Lower Respiratory Flashcards
What is pneumonia and how deadly is it?
- Infection of lung parenchyma
- Significantly high morbidity and mortality rate
What occurs with fluid in the lugns in terms of gas exchange?
What do you do if a patient has fluid?
- Fluid makes O2 getting into the lungs and CO2 getting out less effecient
- Cough
What occurs in pneumonia?
- Decreased cough
- Decreased epiglotal reflexes
- Mucociliary mechanism impaired
What things are you at risk for wen you have pneumonia?
- Aspiration
- Infections (ex. Influenza)
Define…
- Community-Acquired Pneumonia (CAP)
- Hospital-Acquired Pneumonia (HAP)
- Ventilator Acquired Pneumonia (VAP)
CAP- Not hospitalized or in long term care facility 14 days of the onset of symptoms
HAP- 48 hours or longer after hospitlization and not present at time of admission
VAP- type of HAP that occurs more than 48 hours after endotracheal intubation
What blood test is a good measure for inflammation?
ESR- Erythrocyte Sedimentation Rate
—> How quickly erythrocytes settle at the bottom of the test tube
What are the goals/outcomes and treating Pneumonia?
- Clear breath sounds
- Normal breathing patterns
- No signs of hypoxia
- Normal Chest X-Ray
- Normal WBC count
- Absence of complications related to pneumonia
What is empyma?
Pus
What test do you do to know if someone has cystic fibrosis?
Sweat Chloride Test
What are the risk factors for aspiration pneumonia?
- Decrease LOC
- Decreased Gag Reflex
- Dysphagia
- NG Tube
What does necrotizing pneumonia cause?
-IMMEDIATE respiratory insufficiency or failure
What are some signs and symptoms of pneumonia?
- Cough, Fever, Chills
- Dyspnea, Tachypnea
- Pleuritic, Chest Pain
- Green, Yellow, Or Rus-Colored Sputum
What would you find in a physical examination with someone who has pneumonia?
- Fine or course crackles
- Bronchial breath sounds
- Egophony - Increase resonance of voice when auscultating lungs due to something in lungs
- Increased Fremitus- put hands on the patient’s back and percuss so if you feel vibrations, it indicates fluids or a tumor
- Dullness to percussion if pleural effusion present
- Tachycardia
- Confusion to Delirium
What is thoracentesis?
Thoracentesis- Temporary relief if pleuritic effusion is compromising; Needle is put between ribs into the pleural space between the lungs and the chest wall and drain fluid out
What’s one way to decrease the risk of pneumonia?
What’s one way to treat bacterial pneumonia and how does the patient improve?
-Pneumococcal Vaccine (To Prevent Streptococcus Pneumoniae)
- Antibiotics
- –> Decreased Temperature
- –> Improved Breathing
- –> Chest Discomfort
What are some supportive care interventions a nurse can do for a patient with pneumonia and what do they improve?
- O2 for hypoxemia
- Analgesics for chest pain
- Antipyretics for fever
- Individualize rest vs activity
What is a treatment for viral pneumonias?
No definitive treatment
What is the treatment for Influenza Pneumonia?
Antiviral Drugs
What should you do in terms of drug therapy with a patient with pneumonia?
- Start with IV and then switch to oral therapy as soon as patient stable
- Should see improvements in 3-5 days
What should you do in terms of nutritional therapy with a patient with pneumonia?
- Adequate hydration (may have to be IV initially)
- Thin and loosen secretions
How should a patient with pneumonia eat and why?
-High calorie, small, frequent meals
Because it is easier for dyspneic patients to breath because they can’t eat and breath at the same time
Should you monitor for weight loss in patients with penumonia?
Monitor for weight loss for patients with pneumonia?
What are some nursing diagnosis you can make with a person with pneumonia and related to what?
- Impaired gas exchange- related to fluid and exudate accumulation within the alveoli and surrounding lung tissue
- Ineffective breathing pattern- related to inflammation and chest discomfort
- Acute pain- related to inflammation and ineffective pain management
- Activity Intolerance -related to chest discomfort, Inflammation, SOB, and personalized weakness
What are some nursing implementations that can help AT RISK patients from developing pneumonia?
- Reposition every 2 hours
- Strict medical asepsis
- Strict Ventilator bundle to theirs only
- Elevate HOB 30 degrees and have them sit up for all meals
- Assess for Gag Reflex
- Incentive Spirometry
- Mobilize Secretions
- Skin Checks Frequently
- Oral Hygiene and Suctioning
- Avoid unecessary antibiotic use
-Perform Swallow Study for Elderly Patients (ultrasound After Swallowing)
