MedSurg 3 - Pneumonia (Chap 33) Flashcards
Pneumonia
an excess of fluid in the lungs resulting from inflammatory process
Pneumonia
- Pathophysiology -1
- Process begins when organism penetrate the airway mucosa and propagate in the alveoli.
- WBC migrate to the area of infection, causing local papillary leak, edema, and exudate. These fluid collection in and around the alveoli, and the alveolar walls thicken.
- RBC and fibrin also move into the alveoli. The capillary leak spreads the infection into the other part of the lungs.
- If the organism moves into the bloodstream, SEPSIS results.
- If the infection extends into the pleural cavity, EMPYEMA (puss collection in the pleural cavity) results
Pneumonia
- Pathophysiology -2
- Fibrin and edema of inflammation stiffen the lungs= reducing compliance and decreasing the vital capacity. Alveolar collapse (Atlectasis) further reduces the ability of the lung to oxygenate the blood moving through it resulting to Hypoxemia.
- Bacteria multiply quickly in a patient whose immunosuppressed. Tissue necrosis results when an abcess forms and perforates the bronchial wall.
Pneumonia
- Etiology
Pneumonia can be caused by:
- bacteria,
- viruses,
- mycoplamas,
- fungi
- rickettsiae
- protozoa
- helminths (worms)
Noninfectious pneumonia:
- inhalation of toxic gases
- chemical fumes
- smoke
- aspiration of water, food, fluid, & vomitus
Pneumonia Prevention
Pneumococcal Polysaccharide Vaccine (PPV23)
- 65 and older
- immunocompromised patients
- Hand Washing
- Aspiration Precaution esp on pt. on ventilator & pt with dysphagia/dysphasia
- Oral Hygiene
- HOB elevated
- Suctioning
Pneumonia
- Clinical Manifestation -1
- Flushed Cheeks
- Bright Eyes
- Anxious Expression
- Chest or Pleuritic Pain or Discomfort (may have)
- Myalgia
- headache
- Chills, fever, cough
- Tachycardia, dyspnea, tachypnea
- hemoptysis
- Sputum production ( assess amt, color, consistency & odor)
- Severe muscle weakness (may be present from coughing)
- uncomfortable in lying position
Pneumonia
- Clinical Manifestation -2
- Auscultation/Percussion **
Crackles on auscultation
- Wheezing (is heard if inflammation is in the airways)
- Bronchial breath sounds over areas of density and consolidation
- Fremitus is increased over areas of pneumonia
- Percussion is dulled
- Chest expansion is diminished or unequal on inspiration
Pneumonia
- Clinical Manifestation -3
- Vital Signs **
- Compare results from baseline values
- hypotension w/ orthostatic (vasodilation and dehydration)
- Rapid, weak pulse (indicates hypoxemia, dehydration, or impending SHOCK)
- Dysrythmia (due to cardiac tissue hypoxia)
Pneumonia
- Assessment
- Anxiety (due to pain, fatigue, dyspnea)
- use calm, slow approach
- Obtain sputum for C&S (may need suctioning if pt can’t cough)
- CBC to assess elevated WBC count
- Blood Culture (to see if organism has invaded the blood)
- ABG (needed for severely ill patient to know if supplemental oxygen is needed)
- Serum electrolyte levels
- BUN & Createnine
Pneumonia
- Assessment
- Xray **
Chest Xray – most common diagnostic test for pneumonia but may not show changes until 2 or more days after manifestation are present
** In older adults, Chest Xray is essential for early diagnosis bec signs and symptoms are often vague !
Pneumonia
- Assessment & S/S
- Older Adults **
- Weakness, Fatigue, Lethargy, Confusion, Poor Appetite
** Fever & Cough may be ABSENT but HYPOXEMIA is often present
** The most common manifestation of pneumonia in older adult patient is ACUTE CONFUSION from hypoxia.
** WBC count may not be elevated until the infection is SEVERE
** Waiting to treat the disease until more typical manifestation appear greatly increases the RISK for SEPSIS and DEATH !
Pneumonia
- Other Diagnostic Assessment
- Pulse Oximetry to assess hypoxemia.
- Transtracheal Aspiration, Bronchoscopy, or Direct Needle Aspiration of the Lungs.
- Thoracentesis is used for patients with accompanying pleural effusion
Pneumonia
- Interventions
- The same intervention with Chronic Airflow Limitation
- OXYGEN Therapy (via nasal cannula or mask – pt w/ confusion may not tolerate face mask) – check for skin breakdown or redness
- INCENTIVE SPIROMETRY to improve inspiratory muscle action and prevent or reverse atelectasis
- COUGH & DEEP BREATHE every 2 hrs to clear secretions
- HYDRATION (at least 2 liters/day unless restricted) to thin secretions and make easier to expel
- Monitor INTAKE & OUTPUT, Oral Mucous membrane, skin turgor to assess if adequately hydrated
- BRONCHODILATOR when bronchospasm is present. Initially given via nebulizer and then by inhaler
- Inhaled or IV STEROIDS if airway swelling is present
Pneumonia
- Preventing SEPSIS
OUTCOME – Free from invading organisms that is manifested by:
- Absence of Fever
- Absence of pathogens in blood and sputum cultures
- WBC count and differential within normal limits
- When sepsis accompanies pneumonia, the risk for death is high, so antibiotic is given for all types of pneumonia except for caused by viruses.
- Anti-infectives are given for 5 to 7 days for patient with uncomplicated Community Acquired Pneumonia (CAP)
- Anti-infectives are given up to 21 days for immunocompromised patient or one with Hospital Acquired Pneumonia (HAP)
Pneumonia
- Interventions
- aspirated stomach content
– Focused on preventing lung damage and treating the infection
- Aspiration of stomach contents can cause widespread inflammation leading to Acute respiratory Distress Syndrome (ARDS) and Permanent Lung damage.
- — STEROIDS and NSAIDS are used with ANTIBIOTIC to reduce the inflammatory response.
