Pneumonia

Question 1

Pneumonia Interventions

Answer 1

• Oxygen therapy
• Monitor pulse ox
• Cough & deep breath q2
• Incentive spirometry
  > 5-10 breaths per session q1 while awake
• Adequate hydration
  > helps thin secretions
• Assess fluid status
  > monitor I&Os
  > assess oral mucous membranes & skin turgor

Question 2

Pneumonia Drug Therapy

Answer 2

• Anti-infectives
  > priority when there is a bacterial infection (CORE measure)
  > determined by type & severity of infection
• Bronchodilators
• Steroids (IV or inhaled)
• Expectorants

Question 3

Pneumonia Imaging Assessment

Answer 3

• Chest X-Ray
  > most common test
  > may not show changed until 2+ days after manis are present
  > essential for early diagnosis in odler adults
• Pulse ox
• Invasive tests:
  > transtracheal aspiration
  > bronchoscopy
  > direct needle aspiration of lung

Question 4

Pneumonia Lab Assessment

Answer 4

• Sputum by Gram stain, culture, & sensitivity testing
  > determines type of organism
• CBC to assess an elevated WBC count
• Blood cultures
  > determine infection in blood
• ABGs
  > determine need for oxygen & baseline O2 & CO2 lvls
• Serum lactate lvls
  > used for prognosis & effectiveness of treatment
• Procalcitonin
  > used to determine antibiotic use & clinical improvement
• BUN & electrolytes
  > determine fluid status

Question 5

Pneumonia CMs

Answer 5

• Incrd RR or dyspnea
• Hypoxemia
• Cough
• Purulent, blood-tinged, or rust-colored sputum
• Fever w/ or w/out chills
• Lungs: crackles, wheezing, diminished
• Myalgia
• Headache
• Rapid, weak pulse may indicate hypoxemia, dehydration, impending sepsis, or shock
• Hypotension
  > a result of vasodilation & dehydration, especially in ilder sdult
• Acute confusion from hypoxia (most common in older pts; fever or cough may be absent)
• Older adult: confusion, weakness, fatigue, lethary, poor appetite, hypotension

Question 6

Pneumonia Prevent

Answer 6

• Avoid risk factors:
  > annual flu vaccine
  > pneumococcal vaccine
  > acoid crowded public area during flu & holiday seasons
  > handwashing
  > if limited mobility, cough, turn, move, deep breathing exercises
  > Clean resp eqiupment
  > avoid indoor pollutants
  > stop smoking
  > rest & eat healthy, balanced diet
  > 3L of fluids daily

Question 7

Pneumonia Risk Factors

Answer 7

• Older adult
• Not received flu or pneum vaccine
• Chronic health problems
  > esp chronic lung disease
• Recent exposure to resp viral or flu infections
• Limited mobilty
• Uses tobacco or alcohol
• Presence of gram-neg colonization of mought. throat, & stomach
• Altered LOC
• Aspiration
• Presence of endotracheal, trach, or NG tube
• Poor nutritional status
• Have immunocompromised status
• Mechanical vent (vent-associated pneum)