Week 2 - Pneumonia Flashcards
what is pneumonia
- a lower respiratory infection that causes inflammation of the alveoli & lung parenchyma caused by a microbial agent
- and the alveoli may fill with fluid or pus
what are risk factors for pneumonia (11)
things that decrease the resp. system defence:
- weak immune system
- decreased consciouness (=depress the cough)
- tracheal intubation
- post-op pt (not coughing)
- smoking
- air pollution
- COPD & asthma
- prior infection: flu or cold
- immobility
- recent use of antibiotics
- conditions that increase risk of aspiration
how do organisms that cause pneumonia get reach the lungs? (3)
- inhalation
- aspiration
- hematogenous spread
what happens oce the germs get into the lungs
- the alveolar sacs become inflamed & fill w fluid, RBCs, WBCs, and bacteria
= sacs lose ability to inflate and deflate (which are imp. for gas exchange)
= pt starts to experience hypoxemia bc O2 cannot transfer across capillary wall to attach to RBCs to supply body w O2 and body keeps CO2 instead
what are 2 types of pneumonia
- community acquired
2. hospital acquired
what is community acquired pneumonia
- when pts obtains that germs that cause the bacteria outisde of the healthcare system
- onset is in the community or during the first 2 days of hospitalization
what is hospital acquired pneumonia
- pneumonia occurring 48 hr or longer after hospital admission
what is community acquired pneumonia often caused by (3)
- conditions incurring aspiration
- resp infection & recent use of antibiotics
- COPD
what is hospital acquired pneumonia often caused by/risk factors for (2)
- pts on mechanical ventilation
- bacteria
what are symptoms of pneumonia (10)
Productive cough, Pleuritic pain Neuro changes (fatigue, confusion r/t hypoxemia) Elevated labs (WBC, CO2) Unusal breath sounds (crackles) Mild to high fever O2 sats decreased Nausea and vomitting Increased HR and RR Activity intolerance (SOB) , aching joint pain
chills
how might pneumonia be diagnosed (7)
- history
- physical exam
- chest xray
- sputum C&S
- ABGs
- blood cultures
- CBC
what are some potential complications of pneumonia (10)
- pleural effusion
- pleurisy
- atelectasis
- delayed resolution from infection
- lung abcess
- empyema
- pericarditis
- meningitis
- bacteremia
- endocarditis
what is pleurisy
- inflammation of the pleura
what is atelectasis
- alveolar collapse
what are indications of improvement in a pt w pneumonia (3)
- decreased temp
- improved breathing
- reduced chest pain
what is treatment for pneumonia (3)
- antibiotics for bacterial
- antivirals for viral pneumonia
- treat symptoms (supportive measures)
what are some antibiotics used for bacterial pneumonia (4)
- ceftazadime
- vancomycin for MRSA
- gentamicin
- ciprofloxacin
in uncomplicated cases, a pt usually response to anitbiotics therapy in how long
48-72 hrs
how is the antibiotic chosen for bacterial pneumonia
- tailored to the specific bacteria based on sputum sample
what are some antivirals used for viral pneumonia (3)
- amantadine
- zanamivr (relenza)
- osaltamivir (tamiflu)
what supportive measures are used for treatment of pneumonia (7)
- o2 therapy for hypoxemia
- analgesics for chest pain
- antipyretics for fever
- rest
- fluids
- nutrition
- positioning
describe nutritional therapy for a pt with pneumonia (3)
- fluid intake of at least 3L per day (or IV if oral intake cant be maintained)
- at least 1500 cal per day
- small, frequent meals (better tolerated d/t dyspnea)
when should fluid intake be individualized? why is fluid intake imp.
- if pt on fluid restriction ex. heart failure
- fever –> dehydration & lose water thru breathing
why is high cal important for treatment of pneumonia
- to provide energy for increased metabolic processes
how should a pt with pneumonia be positioned? why?
- with the good lung down
- allows maximal lung expansion & gas exchange
list nursing care interventions for a pt w pneumonia (7)
- promote vaccinations
- teach pt to practice good health habits
- prevent aspiration
- early ambulation post-op
- turning
- DB&C
- incentive spirometry
what vaccines can we promote that will help prevent pneumonia (2)
- influenza
- pneumococcal
what “good health habits” should we teach the pt to do? why? (4)
- proper diet
- hygeine
- adequate rest
- regular exercise
can all help maintain natural resistance to organisms
what positions & interventions can help prevent aspiration (3)
- HOB elevated during meals & TB
- if decreased LOC, monitor for inability to swallow secretions
- lateral side lying in decreased LOC
how often should pts be turned w pneumonia or to prevent pneumonia if decreased LOC? why (2)?
- turn & reposition every 2 hr
- facilitates lung expansion & discourages pooling of secretions
why is early ambulation post-op important to prevent pneumonia (4)
- to facilitate deep breathing at frequent intervals
- facilitate lung expansion
- discourage pooling of secretions
- augment bronchial hygeine
what should a nurse be careful to avoid overmedication of to avoid pneumonia (2)? why (2)?
- sedatives and narcotics
- can cause a depressed cough reflex
- & accumulation of fluid in lungs
why is turning, DB&C, and incentive spirometry important for a pt with pneumonia (3)
- increases lung vol
- mobilize secretions
- prevents atelectasis
a nursing diagnosis r/t pneumonia is impaired gas exchange r/t to fluid and exudate accumulation in alveoli. what are 2 categories of nursing interventions for this
- resp monitoring
- o2 therapy
what resp monitoring can be done r/t imapired gas exchange (5)
- auscultate breath sounds
- monitopr rate, rhythmn, depth, effort of resp
- monitor for increased restlessness, anxiety, air hunger
- monitor pts ability to cough effectively
- monitor pts resp secretions
describe o2 therapy for impaired gas exchange (6)
- admin supp o2 as ordered
- set up o2 equipment and admin thru humidified system
- monitor effectiveness of o2 therapy (pulse ox, ABGs)
- monitor for skin breakdown from friction of O2 device
- monitor pts anxiety r/t need for O2 therapy
- periodically check O2 delivery device to ensure the prescribed conc is being delivered
a nursing diagnosis r/t pneumonia is ineffective breathing pattern. what 2 categories of nursing interventions can be done for this. (7)
ventilation assistance
- monitor resp and O2 status
- position to maximize resp efforts
- encourage DB&C, turning
- monitor for resp muscle fatigue
- auscultate breath sounds
- assist w incentive spirometer
- admin meds that promote airway patency
how can we position a pt w pneumonia to maximize resp efforts (3)
- elevate HOB
- provide overbed table for pt to lean on
- good lung down
a nursing diagnosis r/t pneumonia is ineffective airway clearance. what nursing interventions can be done for this (5)
- monitor rate, rhythm, depth, and effort of resp
- auscultate breath sounds
- assist pt to sitting position w head slightly flexed, shoulders relaxed, knees flexed to improve resp status
- encourage use of incentive spirometry
- provide systemic fluid hydration to liquify secretions
a nursing diagnosis r/t pneumonia is acute pain. what nursing interventions can be done for this (5)
- perform comprehensive assessment of pain
- encourage pt to monitor own pain and intervene appropriately
- teach use of nonpharmacologic techniques
- use pain control measures before pain becomes severe
- medicate before an activity to increase participation, but evaluate hazard of sedation
