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Nursing G140 Exam #1 (MS) > PNA > Flashcards

PNA Flashcards

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1
Q

PNA Pathophysiology

A

Inflammatory process —> production of alveoli exudate: decreased O2 diffusion —> migration of WBC to alveoli: decrease O2 diffusion —> decreased ventilation (bronchi edema, secretions): decreased alveolar O2 tension

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2
Q

Ventilation/ perfusion mismatch

A

Oxygen available but cannot reach the capillaries causing blood to leave pulmonary circulation poorly oxygenated

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3
Q

PNA risk factors (10)

A
  • immunosuppressive (older adults)
  • shallow breathing (OA)
  • weak cough reflex (OA)
  • immobility (stroke, frail)
  • mucus and bronchial obstruction
  • smoking
  • NPO, NG/ET tubes
  • supine position
  • respiratory depression]
  • antibiotic therapy
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4
Q

Community-acquired PNA: CAP

A
  • acquired within the community

- diagnosis less than 48h of hospital admission and does not meet criteria for HCAP

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5
Q

Health care-associated PNA: HCAP (what is it and the factors)

A

Diagnosis less than 48 hours after admission with any of the following factors:

  • acute care hospital for more than 2 days within 90 days of diagnosis
  • nursing home or long term care facility
  • recent IV antibiotic therapy, chemotherapy, or wound care within 30 days preceding current diagnosis
  • hospital or hemodialysis clinic
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6
Q

Usual cause of HCAP, how hard is it to treat, what kind of antibiotics?

A
  • usually caused by MDR pathogen (MRSA)
  • difficult to treat due to antibiotic resistance
  • special antibiotics needed (different from CAP)
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7
Q

Hospital acquired PNA: HAP

A
  • occurrence more than 48 hours of hospital admission

- no clinical manifestations at time of admission

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8
Q

Predisposing factors to HAP (4)

A
  • impaired defenses, comorbidities
  • malnutrition, immobility
  • CNS depression with hypoventilation (stroke, respiratory failure)
  • NG tubes, prolonged antibiotic course
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9
Q

HAP Presentation

A
  • CXR: new pulmonary infiltrate
  • evidence of infection: Fever, respiratory symptoms, purulent sputum, leukocytosis
  • may evolve to consolidation: solidification of tissues
  • mediastinal shift: deviation of mediastinal structure towards one side of the chest cavity, indicating severe asymmetry of intrathoracic pressures (***REQUIRES EMERGENCY INTERVENTIONS: THORACOTOMY W/ DRAINAGE)
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10
Q

Ventilator-associated PNA: VAP

A
  • type of HAP

- more than 48 hours after endotracheal tube intubation

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11
Q

Prevention of VAP

A
  • HOB 30-45 degrees
  • daily assess readiness to extubate
  • PUD prophylaxis (peptic ulcer disease)
  • DVT prophylaxis
  • daily oral care with chlorhexidine
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12
Q

Aspiration PNA (most common aspiration, other aspirations, where it occurs, what causes the PNA)

A
  • most common aspiration: bacteria from upper airways
  • other types of aspiration: gastric contents, exogenous chemicals
  • may occur in the community or hospital
  • inflammatory changes lead to bacteria growth —> PNA
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13
Q

PNA Diagnosis

A
  • H&P
  • CXR
  • blood and sputum culture —> only for sever disease, all inpatients empirically treated diet MRS or pseudo
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14
Q

PPSV Vaccination

A
  • one time: all patients 65 or older, adult with chronic diseases or smoking
  • second dose: All 65 year old adults who received first dose more than 5 years ago

PCV13 and PPSV23

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15
Q

Pharmacological therapy: antibiotics for bacterial PNA

A
  • mono therapy or combination

- IV to PO when patients are stable

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16
Q

What does a stable PNA patient look like?

A 
T < 100
HR <100
RR < 24
SBP> 90
O2 Sat > 90%
17
Q

Other therapies for PNA (5)

A
  • symptoms support
  • O2 PRN
  • pulse ox
  • IV fluids
  • ABGs monitoring
18
Q

Gerontological considerations for PNA

A
  • increased mortality
  • classic symptoms may not be present (chest pain, fever, sputum, leukocytosis)
  • onset symptoms: confusion, weakness, increased HR, increased RR, abd upset
  • abnormal breath sounds misleading: decreased at bases, atelectasis, crackles from CHF
19
Q

PNA Complications (4)

A
  • resp failure
  • sepsis and septic shock
  • aspiration
  • pleural effusion: empyema: accumulation of thick purulent fluid; thoracentesis: removal of fluid; chest tube: drainage of fluids, empyema
20
Q

Nursing process assessment (7)

A
  • early detection
  • pleuritic pain
  • fatigue
  • tachypnea
  • use of accessory muscles
  • sputum
  • changes in temp (may be slight in gero patients)
21
Q

Nursing process: diagnosis

A
  • ineffective airway clearance r/try copious secretions
  • impaired gas exchange r/t copious secretions
  • fatigue/activity intolerance r/t impaired resp function
  • imbalanced nutrition: less than body requirements
  • risk for deficient fluid volume r/t fever and tachypnea
22
Q

Nursing process interventions (patency) (6)

A

-improving patency —> hydration and humidification of secretions, lung expansion, effective directed cough, chest pt, O2 therapy, administer prescribed antibiotics and other meds

23
Q

Nursing process interventions (administer ___, promote ____ and ____, maintain or improve ____, promote ___, prevent and manage complications: ___, ___, ___, ____, ____)

A
  • administer antibiotics for bacterial PNA
  • promote rest
  • promote fluid intake (at least 2L/day unless contraindicated)
  • maintain or improve nutritional status
  • promote knowledge: disease and healing
  • prevent and manage complications: assess labs, VS, response to antibiotic treatment, CXR, LOC
24
Q

PNA prevention for post surgical patients

A

Incentive spirometry —> keeps lungs active during bed rest which lowers the risk of PNA

25
Q

Quick risk assessment for sepsis assessment (10 signs of infection)

A
  • increased RR
  • increased HR
  • low BP
  • low output
  • ALOC
  • decreased O2 sat
  • high/low WBC
  • high neutrophils
  • high/low temp
  • high/low bowel sounds
26
Q

qSOFA score

A
  • 2 or 3 means increased risk of mortality or extended ICU stay
  • serum lactate > 2 suggests hypoperfusion
  • SBP < 100
  • RR >22
  • any change in LOC
27
Q

Nursing process: intervention (pt ed) (7)

A
  • antibiotic treatment and side effects
  • breathing exercise (IS w/ goal)
  • follow up with PCP
  • smoking cessation
  • home care PRN
  • eval of adherence to therapy
  • NUTRITION (protein, iron, vitamins)
28
Q

PNA complications: aspiration

A

Inhalation of foreign material

29
Q

Risk factors of aspiration (6)

A
  • seizure
  • brain injury, stroke
  • ALOC
  • flat body positioning
  • swallowing disorders
  • cardiac arrest
30
Q

Aspiration prevention: Absent reflexes

A
  • HOB 30-45
  • avoid sedation
  • swallowing eval-speech therapist
  • soft diet, small bites
  • chin tucked, head turned when swallowing
  • oral suctioning with minimal pharyngeal stimulation
  • patients with ET and feeding tube: cuff pressure 20-30 cm H2O
31
Q

Aspiration Prevention: feeding tubes

A
  • feeding only after placement verifications: CXR!!!!

- verify exit mark

32
Q

Aspiration prevention: delayed stomach emptying (causes, how to prevent aspiration)

A
  • obstruction, increased secretions, paralytic ileus, ascites, peritonitis, opioid side effects
  • verify NG tube, G tube residual volume; notify HCP PRN
33
Q

PNA complications: pleural effusion. What is transudate? what is exudate?

A
  • pleural space fluid collection: secondary disease
  • PNA, HF, lung tumors, PE
  • transudate: plasma from pulmonary capillaries (HF)
  • exudate: fluid extravasacation to pleural space (inflammation or tumors)
34
Q

Pleural effusion (what to treat, how to treat)

A
  • treat underlying cause: PNA, HF, tumors
  • thoracentesis: collection of fluid by suction
  • chest tube for continued fluid drainage: suction to restore negative pressure of thoracic cavity
35
Q

Pleurodesis

A

Chemical irritant instilled in pleural space resulting decrease in pleural space and reaccumulation of fluid

36
Q

PleureX Catheter

A

Outpatient management

37
Q

Pleuroperitoneal shunt

A

Manual pump from pleural space into peritoneal space

38
Q

PNA complications: Empyema (what is it, where is it, how long is the treatment, how to manage, pt teaching about ____)

A
  • accumulation of thick, purulent fluid within pleural space
  • loculated (walled off)
  • drainage
  • antibiotic treatment: 4-6 weeks
  • lung expanding breathing exercises: IS with goal
  • patient teaching about treatment and meds

Nursing G140 Exam #1 (MS) (5 decks)

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