pneumonia Flashcards
What is pneumonia?
Inflammation of lung parenchyma - can be caused by various microorganism
what is the parenchyma?
tissue of the lungs
What is the most common cause of death from infectious disease in the US?
Pneumonia and Flu
What is pneumonia classified by?
origin or causative agent
location
type
What are some types of pneumonia?
Community Acquired - (CAP) bacterial and viral Health Care - Associated (HCAP) Hospital Acquired (HAP) usually bacterial Ventilator -Associated pneumonia (VAP) Aspiration pneumonia - can be CAP or HAP Immunocompromised Host Lobar Pneumonia Bronchopneumonia
- Occurs in a non-hospitalized pt, with extensive health care contact such as nursing home, hemodialysis, home care treatments, antibiotics/chemotherapy within 30 days.
- May be identified in ED
- Causative pathogens are often multi-drug resistant
- Often difficult to treat
Health Care - Associated Pneumonia (HCAP)
Develops at home or within 48 hrs. of admission
Usually begin as common respiratory illness that progresses to pulmonary infection.
Community Acquired Pneumonia (CAP) bacterial and viral
What is the most common bacteria in people less than sixty without comorbidity and in greater than sixty with comorbidity?
pneumococcus (Strep)
Onset >48 hrs. after admission with no infection at admission
Hospital Acquired Pneumonia (HAP)
What are the common types of bacteria found in Hospital Acquired Pneumonia?
pseudomonas, klebsiella, E. coli, and MRSA etc.
Name 3 reasons why you may see HAP?
- host defenses impaired
- organisms reach lower resp. tract and overwhelms the host’s defenses
- or highly virulent organism is present
- A subtype of HAP except pt has an endotracheal tube and has been on ventilator for at least 48 hrs.
- Most common infection in ICU
- Prevention is Key
Ventilator-Associated pneumonia (VAP)
Most common form is bacterial infection from aspiration of bacteria that normally reside in upper airways
Can also be from gastric contents/tube feedings etc.
Aspiration pneumonia (Can be CAP or HAP)
what is commonly seen in AIDS patients or pts on chemo?
Pneumocystis carinii (PCP)
part of one or more lobes involved
Lobar pneumonia
Patchy, originates in one or more areas and extends to surrounding areas
Bronchopneumonia
Which is more common Bronchopneumonia or lobar pneumonia?
Bronchopneumonia
Which pneumonia is usually in adults?
Bacterial
Which pneumonia is usually in children?
Viral
Which pneumonia is more serious, Viral or bacterial?
Bacterial
Some risk factors for pneumonia
Immunocompromised, smokers, COPD, cancer pts, immobility, shallow breathing patterns, rib fracture, NPO, NG Tube, NT Tube, Supine, Altered LOC, Alcohol ingestion, drug overdose, general anesthesia, advanced age, less cough reflex, resp therapy dirty equipment, asthma, inhaled steroids, transmission from healthcare providers
What are preventive measures for pneumonia?
T, C, and DB Stop smoking watch for aspiration and position incentive spirometer ten times per hour while awake Oral hygiene Encourage to cough watch for sedation and resp depression prevent infections hand washing make sure resp equipment is clean flu, pneumonia vaccine
How many different strains are there of bacterial pneumonia?
About 23
What changes occure with pneumonia?
Hypertrophy of mucous membrane Bronchospasm Excess fluid Decreased surface area Inflammation of pleura
What are some clinical manifestations of pneumonia?
Fever, chills, chest pain, tachypnea, may have upper resp infection, cough, rales, rhonchi, fatigue, orthopnea, hypoxia, cyanosis, dyspnea
What is the CXR used for in pneumonia?
to look for fluid or consolidation
Who are prone to get septic?
The Elderly
What antibiotics are normally used for pneumonia if bacterial?
Penecillin, Vancomycin
How long do you keep the pt on bedrest?
until cleared up or stable
How many fluids to give for a pneumonia patient?
2500cc unless cardiac issues
Some respiratory treatments for pneumonia
nebulizers
bronchodilators
chest percussion and postural drainage
when do you d/c from hospital when have pneumonia?
when stable Temp less than or equal to 100 RR less than or equal to 24 HR less than or equal to 100 SBP greater than or equal to 90 O2 Sat greater than or equal to 90%
What are some geriatric considerations for pneumonia?
May have different symptoms - general deterioration, weakness, anorexia, confusion, tachycardia, tachypnea, abdominal symptoms
take flu vaccine yearly and pneumonia vaccine
What is the diet for a patient with pneumonia?
High Calorie, High Protein, Carbs, Fluids/Electrolytes, Small frequent meals
Nursing Diagnosis for Pneumonia
Ineffective airway clearance RT copious secretions
Activity intolerance RT altered respiratory function
Risk fluid volume deficit RT fever and dyspnea
Altered nutrition: less than body requirements
Ineffective breathing pattern
Knowledge defiit
Fatigue RT impaired resp. funtion
Potential complications for pneumonia
Superinfection atelectasis pleural effusion (30% or more will develop this) Hypotension/shock resp failure
Nursing interventions for Pneumonia
Assessment, Documentation Monitor for potential complications improve airway patency hold pillow to abdomen after abdominal surgery when coughing promoting rest/ conserving energy fluids high calories, protein humidified oxygen
Teaching for Pneumonia
Smoking cessation Gradually increase activity breathing exercises return for follow up visits take all meds until gone Oxygen at home hand washing
