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Nursing 172 > Week 6: Pneumonia > Flashcards

Week 6: Pneumonia Flashcards

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1
Q

Pathophysiology of Pneumonia

A

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
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2
Q

Epidemiology of Pneumonia

A
  • occur at anytime at any age
  • > 65 age are at higher risk of death
  • hospital acquired pneumonia develops 48 hours after hospital admission
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3
Q

Risk Factors

A
  • 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
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4
Q

Expected Findings

A

-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

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5
Q

Laboratory Tests

A
  • 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
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6
Q

Diagnostic Procedures

A
  • chest x-ray
  • computed tomography (consodilation)
  • pulse oximetry
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7
Q

Therapeutic Procedures

A
  • O2 for hypoxia
  • adequate hydration
  • proper nutrition
  • antibiotic
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8
Q

Medications

A
  • bronchodilators with Albuterol or Combivent

- antibiotic

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9
Q

Client Education

A
  • 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
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10
Q

Complications

A
  • MRSA CAP can lead to necrotizing bacteria
  • acute meningitis
  • impaired lung function
  • empyema
  • bacteremia
  • atelectasis
  • septic shock
  • organ impairment
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11
Q

Empyema

A

collection of purulent material in the pleural space

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12
Q

Bacteremia

A

bacteria in the bloodstream

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13
Q

Atelectasis

A

complete or partial collapse of lung (alveoli)

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14
Q

Safety Considerations

A

bacteria causing pneumococcal pneumonia can gain access to the blood stream leading to septicemia and septic shock

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15
Q

Most common causative organism

A

Streptococcus

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16
Q

Physical Assessment Findings

A
  • 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
17
Q

Nursing Care

A

-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

18
Q

Medications: Antibiotics

A
  • 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
19
Q

Medications: Bronchodilators

A
  • 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
20
Q

Medications: Anti-inflammatories (glucocorticosteroids)

A
  • 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
21
Q

Nursing Assessment

A
  • vital signs
  • neurological function
  • breath sounds
  • peripheral pulses and skin temperature and color
  • respiratory secretions
  • laboratory testing
  • intake and output
22
Q

Nursing assessment: Vital signs

A
  • 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
23
Q

Nursing Assessment: neurological function

A

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

24
Q

Assessment: breath sounds

A

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

25
Q

Assessment: Peripheral pulses and skin temperature and color

A

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
26
Q

Assessment: Respiratory secretions

A

purulent and/or bloody secretions may result from a buildup of exudate in the alveoli

27
Q

Assessment: Lab testing: Sputum microbiology

A

culture and sensitivity reports indicate the offending organism and list the antibiotics to which the organism is sensitive

28
Q

Assessment: Lab testing: ABGs

A

bacterial respiratory infections may initially cause primary respiratory alkalosis due to increased respiratory rate, as the condition progresses, respiratory acidosis will occur

29
Q

Assessment: Intake and Output

A

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

30
Q

Nursing Actions

A
  • administer humidified oxygen as ordered
  • administer antibiotics as ordered
  • pulmonary hygiene
  • patient positioning
  • monitor intake and output
  • adequate nutritional support
  • activity grouping
31
Q

Nursing Actions: administer antibiotics as ordered

A

prompt administration of antibiotics to defeat the offending organism is the definitive treatment of choice

32
Q

Actions: pulmonary hygiene

A

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

33
Q

Actions: Positioning

A

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
34
Q

Actions: Adequate nutrition

A

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

Nursing 172 (120 decks)

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