Respiratory - Pneumonia Flashcards
Pathophysiology
Pneumonia is a major infection within the lungs causing severe
inflammation & filling the alveoli with mucus, fluid, & debris.
This leads to impaired gas exchange since carbon dioxide
CO2 can’t get out & oxygen O2 can’t get IN, ultimately resulting
in hypoxia (low oxygen).
Signs & Symptoms
- Altered Mental Status (Restlessness, Agitation, Confusion)
- Fever (Over 100.4oF/ 38oC)
- Productive cough “Yellow Sputum”
- Fine or Coarse Crackles
- Dyspnea “Shortness of Breath”
- Pleuritic Chest pain
(Pleural friction rub) Report to HCP
“Sharp chest pain upon inspiration or coughing”
Priority Patient: who to see first?
Post operative patient with suspected pneumonia temp. of 98.2OF, SpO2 94% … becoming restless & agitated.
Lobar pneumonia
- Infection in 1 or more LOBES
- Cause: Streptococcus pneumoniae
- Pleural empyema: collection of pus in the pleural cavity
- Manifestations (signs & symptoms)
1. Sudden onset
2. Rales (crackles)
3. Rusty colored sputum (caused by exudate)
Bronchopneumonia
- Diffuse infx in BOTH LUNGS
- Memory Trick:
B - Bronchopneumonia
B - Both Lungs - Cause: Several different
microorganisms - Manifestation (signs & symptoms)
- Yellow or green sputum
- with productive cough
Diagnostics
- Chest X-ray (CXR) Patho Test Tip
- Elevated white blood cells (WBC) Over 10,000
- Sputum Culture
- ABGs (respiratory acidosis)
Diagnostics TEST TIP
Blood cultures are always taken first BEFORE antibiotics
Diagnostics MEMORY TRICK
A - Antibiotics begin
A - AFTER cultures in order to identify the causative bacteria & choose the best treatment.
Critical Complications
- Pleural Effusion
- ARDS (acute respiratory distress syndrome)
- Septic Shock
- Pleural Effusion
Fluid that fills the pleural space (space between the
lung itself & the chest wall). This prevents full expansion
of the lung, resulting in decreased gas exchange.
- Pleural Effusion KEY SIGNS
- D - During inhalation = Chest pain
- D - Dyspnea
- D - Diminished breath sounds
- D - Dull resonance on percussion
- Pleural Effusion Priority Intervention
- Thoracentesis: big needle in the lung space to drain the fluid!
- 2 BIG complications: Pneumothorax (popped lung)
Hemothorax (blood in the lung space) - PRIORITY to report:
Asymmetrical chest expansion &
Decreased breath sounds
- ARDS (acute respiratory distress syndrome)
ARDS, think HARDS - hard stiff lungs
- ARDS (acute respiratory distress syndrome) KEY SIGNS
1 Sign of Low O2 = Altered Mental status
Refractory Hypoxemia = Low PaO2
REsistant to Oxygen
REfractory Hypoxemia
- Confusion
- Agitation
- Restlessness
- Septic Shock
If the infection gets severe, the body releases chemicals
into the bloodstream to fight the infection resulting in
severe low blood pressure & total body inflammation
which can damage multiple organs causing them to fail,
known as MODS - multiple organ dysfunction syndrome.
- Septic Shock MEMORY TRICK
S - Shock
S - Severely Low BP & perfusion
- Septic Shock Key signs
Hypotension
-Systolic < 90 mm Hg
-MAP < 65 mm Hg
Cap refill over 3 - 4 seconds
Tachycardia
Early - Fever (Over 100.4)
Late - Hypothermia (Under 96.8 F)
Elevated WBC (norm: 10,000 or less)
Decreased Urine Output
-30 ml/hr or Less = Kidney Distress
Risk Factors & Causes
1 - Advanced AGE
-Over 65 years old
VAP - “Ventilator Associated
Pneumonia”
1. Reposition side to side Q 2 hours
2. Oral Care & Suctioning Q 2 hours
3. Chlorhexidine
Best indicators of VAP
-Positive sputum culture
-Fever
-Chest X-ray: new infiltrates
Prolonged immobility - secretions are not mobilized & get stuck in
body
* Post-Operative - Anesthesia - the body is put to sleep which traps
infection in the lungs
Best indicator of ventilator
associated pneumonia (VAP) ?
Positive sputum culture
Best blood lab value shows effective treatment of pneumonia after IV antibiotics?
White Blood Cell count
Nursing Care
Mobilize secretions & Expand Lungs
Mobilize secretions & Expand Lungs
- Chest physiotherapy
-TCDB - turn cough & deep breathe!
-Huff coughing technique
-AVOID cough suppressants
-Fluid 2 - 3 L per day
-Positioning
-HOB UP! High Fowler’s
-Hypoxia in Unilateral
Pneumonia? = Good Lung
Down
Early ambulation
(within 8 hours after surgery)
Cough with splinting
Hand Washing
Mouth Care Q 12 hour
-Chlorhexidine swab
Incentive Spirometer Q Hour
GIVE Pain Meds
Interventions
Mobilize Secretions
Re-expand Alveoli
Prevent Reinfection
Mobilize Secretions
Avoid cough suppressants
-Antitussives: Codeine
Cool mist humidifier at night
Increase Fluids
Re-expand Alveoli
IS - Incentive spirometer at home
Prevent Reinfection
Finish oral antibiotics at home
Pneumonia vaccine (Every 5 years)
Smoking cessation
Hand Washing
Schedule follow up & Chest X-ray
Report: increased or Worsening
-Fever
-Confusion
-SOB, cough, sputum
