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Pneumonia

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Tangela Hales

on 16 March 2015

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Transcript of Pneumonia

Atelectasis & Pneumonia
Epidemiolgy
Pathophysiology
excess fluid in lungs from an inflammatory process caused by bacteria, viruses, fungi or parasites.
What will the client presents with...
*flushed cheeks, bright eyes, anxious expression
*chest pain/pluertic discomfort
*chills, fever, headache, cough, fatigue
*muscle pain
*tachycardia
*dyspnea
*hemopytosis
*sputum production (assess color, consistency, odor and amount)
*crackles, wheezing, bronchial breath sounds
*hypotension with orthostatic changes
labs and DX tests
Treatments
Nursing Diagnosis
nsg article
*activity intolerance
*ineffective airway clearance r/t chest discomfort
*anxiety
*deficient fluid volume r/t increased resp rate
*impaired gas exchange r/t effects of alveolar-
capillary membrane changes
*risk for infection
*imbalanced nutrition: less than body requirements
*acute pain
*disturbed sleep pattern r/t pain
*Sputum collection is done and examined with a gram stain and culture and sensitivity. A patient that can easily cough simply coughs into a specimen container. If a pt is ill or mechanically vented a sputum can be collected with suctioning. A sputum trap is used to obtain this.
*pneumonia is common in older adults, young children, and people that are immunocompromised
*pneumonia affects 2-5 million people each year and is the 8th leading cause of death in the United States.

*pneumonia can be classified as HAP (hospital acquired pneumonia) CAP (community acquired pneumonia) or can be caused from inhalation of toxic gases, chemical fumes and smoke, or from aspiration of water, food, fluid or vomit
*pneumonia often mimics flu, so seeking help may be delayed until symptoms are more severe*
Inflammation occurs in interstitial spaces, alveoli and bronchioles. Organisms then penetrate the airway mucosa and multiply in
the alveloi. WBC's then respond by migrating to the area which leads to local capillary leak, edema, and exudate. When the fluid collects and
thickens this leads to decreased gas exchange and hypoxia.
*CBC to determine WBC levels (check if elevated)
* Blood cultures to determine whether organism has invaded blood
*Serum electrolytes, BUN, & creatinine levels are also checked to rule out dehydration
Lab and DX tests continued
*In severely ill patients ABG's are done to determine a baseline arterial oxygen and carbon dioxide level to determine if supplemental oxygen is necessary.
*Chest x-ray's are done, but may not show changes until 2 or more days until after symptoms are present. Pneumonia may involve a lung segment, lobe, one or both lungs.
*chest x-ray is essential for early dx*
*Anti-infective: given for all types except virus caused pneumonia. The anti infective depends on how pneumonia was acquired, severity of infection, organism suspected and patient factors (health conditions, smoker, etc.)
*IV therapy drugs may be started, but if responded well pt can go on oral drugs in 2-3 days.
*Treatment is usually 5-7 days with CAP and up to 21 days with HAP or immunocompromised person.
*Fever reducers, bronchodilators, and cough suppressors may also be prescribed.
**MAKE SURE TO EMPHASIZE THE IMPORTANCE OF COMPLETING ALL ANTIBIOTICS!!**
*Assess breath sounds checking for wheezes, rhonchi and crackles.
*Observe breathing pattern, position and use of accessory muscles
*Assess cough and sputum (amount, consistency, odor, color)
*Monitor VS q4 and prn (be alert for hypotension and orthostatic hypotension) Also check pulse oximetry
*Cough, deep breath and turn every 2 hours. ENCOURAGE INCENTIVE SPIR-
OMETER
*Monitor i/0 and encourage fluids. Monitor daily weights
*Maintain Sa02 saturation >95% apply supplemental o2 if necessary
*Maintain patent airway, fever free, and a/o x4
*Give antibiotics as ordered and teach importance of finishing them!
*Place client in isolation if necessary and perform good hand hygiene
*Encourage rest and evaluate for anxiety
**Elderly >65 and people with chronic health problems should receive the PPV23 pneumococcal vaccine. (one time vaccine) Also everyone should receive the INFLUENZA vaccine YEARLY!! (pneumonia usually follows influenza)**
nursing care
Tangela Hales,
MSN, RN
http://journals.lww.com/ajnonline/Fulltext/2011/03000/New_Antibiotic_for_MRSA_and_Pneumonia.24.aspx
This article discusses a new IV cephalosporin drug ceftaroline fosamil (Teflaro) that's shown to treat infections caused by MRSA and bacterial pneumonia. Side effects included nausea, rash, and diarrhea.
medical management
treatment is determined by the results of a Gram stain
blood cultures are performed quickly
prompt administration of antibiotics (within 4 hours)
risk factors
conditions that
classifications
Hospital acquired
More than 48 hours post admit
Example: ventilator acquired
Staphyloccal aureas
Community acquired
admitted with or within 48 hours of admit
Streptoccus pneumoniae
Pathophysiology
Atelectasis
clinical manifestations
the term atelectasis refers to collapsed, airless alveoli.
the alveoli is where gas exchange takes place
may be acute or chronic, and may be large or small
slow onset = cough, sputum production, low-grade fever maybe
acute onset = respiratory distress, dyspnea, tachycardia, tachypnea, pleural pain, and anxiety
infection is common in slow onset
labored breathing
central cyanosis (late sign)
Diagnostics
chest x-ray may not see miniscule areas
decreased breath sounds or absent breath sounds
crackles may be heard over affected area
Sat 90% or lower
pleural effusion
pneumothorax
hemothorax
Nursing Responsibility
frequent turning
early mobilization
deep breathing
directed (nurse assist) coughing
incentive spirometer
administer pain meds judiciously
suction
postural drainage and chest percussion
Medical Management
bronchoscopy
thoracentesis
airway stents
radiation
surgery to remove obstructions
medications to improve removal of secretions
*atelectasis may occur as a result of reduced ventilation or any blockage that obstructs passage of air to and from the alveoli, thus reducing alveolar ventilation. after the trapped alveolar air is absorbed into the bloodstream, no additional air can enter into the alveoli because of the blockage. as a result, the affected portion of the lung becomes airless and the alveoli collapse.
Risk Factors
Clinical Manifestations
* development is usually insiduous
*increasing dyspnea, cough, and sputum production
*tachycardia, tachypnea, pleural pain, and central cyanosis
*patients usually have difficulty breathing in the supine position and are anxious
*Post-op clients
effects of anesthesia
supine positioning
splinting of the chest wall
abdominal distention
secretion retention
airway obstruction
impaired cough relfex
*obstructive
causes: foreign body, tumor, or mucus plug
Pneumonia
Immunocompromised Host
Pneumocystis pneumonia
Aspiration Pneumonia
endogenous or exogenous
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