Yes Book (Pneumonia) Flashcards
What is pneumonia?
Inflammation of the lung parenchyma caused by various micro-organisms
What are the classifications of pneumonia?
Community Acquired Pneumonia (CAP)
Healthcare associated Pneumonia (HCAP)
Hospital Acquired Pneumonia (HAP)
Ventilator Acquired Pneumonia (VAP)
What are the risk factors for Pneumonia?
Age >65 Alcoholism Malnutrition Immunosupressive disorders Multiple medical comorbidities Underlying cardiopulmonary disease Residence in a long term care facility Corticosteroid therapy Antibiotic therapy
How do you prevent pneumonia?
Influenza vaccine yearly
Pneumoccocal vaccine every 5 years
Encourage smoking cessation
Encourage reduced or moderate alcohol intake
Promote coughing and expectoration of secretions
Reposition frequently and promote lung expansion exercises
Promote frequent turning, early ambulation, and mobilization
Promote frequent oral hygiene
Elevate head of bed at least 30 degrees
Promote nutritious diet
Monitor patients receiving antibiotic therapy for signs and symptoms of pneumonia
Use strict hand hygiene and gloves
What is Community acquired pneumonia?
Occurs in the community setting or within 48 hours of hospitalization.
What is the most common cause of community acquired pneumonia
S. Pneumoniae is the most common cause of CAP in people younger then 60 without comorbidity and those 60 and older with comorbidity.
What is a type of Community acquired pneumonia (CAP) that affects older adults and those with comorbid illnesses (COPD, Alcoholism, Diabetes)
H. Influenzae.
How is m.pneumonae spread?
Mycoplasma pneumonia is spread by infected respiratory droplets through person to person contact.
What is the most common viral pathogen in immunocompromised patients?
Cytomegalovirus is the most common pathogen in immunocompromised adults, followed by herpes simplex virus, adenovirus, and respiratory syncytial virus.
What are the defining factors of healthcare-associated pneumonia
Causative pathogens are often multiple drug resistant (MDR)
What are the defining factors of hospital-acquired pneumonia
Develops 48 hours after admission; does not appear to be incubating at time of admission.
What are the predisposing factors of hospital-acquired pneumonia?
Impaired host defenses Variety of comorbid conditions Supine positioning and aspiration Coma Malnutrition Prolonged hospitalization Hypotension Metabolic disorders
What are the most common organisms causing hospital acquired pneumonia?
Enterobacter species, escherichia coli, H.influenzae, klebsiella species, proteus, serratia marcescens, pseudomonas aeruginosa, methicillin sensitive or methicillin resistant staphylococcus aureus (MRSA) and S. Pneumoniae
What are the defining factors of ventilator associated pneumonia?
It is a subtype of HAP. Patient has been endotracheally intubated and has recieved mechanical ventilator support for at least 48 hours;
What leads to pneumonia in the immunocompromised host?
Commonly develop pneumonia from organisms of low virulence.
Pneumocystis pneumonia (PCP) caused by pneumocystis jiroveci
Funal pneumonia
Myobacterium tuberculosis
May be caused by the organisms also seen in CAP or HAP
What is aspiration pneumonia?
Pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway.
Most common form is bacterial from aspiration of bacteria normally in upper airway
Other substances may be aspirated - gastric contents, exogenous chemical contents or irritating gases.
What are the clinical manifestations of Streptococcal (Pneumococcal) pneumonia?
Sudden onset of chills, rapidly rising fever, pleuritic chest pain aggravated by deep breathing and coughing
What are the manifestations of pneumonia?
- Patient is severely ill, tachypnea (25-45 bpm) SOB, use of accessory muscles.
- Some patients experience URI, onset of symptoms can be gradual and nonspecific.
- Predominant symptoms: Headache, low-grade fever, pleurtic pain, myalgias, rash, pharyngitis.
- after a few days mucoid or mucopurlent sputum expectorated.
- Severe cases: Cheeks are flushed, cyanosis of lips and nail beds, orthopnea.
- Appetite is poor, diaphoretic, easily tired.
- Purulent sputum - rusty, blood-tinged seen with streptococcal, staphylococcal, and klebsiella pneumonia.
- Purulent sputum or slight changes in respiratory symptoms may be the only signs seen in patients with COPD
What does the nurse assess for in the patient with suspected pneumonia
Pleuritic type pain, tachypnea, use of accessory muscles for breathing, coughing and purulent sputum.
Fever, chills, night sweats, fatigue.
In older adults: Unusual behavior, altered mental status, dehydration, excessive fatigue
History - especially recent respiratory tract infection
Chest X-Ray
Sputum examination and culture sensitivity
Blood in C&S
What are the potential complications to pneumonia?
Continuing symptoms after initiation of therapy. Sepsis Respiratory failure Atelectasis Pleural effusion Confusion
What are the planning/goals associated with pneumonia?
May include improved airway patency, increased activity, maintenance of adequate nutrition, an understanding of the treatment protocol and preventative measures, and absence of complications
What increases the risk of MDR?
Age >65y
Alcoholism
Antibiotic use within 3 mo
Multiple coexisting illnesses (Comorbidities)
What are the macrolides?
Erythromycin
Azithromycin
Clarithromycin
When is a macrolide contraindicated
With allergy, use cautiously in patients with hepatic impairment.
