS)
 2-Smoking cessation
 3-Testing pregnant women for Group B
Streptococcus and Chlamydia trachomatis,
and then giving antibiotic treatment
 4 Suctioning the mouth and throat of
infants with meconium-stained amniotic
fluid decreases the rate of aspiration
pneumonia.
5-Vaccination is important for preventing 
pneumonia in both children and adults.
Vaccinations against Haemophilus
influenza and Streptococcus pneumonia in
the first year of life.

24. Assessment: . 
 The nurse should monitor the
-
following:
 • Changes in temperature and pulse
 • Amount, odor, and color of secretions
 • Frequency and severity of cough
 • Degree of Tachypnea or shortness of
breath
 • Changes in physical assessment
findings (primarily assessed by
inspecting and auscultation the chest)
• Changes in the chest x-ray findings 

25.  NURSING DIAGNOSES
 Based on the assessment data, the
patient’s major nursing diagnose smay
include: -
 •1- Ineffective airway clearance related to
copious tracheobronchial secretions
 •2- Activity intolerance related to impaired
respiratory function
 • 3-Risk for deficient fluid volume related to
fever and dyspnea
 • 4-Imbalanced nutrition: less than body
requirements
• 5-Deficient knowledge about the treatment 
regimen and preventive health

26.  Planning and Goals :-
 The major goals for the patient may
include 1- improved airway
patency, rest to conserve energy,
 2- maintenance of proper fluid
volume, maintenance of adequate
nutrition, 3- an understanding
treatment protocol and preventive
measures, 4- absence of
complications.

27.  Nursing Interventions:-

 1- IMPROVING AIRWAY PATENCY
 2- PROMOTING REST AND CONSERVING
ENERGY.
 3- PROMOTING FLUID INTAKE
 4- MAINTAINING NUTRITION
 5- PROMOTING THE PATIENT’S
KNOWLEDGE
 6- MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
7- PROMOTING HOME AND COMMUNITY- 
BASED CARE &Teaching Patients
Self-Care.

28. EXPECTED PATIENT OUTCOMES 
 a -Has normal vital signs, pulse oximetry,
and arterial blood gas measurements
 b. Reports productive cough that
diminishes over time
 c. Has absence of signs or
symptoms of shock, respiratory failure, or
pleural effusion
 d. Remains oriented and aware of
surroundings
 e. Maintains or increases weight
 8. Complies with treatment protocol and
prevention strategies.
