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375 Exam 1
Pneumonia, Acute Respiratory Failure
| Term | Definition |
|---|---|
| hypoxemic arf | PaO2 less than 60; problem is oxygenation between alveoli and capillaries |
| VQ mismatch | normally amount of blood perfusing lungs is equal; caused by increased secretions (COPD), bronchospasm (asthma), atelectasis, pain; treated with O2 |
| shunt | blood exits the heart without gas exchange; treat with mechanical ventilation, PEEP and FiO2 |
| diffusion limitation | usually from damage to capillary membrane (fibrotic) |
| causes of hypoxemic arf | VQ mismatch, shunt, diffusion limitation; can lead to metabolic acidosis |
| hypoxemic arf symptoms | dyspnea and tachypnea, nasal flaring, use of accessory muscles, late cyanosis, agitation and confusion, decreased level of consciousness |
| hypercapnic arf | PaCO2 is greater than 50 with acidemia; problem is CO2 removal (ventilation) |
| hypercapnia arf causes | CNS overdose of depressant/ injury, neuromuscular disorders (respiratory muscles), chest wall abnormalities, problems of airway and alveoli (COPD, CF) |
| hypercapnia arf symptoms | dyspnea, tripod position, pursed lip breathing, rapid rate and shallow breathing, decreased tidal volume, morning headache |
| diagnostics of acute respiratory failure | chest X ray to rule out possible causes; ABG, cultures, CT scan, VQ scan |
| interprofessional management arf | maintain airway and absence of dyspnea, baseline ABG and breath sounds, respiratory therapy, positioning with the good lung down |
| corticosteroids arf | reduce inflammation; methylprednisolone (solu - medrol); inhaled flovent (not first line because it is not effective immediatley) |
| SABA arf | reduce bronchospasm; side effects tremors and tachycardia |
| diuretic arf | relieve pulmonary congestion |
| antibiotics arf | treat infection |
| benzo and opioid arf | reduce pain, anxiety and restlessness |
| risk factors for pneumonia | age over 65, pre existing lung disease, intubation, chest or abdominal surgery, altered LOC, immunosuppression |
| community acquired pneumonia | occurs in patients who have not been hospitalized or in a LTC facility within 14 days of onset of symptoms |
| hospital acquired pneumonia | occurs 48 hours or more after admission |
| ventilator associated pneumonia | 48 hours after endotracheal intubation |
| pneumonia severity index | determines how sick the client is and how likely they are to die in 30 days; < 70 outpatient, > 91 inpatient |
| manifestations of pneumonia | fever, dyspnea, tachycardia, productive or non productive cough, pleuritic chest pain (hurts to breath) |
| assessment findings pneumonia | increased fremitus, ego phony, coarse or fine crackles, wheezing |
| elderly pneumonia manifestations | atypical signs, afebrile, altered LOC, hypoxia, hypothermic, fatigue and headache |
| diagnosis pneumonia | chest x ray shows immediate consolidation, sputum and blood cultures; c reactive protein (inflammatory biomarker), procalcitonin (tissue injury) |
| antimicrobial stewardship | better patient outcomes with use of antibiotics, reassess patient 2 to 3 days post treatment |
| pneumonia antibiotics | started immediately with broad spectrum until cultures come back; reassess 3 to 5 days after, switch from IV to oral as soon as improving |
| CAP outpatient healthy | macrolides (mycin) |
| CAP inpatient | depends on severity; give beta lactam |
| CAP outpatient with comorbidities | fluoroquinolone (floxacin) added |
| HAP drug therapy | depends on organisms and resistance; will start IV and switch PO |
| health promotion pneumonia | nutrition and hydration to loosen secretions, analgesics and antipyretics, O2 PRN, early mobility, vaccinations |
| pleurisy | inflammation of the pleura |
| pleural effusion | fluid on the pleural space |
| bacteremia | bacterial infection in the blood |
| prevention of VAP | limit ventilator days, limit sedation, elevate HOB, suction and oral hygiene, chlorhexidine swabs |
Created by:
ahommel
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