1
Q
define pneumonia
A
inflammation of the lung parenchyma caused by various microorganisms
2
Q
list risk factors for pneumonia (there is a TON)
A
- heart failure
- diabetes
- alcoholism
- COPD
- AIDS
- cystic fibrosis
- conditions that produce mucous
- immunosuppressed patients and those with low neutrophil count
- smoking
- prolonged immobility
- depressed cough reflex
- aspiration of foreign material
- NPO
- Abx therapy
- alcohol intoxication
- general anesthetic or anything that promotes resp depression
- advanced age
- resp therapy
3
Q
mnfts of pneumonia (theres a ton!! know the main few)
A
- Onset of shaking chills
- Rapidly rising fever
- Pleuritic chest pain
-Aggravated by deep breathing or coughing - Tachypnea
- Respiratory distress
- Headache
- Pleuritic pain
- Myalgia
- Rash
- Pharyngitis
- Central cyanosis
- Orthopnea when reclining
- Poor appetite
- Sputum is purulent
-crackles
4
Q
what is the assessment of penumonia
A
- history
- physical examination
- chest x-ray studies
- blood culture
- sputum examination
5
Q
what is the diagnosis of pneumonia
A
- infective airway clearance r/t copious tracheobronchial secretions
- activity intolerance r/t impaired resp fx
- risk for deficient fluid volume r/t fever and increased rr
- imbalanced nutrition
- deficient knowledge
6
Q
what is the planning (goal) stage for pneumonia?
A
- improved airway patency
- rest to conserve energy
- maintain fluid volume
- maintain adequate nutrition
- treatment protocol and preventative measures
7
Q
what are interventions for pneumonia (11)
A
- prompt use of antibiotics
- chest physiotherapy
- removing secretions
- hydration
- humidification
- position change: breathe deeply and cough
- admin and titrate o2 therapy
- promote rest
- promote fluid intake
- maintain nutrition
- promote knowledge
8
Q
what are the expected outcomes of caring for penumonia?
A
- improved airway patency
- rest and conservation of energy
- maintains hydration
- consumes adequate dietary intake
- states an explanation
- exhibits no complications
- tx protocol
9
Q
what is hospital acquired pneumonia, describe
A
Nosocomial
- Onset of pneumonia symptoms more than 48 hours after admission to the hospital
- Host defenses are impaired, inoculum of organism reaches the patient lower resp tract and over-whelms the host defenses or highly virulent organism is present
10
Q
what are the factors affecting hospital acquired pneumonia
A
-coma
-comorbidity
malnutrition
-prolonged hospitalization
-hypotension
-metabolic disorders
11
Q
what is community acquired pneumonia
A
- Occurs in the community setting or within the first 48 hours of hospitalization or institutionalization
- Hospitalization depends on the severity
12
Q
what is the immunocompromised host
A
Occurs with use of corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, use of broad-spectrum antimicrobial agents, acquired immunodeficiency syndrome, genetic immune disorders, long term advanced life support
13
Q
what is aspiration pneumonia
A
-Pulmonary consequence resulting from the entry of endogenous or exogenous substances into the lower airway
14
Q
where does aspiration pneumonia occur
A
Occur in the community or hospital setting
15
Q
what enters in the system that causes aspiration pneumonia
A
Common pathogens into the airways
-Could also be gastric contents, exogenous chemical contents or irritating gases: may impair the lung defences, cause inflm changes, lead to bacterial growth and result in pneumonia
16
Q
what Dx would you want for pneumonia
A
- chest x ray
- blood culture and sensitivity
- sputum culture and sensitivity
- WBC and differential
- Procalcitonin
- CRP
17
Q
why is a chest xray done for pneumonia
A
-used to detect and help evaluate the severity of a lung infection
18
Q
what findings would indicate potential pneumonia with a blood culture and sensitivity
A
-Detect septicemia when it is suspected that infection has spread from the lungs to the blood or from the blood to the lungs
19
Q
what should you teach relating to sputum culture and sensitivity
A
- having pt rinse mouth with water to minimize contamination of normal oral flora
- breathe deeply several times
- cough deeply
- expectorate the raised sputum into a sterile container
20
Q
what findings would indicate potential pneumonia with a sputum culture and sensitivity
A
gram stain: gram positive test detect that identifies the cause of bacterial pneumonia
21
Q
what findings would indicate potential pneumonia with WBC’s/differentials
A
high levels of WBC’s
22
Q
why is WBC and differential done?
A
to see type and number of WBC’s
23
Q
what is procalcitonin?
A
a blood sample
-substance produced by many types of cells in the body, often responding to bacterial infections
24
Q
what does high CRP indicate
A
presence of inflammation
25
Knowing what you have learned about the clinical manifestations and features of pneumonia list five nursing diagnoses that could occur when a patient has pneumonia.
- SOB r/t pneumonia
- Deep breathing, shortness of breath r/t impaired pulmonary fx
- Sputum r/t impaired ability to secrete sputum
- Crackles r/t pneumonia
- Fever r/t infection
26
For your listed nursing diagnoses, brainstorm some potential nursing interventions
- Spirometry
- Medications via nebulizers
- Other meds
- Encourage deep breathing
- Give pt oxygen
27
how is breathlessness described for a patient?
it's a symptom that can only be described and interpreted by the patient
28
when is breathlessness common in pts
for those with advanced life-threatening illnesses of all types
29
describe breathlessness
• Temporal patterns of breathlessness, including continuous or episodic breathlessness, with or without apparent triggers, are a current topic of research in the hope that such discrimination will inform future management choices
30
what is the prevalence of breathlessness
• The prevalence reaches 90% in cancer, 95% in COPD, 88% in cardiac failure, 80% in end-stage renal disease and 85% in advanced neurological disease
31
what are signs of success in breathlessness
may be a reduction in intensity of breathlessness, a reduction in psychological distress, an increase in activity levels or a reduction in hospital admissions
32
what is the main pharm intervention for breathlessness
opioids
33
why are opioids used for breathlessness?
• Opioids are proposed both to reduce the spontaneous respiratory motor response to hypercapnia and hypoxia and to modulate the central processing with that perceptual sensitivity to breathlessness is diminished
34
who are most likely to benefit with opioids who have breathlessness
• Younger patients and those who experience the greatest severity of breathlessness are most likely to benefit
35
what is often prescribed for palliation of breathlessness in the setting of other advanced disease?
oxygen
36
is oxygen or opioids better for breathlessness?
• Opioids have been found to be significantly better than oxygen in reducing breathlessness
37
what are some non pharm interventions to help with breathlessness (i have 4 listed)
- forward positioning
- walking aid
- acupuncture
- pulmonary rehabilitation and exercise
38
why is forward positioning useful for breathlessness?
- fixes shoulder girdle
| - improves efficacy of accessory muscles
39
why is pulmonary rehabilitation and exercise useful for breathlessness?
- desensitizes patient
- reduces deconditioning
- lowers ventilator demand and slows respiration
40
whats the benefit of a walking aid with breathlessness?
allows forward leaning and decrease in breathing during exercise. also increases pt confidence
41
what is dyspnea?
* Difficult or laboured breathing
* Shortness of breath, feeling as if you are not getting enough air
* Subjective experience
42
what causes dyspnea? (theres alot, just know 5)
* COPD
* Pregnancy
* Panic attack
* Obesity
* MI
* Choking/obstruction
* Airway trauma
* Asthma
* CHF
* Age
* Neuromuscular Disorders
* Physical exertion
* Pulmonary embolism
* Allergies
* Pneumothorax
* Cardiac arrhythmias
43
list the risk factors for dyspnea
* SMOKING
* Exposure to second-hand smoke
* Personal or family history of lung disease
* Genetic make up
* Allergens and environmental pollutants
* Recreational and occupational exposure
* Poor nutrition
* Inadequate exercise
* Substance Abuse
* Stress
44
Dx tests for dyspnea
```
Oxygen saturation
•Hgb, RBC, WBC, ABG’s
•CXR
•CT chest
•Throat or sputum cultures
•Possibly Bronchoscopy
•PFT’s
```
45
what are the nursing interventions for dyspnea
* Use multiple strategies
* Decrease anxiety
* Treat (if possible) underlying pathology
* Oxygen may be helpful if hypoxic
* Patient positioning – which ones?
* Pursed lip breathing
46
what are causes of pneumonia
* Bacteria
* Mycobacteria
* Chlamydial
* Mycoplasma
* Fungi
* Parasites
* Viruses
47
what are the main symptoms for infectious pneumonia
-high fever
-chills
-cough with sputum
-SOB
-pleuritic plain
-headaches
-loss of appetite
ETC
48
what are the 4 pneumonia classifications?
* Community acquired pneumonia
* Hospital Acquired Pneumonia
* Pneumonia in Immunocompromised Host
* Aspiration Pneumonia
49
what is the most lethal type of nosocomial infections?
hospital acquired pneumonia
50
what are some of the organisms r/t hospital acquired pneumonia
* *Enterobacter species
* Escherichia coli
* H. Influenzae
* *Staphylococcus aureus (MRSA)
* *Pseudomonas aeruginos
51
why do hospitalized patients get pneumonia
* Host defenses are impaired
* Inoculums of organisms reaches lower respiratory tract
* Highly virulent
52
how do you prevent HAP (hospital acquired pneumonia)?
- Frequent oral hygiene
- Isolation of patient’s with known pneumonia
- Reposition, early ambulation
- Nutritious diet
- Deep breathing and cough
- Clean equipment
53
describe pneumonia in the immunocompromised host
-immunocompromised due to a variety of factors
•Commonly acquire pneumonia from organisms of low virulence
•Can be caused by organisms that cause CAP or HAP
•*Pneumocystis pneumonia (PCP) and other fungal pneumonias; Mycobacterium tuberculosis (TB)
54
what are diagnostic findings associated with pneumonia
- Tachypnea (25-45), SOB, accessory muscle use
- Tachycardia, bounding pulse
- Some have URTI symptoms (runny nose etc.)
- Rash? Pharyngitis?
- Mucoid or mucopurulent sputum may be evident after a few
55
what diagnostic tests would you run for pneumonia?
- Chest x-ray
- CBC, look for elevated WBC’s and leukocytes in particular
- Blood cultures (bacteremia is common)
- Sputum sample for C&S
- ABG’s
- Oxygen saturation
56
medical management for pneumonia
* Causative agents
* Prompt administration of antibiotic is key
* Length of treatment depends on the causative agent
* Hydration
* Symptoms can be treated with supportive medications
* Bed rest
* Oxygen therapy
57
what do you assess for in someone with pneumonia after they've been diagnosed?
- Head to toe! Changes in physical assessment
- Watch for changes in Temp, Pulse, O2 saturations
- Amount, odour, and colour of secretions
- Frequency and severity of cough
- Degree of tachypnea and dyspnea
- Changes on xray
- Fatigue
- Fluid Balance
- Oral intake of food
- Effect of medications
- Patient’s understanding of treatment
58
what are considerations with pneumonia for older adults?
difficult to treat, higher mortality rate
59
what are symptoms in the elderly for pneumonia?
- general deterioration
- Weakness
- Abdominal symptoms
- Anorexia
- Confusion
- Tachycardia
- Tachypnea
60
what are ped considerations for pneumonia
-primary disease or complication from another
•Clinical manifestations depend on child’s age
•Viruses leave pediatrics susceptible to secondary bacterial infections
•Promoting oxygenation
•Antipyretics
•Fluids•Rest
•Immunizations
61
what temp would you expect to see if someone had pneumonia?
>39.5 degrees celc
62
if someone has pneumonia, will their cough be productive or non productive?
can be either with whitish sputum
63
what type of breath sounds would you hear in someone with pneumonia?
rhonchi (continuous, low pitched rattling) or fine crackles
64
what is nursing care for a child with pneumonia?
primarily supportive and symptomatic but needs thorough resp assessment as well as admin of supplemental oxygen PRN, fluids and abx
65
what are the 4 main things to assess a child for with pneumonia?
1. vitals
2. pain level
3. general disposition
4. level of activity
66
how do you prevent dehydration in a child with pneumonia?
frequent administration of fluids intravenously during the acute phase
67
what position is often most comfortable for a child with pneumonia whos having troubles breathing/has supplemental O2?
placing patient in semierect position
68
how can you reduce the pleural rubbing of the lungs to reduce discomfort with pneumonia?
lying on affected side (if pneumonia is unilateral) splints the chest on the side and can reduce the pleural rubbing that often causes discomfort
N233
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