Pneumonia Overview and Clinical Manifestations

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Questions and Answers

What is a primary characteristic of pneumonia caused by an infectious agent?

Increased lung compliance leading to hyperinflation

Reduced white blood cell count in the bloodstream

Decreased alveolar perfusion due to fluid accumulation (correct)

Vasodilation of pulmonary blood vessels

Which type of pneumonia is primarily acquired in healthcare settings?

Community-acquired pneumonia

Viral pneumonia

Ventilator-associated pneumonia (correct)

Aspiration pneumonia

What is one of the signficant risk factors associated with hospital-acquired pneumonia?

Recent travel history

Contaminated respiratory therapy devices (correct)

Increased physical activity

Routine vaccinations

Which of the following symptoms is least likely to be associated with pneumonia in older adults?

Increased muscle mass Signup and view all the answers

What is the appropriate use of antibiotics in pneumonia treatment?

Used only after a Gram stain has confirmed bacterial infection Signup and view all the answers

Which clinical manifestation is commonly seen in patients with pneumonia?

Pleuritic chest pain Signup and view all the answers

What additional assessments should a nurse consider for older adult patients suspected of having pneumonia?

Changes in mental status Signup and view all the answers

Which of the following is not a supportive treatment for pneumonia?

Daily exercise regimen Signup and view all the answers

What is a key sign that may indicate the presence of pneumonia?

Changes in mental status Signup and view all the answers

Which nursing intervention is aimed at improving airway patency in a patient with pneumonia?

Humidification to loosen secretions Signup and view all the answers

Which medication is considered a first-line treatment for tuberculosis?

Rifampin Signup and view all the answers

What symptom is characteristic of active pulmonary tuberculosis?

Night sweats Signup and view all the answers

What factor may contribute to the rising mortality and morbidity rates related to tuberculosis?

Resistance to TB medications Signup and view all the answers

Which assessment finding is significant in evaluating a patient with suspected tuberculosis?

Size of induration greater than 10 mm on a TB skin test Signup and view all the answers

What is a common complication associated with the treatment of tuberculosis?

Malnutrition Signup and view all the answers

Which of the following factors does NOT increase the risk of tuberculosis transmission?

Sitting in a well-ventilated room Signup and view all the answers

When should the TB skin test results be interpreted?

48-72 hours after injection Signup and view all the answers

Study Notes

Pneumonia

Inflammation of the lung parenchyma caused by microorganisms
Upper respiratory tract has decreased defenses, allowing infectious agents to enter the sterile lower respiratory tract
Inflammatory reaction in the alveoli produces exudate that interferes with gas exchange
White blood cells migrate to the alveoli, filling the normal air spaces
Classified by origin: community-acquired, health care-associated, hospital-acquired, ventilator-associated
Can also occur in immunocompromised clients and from aspiration
Hospital-acquired pneumonia risk factors include: severe acute or chronic illness, contaminated respiratory tract devices or equipment, hands of healthcare personnel, therapeutic agents that depress the CNS, intubation, NG tubes.

Clinical Manifestations

Pleuritic chest pain
Confusion or changes in level of consciousness
Cough
Fatigue
Fever
Nausea/vomiting
Shortness of breath
Specific considerations for older adults include: changes in mental status, fatigue, dehydration, lower body temperature, and concomitant heart failure

Medical Treatment

Supportive treatment includes fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, and antihistamines
Antibiotic therapy guided by Gram stain results
Empiric antibiotic therapy used if etiologic agent is not identified
Antibiotics are not indicated for viral infections but are used for secondary bacterial infection

Nursing Process: Assessment

Changes in temperature and pulse
Amount, odor, and color of secretions
Frequency and severity of cough
Degree of tachypnea or shortness of breath
Changes in physical assessment, especially inspection and auscultation of the chest
Changes in chest X-ray
Changes in mental status, fatigue, dehydration, and concomitant heart failure, especially in older adults

Nursing Process: Diagnosis

Airway clearance
Activity intolerance
Fluid and electrolyte imbalance
Nutrition
Knowledge deficit

Nursing Process: Planning

Improving airway patency:
- Removing secretions: encourage hydration, humidification, coughing techniques, chest physiotherapy, position changes, oxygen therapy
Promoting fluid intake:
- Encourage fluid intake to at least 2 L/day
Maintaining nutrition:
- Provide nutritionally enriched foods and fluids
Promoting patient knowledge:
- Educate on disease process, treatment regimen, and preventive measures
Monitoring and managing complications:
- Potential complications include continuing symptoms after initiation of therapy, sepsis and septic shock, respiratory failure, atelectasis, pleural effusion, delirium

Pulmonary Tuberculosis

Infectious disease primarily affecting the lung parenchyma
Caused by Mycobacterium tuberculosis
Worldwide public health problem with rising mortality and morbidity rates
Transmitted through droplet nuclei expelled by infected individuals when coughing, sneezing, talking, laughing, or singing.
Not everyone exposed to TB becomes infected, and not everyone infected develops active TB disease
Latent TB infection is the asymptomatic state, with 10% progressing to active TB disease

Symptoms in Active Pulmonary TB

Low-grade fever
Cough (non-productive, mucopurulent, or hemoptysis)
Night sweats
Fatigue
Weight loss

Gerontological Considerations for TB

Atypical clinical manifestations may be present
Unusual behavior and altered mental status
Fever
Anorexia and weight loss
No reaction or delayed reaction on TB skin test

Assessment and Diagnostic Findings

Complete history and physical
Chest X-ray
TB skin test (read 48-72 hours after injection)
- Induration greater than 5 mm significant in those at risk
- Induration greater than 10 mm significant in normal or mildly impaired immunity
Sputum smears for acid-fast bacilli
Sputum culture and sensitivity

Medical Management

Treatment with chemotherapeutic agents (antituberculosis agents) for 6 to 12 months
Prolonged treatment duration is necessary to eradicate organisms and prevent relapse
Resistance to TB medications is a global concern and challenge
First-line medications include: INH, rifampin, pyrazinamide, and ethambutol

Nursing Process: Assessment for Tuberculosis

Diagnoses:
- Airway clearance related to copious tracheobronchial secretions
- Ineffective individual management of the therapeutic regimen (noncompliance) related to knowledge deficit
- Activity intolerance related to fatigue, altered nutritional status, and fever

Nursing Process: Interventions for Tuberculosis

Promoting airway clearance:
- Encourage hydration, coughing techniques, chest physiotherapy, and position changes
Advocating adherence to treatment regimen - DOT (directly observed therapy):
- Ensure clients take medications as prescribed to prevent transmission and drug resistance
Managing side effects:
- Monitor and manage adverse side effects (hepatitis, neurologic changes, rash, GI upset)
Preventing transmission:
- Implement infection control measures (isolation, proper mask use, hand hygiene)

Discharge Planning for Tuberculosis

Patient education on:
- Disease process
- Treatment regimen
- Importance of adherence
- Side effects of medications
- Preventive measures to avoid transmission (hand hygiene, covering cough)
- Follow-up appointments and monitoring

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Description

This quiz explores the causes, classifications, and clinical symptoms of pneumonia. It covers the inflammatory processes involved, risk factors for various types of pneumonia, and specific manifestations in different populations, including older adults. Test your knowledge on this important respiratory condition.