Pneumonia

Critical Nursing

Pneumonia

is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.

Pneumonitis

is a more general term that describes the inflammatory process in the lung tissue that may predispose and place the patient at risk for microbial invasion.

Four classifications of Pneumonia

Community-acquired pneumonia

hospital-acquired pneumonia (HAP),

Aspiration pneumonia

pneumonia in the immunocompromised host

First 48 hours after hospitalization

How many hours does HAP occur?

Streptococcus pneumonia, H. influenza, Legionella, and Pseudomonas Aeruginosa

What are the causative agents for CAP?

Fifty percent

How many percentage of the case does the specific etiologic agent become identified

Pneumonia, 60

Blank is the most common cause of CAP in people younger than ___ years of age

Viruses

This is the most common cause of pneumonia in infants and children

Hospital-acquired Pneumonia

also called nosocomial pneumonia

Hospital-Acquired Pneumonia,48

This is defined as the onset of pneumonia symptoms more than ___ hours after admission in patients with no evidence of infection at the time of admission.

most lethal nosocomial infection, death

Hap is considered as the___ and the leading cause of ___ in patients with such infections.

Enterobacter species, Escherichia coli, influenza, Klebsiella species, Proteus, Serratia marcescens, S. aureus, and S. pneumonia

These are the common microorganisms that are responsible for HAP

Pulmonary infiltrate

What is present on chest X-ray as the usual presentation of HAP

Pneumocystis pneumonia, fungal pneumonias and Mycobacterium tuberculosis

What are the present hosts for pneumonia in the immunocompromised?

Patients who are immune compromised

Who are the patients that develop pneumonia from organisms of low virulence

HAP and CAP

Hosts of pneumonia in immunocompromised may be caused by the organisms also observed in

Aspiration Pneumonia

refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway.

bacterial infection from aspiration of bacteria

What is the common form of aspiration pneumonia that normally reside in the upper airways

Community or hospital

Aspiration pneumonia may occur in

S.Pneumonia, H. influenza and S. aureus

Common pathogens in Aspiration Pneumonia

Normal flora, aspiration of flora, oropharynx

Pneumonia arises from ___ present in patients whose resistance has been altered or from ____ present in the _____

Inflammatory reaction, exudates, oxygen and carbon dioxide

___occur in the alveoli, producing__ that interfere with the diffusion of ___ and ___

White blood cells

This migrates into the alveoli and fill the normally air-filled spaces.

Hypoventilation

This is the effect of the ventilation-perfusion mismatch

Arterial hypoxemia

Mixing of oxygenated and poorly oxygenated

60,000 deaths

How many does pneumonia and influenza account for?

Eight leading cause of death

Pneumonia is ranked as the___ in United States

915,000 episodes , 65 years old

What is the estimated number for episodes of CAP that occur in adults____ years old and above in the United States.

15%

HAP accounts for ___ hospital acquired infections and is the leading cause of death in patients with such infections

4 to 7

What is the estimated incidence of HAP episodes per 1000 hospitalizations

Streptococcus pneumonie, Haemophilus influenzae, Mycoplasma Pneumoniae

What are the three common cause of Community- Acquired Pneumonia?

Streptococcus Pneumoniae

This is the leading cause of CAP in people younger than 60 years of age without comorbidity and in those 60 years and older with comorbidity

Haemophilus influenzae

This causes a type of CAP that frequently affects elderly people and those with comorbid illnesses

Staphylococcus aureus, Impaired host defense, comorbid conditions, supine positioning, prolonged hospitalization

What are the causes of hospital-acquired pneumonia

Staphylococcus aureus

occurs through inhalation of the organism.

Impaired Host defenses

When the defenses of the body are down, several pathogens may invade the body

Comorbid Conditions

There are several conditions that lower the immune system, causing bacteria to pool in the lungs and eventually result in pneumonia.

Supine Positioning

When the patient stays in a prolonged supine position, fluid in the lungs pools down and stays stagnant, making it a breeding place for bacteria.

Prolonged Hospitalization

The risk for hospital infections or nosocomial infections increases the longer the patient stays in the hospital.

High fever, Chills

Systemic clinical manifestation of pneumonia

Clamminess, Blueness

Skin Clinical Manifestations of Pneumonia

headaches, loss of appetite, mood swings

What is the central clinical manifestations

Low blood pressure

What is the vascular clinical manifestation of pneumonia

High heart rate

What is the heart clinical manifestation of pneumonia

Nausea, vomitting

What is the gastric clinical manifestation of pneumonia

Pain

What is the joint clinical manifestation of pneumonia

Cough with sputum/ phlegm, SOB, Pleuritic chest pain, hemoptysis

What are the lung clinical manifestations for pneumonia?

Fatigue, Aches

What are the muscular clinical manifestation of pneumonia

Rapidly rising fever, Pleuritic chest pain, Rapid and bounding pulse, tachypnea, purulent sputum

What are the overall clinical manifestations for pneumonia?

Rapidly rising fever

Since there is inflammation of the lung parenchyma, fever develops as part of the signs of an infection

Pleuritic Chest pain

Deep breathing and coughing aggravate the pain in the chest.

Rapid and Bounding pulse

A rapid heartbeat occurs because the body compensates for the low concentration of oxygen in the body

Tachypnea

There is fast breathing because the body tries to compensate for the low oxygen concentration in the body

Purulent Sputum

The sputum becomes purulent because of the infection in the lung parenchyma which produced sputum-filled with pus.

Pneumococcal vaccine, Staff education, Infection and microbiologic surveillance, Modifying host risk for infection

What are the ways to prevent Pneumonia?

Pneumococcal vaccine

This method can prevent pneumonia in healthy patients with an efficiency of 65% to 85%

Staff education

To help prevent HAP, the CDC (2004) encouraged staff education and involvement in infection prevention.

Infection and microbiologic surveillance

It is important to carefully observe the infection so that there could be an appropriate application of prevention techniques.

Modifying host risk for infection

The infection should never be allowed to descend on any host, so the risk must be decreased before it can affect one.

Shock and respiratory failure

Plueral effusion

What are the two complications of Pneumonia?

History taking

Physical examination

chest x ray

fiberoptic bronchoscopy

Abg/ pulse oximetry

gram stain/ culture

cbc

Serologic studies, viral legionella titers, cold agglutinins

Pulmonary function studies

Electrolytes

Bilirubin

Percutaneous aspiration

What are the assessment and diagnostic findings for pneumonia?

Multiple abscesses/infiltrates

Emphysema

Scattered or localized infiltration

Diffuse nodular infiltrates

Mycoplasmal pneumonia - chest x ray may be clear

What are seen in the chest X-ray with patient with pneumonia?

Diagnostic (qualitative x) and therapeutic(re-expansion of lung segment)

type of tests for fiberoptic bronchoscopy

Sputum collection, needle aspiration of empyema pleural and transthoracic fluids

lung biopsies

Blood culture

What is collected for gram stain culture

False

True or false: Sputum culture identifies all offending organisms

True

True or false: Blood culture does show transient bacteremia

Leukocytosis

Low wbc count

Erythrocyte Sedimentation rate elevated

What is seen for CBC?

Serologic studies

This assists in differential diagnosis of specific organisms

Legionella titers

Cold Agglutinins

What are the different types of serologic studies

Congestion and alveolar collapse

Increase airway pressure

Decreased compliance

Present shunting (hypoxemia)

What is seen for pulmonary function studies under pneumonia

Low sodium and chloride levels

What is seen for electrolytes in pneumonia

false- increased

True or false: In pneumonia, bilirubin is decreased

typical intranuclear and cytoplasmic inclusions

Rubeola

What is seen for purcutaenous aspiration under pneumonia?

Blood culture, CAP

This is performed for identification of the causal pathogen and prompt administration of antibiotics in patients in whom ___ is strongly suspected

Drug resistant S. pneumonia

Why is administration of macrolides needed?

Hydration

This is I portent because fever and tachypnea may result in insensible fluid loss

Antipyretics

This is used to treat fever and headache

Antitussives

This is for the treatment of associated cough

Bed rest

This is prescribed until signs of infection are diminished

Oxygen

If hypoxemia develops, what should be given?

Pulse oximetry

This is to determine the the need for oxygen and to evaluate the effectiveness of the therapy

high concentration of oxygen

Endotracheal intubation

Mechanical ventilation

What are the aggressive respiratory measures for pneumonia

Respiratory symptoms

Clinical manifestations

Physical assessment

Elderly patients

What are the nursing assessment needed for pneumonia

Fever

Chills

Night sweats

What is to be assess for respiratory system under pneumonia / signs of bacterial pneumonia?

Pleuritic pain

bradycardia

Tachypnea

Fatigue

Use of accessory muscles for breathing, coughing and purulent sputum

What should be assess for clinical manifestations of pneumonia?

Temperature

pulse

odor and color of secretions

Frequency and severity of cough

Degree of tachypnea/ sob

Changes in xray findings

What are the physica aspects needed to assessl for pneumonia?

altered mental status

dehydration

Unusual behavior

Fatigue

concomitant heart failure

What is to be assessed for elderly patients in pneumonia?

Ineffective airway clearance r/t to copious tracheobronchial secretions

Activity intolerance r/t impaired respiratory function

Risk for deficient fluid volume r/t fever and a rapid respiratory rate

What are the diagnosis for Pneumonia?

copious tracheobronchial secretions

Ineffective airway clearance r/t

impaired respiratory function

activity intolerance r/t

Fever and rapid respiratory rate

risk for deficient fluid volume r/t

Improve airway patency

Rest to conserve energy

Maintenance of proper fluid volume

Maintenance of adequate nutrition

Understanding of treatment protocol and preventive measures

absence of complications

What are your nursing care plan for pneumonia?

Improve respiratory function

prevent complications

support recuperative process

Provide information about the disease process, prognosis, and treatment

What are your nursing priorities for pneumonia?

Remove secretions

Adequate hydration of 2 to 3 liters per day

Humidification

Coughing exercise

Chest physiotherapy

What are your nursing interventions to improve airway patency?

Avoid overexertion and possible exacerbation of symptoms

Semi fowler’s position

How do you promote or conserve energy for pneumonia?

Changing of positions frequently to enhance secretion clearance and pulmonary ventilation and perfusion

Why is semi fowler position important?

2 liters- replace insensible fluid loss

How many liters for fluid intake and what is the reason for fluid intake

cause of pneumonia

Management of symptoms

follow up

Factors contributing to the disease

How do you promote patient’s knowledge regarding his / her condition (pneumonia)

Improved airway patency

conserve energy

adequate hydration

consumes adequate dietary intake

States and complies management strategies

Exhibits no complications

Complies treatment protocol

What are your evaluation for pt with pneumonia

Oral antibiotics

breathing exercise

Follow up check up

smoking cessation

What are your discharge instructions for pt with pneumonia?