Pneumonia & ABG's Flashcards
(4)
1
Q
Pneumonia
- Is an excess of fluid in the lungs resulting from an inflammatory process
- Inflammation is triggered by many infectious organisms and by inhalation of irritating agents
- Inflammation and edema thicken the alveolar walls and capillary leak collects in alveoli spaces
A
- Alveoli can collapse causing atelectasis and severely effects gas exchange
- Infection can spread locally and consolidate (solidify) in a lobe, to the blood, causing sepsis or to the pleural space causing a pleural effusion or empyema (pus in the pleura)
2
Q
Pathophysiology
- Community-acquired pneumonia (CAP)
- Healthcare-acquired pneumonia (HAP)
A
- In the US, 2-5 million cases of pneumonia occur each year and it is the 7th leading cause of death
- Incidence is higher among older adults, nursing home residents, hospitalized patients, and those being mechanically ventilated
- CAP is more common than HAP and occurs in late fall and winter as a complication of influenza
3
Q
- HAP (a nosocomial infection) is commonly acquired as a result of transmission during a hospital stay
- A specific type of HAP is ventilator-associated pneumonia (VAP)
- HAP has a 20-50% mortality rate; the highest incidence is in those patients infected with Pseudomonas aeruginosa, Acinetobacter, Klebsiella, other “high risk” organisms, or secondary bacteremia
- HAP has a higher rate of drug resistance
A
4
Q
Risk Factors - CAP
- Older adult
- No pneumococcal vaccination or received it >6 years ago
- No influenza vaccine in the previous year
- Chronic health problem or other comorbidity
- Exposure to respiratory, viral, or influenza infections
- Tobacco, alcohol, or secondhand smoke
A
Risk Factors - VAP
- Older adult
- Chronic lung disease
- Gram negative colonization of mouth, throat, and stomach
- Altered LOC
- Recent aspiration event
- Endotracheal, tracheostomy, or nasogastric tube
- Nutrition - poor nutritional status
- Immunocompromised (from disease or drug therapy)
- Increased gastric pH (drugs like histamine H2 blockers, antacids) or alkaline tube feedings]
- Mechanical ventilation (currently receiving)
5
Q
General Prevention
- Pneumonia, influenza vaccine (encourage those >65 and with a chronic health problem to get PPV23)
- Hand washing
- Avoid crowds
- Avoid smoke/air contaminants
- Smoking cessation - use of transdermal nicotine patches - can’t smoke with use = may have MI - refer to counseling
- Cough and deep breathing
- 3L liquids
- Proper rest and diet
A
VAP Prevention
- Oral care (w/a disinfecting agent right before intubation) & suctioning
- Oral care @ least q12h
- Remove subglottic secretions frequently (@ least q2h) or continuously (when endotracheal tube has a separate lumen that opens directly above tube cuff)
- Remove jewelry & wash hands
- HOB elevated 30°
- Confirm placement of any NG tube
- Initial x-ray obtained?
- Avoid supine position within hr >bolus tube feeding
- Wean from ventilator
- Consider asap; look @ ABGs; how is pt responding to ↓ O2 on ventilator?
6
Q
Assessment/Data collection
- Lung sounds - diminished/muffled or adventitious (crackles w/alveolar involvement (mucous); wheezes w/narrowing of airways; rhonchi mucous collection in larger bronchioles
- Use of accessory muscles (nasal flaring, supraclavicular, diaphragm muscle)
- Tactile ___ (vibration) - hands in areas of listening to lung sounds w/pt saying “99”
- Areas of increased __ can be areas of consolidation
___ - stethoscope on areas of lung sounds; pt says letter “E”. Should sound like “E”. If sounds like letter “A”, there is probable consolidation (send for cxr)
A
fremitus; fremitus
Egophony
7
Q
- Decreased chest expansion
- Hypotension, tachycardia, tachypnea (septicemia is a concern)
- Sputum production quality & quantity (note amount/appearance/color/odor)
- Pain (pleuritic), anxiety, fatigue
A
- Fever, chills
- Cough (d/t ↑ mucous production)
- Confusion (cyanosis is a late sign of hypoxia; most common manifestation of pneumonia in the elderly from hypoxia)
- Diaphoresis & cyanosis
- Poor appetite
- Cardiac dysrhythmias
8
Q
Data Collection
- Oxygen saturation
- NI - 95% or greater in healthy population; always document how much O2/RA the pt is on when you give the O2 sat
- CBC (elevated WBCs or leukocytosis)
- Chest radiography (1x/day; can show consolidation or pleural effusion [fluid collection in pleura] [0-2 min only]
A
Data collection - Sputum specimen
- Pt can expectorate into sterile cup >rinsing with H2O or saline. Sample must come from mucous deep in lungs and not saliva. Mucous can be loosened with inhaled saline nebulizer. If pt unable to expectorate on own, suctioning may be needed
9
Q
- Gram stain
- Bacterial species that stain purple are classified as Gram-positive organisms; those that stain red are Gram-negative organisms
! This simple difference is very important in guiding the choice of antibiotic therapy (Gram-negative are harder to treat) - Sputum culture (grown in a culture medium)
- Sensitivity
- abx discs put in petri dishes/medium to see which abx kills organism best; takes days to decipher
A
- Antibiotic therapy (intervention)
- Empiric therapy
> Usually within 6 hrs of presentation
> Is admin of abx based on practitioner’s judgement of pathogens most likely to be causing an apparent infection; involves presumptive treatment of infection to avoid treatment delay before specific culture info has been obtained - broad-spectrum coverage of anaerobic, Gram-positive and Gram-negative bacteria - Definitive therapy
> Admin of abx based on known results of C&S testing ID’ing pathogen causing infection - switch helps development of bacterial resistance
> Common organisms for resistance include Streptococcus pneumoniae (DRSP)
> Usually started on IV, then switched to PO - Blood cultures (drawn to r/o organisms that have invaded bloodstream)
10
Q
Body fluid pH is a measure of the body fluid’s free hydrogen ion level (H+)
The lower the pH value of a fluid, the higher the level of free hydrogen ions
We strive to maintain a normal pH in the body of 7.35-7.45, which is actually slightly alkalotic
Imbalances do occur causing the body’s fluids to become more acidotic or alkalotic
pH below __ or above __ is usually fatal
A
6.9; 7.8
11
Q
Changes in pH can
- reduce the function of hormones and enzymes
- cause fluid and electrolyte imbalances
- cause heart, nerves, muscles, and GI tract to be either less or more active than normal
- decreases the effectiveness of many drugs
A
12
Q
What compound is a common acid producer?
A
Carbon dioxide
13
Q
Metabolism of carbohydrates produces the waste product of carbon dioxide that is eliminated by the lungs
CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-
A
14
Q
?
An abnormal deficiency of oxygen in the blood
A
Hypoxemia
15
Q
?
Insufficient oxygen available to meet the metabolic needs of tissues & cells
?
An abnormal deficiency of oxygen in arterial blood
A
Hypoxia
Hypoxemia
31
Q
Respiratory Acidosis
- COPD
- Pneumonia
- Hypoventilation
- Drugs
- CNS
- Airway
- Trauma
- Constriction
- Obesity
- Hypokalemia
- Respiratory muscle disease
A
Respiratory Alkalosis (blowing off excess CO2)
- Hyperventilation
- Fear
- Anxiety
- Mechanical ventilation (if rate too high)
- Shock
- Early stage acute pulmonary problems
