Care of Patients with Pneumonia

Question 1

When Excess fluid builds up in the lungs resulting from an inflammatory process - specifically in the alveoli and bronchioles; fluid accumulates because of an inflammatory process
Inflammation triggered by many infectious organisms and by inhalation of irritating agents; aspiration - inspiration of an irritant that causes inflammatory responses - cause WBC and fibrin and inflammatory things go there and caps start leaking and fluid leaking into areas should not be (ALVEOLI)
Develops when the immune system cannot overcome/fight off the invading organisms - get infectious process and inflammatory process
Because fluid build-up not allowed to have adequate gas exchange, fluid build up in bronchioles trouble with airway clearance
Fluid and pus in alveoli makes it really hard for gas exchange to occur

Answer 1

Pneumonia

Question 2

Community-acquired (CAP)
Hospital-acquired (HAP)
Health care–associated (HCAP)
Ventilator-associated (VAP)
Aspiration pneumonia

Answer 2

Pneumonia: types

Question 3

Acquired out in the community
No recent exposure to healthcare facility

Answer 3

Community-acquired (CAP)

Question 4

Diagnosis > 48 hours after admission to hospital
Currently in the hospital; been in here and contracted pneumonia from infectious organism from hospital setting; diagnosed with pneumonia after being in hospital for more than 48 hrs is HAP

Answer 4

Hospital-acquired (HAP)

Question 5

Diagnosis < 48 hours after admission to hospital and has had recent treatment at a health care facility (inpatient or outpatient)
Not be inpatient hospital; being admitted to hospital with pneumonia and been there < 48 hrs so not HAP; know within last 90 days treated within healthcare facility (inpatient and outpatient setting)

Answer 5

Health care–associated (HCAP)

Question 6

Diagnosis within 48-72 hours of having been intubation with endotracheal tube
Specific one
Ventilator pats
See VAP bundles - do lots oral care, HOB elevated so preventing; sterile technique if suctioning to make sure to preventing VAP; pats have trachs, endotracheal tubes much higher risk for infection because have foreign body in airway and air bypassing norm protective mechanisms have in upper oropharynx

Answer 6

Ventilator-associated (VAP)

Question 7

Pneumonia related to not swallowing and getting food products/fluid in lungs due to inability to swallow

Answer 7

Aspiration pneumonia

Question 8

Older adult - any; CA, HA, HC, VA; immune sys not as effective; more difficulty swallowing and weakness
Not received annual flu or pneumococcal vaccine - viruses can trigger pneumonias
Chronic health problems put at risk
Recent exposure to respiratory viral or influenza infection
Limited mobility - less mobile and not moving secretions as much so they pool and high risk for pneumonia and build up of of bacteria in lungs
Uses tobacco or alcohol - alcohol decreases immune sys and higher risk
Presence of gram-negative colonization of the mouth, throat, and stomach - anybody that might have any sort of infection in upper airway; stomach - issues with aspiration can get into airway
Altered level of consciousness - looking at aspiration risk
Aspiration
Presence of endotracheal, tracheostomy, or nasogastric tube - more VA for endotrach and trach; NG tube higher risk for aspiration - then go into lungs and cause pneumonia
Poor nutritional status - compromises immune sys
Has immunocompromised status
Mechanical ventilation (ventilator-associated pneumonia)

Answer 8

Pneumonia: Risk factors:

Question 9

Especially chronic lung disease

Answer 9

Chronic health problems put at risk

Question 10

Prevent before occur
Avoid risk factors - prevention for VAP
Annual influenza vaccine - make sure get these
Pneumococcal vaccine - make sure get these
If immunocompromised stay away from people who are infected
Avoid crowded public areas during flu and holiday seasons - high risk for flu avoid crowded areas
Handwashing
If limited mobility, cough, turn, move about as much as possible, and perform deep breathing exercises - turn, cough, deep breathing; move as soon as possible
Clean respiratory equipment - O2 at home/CPAP/BiPAP might possible get into airway make sure is clean
Avoid indoor pollutants - smoking, dust
Stop smoking
Rest and eat a healthy, balanced diet
Drink 3 L of fluids each day (unless fluid restriction) - lots of fluids

Answer 10

Pneumonia: prevention

Question 11

Increased respiratory rate or dyspnea - seen commonly; SOB
Hypoxemia - seen commonly; oxygenation down because gas exchange not as good in alveoli
Cough - seen commonly; often times have secretions
Purulent, blood-tinged, or rust-colored sputum - seen commonly; green-yellow looking; sometimes odor; severe - blood in secretions
Fever with or without chills - very common except in elderly
Pleuritic chest discomfort/pain - pleura get inflamed so taking deep breaths is painful
Lungs: coarse crackles, sometimes have wheezing if secretions in airway and bronchoconstriction, often diminished - consolidation and infection and buildup in one area - area have decreased breath sounds
Myalgia
Body aches
Headache
VS: Rapid, weak pulse may indicate hypoxemia, dehydration, impending sepsis, or shock; tachycardia
Hypotension
Acute confusion from hypoxia (most common manifestation in older patients rather than fever or cough – may be absent) - seen commonly
Older adult

Answer 11

Pneumonia: CM

Question 12

A result of vasodilation and dehydration, especially in the older adult

Answer 12

Hypotension

Question 13

Confusion, weakness, fatigue, lethargy, poor appetite, hypotension, altered LOC related to hypoxia, change in mental status, no fever or cough - not same s/s; become septic and into shock easily; want actively treat it; treatment is imp do quickly

Answer 13

Older adult

Question 14

Sputum by Gram stain, culture and sensitivity testing
CBC to assess an elevated WBC count if infectious process going on
Blood cultures
ABGs
Serum lactate levels
Procalcitonin
BUN and electrolytes

Answer 14

Pneumonia: Laboratory assessment

Question 15

Determine the type of organism
Culture - organism
Sensitivity - antibiotics treat organism
Excellent tool for pneumonia so not on broad spectrum but specific one for that organism; sometimes not have productive cough and sometimes sputum culture hard obtain so may need suction if really need one but sometimes diff get sputum

Answer 15

Sputum by Gram stain, culture and sensitivity testing

Question 16

Determine infection in bloodstream and bacteremia - if is increased risk of sepsis

Answer 16

Blood cultures

Question 17

Determine need for oxygen and baseline O2 and CO2 levels
Good get baseline

Answer 17

ABGs

Question 18

Used for prognosis (higher risk of sepsis) and effectiveness of treatment
Communicate if need go to ICU or on unit

Answer 18

Serum lactate levels

Question 19

Used to determine antibiotic use and clinical improvement
For bacterial infections; if clinically not believe pat needs antibiotics and procalcitionin is low and not give antibiotics is another tool that providers will use; take it every few days to see if increasing and indicates bacterial infection improving

Answer 19

Procalcitonin

Question 20

Determine fluid status
Check for dehydration

Answer 20

BUN and electrolytes

Question 21

Chest x-ray
Pulse oximetry - check for hypoxia
Invasive tests - not often
CT scan - better pic as well

Answer 21

Pneumonia: imaging assessment

Question 22

most common diagnostic test/tool for pneumonia
See if have any consolidation
may not show changes until 2 or more days after manifestations are present
essential for early diagnosis esp in the older adult to prevent from progressing to septic situation
Gold standard for pneumonia diagnsis
When present infected lung/area is white

Answer 22

Chest x-ray

Question 23

Hard time getting sputum specimen and need understand what organism it is
Transtracheal aspiration - direct needle aspiration of lungs
Bronchoscopy - sometimes; not done often
Direct needle aspiration of the lung

Answer 23

Invasive tests - not often

Question 24

Impaired gas exchange related to decreased diffusion at the alveolar-capillary membrane - lack gas exchange; at membrane has gas exchange not able exchange O2 and CO2; big priority nursing diagnosis for pneumonia pat
Potential for airway obstruction related to excessive tracheobronchial secretions, fatigue, chest discomfort and muscle weakness; pleuritic chest pain can be painful risk for this and risk for ineffective airway clearance
Potential for sepsis related to the presence of microorganism in a very vascular area; very high risk for this; esp if severe; constantly eval for this

Answer 24

Pneumonia: priority nursing diagnoses and probs

Question 25

Oxygen therapy - not unusual to be little hypoxic
Monitor pulse oximetry - esp if admin O2 therap
Cough and deep breath every 2 hours - helps with airway clearance
Incentive spirometry
Adequate hydration
Assess fluid status
Drug therapy

Answer 25

Pneumonia: nursing interventions

Question 26

> 95% or in the patient’s normal range

Answer 26

Monitor pulse oximetry - esp if admin O2 therapy

Question 27

5 to 10 breaths per session every hour while awake
Helps with airway clearance

Answer 27

Incentive spirometry

Question 28

Always Helps thin secretions
Airway clearance always increase fluids

Answer 28

Adequate hydration

Question 29

Monitor I & O
Check for dehydration esp in older pop - look for s&s of it:
Assess dry oral mucous membranes and decreased skin turgor

Answer 29

Assess fluid status

Question 30

Anti-infectives
Bronchodilators -
Steroids (IV or inhaled) -
Expectorants -

Answer 30

Drug therapy

Question 31

Priority when there is a bacterial infection (CORE measure)
Antibiotics huge - core measure when admitted to acute care facility that admin with 4-6 hours; not have be IV; IV is preferred but have get antibiotics on board because improves pat outcome and shortens length of stay if give antibiotics as quickly as possible to pneumonia pats
Check lactate and procalcitonin levels help determine type antibiotics - severity and type pneumonia determines type antibiotics used
CAP - broad spectrum; HAP - specific and one things cover drug-resistant because likely have pneumonia caused by drug-resistant pneumonia
Determined by type and severity of infection

Answer 31

Anti-infectives

Question 32

open airways; help with airway obstruction

Answer 32

Bronchodilators -

Question 33

decrease inflammation; help with airway obstruction

Answer 33

Steroids (IV or inhaled) -

Question 34

get secretions up; help with airway obstruction

Answer 34

Expectorants -