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N233 > Module 3 Part 1 > Flashcards

Module 3 Part 1 Flashcards

1
Q

define pneumonia

A

inflammation of the lung parenchyma caused by various microorganisms

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2
Q

list risk factors for pneumonia (there is a TON)

A
  • heart failure
  • diabetes
  • alcoholism
  • COPD
  • AIDS
  • cystic fibrosis
  • conditions that produce mucous
  • immunosuppressed patients and those with low neutrophil count
  • smoking
  • prolonged immobility
  • depressed cough reflex
  • aspiration of foreign material
  • NPO
  • Abx therapy
  • alcohol intoxication
  • general anesthetic or anything that promotes resp depression
  • advanced age
  • resp therapy
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3
Q

mnfts of pneumonia (theres a ton!! know the main few)

A
  • Onset of shaking chills
  • Rapidly rising fever
  • Pleuritic chest pain
    -Aggravated by deep breathing or coughing
  • Tachypnea
  • Respiratory distress
  • Headache
  • Pleuritic pain
  • Myalgia
  • Rash
  • Pharyngitis
  • Central cyanosis
  • Orthopnea when reclining
  • Poor appetite
  • Sputum is purulent
    -crackles
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4
Q

what is the assessment of penumonia

A
  • history
  • physical examination
  • chest x-ray studies
  • blood culture
  • sputum examination
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5
Q

what is the diagnosis of pneumonia

A
  • infective airway clearance r/t copious tracheobronchial secretions
  • activity intolerance r/t impaired resp fx
  • risk for deficient fluid volume r/t fever and increased rr
  • imbalanced nutrition
  • deficient knowledge
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6
Q

what is the planning (goal) stage for pneumonia?

A
  • improved airway patency
  • rest to conserve energy
  • maintain fluid volume
  • maintain adequate nutrition
  • treatment protocol and preventative measures
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7
Q

what are interventions for pneumonia (11)

A
  • prompt use of antibiotics
  • chest physiotherapy
  • removing secretions
  • hydration
  • humidification
  • position change: breathe deeply and cough
  • admin and titrate o2 therapy
  • promote rest
  • promote fluid intake
  • maintain nutrition
  • promote knowledge
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8
Q

what are the expected outcomes of caring for penumonia?

A
  • improved airway patency
  • rest and conservation of energy
  • maintains hydration
  • consumes adequate dietary intake
  • states an explanation
  • exhibits no complications
  • tx protocol
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9
Q

what is hospital acquired pneumonia, describe

A

Nosocomial

  • Onset of pneumonia symptoms more than 48 hours after admission to the hospital
  • Host defenses are impaired, inoculum of organism reaches the patient lower resp tract and over-whelms the host defenses or highly virulent organism is present
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10
Q

what are the factors affecting hospital acquired pneumonia

A

-coma
-comorbidity
malnutrition
-prolonged hospitalization
-hypotension
-metabolic disorders

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11
Q

what is community acquired pneumonia

A
  • Occurs in the community setting or within the first 48 hours of hospitalization or institutionalization
  • Hospitalization depends on the severity
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12
Q

what is the immunocompromised host

A

Occurs with use of corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, use of broad-spectrum antimicrobial agents, acquired immunodeficiency syndrome, genetic immune disorders, long term advanced life support

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13
Q

what is aspiration pneumonia

A

-Pulmonary consequence resulting from the entry of endogenous or exogenous substances into the lower airway

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14
Q

where does aspiration pneumonia occur

A

Occur in the community or hospital setting

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15
Q

what enters in the system that causes aspiration pneumonia

A

Common pathogens into the airways
-Could also be gastric contents, exogenous chemical contents or irritating gases: may impair the lung defences, cause inflm changes, lead to bacterial growth and result in pneumonia

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16
Q

what Dx would you want for pneumonia

A
  • chest x ray
  • blood culture and sensitivity
  • sputum culture and sensitivity
  • WBC and differential
  • Procalcitonin
  • CRP
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17
Q

why is a chest xray done for pneumonia

A

-used to detect and help evaluate the severity of a lung infection

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18
Q

what findings would indicate potential pneumonia with a blood culture and sensitivity

A

-Detect septicemia when it is suspected that infection has spread from the lungs to the blood or from the blood to the lungs

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19
Q

what should you teach relating to sputum culture and sensitivity

A
  • having pt rinse mouth with water to minimize contamination of normal oral flora
  • breathe deeply several times
  • cough deeply
  • expectorate the raised sputum into a sterile container
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20
Q

what findings would indicate potential pneumonia with a sputum culture and sensitivity

A

gram stain: gram positive test detect that identifies the cause of bacterial pneumonia

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21
Q

what findings would indicate potential pneumonia with WBC’s/differentials

A

high levels of WBC’s

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22
Q

why is WBC and differential done?

A

to see type and number of WBC’s

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23
Q

what is procalcitonin?

A

a blood sample

-substance produced by many types of cells in the body, often responding to bacterial infections

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24
Q

what does high CRP indicate

A

presence of inflammation

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25
Q

Knowing what you have learned about the clinical manifestations and features of pneumonia list five nursing diagnoses that could occur when a patient has pneumonia.

A
  • SOB r/t pneumonia
  • Deep breathing, shortness of breath r/t impaired pulmonary fx
  • Sputum r/t impaired ability to secrete sputum
  • Crackles r/t pneumonia
  • Fever r/t infection
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26
Q

For your listed nursing diagnoses, brainstorm some potential nursing interventions

A
  • Spirometry
  • Medications via nebulizers
  • Other meds
  • Encourage deep breathing
  • Give pt oxygen
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27
Q

how is breathlessness described for a patient?

A

it’s a symptom that can only be described and interpreted by the patient

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28
Q

when is breathlessness common in pts

A

for those with advanced life-threatening illnesses of all types

29
Q

describe breathlessness

A

• Temporal patterns of breathlessness, including continuous or episodic breathlessness, with or without apparent triggers, are a current topic of research in the hope that such discrimination will inform future management choices

30
Q

what is the prevalence of breathlessness

A

• The prevalence reaches 90% in cancer, 95% in COPD, 88% in cardiac failure, 80% in end-stage renal disease and 85% in advanced neurological disease

31
Q

what are signs of success in breathlessness

A

may be a reduction in intensity of breathlessness, a reduction in psychological distress, an increase in activity levels or a reduction in hospital admissions

32
Q

what is the main pharm intervention for breathlessness

A

opioids

33
Q

why are opioids used for breathlessness?

A

• Opioids are proposed both to reduce the spontaneous respiratory motor response to hypercapnia and hypoxia and to modulate the central processing with that perceptual sensitivity to breathlessness is diminished

34
Q

who are most likely to benefit with opioids who have breathlessness

A

• Younger patients and those who experience the greatest severity of breathlessness are most likely to benefit

35
Q

what is often prescribed for palliation of breathlessness in the setting of other advanced disease?

A

oxygen

36
Q

is oxygen or opioids better for breathlessness?

A

• Opioids have been found to be significantly better than oxygen in reducing breathlessness

37
Q

what are some non pharm interventions to help with breathlessness (i have 4 listed)

A
  • forward positioning
  • walking aid
  • acupuncture
  • pulmonary rehabilitation and exercise
38
Q

why is forward positioning useful for breathlessness?

A
  • fixes shoulder girdle

- improves efficacy of accessory muscles

39
Q

why is pulmonary rehabilitation and exercise useful for breathlessness?

A
  • desensitizes patient
  • reduces deconditioning
  • lowers ventilator demand and slows respiration
40
Q

whats the benefit of a walking aid with breathlessness?

A

allows forward leaning and decrease in breathing during exercise. also increases pt confidence

41
Q

what is dyspnea?

A
  • Difficult or laboured breathing
  • Shortness of breath, feeling as if you are not getting enough air
  • Subjective experience
42
Q

what causes dyspnea? (theres alot, just know 5)

A
  • COPD
  • Pregnancy
  • Panic attack
  • Obesity
  • MI
  • Choking/obstruction
  • Airway trauma
  • Asthma
  • CHF
  • Age
  • Neuromuscular Disorders
  • Physical exertion
  • Pulmonary embolism
  • Allergies
  • Pneumothorax
  • Cardiac arrhythmias
43
Q

list the risk factors for dyspnea

A
  • SMOKING
  • Exposure to second-hand smoke
  • Personal or family history of lung disease
  • Genetic make up
  • Allergens and environmental pollutants
  • Recreational and occupational exposure
  • Poor nutrition
  • Inadequate exercise
  • Substance Abuse
  • Stress
44
Q

Dx tests for dyspnea

A 
Oxygen saturation
•Hgb, RBC, WBC, ABG’s
•CXR
•CT chest
•Throat or sputum cultures
•Possibly Bronchoscopy
•PFT’s
45
Q

what are the nursing interventions for dyspnea

A
  • Use multiple strategies
  • Decrease anxiety
  • Treat (if possible) underlying pathology
  • Oxygen may be helpful if hypoxic
  • Patient positioning – which ones?
  • Pursed lip breathing
46
Q

what are causes of pneumonia

A
  • Bacteria
  • Mycobacteria
  • Chlamydial
  • Mycoplasma
  • Fungi
  • Parasites
  • Viruses
47
Q

what are the main symptoms for infectious pneumonia

A

-high fever
-chills
-cough with sputum
-SOB
-pleuritic plain
-headaches
-loss of appetite
ETC

48
Q

what are the 4 pneumonia classifications?

A
  • Community acquired pneumonia
  • Hospital Acquired Pneumonia
  • Pneumonia in Immunocompromised Host
  • Aspiration Pneumonia
49
Q

what is the most lethal type of nosocomial infections?

A

hospital acquired pneumonia

50
Q

what are some of the organisms r/t hospital acquired pneumonia

A
  • *Enterobacter species
  • Escherichia coli
  • H. Influenzae
  • *Staphylococcus aureus (MRSA)
  • *Pseudomonas aeruginos
51
Q

why do hospitalized patients get pneumonia

A
  • Host defenses are impaired
  • Inoculums of organisms reaches lower respiratory tract
  • Highly virulent
52
Q

how do you prevent HAP (hospital acquired pneumonia)?

A
  • Frequent oral hygiene
  • Isolation of patient’s with known pneumonia
  • Reposition, early ambulation
  • Nutritious diet
  • Deep breathing and cough
  • Clean equipment
53
Q

describe pneumonia in the immunocompromised host

A

-immunocompromised due to a variety of factors
•Commonly acquire pneumonia from organisms of low virulence
•Can be caused by organisms that cause CAP or HAP
•*Pneumocystis pneumonia (PCP) and other fungal pneumonias; Mycobacterium tuberculosis (TB)

54
Q

what are diagnostic findings associated with pneumonia

A
  • Tachypnea (25-45), SOB, accessory muscle use
  • Tachycardia, bounding pulse
  • Some have URTI symptoms (runny nose etc.)
  • Rash? Pharyngitis?
  • Mucoid or mucopurulent sputum may be evident after a few
55
Q

what diagnostic tests would you run for pneumonia?

A
  • Chest x-ray
  • CBC, look for elevated WBC’s and leukocytes in particular
  • Blood cultures (bacteremia is common)
  • Sputum sample for C&S
  • ABG’s
  • Oxygen saturation
56
Q

medical management for pneumonia

A
  • Causative agents
  • Prompt administration of antibiotic is key
  • Length of treatment depends on the causative agent
  • Hydration
  • Symptoms can be treated with supportive medications
  • Bed rest
  • Oxygen therapy
57
Q

what do you assess for in someone with pneumonia after they’ve been diagnosed?

A
  • Head to toe! Changes in physical assessment
  • Watch for changes in Temp, Pulse, O2 saturations
  • Amount, odour, and colour of secretions
  • Frequency and severity of cough
  • Degree of tachypnea and dyspnea
  • Changes on xray
  • Fatigue
  • Fluid Balance
  • Oral intake of food
  • Effect of medications
  • Patient’s understanding of treatment
58
Q

what are considerations with pneumonia for older adults?

A

difficult to treat, higher mortality rate

59
Q

what are symptoms in the elderly for pneumonia?

A
  • general deterioration
  • Weakness
  • Abdominal symptoms
  • Anorexia
  • Confusion
  • Tachycardia
  • Tachypnea
60
Q

what are ped considerations for pneumonia

A

-primary disease or complication from another
•Clinical manifestations depend on child’s age
•Viruses leave pediatrics susceptible to secondary bacterial infections
•Promoting oxygenation
•Antipyretics
•Fluids•Rest
•Immunizations

61
Q

what temp would you expect to see if someone had pneumonia?

A

> 39.5 degrees celc

62
Q

if someone has pneumonia, will their cough be productive or non productive?

A

can be either with whitish sputum

63
Q

what type of breath sounds would you hear in someone with pneumonia?

A

rhonchi (continuous, low pitched rattling) or fine crackles

64
Q

what is nursing care for a child with pneumonia?

A

primarily supportive and symptomatic but needs thorough resp assessment as well as admin of supplemental oxygen PRN, fluids and abx

65
Q

what are the 4 main things to assess a child for with pneumonia?

A
  1. vitals
  2. pain level
  3. general disposition
  4. level of activity
66
Q

how do you prevent dehydration in a child with pneumonia?

A

frequent administration of fluids intravenously during the acute phase

67
Q

what position is often most comfortable for a child with pneumonia whos having troubles breathing/has supplemental O2?

A

placing patient in semierect position

68
Q

how can you reduce the pleural rubbing of the lungs to reduce discomfort with pneumonia?

A

lying on affected side (if pneumonia is unilateral) splints the chest on the side and can reduce the pleural rubbing that often causes discomfort

N233 (4 decks)

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