Pneumonia

Question 1

Pneumonia

Answer 1

• an inflammatory process in the lungs that produces excess fluid
• triggered by infectious organisms or by the aspiration of an irritant (fluid or a foreign object)
• inflammatory process in lung parenchyma results in edema and exudate that fills the alveoli
• can be primary disease or complication of another disease or condition
• affects people of all ages, but the young, older adults, and immunocompromised adults are more susceptible

Question 2

2 types of pneumonia

Answer 2

1) community acquired pneumonia (CAP):
- most common type
- often occurs as complication of influenza
2) hospital acquired pneumonia (HAP)
- higher mortality rate
- more likely to be resistant to antibiotics
- usually takes 24-48 hr from time client is exposed to acquire HAP

Question 3

Health Promotion and Disease Prevention

Answer 3

1) encourage older adult clients (especially those w/ chronic illnesses) to receive immunizations for influenza and pneumonia
2) promote smoking cessation
3) perform frequent hand hygiene to prevent the spread of infection

Question 4

Risk Factors for Pneumonia

Answer 4

1) advanced age
2) recent exposure to viral or influenza infections
3) tobacco use
4) substance abuse (alcohol, cocaine)
5) chronic lung disease (asthma, emphysema)
6) conditions that increase risk of aspiration (dysphagia-difficulty swallowing)
7) mechanical ventilation (ventilator-acquired pneumonia)
8) impaired ability to mobilize secretions (decreased LOC, immobility, recent abdominal or thoracic surgery)
9) immunocompromised status
10) older adults (have decreased lung reverse, a weak cough reflex, and decreased muscle strength)
11) inactivity and immobility

Question 5

Manifestations of Pneumonia

Answer 5

1) anxiety
2) fatigue
3) weakness
4) chest discomfort
5) confusion from hypoxia (most common in older adults)
6) fever
7) chills
8) diaphoresis
9) SOB or difficulty breathing
10) tachypnea
11) pleuritic chest pain (sharp)
12) sputum production (yellow-tinged)
13) crackles and wheezes
14) coughing
15) dull chest percussion over areas of consolidation
16) decreased oxygen saturation levels

Question 6

Lab tests and diagnostic procedures

Answer 6

1) elevated WBC count (may not be present in older adults)
2) sputum culture and sensitivity
- obtain specimen before starting antibiotic therapy
- obtain specimen by suctioning if client is unable to cough
- responsible organism is only identified about 50% of the time
3) ABGs
- hypoxemia (decreased PaO2 < 80 mm Hg)
4) chest x-ray
- will show consolidation (solidification, density) of lung tissue
- important diagnostic tool because early S&S of pneumonia are often vague in older adults
5) pulse oximetry:
- clients w/ pneumonia usually have oximetry levels < 95-100%

Question 7

Nursing Care

Answer 7

1) position client to maximize ventilation (high-Fowler’s = 90%)
2) encourage coughing or suction to remove secretions
3) administer breathing treatments and medications as prescribed
4) administer O2 therapy as prescribed
5) monitor for skin breakdown around the nose and mouth from the oxygen device
6) encourage deep breathing with an incentive spirometer to prevent alveolar collapse
7) determine the client’s physical limitations and structure activity to include periods of rest
8) promote adequate nutrition
9) encourage fluid intake of 2-3 L/day to promote hydration and thinning of secretions, unless contraindicated due to another condition
10) provide rest periods for older adults who have dyspnea
11) reassure client who is experiencing respiratory distress

Question 8

Antibiotics and nursing considerations

Answer 8

1) penicillins and cephalosporins commonly used
- often initially given via IV and then switched to oral form as condition improves
- important to obtain any culture specimens prior to give first dose
- once specimen obtained, antibiotics can be given while waiting for results of ordered culture
2) -observe clients taking cephalosporins for frequent stools
- monitor client’s kidney function, especially older adults
- encourage clients to take penicillins and cephalosporins with food. take some penicillins 1 hr before meals or 2 hr after

Question 9

Bronchodilators

Answer 9

1) reduce bronchospasms and reduce irritation
- short-acting beta2-antagonists (albuterol) provide rapid relief
- cholinergic antagonists (anticolinergic medications–ipratropium (Atrovent)), block the parasympathetic nervous system, allowing for increased bronchodilation and decreased pulmonary secretions
2) methylxanthines (theophylline (Theo-Dur)), require close monitoring of serum medication levels due to narrow therapeutic range.
- monitor serum medication levels for toxicity of clients taking theophylline
- side effects will include tachycardia, nausea, and diarrhea
- watch for tremors and tachycardia for clients taking albuterol
- observe for dry mouth for clients taking ipratropium

Question 10

Anti-inflammatories

Answer 10

1) glucocorticosteroids (fluticasone (Flovent) and prednisone (Deltasone)), can be prescribed to help decrease airway inflammation
- monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, and poor wound healing
- monitor client for decreased immunity function
- monitor client for hyperglycemia
- advise client to report black, tarry stools
- observe client for fluid retention and weight gain
- monitor client’s throat and mouth for aphthous lesions (cold sores)
- encourage client to drink plenty of fluids to promote hydration
- encourage client to take glucocorticosteroids with food

Question 11

Pneumonia Complications

Answer 11

1) atelectasis
- airway inflammation and edema lead to alveolar collapse and increase risk of hypoxemia
- client might report SOB and exhibit signs of hypoxemia
- client might have diminished or absent breath sounds over affected area
- chest x-ray will show area of density
2) bacteremia (sepsis)
- can occur if pathogens enter the bloodstream from the infection in the lungs