The Concept of Infection: Pneumonia (PDF)

THE CONCEPT OF INFECTION: PNEUMONIA NR 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN  Course Student Learning Outcomes 1 2 3 4 Provide safe, patient- Demonstrate...

THE CONCEPT OF INFECTION: PNEUMONIA NR 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN  Course Student Learning Outcomes 1 2 3 4 Provide safe, patient- Demonstrate Relate the impact of Explain management centered, evidence- intermediate levels of quality improvement of care concepts for based nursing care critical thinking & measures to improved adult patients guided by the Caritas clinical reasoning to patient care philosophy provide quality patient care The Concept of Infection: The Chain of Infection  Overview and Pathophysiology Inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) as a result of infection. What types of pathogens can invade the lungs and cause pneumonia? Answer: bacteria, viruses, fungi, protozoa What pathogen causes roughly 50% of pneumonia cases? Answer: streptococcus pneumoniae Disorders can affect the lower respiratory system: Affect ability to ventilate Affect respiration Affect ability to maintain airways Pathophysiology and Etiology What happens when pneumonia occurs? Organisms enter the lungs: Inhaled Through bloodstream from infection elsewhere Aspiration Organisms colonize alveoli Initiate inflammatory, immune response Inflammation, vascular congestion, edema Infectious debris, exudate fill alveoli -Fluid accumulation -Fluid leakage -INFILTRATES (substance denser than air- fluid, pus) -Consolidation (solidification of lung tissue)  Infectious Bacteria, viruses, fungi, protozoa Noninfectious Aspiration of gastric contents Pathophysiology Inhalation of toxic or irritating gases and Etiology Bacterial pathogens Usually in one or more lobes of single lung Viruses Bronchopneumonia Typically a mild disease pattern Aspiration Chemical injury- lower pH material of GI tract can cause a severe inflammatory response Pathophysiology and Etiology – Bacterial Bacterial pathogens will circulate around in the bloodstream leading to the lungs, where they damage cells. Those damage cells will cause cellular debris and mucus which can cause airway obstruction. Usually in one or more lobes of single lung, a pattern termed unilateral lobar pneumonia. Pathophysiology and Etiology – Viral Viruses frequently enter through the upper respiratory tract. Infiltrating the alveoli nearest the bronchi of one or both lungs. They invade the cells, replicate, and burst out forcefully, killing the cells and sending out debris. They rapidly invade adjacent areas, distributing themselves in a scattered patchy pattern referred to as bronchopneumonia. Typically, a mild disease pattern Pathophysiology and Etiology – Aspiration Aspiration of food, emesis, gastric reflux, or hydrocarbons causes a chemical injury and an inflammatory response. Materials with a lower pH causes more inflammation, which sets the stage for bacterial invasion.  Pathophysiology and Etiology Community Acquired (CAP) Healthcare-associated (HCAP) Hospital acquired (HAP) Ventilator associated (VAP) Opportunistic Primarily in immunocompromised patients (AIDS) Immunosuppressive or cytotoxic drugs for cancer  Etiology- Community Acquired Pneumonia Acute bacterial pneumonia Spread via Complications Pneumococcal pneumonia Individual to individual via Pleuritis (streptococcus pneumoniae) droplets Pleural effusion Causes about 50% of Aspiration of resident Lung abscess community acquired bacteria Empyema pneumonia leading to hospital admission Resides in the upper respiratory tract of up to 70% of adults  Etiology- Primary Atypical Pneumonia Patchy inflammatory Mycoplasma pneumoniae changes in alveolar septum, Highly contagious Typically, mild disease interstitial tissue of lung course Presentation, course differ Exudate and consolidation Outbreaks in crowded Oftentimes referred to as from other bacterial of lung tissue not found settings “walking pneumonia” pneumonias Young adults- college students and military recruits Resembles viral pneumonia  Etiology- Viral Pneumonia Typically, a mild Lung involvement is Common organisms disease that often limited to the alveolar Occurs in community are influenza and affects older adults, septum and interstitial epidemics adenovirus people with chronic spaces conditions May present with flu- Headache, fever, Sudden or gradual like symptoms and dry fatigue, malaise, muscle onset cough aches  Etiology- Opportunistic Pneumonia May present with abrupt SIGNIFICANT Pneumocystis jiroveci At risk: Patchy involvement onset, with fever, tachypnea, pneumonia throughout lungs shortness of breath, and dry RESPIRATORY DISTRESS nonproductive cough. Caused by a common People with AIDS Causes alveoli to thicken parasite/fungi found Those with significant and become edematous worldwide called immunocompromise Alveoli fill with foamy and Pneumocystis jiroveci protein-rich fluid Immunity is usually Gas exchange is severely universal, except in those impaired immunocompromised  Aspiration pneumonia Aspiration of gastric contents Chemical and bacterial pneumonia Etiology- Risk Factors Aspiration Emergency surgery or obstetrical procedures Depressed cough and gag reflex Pneumonia Impaired swallowing Low pH of gastric contentsà severe inflammatory response Pulmonary edema, and respiratory failure may occur Common complications Abscesses Bronchiectasis (chronic dilation of bronchi and bronchioles) Gangrene of pulmonary tissues  Risk Factors Altered immunity, compromised immune Frequent exposure to Altered level of Age cigarette smoke Alcohol or drug use consciousness system Infants, young HIV/AIDS, cancer Smoking injures in Alcohol interferes Why? children, older adults patients, organ airway tissue can with macrophage transplants decreases cilia action action Hyperplasia of Injection drug use- bronchial epithelium increased risk of cells bloodstream spread of The chemical in infection cigarettes have a numbing effect on the cough reflex Increased production of mucus  Prevention Identify vulnerable populations Instituting preventative strategies and measures to reduce the mortality and morbidity associated with the condition. Early identification of infecting organism -Why? VACCINES Pneumococcal vaccineà single dose gives lifetime immunity One-time revaccination Immunosuppressed individuals Adults >65 years old who were immunized >5 years previously and before the age of 65  Clinical Manifestations Productive cough, purulent sputum Dyspnea, crackles in Fever & chills Excessive mucous production lungs Hemoptysis (coughing up blood) Headache, fatigue, Chest pain (pleuritic) Confusion muscle pains, diminished sharp, localized appetite  Bacteremia can spread infection to other tissues Can lead to: Meningitis Clinical Manifestations Endocarditis Peritonitis Increased risk of mortality Entry into the bloodstream Septicemiaà septic shock  Diagnostic Tests Computed Sputum culture and Complete blood Chest x-ray tomography (CT Sputum gram stain count (CBC) with scan) sensitivity WBC differential Determine extent, Used when chest Gram positive or Secretion must be Look for “left pattern of lung x-ray not gram negative? from lower shift”- increased involvement diagnostic Antibiotic therapy respiratory tract! circulating Fluid, infiltrates, Can provide a directed to that immature consolidated lung more detailed organism leukocytes tissue image of Atelectasis can be pulmonary tissue seen (areas of alveolar collapse)  Diagnostic Tests Pulse oximetry Arterial Blood Gas (ABG) Bronchoscopy Procalcitonin levels May indicate impaired Evaluate gas exchange May be done to obtain Serum biomarker alveolar gas exchange Arterial partial pressure of sputum specimen Helps distinguish bacterial oxygen (Pa02) of less than Remove secretions from infection from other 75-80 mmHg indicates the bronchial tree causes of infection or impaired gas exchange or inflammation alveolar ventilation Helps guide antibiotic therapy in treating pneumonia