Pneumonia and TB Flashcards
What is pneumonia?
- Acute infection of lung parenchyma.
- Associated with significant morbidity and mortality rates.
- Pneumonia and influenza are eighth leading cause of death in the United States.
What is the etiology of pneumonia?
Normal defense mechanisms:
Air filtration, epiglottis closure over trachea, cough reflex, mucociliary escalator, and reflex bronchoconstriction; IgA, IgG, alveolar macrophages
Defense mechanisms become incompetent or overwhelmed
Aspiration, tracheal intubation, air pollution, smoking, viral URI, aging, chronic diseases
Table 27-1
What are the different classifications of pneumonia?
- May be classified according to causative organism, characteristics of disease, or radiographic appearance.
- Most effective classification:
Community-acquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP) - Helps identify most likely organism and antimicrobial therapy.
Table 27-2
What is community-acquired pneumonia (CAP)?
- Acute infection in patients not hospitalized or residing in a long-term care facility within 14 days of the onset of symptoms.
- Can be treated at home or hospital depending on age, VS, mental status, comorbidities, and condition.
What is hospital-acquired pneumonoa?
- Occurs 48 hours or longer after hospitalization and not present at time of admission.
- Ventilator-associated pneumonia occurs more than 48 hours after endotracheal intubation.
What is empiric antibiotic therapy?
- Starting treatment before definitive diagnosis based on: Risk factors Early versus late onset Presentation Underlying medical conditions Hemodynamic stability Most likely causative organism
What are the types of pneumonia?
- Viral - most common, and may be mild or life-threatening.
- Bacterial - may require hospitalization
- Mycoplasma- atypical
- Aspiration
- Necrotizing
- Opportunistic
What is the pathophysiology of pneumonia?
- Inflammatory response
Attraction of neutrophils
Release of inflammatory mediators
Accumulation of fibrinous exudates, rbc’s and bacteria. - Alveoli fill with fluid and debris (Consolidation)
- Increased production of mucous (Airway obstruction)
- Decreased gas exchange
- Resolution of infection
Macrophages in alveoli ingest and remove debris.
Normal lung tissue restored.
Gas exchange returns to normal.
What are the most common clinical manifestations of pneumonia?
- Most common Cough: productive or nonproductive Green, yellow, or rust-colored sputum Fever, chills Dyspnea, tachypnea Pleuritic chest pain. - Older or debilitated pt: confusion, stupor, or hypothermia.
What can we find in a physical examination for pneumonia?
- Fine or coarse crackles.
- With consolidation
Bronchial breath sounds
Egophony
Increased fremitus - With pleural effusion
Dullness to percussion
What is MDR?
Multidrug-resistant pathogens - major problem in treatment
What are risk factors for pneumonia?
- Advanced age
- Immunosuppression
- History of antibiotic use
- Prolonged mechanical ventilation
- Atelectasis
- Pleurisy
- Pleural effusion
- Bacteremia
- Pneumothorax
- Acute respiratory failure
- Sepsis/septic shock
- Lung abscess
- Empyema
How can we diagnose pneumonia?
- History and physical examination
- Chest x-ray (Fig. 27-3)
- Thoracentesis and/or bronchoscopy
- Pulse oximetry
- Arterial blood gases (ABGs)
- Sputum gram stain, culture & sensitivity
- Ideally before antibiotics started
- Blood cultures
- ## CBC with differential
What are pneumococcal vaccines?
- Prevent Streptococcus pneumoniae
- Examples: Prevnar 13 and Pneumovax 23
Table 27-5
How do we treat pneumonia?
- Prompt antibiotics
- Response generally occurs within 48-72 hours
- Decreased temp
- Improved breathing
- Decreased chest discomfort
What supportive care do we provide for pneumonia?
- Oxygen for hypoxemia
- Analgesics for chest pain
- Antipyretics for fever
- Adjuvant drugs
- Individualize rest and activity
- There is no definitive treatment for viral pneumonia
Antivirals: influenza and herpes
What is the CAP drug therapy?
Initial empiric therapy
Gram-negative and gram-positive organisms
Likely infecting organism (Table 27-2) and risk factors for MDR organisms; varies with local and institutional prevalence and resistance patterns
Should see improvement in 3 to 5 days or need to reevaluate
Antibiotics: IV, proceed to oral when stable; at least 5 days; afebrile 48 to 72 hours
What is the nutritional therapy for pneumonia?
- Adequate hydration; monitor intake
Prevent dehydration
Thin and loosen secretions
Adjust for older adults, patients with HF, or those with preexisting respiratory conditions - Small but frequent, high calorie, nutritious meals; monitor weight.
What is some subjective data we can gather in a nursing assessment for pneumonia?
- Functional health patterns
- Health perception management
Smoking, alcoholism, respiratory infection, malaise. - Nutritional-metabolic
Anorexia
Nausea
Vomiting
Chills - Activity-exercise
Bed rest or altered mobility
fatigue
weakness
dyspnea
cough
nasal congestion - Cognitive perceptual
Pain with breathing
Chest pain
Sore throat
Abdominal pain
Headache
muscle aches
What are some objective findings for pneumonia?
fever, restlessness or lethargy, splinting affected area
Respiratory
tachypnea, asymmetric chest movements, use of accessory muscles, nasal flaring, decreased excursion, crackles, friction rub, dullness on percussion, increased tactile fremitus, sputum amount and color
What cardiovascular issues could you find with pneumonia?
Tachycardia
What neurologic changes can occur in pneumonia?
Changes in mental status
What are possible diagnostic findings with pneumonia?
Increased WBC’s
Abnormal ABG’s
Positive sputum
Abnormal chest x-ray
Name nursing diagnoses for pneumonia.
Impaired gas exchange Impaired breathing Fluid imbalance Hyperthermia Activity intolerance
What are the goals for a patient with pneumonia?
Clear breath sounds Normal breathing patterns No signs of hypoxia Normal chest x-ray Normal WBC count Absence of complications
How can we promote ways to avoid pneumonia?
Teach hygiene, nutrition, rest, regular exercise
Cough or sneeze into elbow
*Avoid cigarette smoke
Avoid exposure to URIs; prompt treatment
Identify risk factors (Table 27-1)
Influenza and pneumococcal vaccines (Table 27-5)
What can we teach patients for home care?
Emphasize need to take full course of antibiotics Drug-drug and drug-food interactions Adequate rest Adequate hydration Avoid alcohol and smoking Cool mist humidifier or warm bath Chest x-ray, vaccinations Takes several weeks (or more) to recover
What are the expected outcomes for pneumonia?
Effective respiratory rate, rhythm, and depth of respirations
Lungs clear to auscultation
Absence of infection
What is the biggest complication with TB treatment?
NON ADHERENCE
What are the first-line anti-TB drugs?
Isoniazid
Rifampin
