pneumonia

Question 1

What is pneumonia?

Answer 1

Inflammation of lung parenchyma - can be caused by various microorganism

Question 2

what is the parenchyma?

Answer 2

tissue of the lungs

Question 3

What is the most common cause of death from infectious disease in the US?

Answer 3

Pneumonia and Flu

Question 4

What is pneumonia classified by?

Answer 4

origin or causative agent
location
type

Question 5

What are some types of pneumonia?

Answer 5

Community Acquired - (CAP) bacterial and viral
Health Care - Associated (HCAP)
Hospital Acquired (HAP) usually bacterial
Ventilator -Associated pneumonia (VAP)
Aspiration pneumonia - can be CAP or HAP
Immunocompromised Host
Lobar Pneumonia
Bronchopneumonia

Question 6

• Occurs in a non-hospitalized pt, with extensive health care contact such as nursing home, hemodialysis, home care treatments, antibiotics/chemotherapy within 30 days.
• May be identified in ED
• Causative pathogens are often multi-drug resistant
• Often difficult to treat

Answer 6

Health Care - Associated Pneumonia (HCAP)

Question 7

Develops at home or within 48 hrs. of admission

Usually begin as common respiratory illness that progresses to pulmonary infection.

Answer 7

Community Acquired Pneumonia (CAP) bacterial and viral

Question 8

What is the most common bacteria in people less than sixty without comorbidity and in greater than sixty with comorbidity?

Answer 8

pneumococcus (Strep)

Question 9

Onset >48 hrs. after admission with no infection at admission

Answer 9

Hospital Acquired Pneumonia (HAP)

Question 10

What are the common types of bacteria found in Hospital Acquired Pneumonia?

Answer 10

pseudomonas, klebsiella, E. coli, and MRSA etc.

Question 11

Name 3 reasons why you may see HAP?

Answer 11

• host defenses impaired
• organisms reach lower resp. tract and overwhelms the host’s defenses
• or highly virulent organism is present

Question 12

• A subtype of HAP except pt has an endotracheal tube and has been on ventilator for at least 48 hrs.
• Most common infection in ICU
• Prevention is Key

Answer 12

Ventilator-Associated pneumonia (VAP)

Question 13

Most common form is bacterial infection from aspiration of bacteria that normally reside in upper airways
Can also be from gastric contents/tube feedings etc.

Answer 13

Aspiration pneumonia (Can be CAP or HAP)

Question 14

what is commonly seen in AIDS patients or pts on chemo?

Answer 14

Pneumocystis carinii (PCP)

Question 15

part of one or more lobes involved

Answer 15

Lobar pneumonia

Question 16

Patchy, originates in one or more areas and extends to surrounding areas

Answer 16

Bronchopneumonia

Question 17

Which is more common Bronchopneumonia or lobar pneumonia?

Answer 17

Bronchopneumonia

Question 18

Which pneumonia is usually in adults?

Answer 18

Bacterial

Question 19

Which pneumonia is usually in children?

Answer 19

Viral

Question 20

Which pneumonia is more serious, Viral or bacterial?

Answer 20

Bacterial

Question 21

Some risk factors for pneumonia

Answer 21

Immunocompromised, smokers, COPD, cancer pts, immobility, shallow breathing patterns, rib fracture, NPO, NG Tube, NT Tube, Supine, Altered LOC, Alcohol ingestion, drug overdose, general anesthesia, advanced age, less cough reflex, resp therapy dirty equipment, asthma, inhaled steroids, transmission from healthcare providers

Question 22

What are preventive measures for pneumonia?

Answer 22

T, C, and DB
Stop smoking
watch for aspiration and position
incentive spirometer ten times per hour while awake
Oral hygiene
Encourage to cough
watch for sedation and resp depression
prevent infections
hand washing
make sure resp equipment is clean
flu, pneumonia vaccine

Question 23

How many different strains are there of bacterial pneumonia?

Answer 23

About 23

Question 24

What changes occure with pneumonia?

Answer 24

Hypertrophy of mucous membrane
Bronchospasm
Excess fluid
Decreased surface area
Inflammation of pleura

Question 25

What are some clinical manifestations of pneumonia?

Answer 25

Fever, chills, chest pain, tachypnea, may have upper resp infection, cough, rales, rhonchi, fatigue, orthopnea, hypoxia, cyanosis, dyspnea

Question 26

What is the CXR used for in pneumonia?

Answer 26

to look for fluid or consolidation

Question 27

Who are prone to get septic?

Answer 27

The Elderly

Question 28

What antibiotics are normally used for pneumonia if bacterial?

Answer 28

Penecillin, Vancomycin

Question 29

How long do you keep the pt on bedrest?

Answer 29

until cleared up or stable

Question 30

How many fluids to give for a pneumonia patient?

Answer 30

2500cc unless cardiac issues

Question 31

Some respiratory treatments for pneumonia

Answer 31

nebulizers bronchodilators chest percussion and postural drainage

Question 32

when do you d/c from hospital when have pneumonia?

Answer 32

``` when stable Temp less than or equal to 100 RR less than or equal to 24 HR less than or equal to 100 SBP greater than or equal to 90 O2 Sat greater than or equal to 90% ```

Question 33

What are some geriatric considerations for pneumonia?

Answer 33

May have different symptoms - general deterioration, weakness, anorexia, confusion, tachycardia, tachypnea, abdominal symptoms take flu vaccine yearly and pneumonia vaccine

Question 34

What is the diet for a patient with pneumonia?

Answer 34

High Calorie, High Protein, Carbs, Fluids/Electrolytes, Small frequent meals

Question 35

Nursing Diagnosis for Pneumonia

Answer 35

Ineffective airway clearance RT copious secretions Activity intolerance RT altered respiratory function Risk fluid volume deficit RT fever and dyspnea Altered nutrition: less than body requirements Ineffective breathing pattern Knowledge defiit Fatigue RT impaired resp. funtion

Question 36

Potential complications for pneumonia

Answer 36

``` Superinfection atelectasis pleural effusion (30% or more will develop this) Hypotension/shock resp failure ```

Question 37

Nursing interventions for Pneumonia

Answer 37

``` Assessment, Documentation Monitor for potential complications improve airway patency hold pillow to abdomen after abdominal surgery when coughing promoting rest/ conserving energy fluids high calories, protein humidified oxygen ```

Question 38

Teaching for Pneumonia

Answer 38

``` Smoking cessation Gradually increase activity breathing exercises return for follow up visits take all meds until gone Oxygen at home hand washing ```