3 Pneumonia &TB

Anatomy and Pathology of the Lungs

• Normal Anatomy

  • Alveoli: Tiny air sacs in the lungs responsible for gas exchange

  • Bronchioles: Small airway passages leading to alveoli

• Pathological Conditions

  • Lobar Pneumonia

    • Affects lower lobe of left lung, often caused by Streptococcus pneumoniae

    • Characterized by fluid and pus-filled alveoli containing bacteria and blood cells

  • Tuberculosis (TB)

    • Infectious disease in the lungs caused by Mycobacterium tuberculosis

    • Transmitted through droplets from coughs or sneezes of an infected person

    • Causes inflammation in the alveolar wall

Pneumonia

• Definition: Infection causing inflammation of lung tissue

  • Can be caused by bacteria, viruses, or fungi

  • Results in alveoli filling with fluid or pus

  • Impair gas exchange

Risk Factors for Pneumonia

• Who is at risk?

  • Elderly

  • Recent hospitalization

  • Smoking/alcohol use

  • Weakened immune systems (Immunocompromised)

  • Exposure to influenza/pneumonia/pollutants

  • Lack of vaccination

  • Poor overall health or chronic conditions

  • Living in crowded conditions

  • Prolonged immobility

• Labs w/ Pneumonia

  • Elevated WBCs

  • Decreased PaO2

  • Increased PaCO2

Classification of Pneumonia

• Types of Pneumonia

  • Community-Acquired Pneumonia (CAP): Develops outside the hospital

    • Seen in older adults, not vaccinated & exposure to virus

    • Broad spectrum antibiotic — start within 4 hours

  • Healthcare Associated (HCAP): cccurs in pts with recent healthcare exposure, such as those residing in nursing homes or receiving outpatient care, and often requires more targeted antibiotic therapy.

    • Pt has pneumonia for 2+ days within the past 90 days at any medical facility

    • Hospital eats the cost

  • Hospital-Acquired Pneumonia (HAP): Develops 48 hours after admission

  • Ventilator-Associated Pneumonia (VAP): Occurs 48-72 hours post-endotracheal intubation

    • Poor oral care = contributing factor

    • Hospital eats the cost

  • Aspiration Pneumonia: Results from inhaling foreign material into lungs

S/S of Aspiration

• Coughing & SOB

• Abnormal breath sounds

• Elevated temp

• Low O2 levels

• Respiratory rate alteration

• Increased pulse rate

• Chest pain

• Foul-smelling respiratory secretions

• Elevated WBC count

• Tan colored secretions, if on tube feedings

Treatment and Management of Pneumonia

• Sputum sample should be taken before initiation of antibiotic therapy for a pt w/ suspected pneumonia

• Evaluative Measures:

  • Chest X-ray, vitals/pulse oximetry, cultures/labs

• Therapeutic Approaches:

  • Oxygen therapy and respiratory treatments

  • Adequate nutrition/hydration

  • Medications: Antibiotics, steroids, bronchodilators, antipyretics, analgesics, expectorants/mucolytics

  • Must complete full course of antibiotics

  • Encourage vaccinations

• Supportive Treatment:

  • Rest, appropriate activity level, patient education, vaccinations

  • Place pt in high fowlers positions

  • Provide oxygen as order

  • Deep breath cough

  • Incentive spirometer

  • Increase fluid intake

Pneumonia Core Measures

• Core Measures:

  • Appropriate antibiotic selection

  • Blood cultures drawn before antibiotic administration

  • Smoking cessation education

  • Influenza & pneumonia vaccination

• Nurse’s Role:

  • Administer antibiotics as ordered

  • Ensure timely completion of cultures—within 24 hours

  • Access resources for counseling on smoking cessation

  • Ensure vaccinations are prescribed and given

    • Document that you offered it, even if pt refuses or says already had it

Risk Factors for Tuberculosis (TB)

• Immunocompromised

• Inadequate healthcare access

• Overcrowded living environments

• Very young/old individuals

• Poor nutrition

• Substance abuse

• Immigration status

TB Transmission

• Isolation Guidelines:

  • Pts should be in a negative pressure room to prevent airborne transmission

  • Visitors should be limited and must wear masks while in the patient's room

• Personal Protective Equipment (PPE):

  • Wear N95 respirators

  • Gowns and gloves

S/S of Active TB

• Coughing that lasts 3 weeks or more

• Coughing up blood

• Fever

• Night sweats

• Fatigue

• Chest pain, or pain w/ breathing or coughing

• Loss of appetite and weight loss

• Chills as part of systemic response

• Unintentional weight loss

• Lethargy

Latent vs Active TB

• Latent TB:

  • TB lives but doesn’t grow in the body

  • Doesn’t make a person feel sick or have symptoms

  • CAN’T spread from person to person

  • Can advance to active TB

• Active TB:

  • TB is active & grows in the body

  • Makes a person feel sick & have symptoms

  • CAN spread from person to person

  • Can cause death if not treated

TB Diagnostic Tests

• Testing Methods:

  • TB Skin Test (Mantoux)

    • Come back 48-72 hours after injection

      • Positive = exposed to TB

        • doesn’t always mean they have TB

      • >5 mm (reduced immunity, HIV) = positive

      • >10 mm = positive

      • If they have received a vaccine from out of the country, it may lead to a false positive result

  • Chest X-ray to identify abnormalities

  • QuantiFERON TB gold blood test

    • determines presences of TB

    • Can’t determine if latent or active TB

  • Sputum culture to confirm presence of bacteria

    • Typically negative after 3 months of treatment

TB Treatment Goals (Responding, Take Action)

• Primary Goals:

  • Disease prevention

  • Early identification of TB

  • Eliminate infection & prevent relapse

  • No mycobacterium in sputum & no colonies of M. tuberculosis

  • Lifestyle changes

    • Necessary for effective management of TB

TB Medication Regimen

• Medication Compliance:

  • Emphasis on adherence to the drug regimen

  • VDOT (Video Directly Observed Therapy)

• Directly Observed Therapy (DOT):

  • Monitoring to ensure proper intake of medications

• Combating Drug Resistance:

  • Use of combination drug therapy to suppress bacterial growth while minimizing resistance.

First-Line Drugs for TB

• Initial Phase (First 8 weeks):

  • Think “RIPE orange”

  • Rifampin (orange/red secretions)

  • Isoniazid (INH)

  • Pyrazinamide (PZA)

  • Ethambutol

• Continuation Phase (Next 18 weeks):

  • Rifampin (Ridadin)

  • Isoniazid (INH)

Nursing Implications

• Place pt in a negative airflow room —> airborne precautions

• Wear N-95 mask

• If pt needs to leave the room, they must wear surgical mask

• Screen family members for TB since it’s highly contagious

• Pt needs to provide sputum sample every couple weeks throughout therapy

  • 3 consecutive negative sputum cultures = not contagious

Patient Education on TB

• Transmission is airborne; close contact increases risk

• Contagiousness decreases after 2-3 weeks of therapy

• Meds = adherence for months, possibly years

• Compliance with medication is crucial; patients must avoid alcohol

• Monitoring for hepatotoxicity during treatment is essential