Module 6: Pneumonia, Pleurisy, Empyema, Aspiration, TB; Pleural Effusion, Pulmonary Edema, ARDs (Ch. 19)

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47 Terms

1

Pneumonia

An inflammation of the alveoli, bronchioles, and arterioles in the lungs caused by microorganisms (bacteria, viruses, fungi)

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Types of pneumonia

  • Community aquired pneumonia

  • Health care associated pneumonia

  • Hospital aquired pneumonia

  • Ventilator associated pneumonia

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3

Pathophysiology of pneumonia

  • Impairment of host defense to microrganisms

  • Affects ventilation and diffusion of the body due to inflammatory reaction interfering with O2 and CO2 diffusion

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Risk factors of pneumonia

  • Older age

  • Younger age (infants and children)

  • Alcoholism

  • Immunosuppressant disorders

  • Multiple comorbidities (HF, DM, COPD, AIDS)

  • Mucus build up and impaired drainage

  • Smoking

  • Prolonged immobility

  • Shallow breathing patter

  • Depressed cough reflex or abnormal swallowing mechanism

  • Sedation

  • Exposure to infected individuals

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s/s of pneumonia

  • Sudden onset of chills

  • Rapidly rising fever

  • Chest pain aggravated by deep breathing and cough

  • Tachpynea

  • SOB; accessory muscle use

  • Breadycardia

  • Headache

  • Orthopenea

  • Poor appetite

  • Cyanosis

  • Breathsounds can vary due to underlying conditions

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6

Priorities of pneumonia

  • Chest x-ray

  • Blood culture

  • Sputum examination

  • Bronchoscopy with severe infection

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Treatment of pneumonia

  • Antibiotics

  • Adequate rest and hydration

  • Supplemental oxygen

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8

Nursing considerations of pneumonia

  • Vitals

    • Pulse oximetry

    • RR

    • ABGs

  • Neurologic assessment

  • Respiratory assessment

  • Secretion assessment

  • Promote coughing

  • Incentive spirometry

  • Smoking cessation

  • Repositioning

  • Frequent oral care

  • Elevate head of bed

  • Equipment sanitization

  • Hand hygiene

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9

Community acquired pneumonia

  • Pneumonia aquired from the community OR less than 48 hours after hospital admision

  • Most common bacterial cause = pneumococcus

  • Mycoplasma pnaumonia = droplet to droplet

  • “walking” pneumonia = viral

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10

Heathcare associated pneumonia

  • Pneumonia occuring in a nonhospitalized individual who has had healthcare contact

  • Infection can occur within 90 days of prior hospitalization

  • Primarily caused by multi-drug resistant organisms

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11

Hospital acquired pneumonia

  • Pneumonia occurring 48 hours after hospitalization; reason for admission is unrelated to pneumonia

  • Difficulty with treatment due to many drug resistant organisms colonizing in/around the hospital setting

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12

Ventilator associated pneumonia

  • Pneumonia aquired 48 hours after endotrachial intubation with a patient recieving mechanical ventilatory support

  • Colonized with bacteria in respiratory tract; does not interact until given access to blood

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13

Pleurisy

  • inflammation of both layers of the pleurae (parietal and visceral)

  • Can develop with pneumonia, respiratory tract infection, tuberculosis, trauma, or PE

  • Inflamed pleural membranes rub together

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s/s of pleurisy

  • Sever, sharp pleuritic pain

  • Pleural fluid development

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15

Priorities of pleurisy

  • Auscultation before more fluid build up

  • Chest x rays

  • Sputum analysis

  • Thoracentisis

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Treatment of pleurisy

  • Pain relief

    • Analgesic agents

    • Heat or cold

    • NSAIDs

  • Treat underlying condition (pneumonia or infection)

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Nursing considerations of pleurisy

  • Turning and positioning for comfortable breathing

  • Splinting

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18

Empyema

Occurs when thick, purulent fluid (pus) accumulates within the pleural space, often with fibrin development and a walled off area where the infection is located

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Pathophysiology of empyema

  • Occurs as a complication of bacterial pneumonia or a lung abscess

  • Can also occur from penetrating chest trauma, blood infection of the pleural space, or invasive medical examinations

  • Pleural fluid is thin at first but progressess into a thick membrane enclosing the lung

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20

Risk factors of empyema

  • Infection

  • Invasive examinations

  • Trauma

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s/s of empyema

  • Fever

  • Night sweats

  • Pleural pain

  • Cough

  • Dyspnea

  • Anorexia; weight loss

  • Impaired lung expansion

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Priorities of empyema

  • Auscultation

  • Chest CT

  • Diagnostic thoracentesis

  • Ultrasound

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Treatment of empyema

  • Sterilization of cavity

  • Surgical management

  • Drainage

    • Thoracentesis = needle aspiration for thin fluid

    • Tube thoracostomy = chest tube used with thrombolytics

    • Open chest thoracostomy

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Nursing considerations of empyema

  • Coping

  • Breathing exercises

  • Education on drainage system

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Aspiration

Pulmonary consequences resulting from the entry of foreign substances into the lower airway

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Pathophysiology of aspiration

Can occur from introduction of upper airway bacteria or GI bacteria

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Risk factors of aspiration

  • Seizures

  • Depressed gag reflex

    • Brain injury

    • Low levels of consciousness

    • Stroke

    • Feeding tubes

    • Dysphasia

    • Sedatives

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Nursing considerations of aspiration

  • Elevate head of bed

  • Avoid stimulation of gag reflex

  • Check feeding tube placement

  • Check feeding tube residuals

  • Thickened fluids

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Pleural effusion

A collection of fluid in the pleural space; secondary to other diseases

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Risk factors of pleural effusion

  • HF

  • TB

  • Pneumonia

  • Infection

  • PE

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s/s of pleural effusion

  • Pleural pain

  • SOB

  • Dyspnea

  • s/s depend on underlying condition/cause and size

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Priorities of pleural effusion

  • Chest xray

  • Chest CT

  • Thoracentesis

  • Bacterial culture

  • WBC counts

  • Pleural biopsy

  • Respiratory assessment

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Treatment of pleural effusion

  • Thoracentesis

  • Chest tube

  • Surgery

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Nursing considerations of pleural effusion

  • Positioning

  • Pain management

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Pulmonary edema

  • Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both

  • Classified as cardiogenic or noncardiogenic

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Noncardiogenic pulmonary edema

  • Occurs due to damage of the pulmonary capillary lining

    • Due to direct trauma, blood infection in the lungs, pr hydrostatic pressure

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Treatment of pulmonary edema

  • Oxygenation

    • ET with positive end-expiration pressure

  • Diuretics

  • Vasodilators

  • Positioning

  • Monitoring

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38

Tuberculosis

  • Infection via M. tuberculosis

  • Spreads via airborne transmission

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Pathophysiology of TB

  • Susceptible individual inhales mycobacteria and becomes infected

  • Bacteria is transmitted via airways to the alveoli and inflammatory reaction is initiated

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Risk factors of TB

  • Droplets from infected individual

    • Talking

    • Coughing

    • Sneezing

    • Laughing

    • Singing

  • Immunocompromised

  • Substance abuse

  • Recent travel

  • Overcrowding

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s/s of TB

  • Low grade fever

  • Cough

  • Night sweats

  • Fatigue

  • Weight loss

  • hemoptysis

  • Crackles

  • Positive mantoux test

    • Erythema

    • 5mm or greater induration

  • Positive quantiferon test

    • Blood test

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Priorities of TB

  • Mantoux testing

  • Complete health hostory

  • Chest x ray

  • Breath sounds

  • Drug resistance testing

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Treatment of TB

  • 6-12 months of anti-TB agents; 4 or more medications

  • First line medications

    • Isoniazid

    • Rifampin

    • Pyrazinamide

    • Ethambutol

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Nursing considerations of TB

  • Airway clearance

  • Adherence to treatment regimen

  • Activity

  • Nutrition

  • Prevent transmission

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45

Acute respiratory distress syndrome

  • Sudden, progressive pulmonary edema, increasing bilateral infiltrates visible on chest x-ray, decreased lung compliance

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s/s of ARDS

  • rapid onset of severe dyspnea

  • hypoxemia unresponsive to supplemental oxygen

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treatment of ARDS

  • intubation; mechanical ventilation with PEEP

  • prone positioning

  • nutritional support

  • reduce anxiety

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