Oxygenation: Pneumonia Flashcards
Pneumonia
- Acute inflammation of the lung parenchyma
- may be infectious or non-infectious
- was #1 COD in US until antibiotics in use….now #8
- Approx. 50,000 people die yearly
- cost is $20 billion annually
parenchyma
actual oxygen exchange occurs
- alveoli
- brochioles
non-infectious pneumonia
aspiration pneumonia
To get pneumonia…
- microbes are either inhaled or aspirated from oropharynx
- mat also enter via bloodstream
- host defenses overwhelmed
Normal defenses against penumonia
- cough reflex (aspiration pnem)
- pulmonary macrophages
- nasopharyngeal defenses
- cilia lining the respiratory tract
Alveoli and bronchioles invaded…
causing inflammation and immune response
Endotoxins released by microbes…
cause congestion and edema
-associated with gram negative
Bacteria enters lungs through
bloodstream, aspiration of resident bacteria, or person to person via droplet
Bacteria characteristics
- damage cells and usually in one lung
- even distribution of microbes
Streptococcus pneumoniae
most common in community
Staph aureus
healthcare associated
Pneumocystis jiroveci
immunocompromised
mycoplasma pneumoniae
“walking pneumonia”
legionella pneumonphilia
Legionnaires’ disease
Viral Characterisitics
- enter from upper airway and infiltrate alveoli in one or both lungs
- invade cells and kill them, send out debris
- patchy distribution
- influenza and adenovirus
Mycoplasma
does not have cell wall
-neither gram neg or positive…more positive
Other causes of infectious pneumonia
fungi and protozoa
Aspiration
food, emesis, reflux, hydrocarbons
-may be infectious or non-infectious; chemical injury and inflammatory response
hydrocarbons
household cleaners
kids
Pneumonia complications
- bronchiectasis
- pleuritis
- pleural effusion
- lung abscess
- empyema
bronchiectasis
walls of bronchi get thickened from inflammation and infection
pleuritis
inflammation of actual pleura
pleural effusion
fluid in pleural space
lung abscess
bacteria pneumonia
-pocket within lung tissue
empyema
puss in pleural space
Pneumonia is common with…
the very young or very old
Infants and penumonia
immature immune system
Elderly and pneumonia
decreased cough and gag
Risk factors of Pneumonia
- infants, elderly
- HIV/Aids
- cancer, organ transplant
- chronic illnesses (DM, cardiac, respiratory)
- endotracheal intubation (ventilator associated pneumonia - VAP)
- NG tubes
- Smoking, alcoholism
Prevention
- Early identification and appropriate treatment
- Vaccines
Vaccines
- Pneumococcal
- PCV13—children under 2 yrs.
- PPSV23—adults
- Hib—children under 2 yrs.
- Influenza
Clinical Manifestations
- fever and chills
- cough (productive and purulent)
- chest pain
- blood-tinged sputum
- SOB
- decreased appetite
- cyanosis
- crackles
- wheezing
Lifespan Considerations: Infants and Children
- airway shorter and more narrow
- high risk of obstruction
- Higher O2 consumption
- Tachypnea, intercostal retractions, nasal flaring
- Dx: blood cultures
- usually bacterial
- recover faster than adults
- common in kids with CF
Lifespan considerations: Older Adults
- decreased cough and gag
- thick, viscous secretions
- decreased cilia
- meds, H/O smoking, COPD
Diagnostic Studies for Pnemonia
- CXR
- CT Scan
- Sputum C&S and Gram stain
- CBC with diff
- Serology (pathogen antibodies)
- Pulse Ox
- ABG
- Bronchoscopy
Pharmacologic Therapy
Depends on microbe
- PCN
- Cephalosporins
- EES
- TMP-SMZ
- Azithromycin
- Clindamycin
- Med may change after gram stain/culture results obtained
- Bronchodilators
- Acetylcysteine (reduce mucous viscosity)
- Expectorants
- Oxygen
- Liquids (2.5-3 L/day)
- incentive spirometer
- chest physiotherapy
CPT Includes
- percussion
- vibration
- postural drainage
Nursing Assessment
- VS
- LOC
- skin color and temp
- respiratory distress
- lung sounds
- consolability (infants)
Nursing Care
- antibiotics as ordered–ask about allergies
- Antipyretics
- I&Os - encourage fluids
- Assess sputum color
- Ongoing respiratory assessment
- Fowlers or high fowlers position
- deep breach cough
- suction
- assess for pleuritic pain
- use pillow for splint when coughing
- O2 as needed
- Teaching: smoking cessation, vaccines
Cephalosporin and PCNs
up to 30% with PCN allergy are also allergic to Cephalosporin
Problem with high fowlers
- drainage for lower lobe pneumonia
- uncomfortable
- ulcers*****
Nursing Care Review for Pneumonia
- Airway management
- Pain management
- Fluids and electrolytes
- Safety initiatives
- skin assessment
- oxygen therapy
- Patient education
