Pneumonia part 4

Question 1

What is the initial empiric therapy for CAP based on?

Answer 1

• likely infecting organism and risk factors for MDR organisms
• varies with local patterns of antibiotic resistance
• improvement within 3-5 days or need to reevaluate
• antibiotics: IV, proceed to oral when stable at least 5 days, afebrile (no fever) 48-72 hours

Question 2

What is the total treatment time for patients with CAP and what needs to be emphasized?

Answer 2

• treatment a minimum of 5 days
• afebrile for 48 to 72 hours
• emphasize importance of completing the full course of antibiotic treatment

Question 3

Explain pneumonia nutritional therapy.

Answer 3

• prevent dehydration (increase fluid to 3L/day
• thin and loose secretions (hydration)
• adjust for older adults and those with preexisting conditions and heart failure
• high calorie, small, frequent meals
• monitor for weight loss

Question 4

What are the possible diagnostic findings?

Answer 4

increased WBC’s
abnormal ABG’s
positive sputum
abnormal chest X ray

Question 5

What is the nursing diagnosis?

Answer 5

• impaired gas exchange
• ineffective breathing pattern
• acute pain
• activity intolerance
• ineffective airway clearance
• fatigue and activity intolerance
• risk for deficit fluid volume (fever and rapid RR)
• imbalanced nutrition
• deficient knowledge about treatment and prevention
• impaired gas exchange ineffective breathing pattern
• acute pain
• activity intolerance

Question 6

What are some patient teaching topics?

Answer 6

hygiene
nutrition
rest 
exercise 
avoid cigarette smoke 
identify risk factors 
vaccination

Question 7

How much hydration should the nurse encourage?

Answer 7

2-3L/day unless contraindicated

-loosens pulmonary secretions

Question 8

At what degree should the patient be at to prevent aspiration?

Answer 8

30 degrees

Question 9

Pneumonia prevention

Answer 9

• proper position to prevent aspiration
• reposition every 2 hours
• strict adherence to ventilator bundle to prevent VAP

Question 10

What type of technique should be used when doing tracheal suctioning?

Answer 10

sterile technique

Question 11

Explain respiratory techniques.

Answer 11

• high fowlers (with tray table in front to lean on)
• oxygen therapy as ordered
• breathing exercises
• early ambulation
• therapeutic positioning
• pain management
• slow deep breathing, turning, coughing, (airway clearance)
• monitor for respiratory muscle fatigue
• incentive spiraometer
• collaboration with respiratory therapy

Question 12

How to teach patient about pain.

Answer 12

• Nurse should perform pain assessment (location, characteristics, onset/duration, frequency, quality, intensity, severity)
• encourage patient to monitor own pain and interven appropriately (prepare for discharge)
• teach nonpharmacologic techniques before, after, during, or along with other pain measures.
• start pain measures before it becomes unmanageable
• medicate before painful activity

Question 13

What are the expected outcomes for a person with pneumonia?

Answer 13

• normal rate, rhythm, and depth of respiration
• lungs clear to auscultation
• reports pain control
• SpO2 > or equal to 95
• clear sputum from airway