BMS Pneumonia & TB

Pneumonia

An infection that causes inflammation of the lung tissue resulting from bacterial, viral, or fungus

It fills with fluid or pus

What happens to the alveoli during pneumonia?

Alveoli

Where does gas exchange occur in the lungs?

There is low gas exchange; can cause cough and pus can develop and abscess (emphysemas)

What happens to the body if the alveoli fills with fluid during pneumonia?

• Recent hospitalization

• Smoking/alcohol

• Exposure to influenza/pneumonia/pollutants

• Lack of vaccination

• Poor overall health/chronic conditions

• Immunocompromised

• Chemotherapy

• Prolonged immobility

• >65 age (all ages are still at risk too)

Who is at risk for getting pneumonia?

Mild to severe

What is the range of severity of pneumonia?

Sepsis

What happens if bacterial infection from pneumonia gets into the blood stream?

• Community acquired (CAP)

• Healthcare associated (HCAP)

• Hospital acquired (HAP)

• Ventilator associated (VAP)

• Aspiration pneumonia

What are the types of pneumonia?

Community Acquired Pneumonia (CAP)

Pneumonia from outside the hospital

Older people with no vaccination or those exposed to virus

What type of people typically develop CAP?

Healthcare Associated Pneumonia (HCAP)

Pneumonia from a hospitalization of at least 2 days or more within the last 90 days (3 months)

• Not necessarily inside hospital

Residents in long term care, home healthcare, dialysis, history of MRSA, inpatient

What type of people typically develop HCAP?

Hospital Acquired Pneumonia (HAP)

Pneumonia acquired >48 hrs after hospital admission

Ventilator Associated Pneumonia (VAP)

Pneumonia that occurs 48-72 hrs after intubation

• HOB 30 degrees or more

• Oral care

• Suctioning

How do you prevent VAP?

Aspiration Pneumonia

Changes in the lung as a result of some foreign substances getting into lower airway and causes infection

Saliva, food, liquid, vomiting

What can aspiration pneumonia be caused by?

Aspiration

Happens when something that should go down your throat into your stomach (like food or liquid) goes down the wrong way and ends up in your lungs because the body’s natural protection (the epiglottis) didn’t block it properly

Physician

Who diagnoses the type of pneumonia?

• Coughing, SOB

• Stridor

• Diminished breath sounds

• Increased Temp

• Low O2 sat

• Increased RR

• Increased pulse (tachycardia)

• Chest pain

• Foul smelling respiratory secretions

• Increased WBC

• If on tube feedings, tan colored secretions

What are the S/S of someone who has aspirated?

• Fever

• Chills

• Clamminess

• Cyanosis

• Cough with sputum

• SOB

• Pleuritic chest pain

• Hemoptysis

• Fatigue

• Aches

• Headache

• Loss of appetite

• Mood swings

• Low BP

• Increased HR

• Nausea, vomiting

Main S/S of infectious pneumonia

Pleuritic Chest Pain

Soreness when breathing in and out

• Chest X-ray

• Vitals/Pulse Ox

• Cultures/labs

• Supportive treatment

• Rest/activity

• Education

• Vaccinations

What are some interventions for pneumonia?

• Oxygen/Respiratory TX

• Nutrition/hydration

• Medications

• Steroids

• Bronchodilators

• Antipyretics

• Antibiotics

• Analgesics

• Expectorants/mucolytics

What are the types of supportive treatment you can do as a nursing intervention?

It can kill a wide range of bacteria and used first until culture lab shows specific bacteria causing the infection is known

Why might a patient be placed on a broad spectrum antibiotic first if they have pneumonia?

• Incentive spirometer

• Turn, Cough, Deep breathe

• Increase fluids (2-3L/day)

What type of patient education can you give to a patient with pneumonia?

• Appropriate antibiotic selection

• Blood culture drawn BEFORE antibiotic administered

• Smoking cessation education

• Influenza and pneumonia vaccination

What are the core measures for pneumonia?

BEFORE antibiotic is administered

When should a blood culture be done if a patient is scheduled for an antibiotic?

Assure that antibiotic therapy is administered as ordered (timeframe)

What is the nurse's role for core measure: appropriate antibiotic secretion?

Assure blood cultures and appropriate antibiotic orders are completed in a timely manner-within 24h admission

What is the nurse's role for core measure: blood culture drown before antibiotic administered?

Provide, or access resources to provide, smoking cessation and substance abuse counseling when indicated

What is the nurse's role for core measure: smoking cessation education?

Assure that appropriate vaccinations are ordered and administered

What is the nurse's role for core measure: influenza and pneumonia vaccination?

Tuberculosis (TB)

Contagious bacterial infection caused by Mycobacterium tuberculosis, which primarily affects the lungs

• Immunocompromised (HIV, AIDS)

• Inadequate healthcare

• Overcrowded living environment

• Very young, very old

• Poor nutrition

• Substance abuse

• Immigration

Who is at risk for TB?

• Countries prevalent in TB

• Delays in detecting TB

• Lack of protection

• Maintaining clinical and public health expertise

What are some risk factors that can cause the spread of TB?

Sneezing and coughing, which spreads droplets

How is TB transmitted?

Airborne precaution

What type of isolation is used in TB?

N95 mask

What type of PPE must be worn when dealing with TB?

Active and latent

What are the two types of TB?

TB: caused by Mycobacterium and the onset is slow and gradual; it also lingers longer
Pneumonia: other bacteria and onset is quicker

What is the difference between TB and Pneumonia?

Night sweats and fever

What is the main S/S of active TB?

Latent TB

TB that lives but doesn’t grow in the body, it is asymptomatic and can last for years or decades before symptoms; it is NOT contagious

No

Is latent TB contagious?

Active TB

TB that is growing in the body and makes a person feel sick and have symptoms; it IS infectious

Death

What can happen to a person if TB disease is not treated?

• TB skin test (Mantoux)

• Chest x-ray

• QuantiFERON TB gold

• Sputum culture

What are some diagnostic tests that can be preformed for TB?

TB Skin Test (Mantoux)

Small amount of PPD placed in person’s forearm and evaluated within 48-72 hours, at first it forms a small bump (swelling or hardness) which is normal

No reaction, no TB

What does a bump of 0-4mm mean in a TB skin test?

TB positive

What does a bump of >5mm mean in a TB skin test?

Recent immigrants in high TB areas or people in high risk areas (healthcare); moderate risk

What does a bump of >10mm mean in a TB skin test?

Low risk individual, TB positive

What does a bump of >15mm mean in a TB skin test?

After a positive TB skin test

When is a chest x-ray preformed for TB?

QuantiFERON TB gold

Blood test for TB, results typically within 24hr; can’t determine active vs. latent

No

Can a QuantiFERON TB gold determine active vs. latent TB?

Sputum culture TB test

Confirm active TB and evaluate effectiveness of treatment

After 3 months of treatment

When is a person considered negative for TB in a sputum test?

• Disease prevention

• Early identification (screening)

• Eliminate infection and prevent relapse

• No Mycobacterium in sputum and no colonies of M.tuberculosis

• Lifestyle changes

What are the goals of TB treatment?

• Medication compliance; DOT

• Drug resistance is a problem

• Combination drug therapy is most effective

What is the TB medication regimen?

Trained healthcare worker or designated person, excluding family, provides drug and watches patient swallow; taken until disease under control

Directive Observed Therapy (DOT)

Multiple drug regimens kill/suppress growth of bacteria while lowering of drug resistance

Why is combination drug therapy most effective?

26 weeks or longer if TB is drug resistant

How long is drug therapy for TB?

8 weeks

How many weeks is the initial phase of TB drug therapy?

• isoniazid (INH)

• rifampin (Rifadin)

• pyrazinamide (PZA)

• ethambutol (Myambutol)

What meds are taken in the first 8 weeks of TB drug therapy?

• isoniazid (INH)

• rifampin (Rifadin)

What meds are taken in the next 18 weeks of TB drug therapy?

Active extracellular TB

What type of TB is eliminated during the initial phase of TB drug therapy?

Any persistent intracellular TB

What type of TB is eliminated during the continuation phase of TB drug therapy?

• Transmitted via airborne route

• Repeated close contact increases risk

• Transmission reduced after 2-3 weeks of proper therapy

• 3 consecutive negative sputum cultures = not contagious

• Meds: adherence for months, possibly years

• Pt. requires close monitoring while taking TB drugs due to hepatotoxicity (LFTs)

• Pt. should avoid alcohol while taking TB meds

What is the patient education for TB?

3 consecutive cultures

How much negative sputum cultures is a patient considered NOT CONTAGIOUS?

2-3 weeks

How many weeks is transmission of TB reduced?

Liver; causes hepatotoxicity

What organ is damaged when taking TB meds?

Alcohol; affects liver

What should the patient avoid while taking TB meds?

Liver can’t produce coagulation; can cause bleeding and jaundice

What other adverse effects can hepatotoxicity cause?

Airborne

What route is TB transmitted?