Alterations in Oxygenation r/t Infectious Processes MS1 exam2
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| Pneumonia | acute inflammation of bronchioles and alveoli; impaired resp defense mechanism (mucociliary, macrophage functions, cough reflex)
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| 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
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| tracheal intubation: at risk for pneumonia after... | 48-72hr; bypass defense mechanisms
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| why are peds at risk for pneumonia? | airway size are smaller, shorter
alveoli only 25million
immature immune system
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| 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
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| 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)
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| 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
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| common CXR findings | consolidation = solid packet if bacteria
infiltrates = fluid filled alveoli
pleural effusion = pneumonia complication, fluid in pleural space
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| 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
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| S/S Pneumonia 2 | sudden onset, may vary depending on organisms
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| describe presenting cough of elderly with pneumonia | dry cough for elderly over 70 due to dehydration
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| describe presenting cough of middle aged, average person | productive cough
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| diagnostic tests for pneumonia | sputum for c&s and gram stain, CXR/CT of lung, CBC with WBC differential, pulsax, ABGs, bronchoscopy
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| priority diagnostic test upon admission | sputum for c&s within 4hr
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| 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
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| what is value of WBC of a pt with pneumonia? | >15000
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| what prompts a bronchoscopy? | not usually done cause it's invasive; done if pt has <cough reflex, dehydrated esp if pt has overwhelming pneumonia
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| pharmacologic therapy for pneumonia | Abx (broad-spectrum then Abx determined by C&S), analgesic, antipyretic, bronchodilator, mucolytic?
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| nutritional support for pneumonia | small, frequent meals, scheduled with regards to activity
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| hydration for pneumonia | 3L/day, IV and PO to thin out secretions unless contraindicated (CHF, renal dissease-contact MD; Peds-based on wt)
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| vaccinations | flu vaccine qyear; pneumococcal? vaccine q5yr (if vac before <65, immunocompromised, other risks)
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| impt complete assessment | -identify pt at risk
-if pt is showing signs, dont rely on just one abnormality, rather do a complete assessment
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| PCs for pneumonia | atelectasis, pleural effusion, resAcidosis shifting to Alkalosis, Pneumothorax, sepsis, bacteremia, empyema, pericarditis, meningitis
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| 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
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| what should be done prior cough/deep breath/splint? | assess pain level, location
premedicate
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| priority care: assessment of RF | pt coming from ICU on ventilator
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| proper use/storage of resp equipments | stored inside a plastic bag near bedside, hanging on headboard; clean technique?
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| why is discharge teaching very impt? | reoccurrence of pneumonia is highest 4-6 wks after being discharged
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| discharge teachings | *complete prescribed meds, cough/deep breath for 6-8wks; avoid smoking, limit activities, >rest periods, adequate fluid/nutrition, report changes in symptoms
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| can flu and pneumococcal vaccines given at the same time? | they can be given at the same time but different arms (L566)
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