pneumonia

Question 1

pneumonia

Answer 1

any type of infection of the lower respiratory system

cause: viral, fungal, protozoa, or parasitic

Question 2

what does PNA cause the body?

Answer 2

inflammation of the lung tissues, alveolar air spaces filled with purulent fluid, inflammatory cells, fibrin

Question 3

how is PNA transmitted

Answer 3

inhaled infectious droplets

droplet precautions –> mask, gloves, eye shield, gown

Question 4

risk factors for PNA

Answer 4

male, winter time
age extremes (>80)
compromised immunity
underlying lung disease
alcoholism
altered LOC
impaired swallowing = aspiration
nursing home resident
hospitalization
influenza

Question 5

CAP vs. HAP

Answer 5

community acquired vs hospital acquired

Question 6

CAP

Answer 6

one of the most common reasons for hospitalizations
easier to treat

Question 7

HAP

Answer 7

PNA developed within 48 hrs after admission
*worse outcomes than CAP - more deadly, contagious, strong
*ICU care

Question 8

VAP and HCAP

Answer 8

ventilator associated pna
*associated with endotracheal intubation
*VAP bundle to prevent

healthcare associated pna

Question 9

patho of PNA

Answer 9

1. aspiration of oropharyngeal secretions [MOST COMMON] OR inhalation of droplets containing bacteria/pathogens

once in lower airway,
2. inflammatory rxn stimulated in lungs –> vasodilation & infection begins to spread into the respiratory tract and alveoli
3. goblet cells are stimulated and mucus is excrete –> mucus accumulates between the alveoli and capillaries (can’t have gas exchange)

4. alveoli attempt to open and close against the purulent exudate, but most can’t –> gas exchange not ideal, difficult to breathe

Question 10

failure of cough reflex

Answer 10

mucociliary defense mechanism
failure allows exudate to invade the alveoli

Question 11

mucociliary defense mechanism is ineffective in ___________ because…

Answer 11

ineffective in smokers because impairs ciliary fxn
*smoking is a risk factor for all resp diseases

Question 12

clinical manifestations of pna

Answer 12

usually happens after an URI
fever, chills, productive OR dry cough, malaise, pleural pain, dyspnea, hemoptysis (coughing up blood)

Question 13

productive cough

Answer 13

bacterial
purulent, sputum may be green, rusty color, red currant jelly
usually gram negative in HAP

Question 14

nonproductive/scanty cough

Answer 14

viral
often the cause of CAP

Question 15

severe manifestations of PNA

Answer 15

tachypnea, signs of resp distress/failure

Question 16

respiratory distress

Answer 16

maintain O2 only by increasing WOB

tachypnea, tachycardia, nasal flaring, pursed lips, stridor/wheezing, agitation, delayed cap refill, pale

Question 17

respiratory failure

Answer 17

can’t compensate for inadequate O2 despite extra respiratory effort and rate
circulatory and resp system collapse

RR >60
grunting, retractions, mottling, head bobbing, severe air hunger, bradycardia, hypotension

Question 18

respiratory attack

Answer 18

bradypnea, inefficient respirations, cyanosis/gray, no air movement

Question 19

how do you diagnose PNA

Answer 19

-s/s from physical assessment
-lung exam: dullness on percussion, inspiratory crackles, increased tactile fremitus, egophony (“e” to “a”)
-diagnostic tests (CXR, CBC, sputum C&S)

Question 20

diagnostic tests for pna

Answer 20

CXR: infiltrates
CBC: determines if bacterial (WBC increase/leukocytosis)
+ sputum for C&S: identifies specific bacteria and ATB that will kill it

Question 21

bacterial pna

Answer 21

gram positive: staphylococcus aureus, streptococcus pneumoniae
gram negative: pseudomonas auruginosa, aceintobacter, klebsiella pneumoniae

Question 22

staphylococcus aureus

Answer 22

gram positive bacteria, HAP

enters through bloodstream (IV) –> to lungs

common cause: MRSA

Question 23

streptococcus pneumoniae

Answer 23

CAP
pneumococcal pna
sputum usually brown or rusty color tinge

Question 24

gram negative organisms

Answer 24

gram - infections make you SICKER and more DIFFICULT TO TREAT

Question 25

aspiration pna

Answer 25

aspirated material from GI tract stimulates inflammatory rxn
*severity of inflammation depends on pH (more acidic = more inflammation)

Question 26

who is at risk for aspiration pna?

Answer 26

NG tube, decreased LOC, decreased gag reflex, decreased gastric emptying

Question 27

nursing considerations with aspiration pna

Answer 27

aspirate can be subtle or abrupt
“silent killer”

*dysphagia eval is crucial

Question 28

viral pna

Answer 28

CAP
virus alters pulmonary immune defense and makes the lungs vulnerable to another bacterial infection (secondary pna)

Question 29

s/s of viral pna

Answer 29

fever, chills, dyspnea on exertion, cough

Question 30

treatment of viral pna

Answer 30

mild, supportive care
NO ATB - unless secondary infection

generally improves in 2-3 weeks

Question 31

atypical pneumonia’s

Answer 31

pneumocystis carini
mycoplasma
legionella
aspergillus

Question 32

pneumocystis carini

Answer 32

r/t immune suppression
yeast-like fungus

Question 33

mycoplasma

Answer 33

“walking pna”
mild; pt may complain of persistent cough, headache, earache
properties of both bacterial and viral

Question 34

legionella

Answer 34

gram neg
spread through water systems –> air conditions, mists sprayed on produce, hot tubs

Question 35

aspergillus

Answer 35

fungal pna
released from walls of old buildings, reconstruction, dead leaves, compost
affects lung tissues

Question 36

PNA treatment

Answer 36

bacterial –> ATB
viral –> symptoms, NO ATB

*ventilation/O2
*hydration
*pulmonary hygiene/toilet
*nebulizer treatments

Question 37

prevention of pneumonia

Answer 37

vaccines:
*PCV13: prevents pneumococcal pna caused by 13 strains of strep pna (4 doses)
*PPSV23: prevents against an additional 23 types of pna bacteria