Pneumonia + TB

Two Main Concepts of Pneumonia

Oxygenation and Gas Exchange

What is Pneumonia?

Inflammatory process in lungs caused by an infection that leads to fluid in alveoli

What Populations are at higher risk for Pneumonia?

Older adults, nursing home residents, hospitalized patients, neurologic/swallowing problems, patients on ventilators, immobility

What is the Role of Alveoli?

Responsible for gas exchange (O₂ in CO₂ out)

Bacterial Pneumonia

Most common Pneumonia that makes up 75% of hospitalized patients

Viral Pneumonia

Caused by viruses like COVID-19, Influenza, and RSV

Atypical (Rare) Pneumonia

Caused by exposure to pollen, mold, etc. that is more common in immunocompromised patients

Aspiration Pneumonia

Caused by food, saliva, liquids, or vomit being breathed into lungs instead of stomach

Who is at risk for Aspiration Pneumonia?

Patients with swallowing difficulty, loss of consciousness, or NG tubes

Community-Acquired Pneumonia (CAP)

Occurs in community or less than 48 hours from hospital admission; S. pneumonia (pneumococcus) is most common

Healthcare Associated Pneumonia (HCAP)

Occurs in non-hospitalized person with extensive healthcare contact; often MDRO pathogens

Hospital-Acquired Pneumonia (HAP)

Occurs 48+ hours after hospital admission and isn’t present at admission; often ventilator associated or Enterobacter

Interventions to Prevent Pneumonia

Oral care, ambulation, incentive spirometer, repositioning

What Diagnostics are done for Pneumonia?

Sputum culture, CBC, chest X-ray, bronchoscopy

Symptoms of Pneumonia

Anxiety, confusion, dyspnea, tachypnea, tachycardia, hypoxia, fever, fatigue, coughing purulent sputum, diaphoresis

Pneumonia Assessment Findings that you HEAR

Crackles, wheezing

Pneumonia Assessment Findings that you FEEL

Dull chest percussion, tactile fremitus

Medications used for Pneumonia

Antibiotics, Bronchodilators, Anti-inflammatories, Mucolytics

Goals for Pneumonia Patients

Clear lung sounds, normal breathing pattern, no hypoxia, normal chest X-ray, normal WBC, no complications

How does a Nurse Manage a patient with Pneumonia?

Good respiratory assessment, O₂ therapy, give meds, hydration, nutrition, hand washing, smoking cessation education, elevate HOB, oral care, early mobilization, check tube placement

An order for O₂ is needed above ___ L/min

2

What is a Nasal Cannula?

A low flow O₂ system that can deliver 1-6 L/min

What should Nurses asses for on patients on Oxygen Therapy?

Skin breakdown, ensure prongs are in nares, humidification above 4 L/min, reinforce that O₂ should be worn AT ALL TIMES

What are the 4 main ways to avoid Pneumonia?

Pneumococcal vaccine, smoking cessation, proper nutrition, mobility

What is TB?

Highly contagious airborne disease caused by Mycobacterium tuberculosis droplets that lodge in bronchioles and form a granuloma

Main Concept of TB

Infection

T or F: TB must be spread by inhalation NOT by physical touch

T

What is a Granuloma?

A casing around TB bacteria making it latent

T or F: TB can stay dormant (latent) or can become active and move to other parts of the body like the kidneys, bones, or brain

T

Precautions for TB Patients

Airborne isolation, negative pressure room, N95 mask

TB Symptoms

Weight loss, hemoptysis, night sweats, fever, chills, weakness, no appetite, nausea, irregular menses, chest pain

What questions should patients suspected of TB be asked?

Recent travel? Living in crowded conditions? Healthcare worker?

Latent TB Considerations

Small amount of TB germs that are alive but inactive, cannot spread to others, no symptoms, positive TB test result, should strongly consider treatment to prevent active TB

Active TB Considerations

Large amount of active TB germs, can spread to others, symptomatic, positive TB test result, requires treatment immediately

2 Main TB Tests

Tuberculin Skin Test (TST) and TB Blood Test (IGRA)

T or F: For TST test you measure the raised, hard area of swelling, NOT the redness

T

T or F: Sputum cultures get the best results first thing in the morning

T

Tuberculosis RIPE Medications

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

How long do TB patients take RIPE medications?

6-12 months

Rifampin

Inhibits DNA-dependent RNA polymerase activity; side effects: orange body fluids, hepatitis

Isoniazid

Inhibits growth by preventing synthesis of mycolic acid in the cell wall; side effects: peripheral neuropathy, hepatotoxicity

Isoniazid should be taken with ___________ to prevent peripheral neuropathy

Vitamin B6

Pyrazinamide Side Effect

Hepatotoxicity

Ethambutol

Suppresses RNA synthesis; side effects: ocular toxicity