Week 6: Pneumonia Flashcards
Pathophysiology of Pneumonia
inflammation of the lung parenchyma (functional lung tissue) resulting from a bacterial, viral, or fungal infection
- inflammatory response and build up of fluid and exudate in alveoli
- may be local or diffuse
Epidemiology of Pneumonia
- occur at anytime at any age
- > 65 age are at higher risk of death
- hospital acquired pneumonia develops 48 hours after hospital admission
Risk Factors
- altered mental status
- advanced age (>65)
- long-term care residence
- smoking
- chronic respiratory disease (asthma, emphysema)
- immune system dysfunction
- prolonged immobility
- aspiration of stomach contents or foreign material
- prolonged NPO
- diminished cough, gag, or swallowing reflexes, exposure to gases, air pollutants, or noxious inhalants
- hospitalization for more than 48 hours
Expected Findings
-localized or diffused
-wheezing, rhonchi, or rales
-fever
-tachypnea/ dyspnea
-tachycardia
-chills
-cough, productive or nonproductive
-pleuritic chest pain
-fatigue
>If Severe: purulent or blood-tinged sputum, low BP, dysrhythmias
-anxiety
-weakness
-chest discomfort due to coughing
-confusion from hypoxia is the most common manifestation of pneumonia in older adults clients
Laboratory Tests
- sputum cultures
- blood cultures: (rule out organisms in the blood)
- CBC: elevated WBC
- ABG: hypoxemia (decreased Pa02 less than 80mmhg)
- Elevated C-reactive protein
- Electrolytes: manifestations of dehydration
Diagnostic Procedures
- chest x-ray
- computed tomography (consodilation)
- pulse oximetry
Therapeutic Procedures
- O2 for hypoxia
- adequate hydration
- proper nutrition
- antibiotic
Medications
- bronchodilators with Albuterol or Combivent
- antibiotic
Client Education
- hand hygiene
- adequate rest
- antibiotics
- understand signs + symptoms
- continue medications for treatment of pneumonia
- avoid crowded areas
- obtain immunizations for influenza and pneumonia
- discontinue tobacco use if needed
Complications
- MRSA CAP can lead to necrotizing bacteria
- acute meningitis
- impaired lung function
- empyema
- bacteremia
- atelectasis
- septic shock
- organ impairment
Empyema
collection of purulent material in the pleural space
Bacteremia
bacteria in the bloodstream
Atelectasis
complete or partial collapse of lung (alveoli)
Safety Considerations
bacteria causing pneumococcal pneumonia can gain access to the blood stream leading to septicemia and septic shock
Most common causative organism
Streptococcus
Physical Assessment Findings
- fever
- chills
- flushed face
- diaphoresis
- shortness of breath or difficulty breathing
- tachypnea
- pleuritic chest pain (sharp)
- sputum production (yellow-tinged)
- crackles and wheezes
- coughing
- dull chest percussion over areas of consodilation
- decreased oxygen saturation levels
- purulent, blood-tinged or rust-colored sputum, which may not always be present
Nursing Care
-position the client to maximize ventilation (high-fowlers = 90%) unless contraindicated
-encourage coughing or suction to remove secretions
-administer breathing treatments and medications
-administer oxygen therapy
-monitor for skin breakdown around the nose and mouth from the oxygen device
-encourage deep breathing with an incentive spirometer to prevent alveolar collapse
-determine the clients physical limitations and structure activity to include periods of rest
-promote adequate fluid and nutrition intake
>increased work of breathing requires additional calories
>proper nutrition aids in the prevention of secondary respiratory infections
>encourage fluid intake of 2 to 3L/ day to promote hydration and thinning of secretions unless contraindicated
-provide rest periods for clients who have dyspnea
-reassure the client
Medications: Antibiotics
- given to destroy infectious pathogens
- often given IV and then switched to an oral form as condition improves
- important to obtain any culture specimens prior to giving the first dose of an antibiotic; once the specimen has been obtained, the antibiotics can be given while waiting for the results of the culture
Medications: Bronchodilators
- given to reduce bronchospasms and reduce irritation
- short-acting beta2 agonists, such as albuterol, provide rapid relief
- cholinergic antagonists (anticholinergics) such as ipratropium, block the parasympathetic nervous system, allowing for increased bronchodilation and decreased pulmonary secretions
- methylxanthines, such as theophylline, require close monitoring of blood medication levels due to the narrow therapeutic range
Medications: Anti-inflammatories (glucocorticosteroids)
- decrease airway inflammation
- glucocorticosteroids such as fluticasone and prednisone are prescribed to reduce inflammation
- monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, and poor wound healing
Nursing Assessment
- vital signs
- neurological function
- breath sounds
- peripheral pulses and skin temperature and color
- respiratory secretions
- laboratory testing
- intake and output
Nursing assessment: Vital signs
- tachypnea: the bodys first compensatory mechanism to a decreased oxygen delivery is increased respiratory rate and depth
- tachycardia: the bodys second compensatory mechanism for a continued impairment of oxygen delivery is to raise the heart rate
- fever occurs as a part of the inflammatory response
Nursing Assessment: neurological function
agitation, restlessness, anxiety, lethargy, and fatigue are the result of decreased tissue perfusion from altered alveolar gas exchange
-diminished cough, gag, and swallow reflexes resulting from altered levels of consciousness can contribute to aspiration risk
Assessment: breath sounds
adventitious breath sounds such as wheezing, rhonchi, crackles, and rales may be audible on lung assessment as a result of bronchospasm and/or fluid and exudates filling the alveoli
Assessment: Peripheral pulses and skin temperature and color
diminished tissue perfusion causes blood to be shunted away from peripheral areas to the main core body organs
- peripheral pulses diminish, and skin becomes moist and pale
- peripheral cyanosis is a late sign of tissue hypoxia
Assessment: Respiratory secretions
purulent and/or bloody secretions may result from a buildup of exudate in the alveoli
Assessment: Lab testing: Sputum microbiology
culture and sensitivity reports indicate the offending organism and list the antibiotics to which the organism is sensitive
Assessment: Lab testing: ABGs
bacterial respiratory infections may initially cause primary respiratory alkalosis due to increased respiratory rate, as the condition progresses, respiratory acidosis will occur
Assessment: Intake and Output
insensible losses from fever and tachypnea along with decreased intake from malaise and increased work of breathing can lead to more serious tachycardia and dehydration
Nursing Actions
- administer humidified oxygen as ordered
- administer antibiotics as ordered
- pulmonary hygiene
- patient positioning
- monitor intake and output
- adequate nutritional support
- activity grouping
Nursing Actions: administer antibiotics as ordered
prompt administration of antibiotics to defeat the offending organism is the definitive treatment of choice
Actions: pulmonary hygiene
through incentive spirometry, coughing and deep breathing, postural drainage, vibration/percussion, and early mobility
-pulmonary hygiene is done in an effort to mobilize respiratory secretions and allow expectoration; this reduces the incidence of atelectasis and worsening pneumonia in hospitalized patients
Actions: Positioning
elevating the head of the bed to 30 degrees prevents aspiration of colonized nasopharyngeal secretions and gastric contents and facilitates lung expansion
- side-to-side turning assists with alveolar recruitment strategies to ensure maximum ventilation -perfusion
- for infiltrates of only one lung, when turning, position patient with the good lung down to maximize perfusion to the functional alveolar units
Actions: Adequate nutrition
adequate caloric intake is necessary for cellular recovery
- small, frequent meals that are high in protein and vitamins are recommended
- assess cough, gag, and swallow reflexes prior to offering food and drink; if reflexes are impaired, maintaining NPO status or initiating enteral feeding via feeding tube may be required until a formal swallow evaluation can be obtained and the degree of aspiration risk can be determined
