Pneumonia Flashcards
a lower respiratory tract infection that causes inflammation of the alveoli sacs
Pneumonia - gas exchange is impaired
Who are the key players in pneumonia ?
Germs - bacteria, virus, fungi
Lung Parenchyma - Alveoli, Alveoli ducts, bronchioles (the trio in gas exchange)
What do the alveolar sacs have surrounding them ?
The capillaries
What happens in pneumonia?
Germs attack the alveoi sacs, which become inflamed and full of fluid. An army of WBCs comes once it senses inflammation. There are a bunch of backed up RBC and bacteria together too.
Impaired gas exchange. There is a buildup of carbon dioxide and low oxygen in the blood (hypoxemia)
Sacs are not able to inflate & deflate.
Risk factors for Pneumonia
Prior infection such as influenza or cold
Weak immune system - infants and elderly
HIV positive or taking immunosuppressant medications
Immobile - stroke or decreased neuro status (aspiration risks)
Lung Problems (COPD, smoker)
Post Op- abdominal/chest surgery
Respiratory Acidosis values
PO2 < 90
pH<7.35
PCO2 >45
To compensate, kidneys will start to keep HCO3 to increase blood’s pH so HCO3 >26 mEq
Most pneumonia infections are caused by
bacteria
Streptococcus Pneumoniae is most common bacteria
This atypical bacterium causes Walking Pneumonia -
Mycoplasma Pneumoniae
symptoms are milder and patients are not necessarily contained in bed- can be up walking
What kind of viruses can cause pneumonia?
RSV, influenza
Do fungi cause a lot of pneumonia infections ?
No they are the least common type of pneumonia. Tends to affect people who have weakened immune system. Get it from outside.
Two types of Pneumonia to be familiar with
Community acquired - person acquired it outside of the hospital
Hospital acquired- patients have contracted this pneumonia within the hospital setting. Patients on ventilators are at high risk. To be hospital acquired, patient must develop it 48-72 hours after admission
How is pneumonia diagnosed ?
Notice: abnormal lungs sound when auscultating with stethoscope may hear coarse crackles, rhonchi (type of wheezing) or bronchial breath sounds within the peripheral lung fields which should be noted only in the tracheal area and this represents lung consolidation.
Chest x-ray, sputum culture (to identify germ)
S/S Pneumonia
PNEUMONIA Mnemonic
Productive cough, Pleuritic pain (chest pain that is caused by coughing, breathing etc.)
Neuro changes (especially ELDERLY patients…may not even have a fever but fatigue and increased respiratory rate)
Elevated labs: PCO2 >45 (retaining carbon dioxide because it can’t pass capillary of alveoli sac), increased WBC (represents infection…body is trying to fight infection off)
Unusual breath sounds: coarse crackles, rhonchi, or bronchial in the peripheral lung fields
Mild to high Fever (bacteria cause produces highest fever….. greater than 104’F)
Oxygen saturation decreased (want >90%) will need supplementary oxygen
Nausea and vomiting (won’t feel like eating)
Increase heart rate and respirations (lungs are trying to blow off excess CO2 and bring in more oxygen)
Aching all over with joint pain, Activity intolerance with shortness of breath
Nursing Interventions for Pneumonia
Monitor _________ system
Respiratory
Auscultate those lung sounds- coarse crackles, wheezing, bronchial breath sounds in the peripheral lung fields that represents consolidation
Monitor those vital signs - are they tachypneic, what is the oxygen saturation?
See how their skin color is - are they cyanotic
Monitor ABGs and compare to previous results - report if anything is getting too abnormal. May need to be placed on BiPap or mechanical ventilation
Collect sputum culture
Assess when they need suction
Assess need for respiratory breathing treatments - Encourage usage of incentive spirometer for deep breathing and encourage coughing and deep breathing.
Keep them hydrated- Encourage 2-3 L of fluid (unless on fluid restriction as with patients who have heart failure)…fever causes dehydration, lose water through breathing (300-400 mL), and patient is too sick to have the urge to drink
Education on prevention: Up-to-date Vaccinations (Pneumovax every 5 years for patients 65+ and 19-64 years old with risk factors and annual flu shot)
Education about stop smoking, avoid people who are sick, hand-washing
Keeping head of bed elevated greater than 30 degree for immobile patients to prevent aspiration especially while eating and after meals along with frequent turning to move secretions around
Breathing treatments and other respiratory therapy treatments (usually by respiratory therapy department). These will be schedule or PRN (as needed).
Medications:
Administering per doctor’s order: fluids, antipyretics, antivirals (if a viral cause), and antibiotics (if a bacterial cause)
If a patient is not getting good oxygen supply, a lot of times they start to turn blue in their
lips
Pneumonia and hydration
Encourage 2-3 L of fluid (unless on fluid restriction as with patients who have heart failure)…fever causes dehydration, lose water through breathing (300-400 mL), and patient is too sick to have the urge to drink
Antibiotics Groups for BACTERIAL Pneumonia
Remember the mnemonic: Various Medications Frequently Treat Pneumonia Cases
Antibiotics used depend on the bacteria type that is causing the infection, the patient’s ability to tolerate etc.
Vancomycin
Macrolides
Fluoroquinolones
Tetracyclines
Penicillins
Cephalosporins
Vancomycin & pneumonia
What kind of pneumonia is it used to treat? What kind of bacteria ? What serious side effect should we look out for ?
used to treat severe cases and is one of the few that can treat bacteria that may be resistant to other antibiotics….watch for HEARING LOSS “ototoxicity”
Macrolides & Pneumonia
This is used in patients with a ___________ allergy. Are these drugs narrow spectrum or broad spectrum?
“Zithromax (Z-Pak)” used in patients with Penicillin allergy….narrow-spectrum targets mainly gram positive bacteria
Tetracyclines & Pneumonia
Is this broad spectrum or narrow spectrum ?
What kind of bacteria does it target ?
It is not for ___________ women or those ___- years or younger due to ______________ retardation & _______ discoloration, ______of the skin and decreases effectiveness of ______________.
What substances should not be taken with this medication because it affects absorption ?
Doxycycline” broad-spectrum that targets gram positive and negative bacteria. Side effects: not for pregnant women or 8 years or younger due to growth retardation and teeth discoloration, photosensitivity of the skin and decreases effectiveness of birth control, no antacids or milk product while taking this medication because it affects absorption.
Fluoroquinolones & Pneumonia
Is it broad spectrum or narrow spectrum?
What kind of bacteria does it target?
Is this treatment for a minor infection ?
Side effects include ____ rupture, _________ infection and cardiac ___________ such as _______________ prolonged ________ interval
“Levaquin” broad-spectrum (targets gram-negative and positive)…treatment for severe infection that are found in the hospital that are resistant. Side effects: c. diff infection, tendon rupture, cardiac arrhythmias such as QT interval prolonged
Cephalosporins & Pneumonia
This is great for ____________ ________ pneumonia but we should watch with patients who are allergic to ___________ penicillin.
“Keflex, Rocephin” watch with patients who are allergic to penicillin (can also be allergic to cephalosporin)…great for community acquired pneumonia… ( 3rd and 4th generations of cephalosporins broad-spectrum)
Penicillin & Pneumonia
Are penicillins narrow or broad spectrum antibiotics? What kind of bacteria do they target ?
We should monitor if patient is allergic to _______________. Penicillins decreases effectiveness of _________ _____________.
“Penicillin G”…narrow-spectrum…target gram positive bacteria…. monitor if patient is allergic to cephalosporins, decreases effectiveness of birth control
Education about antibiotics
Take medications as prescribed and don’t stop in the middle of treatment….even if feeling better which helps decrease resistance
Viruses & Pneumonia
Viral Cases: May be prescribed an antiviral of the virus that is causing the pneumonia ex: Tamiflu
