Pneumonia
An inflammation of the alveoli, bronchioles, and arterioles in the lungs caused by microorganisms (bacteria, viruses, fungi)
Types of pneumonia
Community aquired pneumonia
Health care associated pneumonia
Hospital aquired pneumonia
Ventilator associated pneumonia
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
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
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
Priorities of pneumonia
Chest x-ray
Blood culture
Sputum examination
Bronchoscopy with severe infection
Treatment of pneumonia
Antibiotics
Adequate rest and hydration
Supplemental oxygen
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
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
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
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
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
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
s/s of pleurisy
Sever, sharp pleuritic pain
Pleural fluid development
Priorities of pleurisy
Auscultation before more fluid build up
Chest x rays
Sputum analysis
Thoracentisis
Treatment of pleurisy
Pain relief
Analgesic agents
Heat or cold
NSAIDs
Treat underlying condition (pneumonia or infection)
Nursing considerations of pleurisy
Turning and positioning for comfortable breathing
Splinting
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
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
Risk factors of empyema
Infection
Invasive examinations
Trauma
s/s of empyema
Fever
Night sweats
Pleural pain
Cough
Dyspnea
Anorexia; weight loss
Impaired lung expansion
Priorities of empyema
Auscultation
Chest CT
Diagnostic thoracentesis
Ultrasound
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
Nursing considerations of empyema
Coping
Breathing exercises
Education on drainage system
Aspiration
Pulmonary consequences resulting from the entry of foreign substances into the lower airway
Pathophysiology of aspiration
Can occur from introduction of upper airway bacteria or GI bacteria
Risk factors of aspiration
Seizures
Depressed gag reflex
Brain injury
Low levels of consciousness
Stroke
Feeding tubes
Dysphasia
Sedatives
Nursing considerations of aspiration
Elevate head of bed
Avoid stimulation of gag reflex
Check feeding tube placement
Check feeding tube residuals
Thickened fluids
Pleural effusion
A collection of fluid in the pleural space; secondary to other diseases
Risk factors of pleural effusion
HF
TB
Pneumonia
Infection
PE
s/s of pleural effusion
Pleural pain
SOB
Dyspnea
s/s depend on underlying condition/cause and size
Priorities of pleural effusion
Chest xray
Chest CT
Thoracentesis
Bacterial culture
WBC counts
Pleural biopsy
Respiratory assessment
Treatment of pleural effusion
Thoracentesis
Chest tube
Surgery
Nursing considerations of pleural effusion
Positioning
Pain management
Pulmonary edema
Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both
Classified as cardiogenic or noncardiogenic
Noncardiogenic pulmonary edema
Occurs due to damage of the pulmonary capillary lining
Due to direct trauma, blood infection in the lungs, pr hydrostatic pressure
Treatment of pulmonary edema
Oxygenation
ET with positive end-expiration pressure
Diuretics
Vasodilators
Positioning
Monitoring
Tuberculosis
Infection via M. tuberculosis
Spreads via airborne transmission
Pathophysiology of TB
Susceptible individual inhales mycobacteria and becomes infected
Bacteria is transmitted via airways to the alveoli and inflammatory reaction is initiated
Risk factors of TB
Droplets from infected individual
Talking
Coughing
Sneezing
Laughing
Singing
Immunocompromised
Substance abuse
Recent travel
Overcrowding
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
Priorities of TB
Mantoux testing
Complete health hostory
Chest x ray
Breath sounds
Drug resistance testing
Treatment of TB
6-12 months of anti-TB agents; 4 or more medications
First line medications
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Nursing considerations of TB
Airway clearance
Adherence to treatment regimen
Activity
Nutrition
Prevent transmission
Acute respiratory distress syndrome
Sudden, progressive pulmonary edema, increasing bilateral infiltrates visible on chest x-ray, decreased lung compliance
s/s of ARDS
rapid onset of severe dyspnea
hypoxemia unresponsive to supplemental oxygen
treatment of ARDS
intubation; mechanical ventilation with PEEP
prone positioning
nutritional support
reduce anxiety