Pneumonia Flashcards
What is pneumonia and where does it occur
Excess fluid in lungs from INFLAMMATORY process.
Occurs in the interstitial space, alveoli, and bronchioles
causes of inflammation leading to pneumonia?
infectious organism or inhaling irritating agents
Pneumonia from an ________ process will have more formation of exudate
infectious
What does pneumonia result in?
reduces gas exchange
Pathophysiology of pneumonia
Pathogens enter airway (infectious or irritating agent).
If an infectious organism, it will multiply.
Immune Response: WBC arrive.
Causes capillary leak, edema, and exudate formation.
Exudate collects in and around alveoli.
Alveolar walls thicken and lungs stiffen (from fibrin and edema).
Diffusion is impaired– reducing gas exchange.
Who has highest risk of pneumonia?
Rate is higher among older adults (>65), nursing home
patients, hospital patients, and patients with
neurological, dysphagia, or ventilated patients.
which is more common- community acquired or hospital acquired pneumonia?
community acquired
what is most common cause of sepsis
community acquired pneumonia
2 types of pneumonia based on location in lung:
Lobar Pneumonia: Consolidation in a segment or lobe (aspiration)
Bronchopneumonia: Scattered patches around bronchi
3 main types of pneumonia
Community acquired
Healthcare acquired
Ventilator acquired
definition of community acquire pneumonia? 2 common pathogens causing it?
pneumonia that is acquired outside the hospital.
-The most commonly pathogens are Streptococcus
pneumoniae, Haemophilus influenzae
what can occur as complication of influenza?
pneumonia
Hospital-acquired pneumonia (HAP/HCAP) is defined
as
…. a pneumonia that was not incubating at the time of hospital admission and that presents 2 or more
days after hospitalization.
(Pneumonia that presents sooner should be regarded as community acquired pneumonia.)
define ventilator associate pneumonia?
a lung infection that develops in a
person who is on a ventilator.
infectious causes of pneumonia- name the 3 weird ones
Bacteria
Viruses
Mycoplasmas
Fungi
Weird:
Rickettsiae -ticks/fleas
Protozoa
Helminths- wormies
Non infectious causes of pneumonia
Toxic gases
Chemical fumes
Smoke
Aspiration (water/fluid, food, saliva, vomit)
Risk factors for developing pneumonia ?
Age
Unvaccinated
Unvaccinated or Pneumococcal Vaccine > 5 years ago
Unvaccinated against influenza Chronic health issues
Chronic lung disease Immunocompromised Tobacco Use and smoke (including vaping) Recent respiratory illness (viral or flu) exposure ETOH Altered level of consciousness Aspiration risk Endotracheal tube, tracheostomy, nasogastric tube Poor nutritional status
Risk factors for developing pneumonia ?
- Age
- Unvaccinated
- –> Unvaccinated or Pneumococcal Vaccine > 5 years ago
- —> Unvaccinated against influenza Chronic health issues
- Chronic lung disease
- Immunocompromised
- Tobacco Use and smoke (including vaping)
- Recent respiratory illness (viral or flu) exposure
- ETOH
- Altered level of consciousness
- Aspiration risk
- Endotracheal tube, tracheostomy, nasogastric tube
- Poor nutritional status
Prevention for pneumonia
Vaccination –> only protects from INFECTIOUS agent
Avoid crowded areas
Clean respiratory equipment
Avoid indoor pollutants (i.e dust, smoke, aerosols) Balanced Diet
Adequate fluid intake (unless on fluid restriction) Adequate sleep
Tobacco Cessation, including vaping
Handwashing
Incentive Spirometry
Nursing Interventions for Prevention of pneumonia
what kind of water should you put in GI tube?
Pulmonary hygiene (cough, turn, deep breathe) Mobility Handwashing Incentive Spirometry Sterile H2O in GI tubes Aspiration precautions Ventilator bundle Patient Education Evaluate vaccine status/needs
vaccination for pneumonia? 2 types when we do it?
- Prevnar Pneumococcal Conjugate Vaccine (PCV 13)
6-12 months later
2.Pneumovax Pneumococcal Polysaccharide Vaccine (PPSV 23)
For persons 65+ OR Adults 19-64 who have risk factors. CDC recommends to be vaccinated with both, FIRST with with Prevnar then 12 months later with Pneumovax. Don’t forget annual flu vaccine.
**renew pneumovax every 5 years
Pneumonia complications
- Sepsis (Bloodstream infection with system wide
inflammation) - Empyema (Exudate in the pleural cavity)
- Pleural Effusion
- Lung Abscess/ Necrosis
- Death
what is an empyema?
exudate in pleural cavity
objective assessment signs of pneumonia?
Chest pain/discomfort (pleuritic) Headache Dyspnea Myalgia Chills Anxious
*note no fever
Generalized Appearance of pneumonia assessment
Flushed cheeks
Anxious appearance
Fever (may not be present)
Cardiac assesment for pneumonia
Tachycardia
Dysrhythmias
Respiratory assessment for pneumonia
Respiratory
- -Breathing pattern : Shallow , Labored, Accessory Muscles , Chest Expansion, Rate
- -Positioning: Tripod or Orthopnea (shortness of breath lying down)
- Cough (may or may not be present)
- –> Productive: Assess color, amount, consistency, and odor.
- -Adventitious breath sounds: Crackles (fluid), Diminished, Wheezing, Bronchial, Hypoxia
Labs for pneumonia?
ABG
Sputum Culture and Sensitivity
BMP, CBC, Lactate
Possibly: Blood cultures, viral panel
indepedent sputum collection- how much sputum ya need?
- do not touch inside of container or lid
- stand on side of pt
- several deep beraths then cough
- -> do not let pt clear throat and put saliva in
- need 10-15 ml
assisted sputum collection
- sterile
- use sputum trap
- insert tube into nose, suction out while coughing
nurisng interventions for pneumonia?
- Oxygen Therapy
- Incentive Spirometry (Improves inspiratory muscles, preventing atelectasi)
- Pulmonary hygiene
- Encourage fluids, unless on fluid restriction
- Aspiration assessment and prevention
- Hand hygiene
- Oral care
- Mobility
- Medications: Bronchodilators, Steroids, Expectorants, Anti Infectives (non-viral cause), consider resistance.
- –Ventilated patients:
- —> Vent Bundle (HOB >30, oral care every 2 hr with CHG, PUD prop, DVT prop, suctioning, sedation wean…)
vent bundle?
Vent Bundle (HOB >30, oral care every 2 hr with CHG, PUD prop, DVT prop, suctioning, sedation wean…)
