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Questions and Answers
What is a primary characteristic of pneumonia caused by an infectious agent?
Which type of pneumonia is primarily acquired in healthcare settings?
What is one of the signficant risk factors associated with hospital-acquired pneumonia?
Which of the following symptoms is least likely to be associated with pneumonia in older adults?
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What is the appropriate use of antibiotics in pneumonia treatment?
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Which clinical manifestation is commonly seen in patients with pneumonia?
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What additional assessments should a nurse consider for older adult patients suspected of having pneumonia?
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Which of the following is not a supportive treatment for pneumonia?
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What is a key sign that may indicate the presence of pneumonia?
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Which nursing intervention is aimed at improving airway patency in a patient with pneumonia?
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Which medication is considered a first-line treatment for tuberculosis?
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What symptom is characteristic of active pulmonary tuberculosis?
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What factor may contribute to the rising mortality and morbidity rates related to tuberculosis?
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Which assessment finding is significant in evaluating a patient with suspected tuberculosis?
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What is a common complication associated with the treatment of tuberculosis?
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Which of the following factors does NOT increase the risk of tuberculosis transmission?
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When should the TB skin test results be interpreted?
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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
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Improving airway patency:
- Removing secretions: encourage hydration, humidification, coughing techniques, chest physiotherapy, position changes, oxygen therapy
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Promoting fluid intake:
- Encourage fluid intake to at least 2 L/day
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Maintaining nutrition:
- Provide nutritionally enriched foods and fluids
-
Promoting patient knowledge:
- Educate on disease process, treatment regimen, and preventive measures
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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
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Promoting airway clearance:
- Encourage hydration, coughing techniques, chest physiotherapy, and position changes
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Advocating adherence to treatment regimen - DOT (directly observed therapy):
- Ensure clients take medications as prescribed to prevent transmission and drug resistance
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Managing side effects:
- Monitor and manage adverse side effects (hepatitis, neurologic changes, rash, GI upset)
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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.
