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3Pneumonia
Alterations in Oxygenation r/t Infectious Processes MS1 exam2
| Question | Answer |
|---|---|
| Pneumonia | acute inflammation of bronchioles and alveoli; impaired resp defense mechanism (mucociliary, macrophage functions, cough reflex) |
| RF for Pneumonia | altered oropharyngeal flora, chronic disease (DM, alcoholism, cardiac)/compromised immune, drugs, immobility, gastric feeding, malnutrition, smoking, alcohol, TRACHEAL INTUBATION, PROLONGED HOSPITALIZATION, ALTERED LOC, AGING, PEDS |
| tracheal intubation: at risk for pneumonia after... | 48-72hr; bypass defense mechanisms |
| why are peds at risk for pneumonia? | airway size are smaller, shorter alveoli only 25million immature immune system |
| community acquired pneumonia (CAP) | droplets transmission; LRI, onset in community OR first 2days, >incidents in winter months common organisms: S. pneumoniae, M. pneumoniae, H. influenza |
| why is a good physical assessment important for every patient? | determine if they had pneumonia prior to hospitalization, DOCUMENTATION impt (>grade fever, dry/productive cough) |
| hospital acquired pneumonia (HAP) | 2nd most common nosocomial infection; occurs >48h after admission, not incubating at time of hospitalization; highest in mechanically ventilated pt common organisms: S. aureus, P. aureginosa, E. coli, K. pneumoniae uncovered by insurance |
| common CXR findings | consolidation = solid packet if bacteria infiltrates = fluid filled alveoli pleural effusion = pneumonia complication, fluid in pleural space |
| S/S Pneumonia 1 | dyspnea, confusion, stupor-elderly presenting; fever (>100F,depends on pt), chills, productive cough, pleuritic chest pain, tachycardia/pnea, dull percussion, crackles,ronchi, <breath sounds, >tactile fremitus, retractions/nasal flaring |
| S/S Pneumonia 2 | sudden onset, may vary depending on organisms |
| describe presenting cough of elderly with pneumonia | dry cough for elderly over 70 due to dehydration |
| describe presenting cough of middle aged, average person | productive cough |
| diagnostic tests for pneumonia | sputum for c&s and gram stain, CXR/CT of lung, CBC with WBC differential, pulsax, ABGs, bronchoscopy |
| priority diagnostic test upon admission | sputum for c&s within 4hr |
| why is it impt to take the sputum for c&s within 4hr of admission? | pt is usually given a broad-spectrum abx therapy upon admission, but prior to this a sputum c&s is done to make sure results are not altered by the therapy |
| what is value of WBC of a pt with pneumonia? | >15000 |
| what prompts a bronchoscopy? | not usually done cause it's invasive; done if pt has <cough reflex, dehydrated esp if pt has overwhelming pneumonia |
| pharmacologic therapy for pneumonia | Abx (broad-spectrum then Abx determined by C&S), analgesic, antipyretic, bronchodilator, mucolytic? |
| nutritional support for pneumonia | small, frequent meals, scheduled with regards to activity |
| hydration for pneumonia | 3L/day, IV and PO to thin out secretions unless contraindicated (CHF, renal dissease-contact MD; Peds-based on wt) |
| vaccinations | flu vaccine qyear; pneumococcal? vaccine q5yr (if vac before <65, immunocompromised, other risks) |
| impt complete assessment | -identify pt at risk -if pt is showing signs, dont rely on just one abnormality, rather do a complete assessment |
| PCs for pneumonia | atelectasis, pleural effusion, resAcidosis shifting to Alkalosis, Pneumothorax, sepsis, bacteremia, empyema, pericarditis, meningitis |
| nursing interventions for pneumonia | <aspiration risk, rest during acute phase then ambulate, >HOB, cough/deep breath/splint, suction, fluids, relaxation, meds, O2, handwashing, proper use of resp equipments, treatment of URIs |
| what should be done prior cough/deep breath/splint? | assess pain level, location premedicate |
| priority care: assessment of RF | pt coming from ICU on ventilator |
| proper use/storage of resp equipments | stored inside a plastic bag near bedside, hanging on headboard; clean technique? |
| why is discharge teaching very impt? | reoccurrence of pneumonia is highest 4-6 wks after being discharged |
| discharge teachings | *complete prescribed meds, cough/deep breath for 6-8wks; avoid smoking, limit activities, >rest periods, adequate fluid/nutrition, report changes in symptoms |
| can flu and pneumococcal vaccines given at the same time? | they can be given at the same time but different arms (L566) |
Created by:
sarahjqs
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