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iggy.pneumonia.33
| Question | Answer |
|---|---|
| pneumonia | excess of fluid in the lungs resulting from an inflammatory process |
| community-acquired-hospital acquired | CAP - HAP or HAI |
| what pneumonia might be harder to cure? | hospital acquired pneumonia |
| where is infection in lung? | INTERSTITIAL spaces, alveoli and often bronchioles |
| what causes fluid? | inflammatory response-white blood cells migrate to infection, causing capillary lead , edema and exudate-fluids collect & alveolar walls thicken |
| what spreads infection? | capillary leak spreads to other areas of lung--if organisms move into the bloodstream, sepsis results |
| sepsis | Sepsis (from Gr. Σῆψις: the state of putrefaction or decay) is a potentially deadly medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) & infection |
| hypoxemia | Hypoxemia (or hypoxaemia) is generally defined as decreased partial pressure of oxygen in blood,[1][2][3][4] sometimes specifically as less than 60 mmHg (8.0 kPa)[3][4] or causing hemoglobin oxygen saturation of less than 90%.[4] |
| empyema | pus in a body cavity; refers to pyothorax |
| inflammation effects | fibrin and edema stiffen the lung, reducing compliance & decreasing vital capacity |
| most common manifestation of pneumonia in older adults | acute confusion from hypoxia (rather than fever or cough)-remember, lungs are consolidated & not oxygenating the blood properly |
| consolidation | solidification, lack of air spaces |
| bronchopneumonia | patches around bronchi |
| pneumonia - tissue necrosis | organisms form and abscess that perforate bronchial wall |
| etiology of pneumonia | people develop when their immune systems cannot combat the virulence of invading organisms |
| aspiration pneumonia | Aspiration pneumonia is caused by breathing foreign materials (usually food, liquids, vomit, or fluids from the mouth) into the lungs. This may lead to: A collection of pus in the lungs (lung abscess) An inflammatory reaction A lung infection (pneumonia) |
| 7th leading cause of death - victims | older adults, nursing home residents, hospitalized patients and mechanically vented patients |
| CAP - community acquired pneumonia | winter-late fall - complication of influenza |
| HAP Hospital acquired pneumonia | Nosocomial infection - high-risk - pseudomonas aeruginosa, acinetobacter "high risk" organisms |
| VAP | ventilator-associated pneumonia |
| mortality rate is highest | severe hypoxemia (arterial oxygen <80 mm Hg) - widespread atelectasis - pleural effusion or ventilatory failure |
| acinetobacter baumannii | a cinema - doesn't move |
| PPV23 | pneumococcal polysaccharide vaccine |
| how many times is PPV23 given? | usually given once; however, older adults and chronic health problems get again if more than 5 years has passed since first vaccination |
| pneumonis prevention | handwashing; avoid large crowds in cold/flu season; |
| Teach patients (3) | 1. see MD if fever longer than 24 hours; if lasts longer than 1 week; if symptoms worsen |
| nosocomial - hospital respiratory equipment | use sterile water (NOT tap water) in GI tubes, |
| Aspiration Precautions - hospital | |
| VAP protection | hand hygiene, oral care and head-of-bed elevation |
| pneumonia - history | swallowing problems, NG tube, drug addiction, viral infection - insect bites - skin rashes - exposure to animals |
| pneumonia - history - chronic resp. | resp. equipment in home? clean?vaccine? |
| pneumonia - general appearance | flushed cheeks - bright eyes - anxious expression |
| pneumonia - symptoms | pleural or chest pain - myalgia - fever, chills, cough - sputum production |
| pneumonia - sustained coughing | severe chest muscle weakness |
| pneumonia - heart | tachycardia |
| breathing pattern | use of accessory muscles-uncomfortable in lying position - assess cough & sputum - |
| ascultation | crackles, wheezing-result of inflammation & exudate in airways |
| ascultation - bronchial breath sounds | can be heard over consolidation |
| areas of pneumonis | tactile fremitus can be heard-also percussion is dulled |
| tactile fremitus | Pleural fremitus is a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs. See pleural friction rub for the auditory analog of this sign. |
| older adult | acute confusion from hypoxia - most common |
| older adult-is fever and cough present? | may be absent-but hypoxemia is present-weakness, fatigue, poor appetite |
| wikepedia | The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain.[2] Inspiratory crackles may be heard on exam.[2] A chest x-ray can be useful to differential pneumonia from congestive heart failure.[2] bacterial cause |
| dyspnea | Dyspnea (also spelled dyspnoea), shortness of breath (SOB), or air hunger,[1] is the subjective symptom of breathlessness.[ |
| leukocytosis | elevated WBC count |
| pneumonia - BUN | high BUN (blood urea nitrogen) may occur due to dehydration |
| Pneumonia - dehydration effect | hypernatremia - fever and decreased fluid intake |
| older adult-chest x-ray | chest x-ray essential because symptoms are vague |
| thorocentesis (or pleural tap) | Thoracentesis (pronounced /ˌθɔrəsɨnˈtiːsɨs/) (also known as thoracocentesis or pleural tap) is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. |
| impaired gas exchange | goals-maintain 95% pulse ox;no cyanosis; no confusion |
| impaired gas exchange - interventions | hypoxemia is primary problem; oxygen therapy via nasal cannula or face mask; incentive spirometry |
| is CO2 retention common in pneumonia patients? | no |
| ineffective airway clearance | maintain patent airway - effective cough; no pallor or cyanosis; no cracles or wheezes; pulse ox 95% |
| ineffective airway clearance - interventions | similar to COPD/asthma - cough & deep breathe (every 2 hours) - incentive spirometer; no chest PT for uncomplicated pneumonia; encourage 3 L fluid to avoid dehydration |
| ineffective airway clearance - MD/pharm | bronchodilators |
| potential for sepsis | goal: free of organisms-no fever; no pathogens-WBC count normal |
| Anti-infective agents | IV-2or 3 days - uncomplicated CAP-5-7days; HAP - up to 21 days |
| drug-resistant streptococcu pneumoniae - DRSP | older than 65 years-people in day-care who see young children |
| aspiration pneumonia | prevent lung damage & treat infection |
| acidic substances | stomach contents - vomitus - can cause inflammation, and permanent lung damage |
| recovery - older person | can take weeks- fatigue, weakness & residual cough |
| patient teaching | need to call MD-chills, fever, persistent cough, hemoptysis recurs or symptoms don't go away |
| teach patient & family | AVOID - crowds (fall & winter) - people who have colds - exposure to irritants like smoke |
| nicotine patches - what if patient smokes? | myocardial infarction |
| tuberculosis | The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss (the last giving rise to the formerly prevalent colloquial term "consumption"). Infection of other organs causes a wide range of symptoms. |
| consumption | old term-refers to weight loss |
| spread of TB | aerosolization - airborne route |
| does everyone who has bacillus develop TB? | no-many people have it dormant |
| TB - initial infection | bacteria multiplies in alveoli-immune response-exudate-then lesion are controlled by body |
| caseation necrosis | tubercle becomes surrounded by collagen, fibroblasts & lymphocytes - necrotic tissue turns into granular mass |
| Ghon tuburcle | primary lesion for tuberculosis |
| caseation - further | areas of caseation undergo resorption-degeneration and fibrosis |
| calcification or liquefaction? | liquid material will empty into bronchus & cause a cavity |
| do bacilli grow in caseous area? | yes- necrotic cavity will contain bacilli- |
| miliary or hematogenous TB | TB looks like "millets" spreads throughout body - "hema" togenous |
| most common site of initial infection | middle or lower lobes |
| reactivation | upper lobes |
| is an infected person able to spread disease? | no, not until manifestations of TB occur |
| secondary TB | reactivation in a previously infected person-HIV disease & older adults |
| what kind of bacteria? | acid-fast rod |
| incidence of TB among recent immigrants | 10x the American population |
| TB has a slow onset | patients not aware of symptoms |
| consider TB if: | Persistent cough; hemoptysis; weight loss; anorexia; night sweats; shortness of breath; fever & chills |
| foreign countries & BCG vaccine | not used in US-contains tubercle bacilli - may complicate TB tests |
| TB symptoms | cough (for weeks or months) mucopurulent sputum, streaked with blood; chest tightness and dull, aching chest pain occur with cough; fatigue |
| physical exam of chest | this does not prove TB-dullness with percussion; bronchial breath sounds; crackles |
| smear test | sputum from patient is smeared on slide; stained with red dye; then treated with acid alcohol to remove stain - TB does not lose stain |
| is the smear test definitive? | no, it shows acid-fast bacillus - others are also acid-fast-but this method is needed to start precautions |
| sputum culture confirms TB diagnosis | TB cultures & mycobacterial cultures require 1-4 weeks to determine a positive or negative result |
| mantoux test - tuberculin test | PPD (purified protein derivative) is injected under the skin |
| induration | hard |
| anergy | n cases of anergy, a lack of reaction by the body's defence mechanisms when it comes into contact with foreign substances, the tuberculin reaction will occur weakly, |
| HIV infection - how big is area of induration? | 5 mm - positive |
| normal person - how big is area of induration | 10 mm - positive |
| do you measure red area? | no-just hard area |
| what about health care workers? | 10 mm |
| skin test is positive - tB | chest x-ray - looking for clinically active TB - caseation and inflammation |
| drugs - how long? | 6 months |
| how long before TB noninfectious? | when 3 sputum cultures are negative |
| tb drugs - side effects | nausea-take at bedtime - use antiemetic drugs |
| not taking drugs exactly as prescribed | may lead to total drug resistance |
| multi-drug resistant TB (MDR TB) strain | Isonizid & Rifampin - drug does not care |
| family members - during treatment | they are already exposed - |
| in public | covere mouth with tissue, place tissue in plastic bags- WEAR A MASK in crowds |
| hospitalized patient with TB | airborne precautions |
| patient takes drugs | 6 months, however, most patients OK after 2-3 consecutive weeks |
| nursing diagnosis | impaired gas exchange; deficient knowledge; imbalanced nutrition; social isolation |
| imbalanced nutrition | need foods rich in iron, protein and C and B vitamins |
Created by:
walterina4327