IntroductionPneumonia is an acute respiratory infection of the lungs. The air sacs fill with pus and, which makes breathing difficult. There are approximately 808 694 children died in 2017 because of pneumonia, approximately 15% of deaths of children who are approximately under five years old. (world health organisation, n.d.) Pneumonia noted during early Greek civilization and this becomes a serious medical concern because there are million deaths and admissions in the hospitals. The bacteria Streptococcus pneumonia is the most common bacteria which cause pneumonia. This bacteria was discovered in 1881 by French microbiologist, Louis Paster, and, American microbiologist, George Sternberg independently by searching lancet-shaped bacteria in saliva. Further studies about bacteria’s physical structure determined its reaction with the immune system, was done in the early 1900s. By 1913, anti-pneumococcal serum therapy began and was able to reduce the death rate from 25% to 7.5%, but it was expensive and time-consuming. Then in 1940 antibiotic penicillin was discovered. Nowadays PCV is given to the children and there was a decrease in the death rate by 1990 and 2015. (Chow, 2018).In Australia, more than 100,000 people found positive for the flu in 2015. Professor Paul VanBuynder the Chairman of the Immunisation Coalition said. “I’m confident this is not just the biggest on record but the largest flu outbreak we’ve seen for some time,” (Dunlevy, 2017). I will discuss bacterial pneumonia, pathophysiology, risk factor, nursing management, and evaluation and conclusion.Health issuesThere are various health issues related to pneumonia that are listed as; mental confusion, heart failure, organ failure, urinary tract infection, septic shock, bluish skin color, and breathing difficulty. (Luo, 2017)ContentThe sign and symptom of pneumonia can vary according to age and the immune system of the body to fight against germ causing infection. The most common symptoms are fever, cough, weakness, chest pain, dyspnoea, sweating, body ache, sweating. Haemophilus influenzae, Klebsiella, Staphylococcus, and legionella are the agents that cause pneumonia (Gamache, 2019). There is a number of the risk factor for bacterial pneumonia such as the people who are having a viral infection, hospitals workers, who are with week immune system, people having lung disease, having asthma, diabetes, and cardiac problem and old age people and children of 2 years of age at the risk of pneumonia. The patients after the operation as well as who are not taking sufficient vitamins are also at the risk of infection. Other risk factors are tumors, chronic obstructive pulmonary disease. Pneumonia infection is classified as community-acquired, hospital-acquired, and aspiration pneumonia, atypical pneumonia, bacterial pneumonia, bronchial pneumonia, mycoplasmal pneumonia, Pneumocystis carinii Pneumonia, Ventilator-Associated Pneumonia, and viral pneumonia. There are three types of bacterial pneumonia are Gram-positive organism, Gram-negative organism, and Atypical organism.PathophysiologyPneumonia is divided into four stages that are consolidation, red hepatization, grey hepatization, and resolution. Consolidation occurs within 24 hours, red hepatization occurs after 2-3 days of consolidation, Grey hepatization occurs after 2-3 days of red hepatization, and there is more inflammation and across the pleural space. (contributors, 2019)The infected person exhaled in air and this bacteria or virus inhaled by the healthy person when he takes a breath in the air and then a healthy person get the infection by droplet transmission. When an infected person cough or sneeze in the air then another person get infected this is called droplet spray transmission. The microorganisms that are present in the upper respiratory tract, enter in the lower respiratory tract, and the lungs inflamed which leads to pus formation. If there is a continuous formation of pus, the white blood cells and pathogens died. Now it slows down the process of gas exchange. The collection of fluid in the lungs stop interexchange of gas which leads to respiratory acidosis. If pneumonia does not treat then the condition can become worse. (Cillóniz, 2018).The most common diagnoses of pneumonia are – Air exchange disability, related to inflammation of lungs; inadequate airway clearance, related to respiratory secretions; hyperthermia, related to lung infection; and malnutrition, related to inadequate intake.Nursing managementThe nurse will Start nursing management of the patient suffering from pneumonia with an assessment of the past medical history of the patient, by assessing the severity of pneumonia, respiratory rate depth and efforts every four hourly, physical examination and observation for any cyanosed symptom, by observation of the color of sputum, by measuring ABG. Apart from this, oxygen therapy, suctioning, coughing, deep breathing exercise and adequate hydration are general nursing management.The nurse will check the pneumonia severity index that is used to calculate the morbidity and mortality rate of the patients with community-acquired pneumonia. (Pneumonia severity index, 2018). The nurse will check the respiratory rate and sign for labored breath and provide respiratory support. The semi fowler’s position is the comfortable position which helps the patient to breathe easily. Change the position quickly and ambulate the patient as much as possible Oxygen is an important method to treat pneumonia.there are two methods to administer oxygen; nasal cannula and mechanical ventilator. The nurse will check the spo2 level by pulse oximeter and will administer oxygen until the SaO2 level >90% and until hypoxia will not be treated. There are greater differences in the methods of administered oxygen between the WHO and BTS. The WHO suggests nasal prongs or nasopharyngeal catheter and BTS suggests using a face mask, nasal cannula, or a headbox. There is no strong evidence that which method is more accurate (Principi N, 2011) The doctor may prescribe nebulization therapy to clear the airway and if the patient is unable to spit out secretions then suction has to be done. Chest physiotherapy is helpful to treat some respiratory problems, help to remove secretions. It is helpful to reduce airway obstructions and will decrease dyspnoea. The positive result of chest physiotherapy is a reduction in the length of hospital stay and the episode of fever. The effect of chest physiotherapy may depend on the skills of a professional person and there may be adverse effects of physiotherapy if done wrongly. This effect of therapy may be different for different patients. (Yang M, 2013)The patient can not take enough fluid orally due to breathlessness and cough. The nurse will provide adequate fluid either through intravenous or by nasogastric. But it will be difficult through nasogastric because of breathing difficulty. Hypotension and tachycardia can be managed by intravenous fluid. But the nurse should be cautious to prevent volume overload if the patient is having a cardiac problem such as MI. (Gamache, medscape, 2019). Fever is a rise in the body temperature which results in dehydration because of sweating. Encourage the patient to take plenty of fluid, if the patient can not take orally then administer intravenously. The nurse should check the vital signs 2 hourly. Give antipyretic medication as prescribed by the doctor. Remove extra clothes and linen from the patient. Oral care is the most important part of the pneumonia patient. some patients are unconscious and they need quick oral care. The nurse can give 8 hourly oral care to reduce the mortality rate. Oral hygiene can prevent the chance of aspiration pneumonia. The protocol of oral care was started in 2012 with 63 patients of age 83 years old. The observation day was 130. There was the reduction in the incidence of fever, antibiotics administration, blood tests, and radiological examinations from 1.20 to 0.45, 24.57 to 17.48, 25.52 to 10.12, 10.91 to 6.54, and 6.33 to 3.09 %, respectively. The present study shows that daily oral care for patients reduced the incidence of pneumonia. This help to reduce the mortality rate of pneumonia patients. (Maeda, 2014).Corticosteroid will be prescribed to treat pneumonia as it is effective. The study recommended that corticosteroid reduce the morbidity rate but not the mortality rate in CAP in adults. It also reduces the complication risk and length of hospital stay. (Stern A, 2017).The doctor might be prescribed diagnostic for pneumonia that may be blood tests, chest x-ray, sputum tests. If the patient is older than 65 years then it may be CT scan and pleural fluid culture. (mayo clinic, 2018). Then the doctor will prescribe antibiotics, antipyretics and cough medicine. The treatment of cough is important to improve the quality of life. The author found four studies for the cough medicine.one was applied for children and three for adults.but the data was recorded only from two studies, both studies were using mucolytics with antibiotics. The study showed that the effect of mucolytics was the same as those who were not taking mucolytics. But the cough was cured at 10 days. Due to lack of evidence the cough medication was not recommended. (Chang CC, 2014).The antibiotic treatment prescribed for CAP is based on clinical signs and symptoms, patient’s age, disease severity, and need to use of antibiotic with the right dose and right time. (Ben-Shimol, 2014). The nurse should wash the hands properly before and after every task and also give health education about hand hygiene to the family members.As the patient does not take adequate nutrition due to dyspnoea. The patient may feel nausea. So it is compulsory to meet the nutritional and calory demand to the patient which will help to fight with infection. The nurse should inform to the dietician about the requirement of the patient. The doctor prescribed a gastric tube feed to the unconscious patient to fulfill the nutritional requirement. The study showed evidence of a reduction in the rate of pneumonia and decrease the complications. (Alkhawaja S, 2015).Adequate rest is important to subside the sign of dyspnea. The patient should take proper rest at night time and a nap in the day time. The nurse should provide a calm and peaceful environment. There should be restrictions on visitors entry. If more visitor will come in the ICU then the patient will get more infection.EvaluationThe nurse will assess the condition of the patients by using the PSI and will decide to start nursing management. The patient will be able to breathe easily as fowlers position gave and oxygen therapy administered. The patient might be able to spit out secretions when chest physiotherapy and nebulizer therapy is given. The respiratory rate and tachycardia will be at normal range as the airway clearance. An adequate amount of fluid given to the patient and patient will be hydrate and electrolyte balance will be maintained. Antipyretics and antibiotic administered in order to reduce fever and infection. The risk of infection will reduce by oral hygiene. Oral care is given 4 hourly. The patient will be met with nutritional requirements. Overall, the patient will be recovered by nursing interventions.Learning objectivesI learned about the disease condition pneumonia, causes, risk factors, and symptoms. Through this assignment, I am able to calculate the pneumonia severity index. The patient’s needs and the management of the patient with pneumonia. Health education is given to the patient and family members about nutrition requirement as well as about hand hygiene. Learned about the treatment of the patient with pneumonia.ConclusionPneumonia is a common and life-threatening disease. The patients suffering from pneumonia should be assessed thoroughly because there may be other complications if not treated properly. The patient will be treated with adequate treatment for iv fluids, antibiotics, and analgesics. Any complication should be detected early and intervention should be given according to that. People should be aware of pneumonia and its prevention so that people can take appropriate action on the onset of any symptom of the disease condition. People should also educate about the vaccination of pneumonia to reduce the children mortality rate. Hand hygiene is a must in the prevention of the risk factor of this disease condition. The unconscious patient or a patient on ventilator support needs proper care related to nutrition, adequate fluid, and oral hygiene. ReferencesAlkhawaja S, M. C.‐S. (2015). Post‐pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults.Ben-Shimol, S. (2014). Pneumonia. Evidence for a short duration of antibiotic treatment, 16-23.Chang CC, C. A. (2014). Over‐the‐counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database of Systematic Reviews.Chow, S. (2018, August 23). News medical life science. Retrieved from www.newsmedical.com: https://www.news-medical.net/health/Pneumonia-History.aspxCillóniz, C. (2018). Epidemiology, pathophysiology, and microbiology of community-acquired pneumonia. ARH.contributors, P. (2019). Pneumonia. Physiopedia.Dunlevy, S. (2017, August 15). news corp Australia. Retrieved from www.news.com.au: https://www.news.com.au/lifestyle/health/health-problems/australia-hit-by-worst-flu-outbreak-on-record-in-2017Gamache, J. (2019, August 22). medscape. Retrieved from www.emedicine.medscape.com: http://emedicine.medscape.com/article/300157-treatmentGamache, J. (2019, August 22). Medscape. Retrieved from www.medicine.medscape.com: https://emedicine.medscape.com/article/300157-overview#a4Hilaire J. Thompson. (2012). Clinical management of fever by nurses. HHS public assesses.Luo, E. K. (2017, June 23). Healthline. Retrieved from www.healthline.com: https://www.healthline.com/health/pneumonia/effects-on-body#1Maeda, K. ( 2014). Oral Care May Reduce Pneumonia in the Tube-fed Elderly: A Preliminary Study. Dysphagia, 616–621.mayo clinic. (2018, March 13). Retrieved from www.mayoclinic.com: https://www.mayoclinic.org/diseases-conditions/pneumonia/diagnosis-treatment/drc-20354210pneumonia. (n.d.). Retrieved from www.wikipedia.com: https://en.wikipedia.org/wiki/PneumoniaPneumonia severity index. (2018, March 21). Retrieved from www.wikipedia.com: https://en.wikipedia.org/wiki/Pneumonia_severity_indexPrincipi N, E. S. (2011). Management of severe community-acquired pneumonia of children in developing and developed countries. BMJ Journals; 66:815-822.Stern A, S. K. (2017). Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews.world health organization. (n.d.). Retrieved from www.who.com: https://www.who.int/news-room/fact-sheets/detail/pneumoniaYang M, Y. Y. ( 2013). Chest physiotherapy for pneumonia in adults. Cochrane Database of Systematic Reviews.