Pneumonia PDF

Pneumonia Learning Outcomes Describe the pathophysiology of pneumonia Identify the types of pneumonia and risk factor Recognize and Analyze cues with diagnostic assessment findings Formulate a plan of care for the patient with pneumonia Discuss the medical...

Pneumonia Learning Outcomes Describe the pathophysiology of pneumonia Identify the types of pneumonia and risk factor Recognize and Analyze cues with diagnostic assessment findings Formulate a plan of care for the patient with pneumonia Discuss the medical management of pneumonia Evaluate interventions Pneumonia Infection of the lower respiratory tract microorganisms o Causes: bacteria, viruses, fungi, protozoa, and parasites o Aspiration and inhalation 1% of the population. 1.5 million hospitalizations annually High mortality and morbidity Pneumonia from by COVID-19 is the leading cause of death by infectious source in the United States Influenza and other pneumonias is the ninth overall cause of death Classification Microbiologic cause, Host condition Host setting Community-acquired pneumonia (CAP) Hospital-acquired (nosocomial) pneumonia (HAP) Ventilator-associated pneumonia (VAP) Pneumonia in an immunocompromised patient Overview- Pathophysiology of Pneumonia Pathogens enter the lung Host defenses are overwhelmed by number of organisms or virulence in order for infection to develop Colonization of organisms in alveoli causes inflammatory and immune response Overview- Pathophysiology of Pneumonia Antigen-Antibody and endotoxins cause damage to bronchial and alveolar mucous membranes This leads to inflammation and vascular congestion and edema Exudate and debris fill alveoli and decrease gas exchange--- Leads to consolidation of lung tissue  Clinical Manifestations of Bacterial Pneumonia Chills (Rigors) Dyspnea Fever Cough Rust colored sputum or Decreased oxygen purulent sputum saturation Pleuritic chest pain Cyanosis Adventitious breath sounds Anxiety (decreased, crackles, rhonchi) Confusion Abrupt onset Community-Acquired Pneumonia (CAP) Risks factor Smoking Alcohol use disorder Dysphagia Pre-existing hypoxemia HIV Acidosis Chronic kidney or liver disease Toxic inhalations Malnutrition; underweight Pulmonary edema Immunosuppressive therapies Altered mental status Poor dental hygiene COPD, asthma Age older than 65 years Intravenous drug use Cardiovascular diseases (HF) Regular contact with children Cerebrovascular disease 10 or more people living in a household Parkinson disease Epilepsy Previous episodes of pneumonia Dementia Environmental conditions Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) Debilitation Malnutrition Altered mental status Previous exposure to antibiotics (within the last 90 days) Hospital stays of 5 days or longer High rates of antibiotic resistance (hospital or unit-specific) Immunosuppressive therapies or diseases Prolonged (greater than 48 hours) intubation or a tracheostomy Male biologic sex Treatment related, e.g., mechanical ventilation, unintentional extubation, upper abdominal surgery, thoracic surgery Supine position Diagnostic Evaluation Chest X-ray Sputum gram stain Laboratory Studies: CBC Blood cultures Arterial blood gases HIV test Electrolytes Bronchoscopy Interprofessional Care- Pharmacotherapy Oxygen therapy Antibiotics Antipyretics Anti-virals Anti-inflammatory agents Bronchodilators Mucolytics Cough Expectorants Interprofessional Care Influenza & Pneumococcal Vaccines Supportive therapy Nursing Assessment Subjective Data (Patient history) Objective Data (Physical Assessment) Review diagnostic test results Nursing Goals of Care Pt will exhibit… Clear breath sounds Breathing pattern within normal limits No signs of hypoxia No complications associated with pneumonia Client Problems Ineffective airway clearance Activity intolerance Risk for deficient fluid volume Malnutrition risk for less than body requirements Knowledge deficiency Nursing Process- Planning Goals of Care Pt will exhibit… Clear breath sounds Breathing pattern within normal limits No signs of hypoxia No complications associated with pneumonia Nursing Health Promotion (Hospitalized patient) Identify patient at risk for pneumonia Careful consideration of positioning of patient with altered level of consciousness or aspiration risk Encourage patient to get out of bed Encourage deep breathing Maintain strict medical asepsis during patient care and in between patient contact  NURSING INTERVENTIONS: IMPROVING AIRWAY PATENCY Removing secretions Hydration (2 to 3 L/day) as tolerated Humidification Lung expansion maneuvers such as Deep breathing and cough incentive spirometer Good Lung down Chest PT Consult Respiratory Nursing Actions Monitor respiratory parameters on ongoing basis (rate, rhythm, breath sounds, pulse oximetry, ABGs if ordered) Monitor Neurologic status Monitor Temperature every 4 hours Nursing Actions Maintain head of bed at Fowler’s position with arms supported Provide supplemental humidified oxygen as prescribed Encourage deep breathing & assist with position changes Nursing Actions Assist with Chest Physiotherapy as appropriate Teach & encourage incentive spirometer use Teach pt to splint chest with coughing Nursing Actions Encourage fluids (2-3 liters per day unless contraindicated)- may be PO & or IV Set up suction equipment and suction if necessary Administer antibiotics, inhalers, antipyretics as prescribed Nursing Actions Provide comfort measures (dry bedclothes, sheets, oral care) Provide foods that are easier to chew and digest Space activity with rest periods Nursing Actions Provide receptacle to place secretions & teach pt. importance of placing items in receptacle Provide time to answer questions & to allay anxiety and fears Nursing Action Health (Discharge) Teaching: Hand hygiene Obtain rest, nutrition, exercise Avoid known exposure to URIs Obtain care for symptoms > 7 days Nursing Actions Obtain Flu and Pneumonia vaccines (Health Promotion) Provide smoking cession education (Health Promotion) Complete full course of antibiotics Resume activities gradually Complication Shock Respiratory Failure Atelectasis Pleural effusions Superinfection Confusion Nursing Process- Evaluation Are Goals and Outcomes Met? How would you evaluate if medications and treatment are effective? What criteria would you use to determine if plan of care has been effective?