Week 2 - Pneumonia Flashcards
1
Q
what is pneumonia
A
- 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
2
Q
what are risk factors for pneumonia (11)
A
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
3
Q
how do organisms that cause pneumonia get reach the lungs? (3)
A
- inhalation
- aspiration
- hematogenous spread
4
Q
what happens oce the germs get into the lungs
A
- 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
5
Q
what are 2 types of pneumonia
A
- community acquired
2. hospital acquired
6
Q
what is community acquired pneumonia
A
- 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
7
Q
what is hospital acquired pneumonia
A
- pneumonia occurring 48 hr or longer after hospital admission
8
Q
what is community acquired pneumonia often caused by (3)
A
- conditions incurring aspiration
- resp infection & recent use of antibiotics
- COPD
9
Q
what is hospital acquired pneumonia often caused by/risk factors for (2)
A
- pts on mechanical ventilation
- bacteria
10
Q
what are symptoms of pneumonia (10)
A
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
11
Q
how might pneumonia be diagnosed (7)
A
- history
- physical exam
- chest xray
- sputum C&S
- ABGs
- blood cultures
- CBC
12
Q
what are some potential complications of pneumonia (10)
A
- pleural effusion
- pleurisy
- atelectasis
- delayed resolution from infection
- lung abcess
- empyema
- pericarditis
- meningitis
- bacteremia
- endocarditis
13
Q
what is pleurisy
A
- inflammation of the pleura
14
Q
what is atelectasis
A
- alveolar collapse
15
Q
what are indications of improvement in a pt w pneumonia (3)
A
- decreased temp
- improved breathing
- reduced chest pain
16
Q
what is treatment for pneumonia (3)
A
- antibiotics for bacterial
- antivirals for viral pneumonia
- treat symptoms (supportive measures)
17
Q
what are some antibiotics used for bacterial pneumonia (4)
A
- ceftazadime
- vancomycin for MRSA
- gentamicin
- ciprofloxacin
18
Q
in uncomplicated cases, a pt usually response to anitbiotics therapy in how long
A
48-72 hrs
19
Q
how is the antibiotic chosen for bacterial pneumonia
A
- tailored to the specific bacteria based on sputum sample
20
Q
what are some antivirals used for viral pneumonia (3)
A
- amantadine
- zanamivr (relenza)
- osaltamivir (tamiflu)
21
Q
what supportive measures are used for treatment of pneumonia (7)
A
- o2 therapy for hypoxemia
- analgesics for chest pain
- antipyretics for fever
- rest
- fluids
- nutrition
- positioning
22
Q
describe nutritional therapy for a pt with pneumonia (3)
A
- 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)
23
Q
when should fluid intake be individualized? why is fluid intake imp.
A
- if pt on fluid restriction ex. heart failure
- fever –> dehydration & lose water thru breathing
24
Q
why is high cal important for treatment of pneumonia
A
- to provide energy for increased metabolic processes
25
how should a pt with pneumonia be positioned? why?
- with the good lung down
| - allows maximal lung expansion & gas exchange
26
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
27
what vaccines can we promote that will help prevent pneumonia (2)
- influenza
| - pneumococcal
28
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
29
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
30
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
31
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
32
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
33
why is turning, DB&C, and incentive spirometry important for a pt with pneumonia (3)
- increases lung vol
- mobilize secretions
- prevents atelectasis
34
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
35
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
36
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
37
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
38
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
39
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
40
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
