Respiratory - Pneumonia

Question 1

Pathophysiology

Answer 1

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).

Question 2

Signs & Symptoms

Answer 2

1. Altered Mental Status (Restlessness, Agitation, Confusion)
2. Fever (Over 100.4oF/ 38oC)
3. Productive cough “Yellow Sputum”
4. Fine or Coarse Crackles
5. Dyspnea “Shortness of Breath”
6. Pleuritic Chest pain
   (Pleural friction rub) Report to HCP
   “Sharp chest pain upon inspiration or coughing”

Question 3

Priority Patient: who to see first?

Answer 3

Post operative patient with suspected pneumonia temp. of 98.2OF, SpO2 94% … becoming restless & agitated.

Question 4

Lobar pneumonia

Answer 4

• 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)

Question 5

Bronchopneumonia

Answer 5

• 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

Question 6

Diagnostics

Answer 6

1. Chest X-ray (CXR) Patho Test Tip
2. Elevated white blood cells (WBC) Over 10,000
3. Sputum Culture
4. ABGs (respiratory acidosis)

Question 7

Diagnostics TEST TIP

Answer 7

Blood cultures are always taken first BEFORE antibiotics

Question 8

Diagnostics MEMORY TRICK

Answer 8

A - Antibiotics begin
A - AFTER cultures in order to identify the causative bacteria & choose the best treatment.

Question 9

Critical Complications

Answer 9

1. Pleural Effusion
2. ARDS (acute respiratory distress syndrome)
3. Septic Shock

Question 10

1. Pleural Effusion

Answer 10

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.

Question 11

1. Pleural Effusion KEY SIGNS

Answer 11

1. D - During inhalation = Chest pain
2. D - Dyspnea
3. D - Diminished breath sounds
4. D - Dull resonance on percussion

Question 12

1. Pleural Effusion Priority Intervention

Answer 12

• 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

Question 13

2. ARDS (acute respiratory distress syndrome)

Answer 13

ARDS, think HARDS - hard stiff lungs

Question 14

2. ARDS (acute respiratory distress syndrome) KEY SIGNS

Answer 14

1 Sign of Low O2 = Altered Mental status

Refractory Hypoxemia = Low PaO2
REsistant to Oxygen
REfractory Hypoxemia

1. Confusion
2. Agitation
3. Restlessness

Question 15

3. Septic Shock

Answer 15

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.

Question 16

3. Septic Shock MEMORY TRICK

Answer 16

S - Shock
S - Severely Low BP & perfusion

Question 17

3. Septic Shock Key signs

Answer 17

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

Question 18

Risk Factors & Causes

Answer 18

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

Question 19

Best indicator of ventilator
associated pneumonia (VAP) ?

Answer 19

Positive sputum culture

Question 20

Best blood lab value shows effective treatment of pneumonia after IV antibiotics?

Answer 20

White Blood Cell count

Question 21

Nursing Care

Answer 21

Mobilize secretions & Expand Lungs

Question 22

Mobilize secretions & Expand Lungs

Answer 22

• 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

Question 23

Early ambulation

Answer 23

(within 8 hours after surgery)
Cough with splinting
Hand Washing
Mouth Care Q 12 hour
-Chlorhexidine swab
Incentive Spirometer Q Hour
GIVE Pain Meds

Question 24

Interventions

Answer 24

Mobilize Secretions
Re-expand Alveoli
Prevent Reinfection

Question 25

Mobilize Secretions

Answer 25

Avoid cough suppressants
-Antitussives: Codeine
Cool mist humidifier at night
Increase Fluids

Question 26

Re-expand Alveoli

Answer 26

IS - Incentive spirometer at home

Question 27

Prevent Reinfection

Answer 27

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