pneumonia/dyspnea Flashcards
what is dyspnea
laboured or difficulty breathing
shortness of breath, feeling your not getting enough air
SUBJECTIVE experience
risk factors for dyspnea?
SMOKING exposure to second hand smoke family history of lung disease genetic make up allergens and environmental pollutants recreational and occupational exposure poor nutrition inadequate exercise substance abuse stress
diagnostic tests for dyspnea?
o2 sat hgb, RBC, WBC, ABGs chest x-ray CT chest throat or sputum cultures possibly bronchoscopy PFTs
nursing interventions for dyspnea
multiple strategies decrease anxiety treat (if possible) underlying pathology oxygen may be helpful patient position pursed lip breathing meds
what is pneumonia?
inflammation of lung parenchyma caused by various microorganisms
-leading cause of death from infection, 5th leading cause of death worldwide
causes of pneumonia?
bacteria mycobacteria chlamydial mycoplasma fungi parasites viruses
community-acquired pneumonia?
develops in community or within 48 hrs of admission -STREPOTOCOCCUS PNEMONIAE (most common) haemophilus influenza pseudomonas aeurignosa legionella
hospital-acquired pneumonia (nosocomial)?
onset of symptoms more than 48 hrs after admission -most lethal of infetions -eneterobcater species e coli h influenzae staphylococcus auerus (MRSA) pseudomonas aeruginosa
why do hospitalized pts develop pneumonia?
- host defences impaired,
- inoculums or organisms reach lower resp tract
- HIGHLY virulent
how to prevent HAP?
frequent oral hygiene isolation of pts with known pneumonia reposition, early ambulation nutritious diet deep breathing and cough clean equipment
pneumonia in the immunocompromised ptient?
immunocompromised due to a variety of factors
-could be caused by CAP o HAP organisms
commonly acquire pneumonia from organisms of low virulence
-pneumocystis pneumonia and other fungal pneuonia
TB (mycobacterium tuberculosis)
aspiration pneumonia?
resulting from entry of endogenous or exogenous substances into lower airway
-most common form of aspiration of bacteria that normally live in upper airway, substances other than bacteria can aspirate and cause pneumonia
diagnostic findings associated with pneumonia?
-history of resp tract infection
-physical exam reveals: fever, chills, rigors, pleuritics chest pain worsened by coughing and deep breathing, may have flushed cheeks and circumoral cyanosis, cyanotic nail beds
-tachypnea (24-45), SOB, acessory muscle use
-some have URTI symptoms (running nose etc)
rash, pharyngitis
-mucoid or mucopurulent sputum may be evident after a few days
diagnostics for pneumonia?
chest x-ray CBC (elevated WBCs, leukcytes) sputum sample for c and s blood cultures (bacteremia common) ABGs oxygen sats
medical management of pneumonia?
-causative agents
-prompt administration of abx
prompt administration of antibiotic is KEY
length of treatment depends on causative agent
hydration
symptoms can be treated with supportive meds
bed rest
oxygen therapy
nursing assessments of pneumonia?
fever, chills, night sweats pleuritic-type pain fatigue tachypnea (use of accessory muscles) coughing, purulent sputum bradycardia assess oldeer pt for unusual behaviour, altered mental status, dehydration, fatigue, HF
nursing assessments after diagnosis?
-head to toe: changes in physical assessment watch for changes in temp, pulse, 02 sats -amount odour and color of secretions -degree of tachypnea and dyspnea -changes on chest x-ray -fatigue -fluid balance -oral intake of fluid -effect of meds -pt understanding of treatment
considerations for older adults?
- difficult to treat, higher mortality rate
- symptoms in elderly: general deterioration, weakness, abd symptoms, anorexia, tachycardia, confusion, tachypne
pediatric considerations?
IMMUNIZATIONS (2) pneumococcal conjugate and pneumococcal polysaccharide vaccine
- antipyretics
- promote oxygenation
- susceptible to secondary bacterial infections
- fluids
- rest
patho of pneumonia…
- upper airway characteristics usually prevent infectious particles from reaching normally sterile lower resp tract
- arises from normally present flora from pt whose resistance has been altered or from aspiration of flora in oropharynx, may also be due to blood borne organisms
- affects in ventilation and diffusion
- inflammation
- decrease alveolar oxygen, hypoventilation… hypoxemia
substantial portion of one of more lobes=
lobar pneumonia
bronchopneumonia=
patchy pneumonia more commmon than lobal
severe pneumonia symptom?
cheeks flushed, lips and nail beds demonstrate central cyanosis
orthopnea as a manifestation of pneumonia?
shortness of breath when reclining, may prefer to sit upright or lean forward
possible only sign of pneumoonia in COPD patients?
purulent sputum or slight changes in resp symptoms
sputum examination?
rinse mouth with water to minimize contamination
breathe deeply several times
cough deeply
expectorate raised sputum into sterile container
vancomycin for…
MRSA
atypical pneumonia=
10-21 days
viral pneumonia treatment?
same as abcterial (primarily supportive, antihistamines, antipyretics, hydration, decongestion, bed rest. NO antimicrobial)
why may diagnosis of pneumonia go missed in elderly?
less likely to exhibit classic symptoms, may be seen as normal aging
-general deteriration, abdominal symptoms, weakness, anorexia, confusion
VACCINATION recommended
complication: shock and resp failure
hypotension, shock, resp failure (occurs usually in pt late ot be treated) aggressive therapy (hemodynamic and ventilatory support) vasopressor, cortciosteroids, intubation
complication: atelectasis and pleural effusion
obstruction of bronchus by accumulated secretions
- pleural effusions associated with bacterial pneumonia
- chest tube to drain, antibiotics, sometimes surgical management
emphyema=
thick purulent fluid accumulates in pleural space, often with fibrin development
complication: superinfection
- may occur with admin of very large doses of antibiotics
- bacteria may become resistent to antibiotic therapy
- if pt improves and fever diminishes after initial, but then rise in temp with increasing cough—> pneumonia spread, superinfection likely
nursing interventions for pneumonia?
- improve airway patency, remove secretions
- hydration things and loosen pulmonary secretions
- humidity, loosen secretions
- incentive spirometer
- effective directed cough (deep inspiratory manoeuvre, glottic closure, explosive expiration)
- chest pysio (percussion and postural drainage) indicated with sputum retention, hx of pul problems
- after each position change, deep breath and cough
- nasotrachal suctioning if pt cannot breathe deeply and cough
other PRIME nursing care for pneumonia
-promote rest and conserve energy (bed rest, semi-fowlers, changing freq)
-promote fluid intake (increased resp rate= fluid loss) at least 2 L a day
maintaining nutrition (decreased appetite, enriched drinks or shakes)
-promoting pt knowledge (purpose and meaning of treatment, simple, may need to repeat)
monitoring and managing complications?
should respond to treatment within 24-28 hrs of antibiotics
- monitor vitals for shock and resp failure, report deterioarting status, assist in admin IV
- thoracentesis to remove fluid for atelectasis and pleural effusion, maybe chest tube
- confusion, changes in cognition (may be dt hypoxemia, fever, sleep deprivation, sepsis, underlying comorbidities
most common way to describe SOB from patients?
breathlessness
prevalence for dyspnea?
cancer, COPD, end-stage renal, neurological disease
common in patients with advanced life-threatening illness
is dyspnea a simple symptom?
no it is a complex set of interactions between physical, psychological and emotional factors further modulated by individuals experience and fears
sensation of breathlessness is felt when…
higher cortical centers perceive what the resp system can provide as inadequate or unsustainable to meet bodys requirements, may feel a threat to survival
non-pharmacological threatment of dyspnea?
pulm rehabilitation, exercise, NMEs, forward positioning, walking aid, breathing retraining/blow as you go pursed lip breathing
- facial cooling
- acupuncture, anxiety reducing things
- clinic??
pharmacological treatment of dyspnea?
- opioids low dose morphine, now recommended
- oxygen, improves survival and quality of life
- anxiolytics for anxiety
