pneumonia Flashcards
pneumonia
any type of infection of the lower respiratory system
cause: viral, fungal, protozoa, or parasitic
what does PNA cause the body?
inflammation of the lung tissues, alveolar air spaces filled with purulent fluid, inflammatory cells, fibrin
how is PNA transmitted
inhaled infectious droplets
droplet precautions –> mask, gloves, eye shield, gown
risk factors for PNA
male, winter time
age extremes (>80)
compromised immunity
underlying lung disease
alcoholism
altered LOC
impaired swallowing = aspiration
nursing home resident
hospitalization
influenza
CAP vs. HAP
community acquired vs hospital acquired
CAP
one of the most common reasons for hospitalizations
easier to treat
HAP
PNA developed within 48 hrs after admission
*worse outcomes than CAP - more deadly, contagious, strong
*ICU care
VAP and HCAP
ventilator associated pna
*associated with endotracheal intubation
*VAP bundle to prevent
healthcare associated pna
patho of PNA
- 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)
- alveoli attempt to open and close against the purulent exudate, but most can’t –> gas exchange not ideal, difficult to breathe
failure of cough reflex
mucociliary defense mechanism
failure allows exudate to invade the alveoli
mucociliary defense mechanism is ineffective in ___________ because…
ineffective in smokers because impairs ciliary fxn
*smoking is a risk factor for all resp diseases
clinical manifestations of pna
usually happens after an URI
fever, chills, productive OR dry cough, malaise, pleural pain, dyspnea, hemoptysis (coughing up blood)
productive cough
bacterial
purulent, sputum may be green, rusty color, red currant jelly
usually gram negative in HAP
nonproductive/scanty cough
viral
often the cause of CAP
severe manifestations of PNA
tachypnea, signs of resp distress/failure
respiratory distress
maintain O2 only by increasing WOB
tachypnea, tachycardia, nasal flaring, pursed lips, stridor/wheezing, agitation, delayed cap refill, pale
respiratory failure
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
respiratory attack
bradypnea, inefficient respirations, cyanosis/gray, no air movement
how do you diagnose PNA
-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)
diagnostic tests for pna
CXR: infiltrates
CBC: determines if bacterial (WBC increase/leukocytosis)
+ sputum for C&S: identifies specific bacteria and ATB that will kill it
bacterial pna
gram positive: staphylococcus aureus, streptococcus pneumoniae
gram negative: pseudomonas auruginosa, aceintobacter, klebsiella pneumoniae
staphylococcus aureus
gram positive bacteria, HAP
enters through bloodstream (IV) –> to lungs
common cause: MRSA
streptococcus pneumoniae
CAP
pneumococcal pna
sputum usually brown or rusty color tinge
gram negative organisms
gram - infections make you SICKER and more DIFFICULT TO TREAT
aspiration pna
aspirated material from GI tract stimulates inflammatory rxn
*severity of inflammation depends on pH (more acidic = more inflammation)
who is at risk for aspiration pna?
NG tube, decreased LOC, decreased gag reflex, decreased gastric emptying
nursing considerations with aspiration pna
aspirate can be subtle or abrupt
“silent killer”
*dysphagia eval is crucial
viral pna
CAP
virus alters pulmonary immune defense and makes the lungs vulnerable to another bacterial infection (secondary pna)
s/s of viral pna
fever, chills, dyspnea on exertion, cough
treatment of viral pna
mild, supportive care
NO ATB - unless secondary infection
generally improves in 2-3 weeks
atypical pneumonia’s
pneumocystis carini
mycoplasma
legionella
aspergillus
pneumocystis carini
r/t immune suppression
yeast-like fungus
mycoplasma
“walking pna”
mild; pt may complain of persistent cough, headache, earache
properties of both bacterial and viral
legionella
gram neg
spread through water systems –> air conditions, mists sprayed on produce, hot tubs
aspergillus
fungal pna
released from walls of old buildings, reconstruction, dead leaves, compost
affects lung tissues
PNA treatment
bacterial –> ATB
viral –> symptoms, NO ATB
*ventilation/O2
*hydration
*pulmonary hygiene/toilet
*nebulizer treatments
prevention of pneumonia
vaccines:
*PCV13: prevents pneumococcal pna caused by 13 strains of strep pna (4 doses)
*PPSV23: prevents against an additional 23 types of pna bacteria
