Oxygenation: Pneumonia

Question 1

Pneumonia

Answer 1

• 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

Question 2

parenchyma

Answer 2

actual oxygen exchange occurs

• alveoli
• brochioles

Question 3

non-infectious pneumonia

Answer 3

aspiration pneumonia

Question 4

To get pneumonia…

Answer 4

• microbes are either inhaled or aspirated from oropharynx
• mat also enter via bloodstream
• host defenses overwhelmed

Question 5

Normal defenses against penumonia

Answer 5

• cough reflex (aspiration pnem)
• pulmonary macrophages
• nasopharyngeal defenses
• cilia lining the respiratory tract

Question 6

Alveoli and bronchioles invaded…

Answer 6

causing inflammation and immune response

Question 7

Endotoxins released by microbes…

Answer 7

cause congestion and edema

-associated with gram negative

Question 8

Bacteria enters lungs through

Answer 8

bloodstream, aspiration of resident bacteria, or person to person via droplet

Question 9

Bacteria characteristics

Answer 9

• damage cells and usually in one lung

- even distribution of microbes

Question 10

Streptococcus pneumoniae

Answer 10

most common in community

Question 11

Staph aureus

Answer 11

healthcare associated

Question 12

Pneumocystis jiroveci

Answer 12

immunocompromised

Question 13

mycoplasma pneumoniae

Answer 13

“walking pneumonia”

Question 14

legionella pneumonphilia

Answer 14

Legionnaires’ disease

Question 15

Viral Characterisitics

Answer 15

• 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

Question 16

Mycoplasma

Answer 16

does not have cell wall

-neither gram neg or positive…more positive

Question 17

Other causes of infectious pneumonia

Answer 17

fungi and protozoa

Question 18

Aspiration

Answer 18

food, emesis, reflux, hydrocarbons

-may be infectious or non-infectious; chemical injury and inflammatory response

Question 19

hydrocarbons

Answer 19

household cleaners

kids

Question 20

Pneumonia complications

Answer 20

• bronchiectasis
• pleuritis
• pleural effusion
• lung abscess
• empyema

Question 21

bronchiectasis

Answer 21

walls of bronchi get thickened from inflammation and infection

Question 22

pleuritis

Answer 22

inflammation of actual pleura

Question 23

pleural effusion

Answer 23

fluid in pleural space

Question 24

lung abscess

Answer 24

bacteria pneumonia

-pocket within lung tissue

Question 25

empyema

Answer 25

puss in pleural space

Question 26

Pneumonia is common with…

Answer 26

the very young or very old

Question 27

Infants and penumonia

Answer 27

immature immune system

Question 28

Elderly and pneumonia

Answer 28

decreased cough and gag

Question 29

Risk factors of Pneumonia

Answer 29

• infants, elderly
• HIV/Aids
• cancer, organ transplant
• chronic illnesses (DM, cardiac, respiratory)
• endotracheal intubation (ventilator associated pneumonia - VAP)
• NG tubes
• Smoking, alcoholism

Question 30

Prevention

Answer 30

• Early identification and appropriate treatment

- Vaccines

Question 31

Vaccines

Answer 31

• Pneumococcal
• PCV13—children under 2 yrs.
• PPSV23—adults
• Hib—children under 2 yrs.
• Influenza

Question 32

Clinical Manifestations

Answer 32

• fever and chills
• cough (productive and purulent)
• chest pain
• blood-tinged sputum
• SOB
• decreased appetite
• cyanosis
• crackles
• wheezing

Question 33

Lifespan Considerations: Infants and Children

Answer 33

• 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

Question 34

Lifespan considerations: Older Adults

Answer 34

• decreased cough and gag
• thick, viscous secretions
• decreased cilia
• meds, H/O smoking, COPD

Question 35

Diagnostic Studies for Pnemonia

Answer 35

• CXR
• CT Scan
• Sputum C&S and Gram stain
• CBC with diff
• Serology (pathogen antibodies)
• Pulse Ox
• ABG
• Bronchoscopy

Question 36

Pharmacologic Therapy

Answer 36

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

Question 37

CPT Includes

Answer 37

• percussion
• vibration
• postural drainage

Question 38

Nursing Assessment

Answer 38

• VS
• LOC
• skin color and temp
• respiratory distress
• lung sounds
• consolability (infants)

Question 39

Nursing Care

Answer 39

• 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

Question 40

Cephalosporin and PCNs

Answer 40

up to 30% with PCN allergy are also allergic to Cephalosporin

Question 41

Problem with high fowlers

Answer 41

• drainage for lower lobe pneumonia
• uncomfortable
• ulcers*****

Question 42

Nursing Care Review for Pneumonia

Answer 42

• Airway management
• Pain management
• Fluids and electrolytes
• Safety initiatives
• skin assessment
• oxygen therapy
• Patient education