Pneumonia Flashcards
Risk Factors for developing Pneumonia
Infection
Abd or thoracic surgery
Chronic conditions (such as bronchitis, DM)
Smoking
URI (upper respiratory infection)
Clinical Manifestations
Fever, chills
Productive (or dry) cough
Green, yellow, rust-colored
Crackles, rhonchi
Decreased SpO2
Alterd menta status
Exam
diagnostic studies
CBC (elevated WBCs)
C Reactive Protein (presence of inflammation)
procalcitonin(hormone calcitonin)
SpO2 &/or ABGs (Hypoxemia)
Sputum gram stain & sputum cultures (ordered)
Collaborative Care
Pneumococcal vaccine
Bronchodilators
Empiric antibiotics – start immediately
Broad spectrum abx
Oxygen
Fluids
Chest physiotherapy
Position patient(30-45)
Rest and mobilization balance
Ventilator Associated Pneumonia
(VAP)
How to prevent?
New onset pneumonia within 48 hours in intubated patient
drain away from patient
Don’t instill NS into ET tube
Use ET tube with dorsal lumen for suction
Elevate HOB 30◦-45◦ angle
Daily “sedation vacations”
Oral care with chlorohexidine q 2-4 hrs
Oral moisturizer q 2-4 hrs, Brush q 12 hrs
Complication
The most bad one?
Respiratory failure -leading cause of death from pneumonia
When caring for a patient with acute respiratory distress syndrome (ARDS), which finding indicates therapy is appropriate?
Arterial pH is 7.32.
PaO2 is greater than or equal to 60 mm Hg.
PEEP increased to 20 cm H2O caused BP to fall to 80/40.
No change in PaO2 when patient is turned from supine to prone position.
PaO2 is greater than or equal to 60 mm Hg.
The overall goal in caring for the patient with ARDS is for the PaO2 to be greater than or equal to 60 mm Hg with adequate lung ventilation to maintain a normal pH of 7.35 to 7.45. PEEP is usually increased for ARDS patients, but a dramatic reduction in BP indicates a complication of decreased cardiac output. A positive occurrence is a marked improvement in PaO2 from perfusion better matching ventilation when the anterior air-filled, nonatelectatic alveoli become dependent in the prone position.
A patient is in acute respiratory distress syndrome (ARDS) from sepsis. Which measure would be implemented to maintain cardiac output?
Administer IV crystalloid fluids.
Place the patient on a strict fluid restriction.
Position the patient in Trendelenburg position.
Perform chest physiotherapy and assist with staged coughing.
Administer IV crystalloid fluids.
Low cardiac output may necessitate crystalloid fluids in addition to lowering positive end-expiratory pressure (PEEP) or giving inotropes. The Trendelenburg position is not recommended to treat hypotension. Chest physiotherapy is unlikely to relieve decreased cardiac output. Fluid restriction would be an inappropriate intervention.
The patient with pulmonary fibrosis has hypoxemia during exercise but not at rest. To plan patient care, the nurse identifies the patient is experiencing which physiologic mechanism of respiratory failure?
Diffusion limitation
Intrapulmonary shunt
Alveolar hypoventilation
Ventilation-perfusion mismatch
Diffusion limitation
The nurse is providing care for an older adult patient who has a low partial pressure of oxygen in arterial blood (PaO2) due to worsening left-sided pneumonia. Which intervention should the nurse use to help the patient mobilize his secretions?
Augmented coughing or huff coughing
Positioning the patient side-lying on his left side
Frequent and aggressive nasopharyngeal suctioning
Application of noninvasive positive pressure ventilation
Augmented coughing or huff coughing
Augmented coughing and huff coughing techniques may aid the patient in the mobilization of secretions. If positioned side-lying, the patient should be positioned on his right side (good lung down) for improved perfusion and ventilation. Suctioning may be indicated but should always be performed cautiously because of the risk of hypoxia. NIPPV is inappropriate in the treatment of patients with excessive secretions.
The nurse is caring for a patient who has developed acute respiratory failure. Which medication is used to decrease patient pulmonary congestion and agitation?
Morphine
Albuterol
Azithromycin
Methylprednisolone
Morphine
For a patient with acute respiratory failure related to the heart, morphine is used to decrease pulmonary congestion as well as anxiety, agitation, and pain. Albuterol is used to reduce bronchospasm. Azithromycin is used for pulmonary infections. Methylprednisolone is used to reduce airway inflammation and edema.
The nurse is admitting a patient with asthma in acute respiratory distress. The nurse auscultates the patient’s lungs and notes cessation of the inspiratory wheezing. The patient has not yet received any medication. What should this finding suggest to the nurse?
Spontaneous resolution of the acute asthma attack
An acute development of bilateral pleural effusions
Airway constriction requiring immediate interventions
Overworked intercostal muscles resulting in poor air exchange
Airway constriction requiring immediate interventions
When a patient in respiratory distress has inspiratory wheezing and then it ceases, it is an indication of airway obstruction. This finding requires emergency action to restore airway patency. Cessation of inspiratory wheezing does not indicate spontaneous resolution of the acute asthma attack, bilateral pleural effusion development, or overworked intercostal muscles in this asthmatic patient that is in acute respiratory distress.
When caring for older adult patients with respiratory failure, the nurse will add which intervention to individualize care?
Assess frequently for manifestations of delirium.
Position the patient in the supine position primarily.
Provide early endotracheal intubation to reduce complications.
Delay activity and ambulation to provide additional healing time.
Assess frequently for manifestations of delirium.
Older adult patients are more predisposed to delirium and health care-associated infections. Individualizing the older patient’s care plan to address these factors will improve care. Older adult patients are not required to remain in a supine position only and should increase activity as soon as stability is determined. Endotracheal intubation is not provided early, and noninvasive positive pressure ventilation may be considered as an alternative. The nurse should consider that the aging process leads to decreased lung elastic recoil, weakened lung muscles and reduced gas exchange, which may make the patient difficult to wean from the ventilator.
The nurse is caring for a patient with multiple fractured ribs from a motor vehicle crash. Which assessment findings would be early indications that the patient is developing respiratory failure?
Tachycardia and pursed lip breathing
Kussmaul respirations and hypotension
Frequent position changes and agitation
Cyanosis and increased capillary refill time
Frequent position changes and agitation
A change in mental status is an early indication of respiratory failure. The brain is sensitive to variations in oxygenation, arterial carbon dioxide levels, and acid-base balance. Restlessness, confusion, agitation, and combative behavior suggest inadequate oxygen delivery to the brain.
