Pneumonia

Question 1

what is pneumonia?

Answer 1

an infection and inflammatory condition of one or both of the lungs caused by a bacteria, viruses or fungi

Question 2

List some causes of pneumonia

Answer 2

1. bacterial
2. viral
3. fungal
4. inhalation of toxic or caustic chemicals, smoke dusts, or gases via airborne transmission
5. aspiration of food, fluids, or vomitus

Question 3

List risk factors of pneumonia

Answer 3

1. age
2. chronic bronchitis
3. poorly controlled diabetes
4. uremia
5. dehydration
6. malnutrition
7. prior existing critical illness
8. confinement to an extended stay facility, ICU, or hospital
9. intubation, surgery, receipt of immunosuppression drugs and chemotherapy

Question 4

describe the pathogenesis of pneumonia

Answer 4

1. a full-scale inflammatory and immune responses with damage side effects to the lung tissue
2. endotoxins released by some microorganisms damage bronchial and alveolocapillary membranes
3. damage type II cells which produce surfactant

Question 5

what are the systemic effects of pneumonia?

Answer 5

1. pro-inflammatory state
2. fever
3. chills
4. malaise
5. myalgia

Question 6

describe community-acquired pneumonia

Answer 6

develops in people with limited or no contact with medical institutions or setting

remains a common and serious clinical problem

Question 7

describe hospital-acquired pneumonia

Answer 7

has an even higher mortality rate

accounts for almost 40% of hospital; 90% of those fatalities occur in people older than age 65 years

pneumonia is a common complications of the flu

Question 8

what is included in pneumonia diagnosis?

Answer 8

1. Auscultation
   
   1. crackles over the affected areas
   2. pleural friction rub
2. Chest X-ray
   
   1. will show decreased lung expansion and patchy opacity on the affected side with ill defined margins
3. Sputum samples
   
   1. to diagnosis the type of pneumonia that is present

Question 9

List S/S of Pneumonia

Answer 9

1. sudden and sharp pleuritic chest pain aggravated by chest movement and accompanied by a hacking; productive cough with rust-colored/green purulent sputum
2. inappropriate dyspnea
3. tachypnea accompanied by decreased chest excursion on the affected side
4. cyanosis
5. HA
6. Fatigue
7. Fever and chills
8. Generalized aches and myalgias
9. associated changes in gas exchange (hypoxemia and hypercapnia) may result in AMS or LOB and may lead to falls

Question 10

list and describe some complications of pneumonia

Answer 10

1. pleural effusion → fluid accumulates between visceral and parietal. Can lead to atelectasis or collapse of the lung or some portion of a lung lobe
2. lung abscess → infection has destroyed lung tissue and a cavity filled with pus is formed
3. sepsis

Question 11

describe medical management of pneumonia

Answer 11

1. antibiotic therapy along with rest and fluids
2. pneumonia vaccine

Question 12

list PT management of pneumonia

Answer 12

1. modified postural drainage
2. shaking and vibration
3. coughing and huffing
4. breathing exercises
5. intermittent IPPD administration
6. intermittent +pressure breathing therapy
7. mobilization of the pt
8. incentive spirometry

Question 13

what is intermittent positive pressure breathing therapy?

Answer 13

essentially a positive pressure breathing procedure

• increases inspiratory reserve volume
• assists in clearing sputum from the lungs

Question 14

describe deep breathing techniques that can be used with pneumonia

Answer 14

1. breathe in deeply and slowly through your nose, expanding your lower rib cage, and letting your abdomen move forward
2. hold for a count of 3-5
3. breath out slowly and completely through pursed lips. don’t force your breath out
4. rest and repeat 10x every hour. rest longer if you become dizzy or lightheaded

Question 15

describe the use of an incentive spirometer

Answer 15

1. sit edge of bed
2. cover the mouthpiece tightly with your lips to create a seal
3. slowly breathe in as deep as you can
4. hold your breath for at least 5 seconds
5. then exhale until the piston falls to the bottom of the spirometer
6. rest for several seconds and repeat at least 10x per hour
7. cough

Question 16

what are early mobilization activities?

Answer 16

defined as transfer from lying in bed to sitting on the edge of the bed with the feet on the floor/sitting in a chair, and standing and walking as early as possible after surgery, preferably as soon as the day after surgery

performed 4x/day

Question 17

how often should deep breathing exercises be done using PEP?

Answer 17

4x/day

target expiratory pressure 10-15 cmH2O

Question 18

what is an OscPEP device?

Answer 18

oscillatory positive expiratory pressure device

• use resistance to make it more difficult during the breath out, like non-oscillatory PEP devices
• also create vibrations when a pt exhales.
  
  • the vibrations move mucus from the surface of the airways. After blowing through the device several times, the person will huff and cough to clear the mucus from the lung

Question 19

what is a CAS?

Answer 19

cumulated ambulation score

describes the pt’s ability to carry out 3 activities:

1. to rise from lying in bed to sitting at the EOB and return to lying
2. sitting to standing to sitting in a chair with armrests
3. walking at least 3 meters

Question 20

how is the CAS scored?

Answer 20

each activity is assessed on a 3-pt scale from 0-2

Question 21

list an outcome measure that can be used to assess mobility

Answer 21

1. ICU Mobility Scale
   
   1. records the pt’s highest level of mobility in the ICU
2. Perme ICU Mobility Score
   
   1. assesses mobility status in critically ill pts

Question 22

pulmonary function is improved with _______

Answer 22

more erect posture in both healthy subjects and those with lung, heart, neuromuscular disease and obesity

Question 23

describe other positioning impacts on lung function

Answer 23

1. sitting allows secretions to accumulate in the bottom of the lungs however this accumulation can, over time, impair lung function and gas exchange
2. lateral recumbent positioning can help secretions to be extruded more easily
3. may not be comfortable requiring frequent pt repositioning

Question 24

Pneumonia implications for PT

Answer 24

1. careful hand washing
2. teach deep breathing techniques, coughing techniques, airway clearance techniques
3. adequate hydration
4. early ambulation, proper positioning, sitting, out of bed activities, upright posture
5. observe pt position in bed-often lie on on the side of pleuritic pain
6. pneumonia vaccine and appropriate care of comorbidities