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3Pneumonia

Alterations in Oxygenation r/t Infectious Processes MS1 exam2

QuestionAnswer
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