Pneumonia Exam 2 Flashcards
What in Pneumonia?
Acute infection of the lung parenchyma
Associated with significant morbidity and mortality rates
Community-acquired pneumonia (CAP) 6th leading cause of death in people aged 65 years or older in United States
- Non-Specific Symptoms
- Nausea, H/A, Fatigue, Anorexia
Etiology of Pneumonia
Likely to result when defense mechanisms become incompetent or overwhelmed
↓ Cough and epiglottal reflexes may allow aspiration.
Mucociliary mechanism impaired
Pollution
Cigarette smoking
Upper respiratory infections
Tracheal intubation
Aging
Chronic diseases suppress immune system.
Types of Pneumonia
Can be classified according to causative organism
Clinical classification:
Community-acquired (CAP)
Medical care-associated acquired (MCAP)
Hospital-associated (HAP)
Ventilator-associated (VAP)
Treatment is based on
Known risk factors
Early versus late onset
Probable organism
Multidrug-resistant (MDR) organisms are major problem in treating HCAP.
What is aspiration Pneumonia?
Aspiration Pneumonia
Occurs as either CAP or MCAP
Results from abnormal entry of secretions into lower airway
Major risk factors:
Decreased level of consciousness
Difficulty swallowing
Nasogastric intubation
What is opportunistic Pneumonia?
Opportunistic Pneumonia
Patients at risk
Severe protein-calorie malnutrition
Immune deficiencies
Chemotherapy/radiation recipients
Long-term corticosteroid therapy
Caused by microorganisms that do not normally cause disease
Clinical manifestations of Pneumonia
Most common-
Cough
Fever, shaking chills
Dyspnea, tachypnea
Pleuritic chest pain
Green, yellow, or rust-colored sputum
Change in mentation for older or debilitated patients
Nonspecific manifestations
Physical examination findings with pneumonia
Rhonchi and crackles
Bronchial breath sounds
Egophony
↑ Fremitus
Dullness to percussion if pleural effusion present
Complications of Pneumonia
Pleurisy…pleural friction rub
Pleural effusion = decreased breath sounds
Atelectasis
Bacteremia
Empyema
Pericarditis
Meningitis
Sepsis
Acute respiratory failure
Pneumothorax
What diagnostic test are used to disgnose or drive treatment for pneumonia?
History
Physical examination
Chest x-ray
Sputum analysis
CBC with differential
Pulse oximetry or ABGs
Blood cultures
Thoracentesis
Bronchoscopy with washings
Biologic markers to guide clinical decisions:
C-reactive protein (CRP)
Procalcitonin
CRP and Procalcitonin guide the source of antibiotics
Collaborative Care
Pneumococcal vaccine
To prevent S. pneumoniae (pneumococcus) pneumonia
Indicated for those at risk
Age 65 or older
Age 2-64 years with long-term health problem or immunosuppression
Age 19-64 who smoke or have asthma
Live in nursing homes or long-term care facility
Antibiotic therapy
Repeat chest x-ray
Supportive care
Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics
Individualize rest and activity
Antivirals for influenza pneumonia
Drug Therapy
Start with empiric therapy.
Based on likely infecting organism and risk factors for MDR(multidrug resistant) organisms
Varies with localities
Should see improvement in 3-5 days.
Start with IV and then switch to oral therapy as soon as patient stable.
Minimum 5 days of antibiotic therapy
Nutrtional therapy
Adequate hydration
Hi-calorie, small, frequent meals
Nursing Assessment
Subjective Data
Past health history: lung cancer, COPD, diabetes, malnutrition, Chronic debilitating disease
Use of antibiotics, corticosteroids, chemotherapy, or immunosuppressants
Recent abdominal or thoracic surgery
Recent intubation
Tube feedings
Nursing Assessment
Objective Data
Fever
Restlessness or lethargy
Splinting affected area
Tachypnea
Asymmetric chest movements
Use of accessory muscles
Crackles
Friction rub
Dullness on percussion
Increased tactile fremitus
Sputum amount and color
Tachycardia
Changes in mental status
Nursing Diagnoses
Impaired gas exchange
Ineffective breathing pattern
Acute pain
