The pneumonia struggle is real!

[Ames coolvibeman]

Hi all,

so currently i'm writing a pathophysiology assignment on pneumonia, and i'm stuck on the four stages of it (Congestion, red hepatisation, grey hepatisation and resolution). In particular how the sign/symptoms of these 4 stages present in the patient/client.

I understand the signs/symptoms but i cannot find anything that tells me how the signs/symptoms are presented in each of the stages in the patient/client.

In the assignment we are to pick 3 signs/symptoms, 3 nursing assessments and 3 interventions all with pathophysiological rationale.

My 3 signs/symptoms are dyspnea, productive cough, and high fever.

Now at the beginning of the assignment we have to explain the pathophysiology of the condition and this is what i am stuck on.

Hope this made sense,

any help would be fabby mouse.

Thanks anyone and everyone!

-Amy

[Esme12, ASN, BSN, RN]

Lobar pneumonia is an acute exudative inflammation of an entire pulmonary lobe, produced in 95 % of cases by Streptococcus pneumoniae (pneumococci).

If not treated, lobar pneumonia evolves in four stages. Common to all stages is the enlargement of the affected lobe with loss of it's spongy appearance.

• In the first stage, congestion (day 1 - 2), the affected lung parenchyma is partially consolidated, and red-purple, partially aerated. Microscopy: alveolar lumen contains serous exudate, bacteria and rare leucocytes.
  
• In the second stage, red hepatization (day 3 - 4), the pulmonary lobe appears consolidate, red-brown, dry, firm, with a liver-like consistency (hepar, gr. - liver). The cut surface is dry, rough. Microscopy : the characteristic aspect of this stage is determined by the accumulation in the alveolar spaces of an exudate rich in fibrin (mainly), with bacteria, leucocytes, and erythrocytes. Alveolar walls are thickened due to capillary congestion and edema.
  
• The third stage, gray hepatization (day 5 - 7), the affected lobe has a liver-like consistency, with uniform gray colour (Figure 1). On the cut surface, a grayish purulent liquid drains. It is because alveolar lumens are filled with leukocytic (suppurative) exudate (neutrophils and macrophages, in order to remove the fibrin) (leukos, gr. - white). Capillary congestion and edema are still present, therefore alveolar walls are thick. (Figures 2 and 3)
  
• The resolution stage begins on day 8 and continues for 3 weeks (uncomplicated cases), while the exudate within the alveolar spaces will be drained through lymphatics and airways ("productive" cough) with gradually aeration of the affected segment.
  

Lobar pneumonia (leukocytic alveolitis)

Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution.

• Consolidation
  
  • Occurs in the first 24 hours
    
  • Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air
    
  • Capillaries in the surrounding alveolar walls become congested
    
  • The infections spreads to the hilum and pleura fairly rapidly
    
  • Pleurisy occurs
    
  • Marked by coughing and deep breathing (Atkuri & King, 2006; Steyl, 2007
    

  [*]Red Hepatization

  • Occurs in the 2-3 days after consolidation
    
  • At this point the consistency of the lungs resembles that of the liver
    
  • The lungs become hypeaemic
    
  • Alveolar capillaries are engorged with blood
    
  • Fibrinous exudates fill the alveoli
    
  • This stage is "characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli" (Atkuri & King, 2006; Steyl, 2007)
    

• Grey Hepatization
  
  • Occurs in the 2-3 days after Red Hepatization
    
  • This is an avascular stage
    
  • The lung appears "gray-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin"
    
  • The pressure of the exudates in the alveoli causes compression of the capillaries
    
  • "Leukocytes migrate into the congested alveoli" (Atkuri & King, 2006; Steyl, 2007)
    

• Resolution
  
  • This stage is characterized by the "resorption and restoration of the pulmonary architecture"
    
  • A large number of macrophages enter the alveolar spaces
    
  • Phagocytosis of the bacteria-laden leucocytes occurs
    
  • "Consolidation tissue re-aerates and the fluid infiltrate causes sputum"
    
  • "Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions" (Atkuri & King, 2006; Steyl, 2007)
    

Pneumonia - Physiopedia, universal access to physiotherapy knowledge.

I think these site will help.