PNA Flashcards
(38 cards)
PNA Pathophysiology
Inflammatory process —> production of alveoli exudate: decreased O2 diffusion —> migration of WBC to alveoli: decrease O2 diffusion —> decreased ventilation (bronchi edema, secretions): decreased alveolar O2 tension
Ventilation/ perfusion mismatch
Oxygen available but cannot reach the capillaries causing blood to leave pulmonary circulation poorly oxygenated
PNA risk factors (10)
- immunosuppressive (older adults)
- shallow breathing (OA)
- weak cough reflex (OA)
- immobility (stroke, frail)
- mucus and bronchial obstruction
- smoking
- NPO, NG/ET tubes
- supine position
- respiratory depression]
- antibiotic therapy
Community-acquired PNA: CAP
- acquired within the community
- diagnosis less than 48h of hospital admission and does not meet criteria for HCAP
Health care-associated PNA: HCAP (what is it and the factors)
Diagnosis less than 48 hours after admission with any of the following factors:
- acute care hospital for more than 2 days within 90 days of diagnosis
- nursing home or long term care facility
- recent IV antibiotic therapy, chemotherapy, or wound care within 30 days preceding current diagnosis
- hospital or hemodialysis clinic
Usual cause of HCAP, how hard is it to treat, what kind of antibiotics?
- usually caused by MDR pathogen (MRSA)
- difficult to treat due to antibiotic resistance
- special antibiotics needed (different from CAP)
Hospital acquired PNA: HAP
- occurrence more than 48 hours of hospital admission
- no clinical manifestations at time of admission
Predisposing factors to HAP (4)
- impaired defenses, comorbidities
- malnutrition, immobility
- CNS depression with hypoventilation (stroke, respiratory failure)
- NG tubes, prolonged antibiotic course
HAP Presentation
- CXR: new pulmonary infiltrate
- evidence of infection: Fever, respiratory symptoms, purulent sputum, leukocytosis
- may evolve to consolidation: solidification of tissues
- mediastinal shift: deviation of mediastinal structure towards one side of the chest cavity, indicating severe asymmetry of intrathoracic pressures (***REQUIRES EMERGENCY INTERVENTIONS: THORACOTOMY W/ DRAINAGE)
Ventilator-associated PNA: VAP
- type of HAP
- more than 48 hours after endotracheal tube intubation
Prevention of VAP
- HOB 30-45 degrees
- daily assess readiness to extubate
- PUD prophylaxis (peptic ulcer disease)
- DVT prophylaxis
- daily oral care with chlorhexidine
Aspiration PNA (most common aspiration, other aspirations, where it occurs, what causes the PNA)
- most common aspiration: bacteria from upper airways
- other types of aspiration: gastric contents, exogenous chemicals
- may occur in the community or hospital
- inflammatory changes lead to bacteria growth —> PNA
PNA Diagnosis
- H&P
- CXR
- blood and sputum culture —> only for sever disease, all inpatients empirically treated diet MRS or pseudo
PPSV Vaccination
- one time: all patients 65 or older, adult with chronic diseases or smoking
- second dose: All 65 year old adults who received first dose more than 5 years ago
PCV13 and PPSV23
Pharmacological therapy: antibiotics for bacterial PNA
- mono therapy or combination
- IV to PO when patients are stable
What does a stable PNA patient look like?
T < 100 HR <100 RR < 24 SBP> 90 O2 Sat > 90%
Other therapies for PNA (5)
- symptoms support
- O2 PRN
- pulse ox
- IV fluids
- ABGs monitoring
Gerontological considerations for PNA
- increased mortality
- classic symptoms may not be present (chest pain, fever, sputum, leukocytosis)
- onset symptoms: confusion, weakness, increased HR, increased RR, abd upset
- abnormal breath sounds misleading: decreased at bases, atelectasis, crackles from CHF
PNA Complications (4)
- resp failure
- sepsis and septic shock
- aspiration
- pleural effusion: empyema: accumulation of thick purulent fluid; thoracentesis: removal of fluid; chest tube: drainage of fluids, empyema
Nursing process assessment (7)
- early detection
- pleuritic pain
- fatigue
- tachypnea
- use of accessory muscles
- sputum
- changes in temp (may be slight in gero patients)
Nursing process: diagnosis
- ineffective airway clearance r/try copious secretions
- impaired gas exchange r/t copious secretions
- fatigue/activity intolerance r/t impaired resp function
- imbalanced nutrition: less than body requirements
- risk for deficient fluid volume r/t fever and tachypnea
Nursing process interventions (patency) (6)
-improving patency —> hydration and humidification of secretions, lung expansion, effective directed cough, chest pt, O2 therapy, administer prescribed antibiotics and other meds
Nursing process interventions (administer ___, promote ____ and ____, maintain or improve ____, promote ___, prevent and manage complications: ___, ___, ___, ____, ____)
- administer antibiotics for bacterial PNA
- promote rest
- promote fluid intake (at least 2L/day unless contraindicated)
- maintain or improve nutritional status
- promote knowledge: disease and healing
- prevent and manage complications: assess labs, VS, response to antibiotic treatment, CXR, LOC
PNA prevention for post surgical patients
Incentive spirometry —> keeps lungs active during bed rest which lowers the risk of PNA
