TEST 2 MOD 10 WINKS Flashcards
Difference between Health care associated vs. community acquired
Community-acquired pneumonia (CAP):
Acute infection in patients who have not been hospitalized or lived in a long-term care facility within 14 days of the onset of symptoms
Hospital-acquired pneumonia (HAP):
Occurring 48 hours or longer after admission and not incubating at time of hospitalization
also known asnosocomial pneumonia
Once the diagnosis of CAP, HAP, or VAP is made, treatment is started based on known risk factors, early versus late onset, presentation, underlying medical conditions, hemodynamic stability, and the likely causative pathogen.
Empiric antibiotic therapy,the initiation of treatment before a definitive diagnosis or causative agent is confirmed, should be started as soon as pneumonia is suspected. Empiric antibiotic therapy is based on the knowledge of drugs known to be effective for the likely cause. Antibiotic therapy can be adjusted once the results of sputum cultures identify the exact pathogen.
Pneumonia Prevention
Pneumococcal conjugate vaccine (PCV13, Prevnar 13): Protects against 13 types of pneumococcal bacteria
All adults ≥ 65
Adults with certain medical conditions. Single dose
Pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23): Protects against 13 types of pneumococcal bacteria
All adults ≥ 65
Adults with certain medical conditions, conditions that increase infection risk, smokers, those with asthma
Single dose. May receive 1-2 additional doses
Nursing management of Pneumonia
Prevention for at-risk patients (The older adult or chronically ill patient may have a prolonged period of convalescence.)
Elevate head of bed 30 to 45 degrees for patients
with feeding tube
Aspiration precautions (Place the patient with altered consciousness in positions (e.g., side-lying, upright) that will prevent or minimize the risk for aspiration)
Assist immobile patients with turning and deep breathing (Turn and reposition patients at least every 2 hours to promote adequate lung expansion and mobilization of secretions. Encourage and assist with ambulation and positioning into a chair.)
Emphasize need to take course of medication(s).
Teach drug–drug interactions.
Medications administered
Antibiotics
Bronchodilators
Expectorants
Specimen collection
Respiratory assessment, pulse oximetry
Oxygen therapy
Hydration
Nutritional support
Breathing exercises
Early ambulation
Basic concepts of medical management in regards to Pneumonia
Antibiotic therapy
Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics
Bronchodilators
Expectorants
Fluid intake at least 3 L per day
Caloric intake at least 1500 per day
In uncomplicated cases, the patient responds to drug therapy within 48 to 72 hours. Signs of improvement include decreased temperature, improved breathing, and reduced chest discomfort. Abnormal physical findings can last more than 7 days. A repeat chest x-ray may be done in 6 to 8 weeks to assess for resolution.
Currently, no definitive treatment exists for most viral pneumonias. Care is generally supportive. In most circumstances, viral pneumonia is self-limiting and will often resolve in 3 to 4 days. Antiviral therapy may be used to treat pneumonia caused by influenza (e.g., oseltamivir, zanamivir) or a few other viruses (e.g., acyclovir [Zovirax] for herpes simplex virus).
Hydration is important in the supportive treatment of pneumonia to prevent dehydration and to thin and loosen secretions.
Weight loss may occur in patients with pneumonia because of increased metabolic needs and difficulty eating due to shortness of breath or nonspecific abdominal symptoms. Small, frequent meals are easier for dyspneic patients to tolerate. Offer foods high in calories and nutrients.
Clinical manifestations of Pneumonia
Sudden onset of fever
Shaking chills
Shortness of breath
Cough productive of purulent sputum
Pleuritic chest pain
Adventitious breath sounds
The older or debilitated patient may not have classic symptoms of pneumonia. Confusion or stupor (possibly related to hypoxia) may be the only finding. Hypothermia, rather than fever, also may be seen in the older adult.
Nursing diagnoses of Pneumonia
Impaired gas exchange
Impaired breathing
Fluid imbalance
Hyperthermia
Activity intolerance
Nursing evaluation of Pneumonia
Assess for signs of pneumonia and respiratory distress which will require immediate intervention. Physical assessment consists of: auscultating lung sounds, obtaining vital signs (to include pulse oximetry), and skin assessment for the client’s overall respiratory health.
fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis.
Viral pneumonia
Cytomegalovirus(CMV)
Fungal pneumonia
P. jirovecipneumonia (PJP
Pathology of Pneumonia
Almost all pathogens trigger an inflammatory response in the lungs. Inflammation, characterized by an increase in blood flow and vascular permeability, activates neutrophils to engulf and kill the offending pathogens. As a result, the inflammatory process attracts more neutrophils, edema of the airways occurs, and fluid leaks from the capillaries and tissues into alveoli. Normal O2transport is affected, leading to manifestations of hypoxia (e.g., tachypnea, dyspnea, tachycardia).
Dx tests that indicate presence of pneumonia
CBC: Leukocytosis (an elevated white blood cell (WBC) count, typically above 11.0x10^9/L)
ABG: Initially: Normal or decreased PaO2, mild respiratory alkalosis
Later: Decreased PaO2, respiratory acidosis
Sputum is positive on gram stain culture
Abnormal chest xray
What feature is typical of BACTERIAL pneumonia
Pulmonary consolidation (pneumonia) describes the presence of exudate in the airways and alveoli, usually as a result of infection.
PH Normal Range
7.35-7.45
PaO2 Normal Range
Amount of oxygen dissolved in arterial blood 80-100 mm Hg
SaO2 Normal Range
Arterial oxygen saturation 95-100%
PaCO2 Normal Range
amount of carbon dioxide dissolved in arterial blood 35-45 mm/Hg
HCO3 Normal Range
amount of bicarb in the bloodstream 22-26 mEq/liter
Measures to promote adherence with TB medications
Directly observed therapy (DOT)
Noncompliance is major factor in multidrug resistance and treatment failures.
Requires watching patient swallow drugs
Preferred to ensure adherence
when is a TB skin test positive
Induration refers to the thickening and hardening of soft tissues of the body, specifically the skin, and is the result of an inflammatory process caused by various triggering factors. Indurated areas commonly appear on the hands and face
The tuberculin skin test (TST) (Mantoux test) using purified protein derivative (PPD) is the standard method to screen people forM. tuberculosis. The test is given by injecting 0.1 mL of PPD intradermally on the ventral surface of the forearm. The test is read by inspection and palpation 48 to 72 hours later for the presence or absence of induration. Induration, a palpable, raised, hardened area or swelling (not redness) at the injection site means the person has been exposed to TB and has developed antibodies. Antibody formation occurs 2 to 12 weeks after initial exposure to the bacteria.
Intradermal administration of tuberculin
Positive reactions
> 5 mm—immunocompromised patients, people with close personal contact to infected person
> 10 mm—recent immigrants from areas with increased TB incidence, IV drug users, residents or employees of prisons, SNFs, homeless shelters
> 15 mm—no known risk factors
Two-step testing for individuals who will be tested periodically
TB 3 =
TB, clinically active
Positive bacteriologic studies or both a significant reaction to TST and clinical or x-ray evidence of current disease
Tb 5=
TB suspect
Diagnosis pending
TB 4 =
TB, but not clinically active
History of previous episode of TB or abnormal, stable x-ray findings in a person with a positive reaction to TST. Negative bacteriologic studies if done. No clinical or x-ray evidence of current disease.
TB 0 =
No TB exposure
No history of exposure, negative tuberculin skin test (TST)
TB 1 =
TB exposure, no infection
History of exposure, negative TST
TB 2 =
Latent TB infection, no disease
Positive TST, negative bacteriologic studies, no x-ray findings compatible with TB, no clinical evidence of TB
TB is caused by
Mycobacterium tuberculosis
TB is spread by
airborne droplets when infected person
Coughs
Speaks
Sneezes
Sings
Spread
Inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli.
Multiply with no initial resistance
