Dengan Nama Allah,yang tidak memberikan mudarat sesuatu di bumi dan juga di langit dan dia maha mendengar lagi maha mengetahui..

Tuesday, January 26, 2016

Physiotherapy and Pneumonia


Bismillahirahmanirahim , in physio this is one of the disease that have a one goal for us to setting for the patient ,is to make sure their lungs is clear .Pneumonia is one of the common problem happen in kids and elder people, here I want to share the info regarding the cause and how we need to understand this disease.

What are we understand about pneumonia ?
Pneumonia is an inflammatory process of the lung parenchyma that is commonly caused by infectious agents.


Classification of pneumonia
According to causes
·         Bacterial (the most common cause of pneumonia)
·         Viral pneumonia
·         Fungal pneumonia
·         Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance)
·         Inhalation pneumonia (aspiration pneumonia)
According to areas involved
·         Lobar pneumonia; if one or more lobe is involved
·         Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue.

How the pneumonia can be transmitted ?
In the study its shown some of the result the ways you can get pneumonia include:
·         Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
·         You may breathe some of these germs directly into your lungs (droplets infection).
·         You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).
Predisposing factor to get pneumonia is
·         Immuno-suppresed patients
·         Cigarette smoking
·         Difficult swallowing (due to stroke, dementia,parkinsons disease, or other neurological conditions)
·         Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)
·         Chronic lung disease (COPD, bronchostasis)
·         Frequent suction (Non sterile technique)
·         Other serious illness such as heart disease, liver cirrhosis, and DM
·         Recent cold, laryngitis or flu

What can we understand about pathophysiology of pneumonia ?
·         It can be a a factor like The streptococci reach the alveoli and lead to inflammation and pouring of an exudates into the air spaces.

·         WBCs(white blood cells) migrates to alveoli, the alveoli become more thick due to its filling consolidation, involved areas by inflammation are not adequately ventilated, due to secretion and edema. This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content.

·         Venous blood that goes to affected areas without being oxygenated and returns to the heart. This will lead to arterial hypoxemia and even death due to interference with ventilation


The symptom and clinical sign people get pneumonia is
·         Shaking chills
·         Rapidly rising fever ( 39.5 to 40.5 degree)
·         Stabbing chest pain aggravated by respiration and coughing
·         Tachypnea, nasal flaring
·         Patient is very ill and lies on the affected side to decrease pain
·         Use of accessory muscles of respiration e.g. abdomen and intercostals muscles
·         Cough with purulent, blood tinged, rusty sputum
·         Shortness of breath
·         Flushed cheeks
·         Loss of appetite, low energy, and fatigue
·         Cyanosed lips and nail beds

What is the test the Dr will given to the  pneumonia patient ?
·         History taking
·         Physical examination
·         Chest x-ray
·         Blood test
·         Sputum culture
Chest X-ray shown a pneumonia


What is medical management for pneumonia ?
·         Antibiotic, depending on sputum and blood culture
·         Oxygen therapy
·         Chest physiotherapy (Breathing Exercise , Postural Drainage and effective cough )

What is the complication of the pneumonia if not treated early ?
·         Acute respiratory distress syndrome (ARDS)
·         Pleural effusion
·         Lung abscesses
·         Respiratory failure (which requires mechanical ventilator)
·         Sepsis, which may lead to organ failure

What is Physiotherapy and Nurse can help and manage the pneumonia ?
·         Maintain a patent airway and adequate oxygenation.
·         Obtain sputum specimens as needed.
·         Use suction in cleaning technique if the patient can’t produce a specimen.
·         perform chest physiotherapy.
·         Provide a high calorie, high protein diet of soft foods.
·         To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly.
·         To control the spread of infection, dispose secretions properly.
·         Provide a quiet, calm environment, with frequent rest periods.
·         Monitor the patient’s ABG levels, especially if he’s hypoxic.
·         Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours.
·         Monitor fluid intake and output.
·         Evaluate the effectiveness of administered medications.
·         Explain all procedures to the patient and family.
·         Frequent turning of bed ridden patients and early ambulation as much as possible.
·         Coughing and breathing techniques.
·         Sterilization of respiratory therapy equipment
·         Suctioning of secretion in the unconscious who have poor cough and swallowing reflexes, to prevent aspiration of secretions and its accumulation.
Close Suctioning is one of the best prevention to get nosocomial infection that can lead to pneumonia 


How can we understand about the prognosis of pneumonia ?
With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.So the most important to treat early when the symptom is appear and always follow the guideline prescribe by the physician and the therapist 
wallahuaklam..





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