Pneumonia Flashcards
What would you observe initially for any patient
General appearance- eyes, mouth, hands, oedema Position of them in bed/ walk in Chest- shape, WOB, chest wall movement, breathing pattern Skin colour- pale, cyanosed, ruddy, Abdomen Use of accessory muscles Nasal flaring Lines, drains O2 therapy Quality of voice
What would you expect to observe in a patient with pneumonia
Fever- so skin may be sweaty/ due to increased temperature, may be ruddy or cyanosed, fatigue may be able to tell by body position and quality of voice, sob may be able to tell when looking at chest shape and pattern of breathing, you would expect to see fast breathing pattern in pneumonia, pursed lip breathing and use of accessory muscles, coughing is it productive or not productive, eyes you may see plethora because rapid heart beat is a symptom, eyes are red
What would you palpate in someone with pneumonia
Chest expansion in pneumonia is decreased, tactile fremitus felt in pneumonia, body temperature may be increased due to fever, chest pain symptom of pneumonia, skin also relates to fever
What tools could you use to assess someone with pneumonia
Chest x rays, auscultation,
Why would you use auscultation, what is it, what would you expect to hear
Auscultation is the listening and interpretation of sounds produced within the thorax, ask patient to cough before assessment to prevent masking other Sounds, used to verify observed and palpated findings before during and after treatment, in pneumonia you would expect to hear crackles (added sounds) because sputum is causing turbulence in airways, you would also expect to hear increased breath sounds because lung tissue is more dense due to filling of consolidate, sound more coarse compared to normal, earth Vader breathing
What spins a chest x ray, why use a chest x ray for pneumonia what would you expect to see,
A chest x ray is produced by electro magnetic beams passing through thorax and exposing a photographic film/plate, in pneumonia you would expect to see infiltrates which are areas of infected tissue they are
white spots which are radiopaque, also determine if there are any complications due to pneumonia such as pleural effusion, preliminary checks name and date, projection, exposure, position, inspiration, who, what, when, why, how, A-G system approach, alignment, bones, cardiac, diaphragm, expansion, fields, gadgets
Treatments for pneumonia
Positioning, breathing exercises
Why would you use positioning
To maximise respiratory function, maximise breathing and encourage secretions to move up from the bases of the lungs up into larger airways so they can be coughed out
How does positioning influence ventilation perfusion matching
Ventilation is the volume of gas inhaled and exhaled form the lungs in a given time, perfusion is the total volume of blood reaching capillaries in a given time period, the ideal VQ ratio is 1 for efficient pulmonary function, however ratio depends on part of lung concerned, there are different ratios for different areas, areas of the lung below the heart have increased perfusion relative to ventilation due to gravity reducing VQ ratio
How does gravity trigger changes in ventilation and perfusion
Pleural pressure is increased at the base of the lungs, alveoli more compliant alveoli and increased ventilation
Hydrostatic pressure decreases at apex of lung resulting in decreased flow and perfusion
Why is there reduced ventilation of the lungs in pneumonia
The alveoli are filled with exudate impairing delivery of air to alveoli and lengthening diffusion pathway
Why is there reduced ventilation in COPD
Caused by smooth muscle contraction increasing resistance to airflow in alveoli, structural airway damage caused by inflammatory changes can lead to impaired gas exchange which can worsen in a acute exacerbation
What are the 4 stages of pneumonia
Congestion- (24 hours) vascular engorgement, Intra alveolar fluid and bacteria, lungs boggy and red
Red hepatisation-(2-3 days) liver like consistency, alveolar congested with exudate
Grey hepatisation-(4-6 days) avascular lungs appear grey due to disintergration of red blood cells
Resolution-occurs,when exudate experiences enzymatic digestion, reabsorbed or Ingested by macrophages and coughed up
