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Med Surg Ch. 28 Lower respiratory
Terms in this set (53)
What is pneumonia?
Pneumonia is an acute infection of the lung parenchyma. Until 1936, pneumonia was the leading cause of death in the United States.
The discover of what was pivotal in treating pneumonia?
sulfa drugs and penicillin
What is the sixth leading cause of death for people 65 years or older in the US?
Community-acquired pneumonia (CAP)
What normally protects you from infection?
Normally, the airway distal to the larynx is protected from infection by various defense mechanisms.
What are mechanisms that create a mechanical barrier?
Mechanisms that create a mechanical barrier to microorganisms include air filtration, epiglottis closure over the trachea, cough reflex, mucociliary escalator mechanism, and reflex bronchoconstriction.
What are immune defense mechanism?
Immune defense mechanisms include secretion of immunoglobulins A and G and alveolar macrophages.
When is pneumonia more likely to occur?
Pneumonia is more likely to occur when the defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents.
What does decreased consciousness do?
Decreased consciousness depresses the cough and epiglottal reflexes, which may allow aspiration of oropharyngeal contents into the lungs.
What are some risk factors for pneumonia?
abdominal or thoracic surgery, over 65, air pollution, altered consciousness (alcoholism, head injury, overdose, stroke), bed rest, chronic diseases, immunosuppressive disease, IV drug use, malnutrition, smoking, etc.
What are potential causes of pneumonia?
Bacteria, viruses, Mycoplasma organisms, fungi, parasites, and chemicals
What is a clinically effective way to classify pneumonia?
community-acquired or medical care-associated pneumonia.
Why is it important to classify pneumonia?
the differences in the likely causative organisms and the selection of appropriate antimicrobial therapy.
What is the CURB-65?
a way of assessing pneumonia to determine the severity of pneumonia and if patients need to be hospitalized
What does CURB-65 stand for?
R- respiratory rate>/30 breaths/min
B- systolic blood pressure <90 or diastolic blood pressure</60
65- age 65 or older
What is aspiration pneumonia?
Aspiration pneumonia, occurring as either CAP or MCAP, results from the abnormal entry of material from the mouth or stomach into the trachea and lungs.
What does the aspirated material (food, water, vomitus, or oropharyngeal secretions) cause?
triggers an inflammatory response.
Who is at risk for opportunistic pneumonia?
include those with altered immune responses. This can include people with severe protein-calorie malnutrition or immunodeficiencies (e.g., human immunodeficiency virus [HIV] infection), and those receiving radiation therapy, chemotherapy, and any immunosuppressive therapy, including long-term corticosteroid therapy.
What do the majority of organism that cause pneumonia trigger?
an inflammatory response in the lung. A vascular reaction occurs, characterized by an increase in blood flow and vascular permeability. Neutrophils are activated to engulf and kill the offending organisms.
What causes clinical manifestations of hypoxia?
The neutrophils, the offending organism, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation, leading to clinical manifestations of hypoxia (e.g., tachypnea, dyspnea, tachycardia).
What does mucus production cause?
Mucus production is also increased, which can obstruct airflow and further decrease gas exchange.
What is consolidation?
Consolidation, a feature typical of bacterial pneumonia, occurs when the normally air-filled alveoli become filled with fluid and debris. Complete resolution and healing occur if there are no complications. Macrophages lyse and process the debris, normal lung tissue is restored, and gas exchange returns to normal.
What are the most common presenting symptoms of pneumonia?
cough, fever, shaking chills, dyspnea, tachypnea, and pleuritic chest pain. The cough may or may not be productive. Sputum may appear green, yellow, or even rust colored (bloody).
What can viral pneumonia initially be seen as?
influenza, with respiratory symptoms appearing and/or worsening 12 to 36 hours after onset.
What are some symptoms that older people usually have when they have pneumonia?
The older or debilitated patient may not have classic symptoms of pneumonia. Confusion or stupor (possibly related to hypoxia) may be the only finding. Hypothermia, rather than fever, may also be noted with the older patient.
What can you sometimes hear when listening to the lungs when someone has pneumonia?
rhonchi and crackles may be auscultated over the affected region.
What can you hear if there is consolidation?
If consolidation is present, bronchial breath sounds, egophony, and increased fremitus (vibration of the chest wall produced by vocalization) may be noted.
What would patients with pleural effusion show?
Patients may exhibit dullness to percussion over the affected area.
Why would complications to pneumonia happen?
Complications develop more frequently in older individuals and those with underlying chronic diseases.
What are some potential complications to pneumonia?
pleurisy, pleural effusion, atelectasis, bacteremia, lung abscess, empyema, pericarditis, meningitis pneumoniae, sepsis, acute respiratory failure, and pneumothorax.
What is pleurisy?
Pleurisy (inflammation of the pleura) is relatively common.
what is pleural effusion?
• Pleural effusion (fluid in the pleural space) can occur. In most cases, the effusion is sterile and is reabsorbed in 1 to 2 weeks. Occasionally, effusions require aspiration by thoracentesis.
What is atelectasis?
• Atelectasis (collapsed, airless alveoli) of one or part of one lobe may occur. These areas usually clear with effective coughing and deep breathing.
Why would bacteremia happen from pneumonia?
• Bacteremia (bacterial infection in the blood) is more likely to occur in infections with Streptococcus pneumoniae and Haemophilus influenzae.
Why would lung abscesses occur from pneumonia?
• Lung abscess is not a common complication of pneumonia. However, it may occur with pneumonia caused by S. aureus and gram-negative organisms.
What is empyema?
• Empyema, the accumulation of purulent exudate in the pleural cavity, occurs in less than 5% of cases and requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage.
What is pericarditis?
• Pericarditis results from spread of the infecting organism from infected pleura or via a hematogenous route to the pericardium.
How can meningitis occur from pneumonia?
• Meningitis can be caused by S. pneumoniae. The patient with pneumonia who is disoriented, confused, or drowsy may have a lumbar puncture to evaluate the possibility of meningitis.
How can sepsis occur from pneumonia?
• Sepsis can occur when bacteria within alveoli enter the bloodstream. Severe sepsis can lead to shock and multisystem organ dysfunction syndrome (MODS).
What is acute respiratory failure?
• Acute respiratory failure is one of the leading causes of death in patients with severe pneumonia. Failure occurs when pneumonia damages the lungs' ability to exchange oxygen for carbon dioxide.
What is a pneumothorax?
• Pneumothorax can occur when air collects in the pleura space, causing the lungs to collapse.
What are diagnostics studies for pneumonia?
History, physical examination, and chest x-ray often provide enough information
What do you do before beginning antibiotic therapy?
Ideally, a sputum specimen for culture and Gram stain to identify the organism is obtained before beginning antibiotic therapy.
When should a person get a pneumonia vaccine?
recommended for individuals 65 years of age or older and younger patients who are at high risk. A one-time repeat vaccination in 5 years is recommended for those who received their initial vaccination when less than 65 years of age
What are some supportive measures to individualize patients needs?
These may include O2 therapy to treat hypoxemia, analgesics to relieve chest pain, and antipyretics such as aspirin or acetaminophen for significantly elevated temperature. Although cough suppressants, mucolytics, bronchodilators, and corticosteroids are often prescribed as adjunctive therapy, there is insufficient evidence to support their use.
Rest and activity for patients with pneumonia?
Individualize rest and activity to the patient's tolerance. Benefits of mobility include improved diaphragm movement andchest expansion, mobilization of secretions, and prevention of venous stasis.
What is the treatment for viral pneumonia?
Currently, no definitive treatment exists for the majority of viral pneumonias. Care is generally supportive. Antiviral therapy may be used to treat pneumonia caused by influenza (e.g., oseltamivir or zanamivir) and a few other select viruses (e.g., acyclovir [Zovirax] for herpes simplex virus)
What is nutritional therapy for pneumonia?
Hydration is important in the supportive treatment of pneumonia to prevent dehydration and loosen secretions.
What are some nursing diagnoses for a patient with pneumonia?
• Impaired gas exchange related to fluid and exudate accumulation at the capillary-alveolar membrane
• Ineffective breathing pattern related to inflammation and pain
• Acute pain related to inflammation and ineffective pain management and/or comfort measures
What are some overall goals for a patient with pneumonia?
patient will have (1) clear breath sounds, (2) normal breathing patterns, (3) no signs of hypoxia, (4) normal chest x-ray, and (5) no complications related to pneumonia.
What should you do to reduce the risk of pneumonia?
teach individuals to practice good health habits, such as frequent hand washing, proper nutrition, adequate rest, regular exercise, and coughing or sneezing into the elbow rather than hands.
What is one of the most important health promoting behaviors to reduce pneumonia?
Avoidance of cigarette smoke is one of the most important health-promoting behaviors.
What is essential nursing care for patients with pneumonia?
monitoring physical assessment parameters, providing treatment, and monitoring the patient's response to treatment. Along with physical assessment (including pulse oximetry monitoring), prompt collection of specimens and initiation of antibiotics are critical. Oxygen therapy, hydration, nutritional support, breathing exercises, early ambulation, and therapeutic positioning are part of nursing management. Collaboration with respiratory therapy for postural drainage and chest percussion is important.
What should you recommend to a patient to help them breath easier?
A cool mist humidifier or warm bath
This set is often in folders with...
Med Surg Ch. 33
Med Surg Ch. 38 Vascular Disorders
Meg Surg Ch. 67 Shock
Med Surg Ch 29 Obstructive Pulmonary Disease
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