Yes Book (Pneumonia)

Question 1

What is pneumonia?

Answer 1

Inflammation of the lung parenchyma caused by various micro-organisms

Question 2

What are the classifications of pneumonia?

Answer 2

Community Acquired Pneumonia (CAP)
Healthcare associated Pneumonia (HCAP)
Hospital Acquired Pneumonia (HAP)
Ventilator Acquired Pneumonia (VAP)

Question 3

What are the risk factors for Pneumonia?

Answer 3

Age >65 
Alcoholism 
Malnutrition 
Immunosupressive disorders
Multiple medical comorbidities 
Underlying cardiopulmonary disease
Residence in a long term care facility 
Corticosteroid therapy 
Antibiotic therapy

Question 4

How do you prevent pneumonia?

Answer 4

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

Question 5

What is Community acquired pneumonia?

Answer 5

Occurs in the community setting or within 48 hours of hospitalization.

Question 6

What is the most common cause of community acquired pneumonia

Answer 6

S. Pneumoniae is the most common cause of CAP in people younger then 60 without comorbidity and those 60 and older with comorbidity.

Question 7

What is a type of Community acquired pneumonia (CAP) that affects older adults and those with comorbid illnesses (COPD, Alcoholism, Diabetes)

Answer 7

H. Influenzae.

Question 8

How is m.pneumonae spread?

Answer 8

Mycoplasma pneumonia is spread by infected respiratory droplets through person to person contact.

Question 9

What is the most common viral pathogen in immunocompromised patients?

Answer 9

Cytomegalovirus is the most common pathogen in immunocompromised adults, followed by herpes simplex virus, adenovirus, and respiratory syncytial virus.

Question 10

What are the defining factors of healthcare-associated pneumonia

Answer 10

Causative pathogens are often multiple drug resistant (MDR)

Question 11

What are the defining factors of hospital-acquired pneumonia

Answer 11

Develops 48 hours after admission; does not appear to be incubating at time of admission.

Question 12

What are the predisposing factors of hospital-acquired pneumonia?

Answer 12

Impaired host defenses
Variety of comorbid conditions 
Supine positioning and aspiration 
Coma 
Malnutrition 
Prolonged hospitalization 
Hypotension
Metabolic disorders

Question 13

What are the most common organisms causing hospital acquired pneumonia?

Answer 13

Enterobacter species, escherichia coli, H.influenzae, klebsiella species, proteus, serratia marcescens, pseudomonas aeruginosa, methicillin sensitive or methicillin resistant staphylococcus aureus (MRSA) and S. Pneumoniae

Question 14

What are the defining factors of ventilator associated pneumonia?

Answer 14

It is a subtype of HAP. Patient has been endotracheally intubated and has recieved mechanical ventilator support for at least 48 hours;

Question 15

What leads to pneumonia in the immunocompromised host?

Answer 15

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

Question 16

What is aspiration pneumonia?

Answer 16

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.

Question 17

What are the clinical manifestations of Streptococcal (Pneumococcal) pneumonia?

Answer 17

Sudden onset of chills, rapidly rising fever, pleuritic chest pain aggravated by deep breathing and coughing

Question 18

What are the manifestations of pneumonia?

Answer 18

• 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

Question 19

What does the nurse assess for in the patient with suspected pneumonia

Answer 19

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

Question 20

What are the potential complications to pneumonia?

Answer 20

Continuing symptoms after initiation of therapy. 
Sepsis 
Respiratory failure 
Atelectasis 
Pleural effusion 
Confusion

Question 21

What are the planning/goals associated with pneumonia?

Answer 21

May include improved airway patency, increased activity, maintenance of adequate nutrition, an understanding of the treatment protocol and preventative measures, and absence of complications

Question 22

What increases the risk of MDR?

Answer 22

Age >65y
Alcoholism
Antibiotic use within 3 mo
Multiple coexisting illnesses (Comorbidities)

Question 23

What are the macrolides?

Answer 23

Erythromycin
Azithromycin
Clarithromycin

Question 24

When is a macrolide contraindicated

Answer 24

With allergy, use cautiously in patients with hepatic impairment.

Question 25

What are the side effects of macrolides?

Answer 25

Abdominal cramping
anorexia
Diarrhea 
Vomitting 
allergic reactions ranging from rash to anaphylaxis 
super infection

Question 26

What do the nurse monitor in the patient taking macrolides?

Answer 26

Monitor for liver function
Provide frequent small meals if GI problems occur
Monitor for irritation, burning, itching at the IV site.

Question 27

What are the fluroquinolones?

Answer 27

Ciproflaxcin
Moxifloxacin
Levoflaxacin
Gemifloxacin

Question 28

What are the contraindications of fluroquinolones?

Answer 28

Allergy
Pregnancy and lactation
Use caution in patients with renal impairment/seizures

Question 29

What are the adverse effects of fluroquinolones?

Answer 29

Headache, nausea, vomiting, diarrhea, abdominal discomfort, allergy skin reactions.
Increased BUN, AST, ALT
Photosensitivity, blurred vision

Question 30

What are the nursing implications surrounding fluroquinolones?

Answer 30

Administer oral drug 1 h ac or 2 h pc with a glass of water.
Ensure that patient is well hydrated to reduce nephrotoxicity.
Caution: Hepatic disease (Cirrhosis)
Avoid exposure to light during and after several days of taking the drug.
May cause dizziness or lightheadness.

Question 31

What are the beta lactams?

Answer 31

Penicillins - Ampicillin 
Amoxicillin clavunate 
Cephalosporin, cefazolin 
Carbapenem - impenem 
Monobactam - Aztreonam

Question 32

What are the contraindications to the use of BLactams?

Answer 32

Contraindicated with allergies to PCN and cephalosporins

Question 33

What are the adverse effects of b.lactams?

Answer 33

Stomatitis, gastritis, nausea, vomiting, diarrhea, pseudomembranous colitis, abdominal pain, super infection, rash, fever, wheezing, anaphylaxis.

Question 34

What are the nursing implications of beta lactams?

Answer 34

Advise patient to take with food.

Advise patient to take full course of medication.

Question 35

What are the aminoglycosides?

Answer 35

Gentamycin
Tobramycin
Amikacin
Streptomycin

Question 36

Why are peak & trough levels necessary when taking aminoglycosides?

Answer 36

To maintain therapeutic serum levels.

Question 37

What are the adverse effects of aminoglycosides?

Answer 37

Use cautiously in older adults with decreased renal function. It may cause aminoglycoside-induced nephrotoxicity. (May be reversible if drug is discontinued) and ototoxicity (Hearing loss, vertigo, dizziness, tinnitus.)

Question 38

What is the nurses responsibility when administering aminoglycosides?

Answer 38

Monitor renal functioning. Prolonged IV therapy (Greater then 1 week) increases the risk of toxicity.