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Flashcards in week 11- pneumonia and influenza Deck (30)
1

Influenza

Highly contagious acute viral respiratory infection
Occurs in all ages
Epidemics common
Caused by several viruses (A, B,C)
Usually lasts 2-7 days

2

High Risk Groups influ

children 6-23 months old
persons 65 +
pregnant women
adults and children with chronic health
problems

3

Lifespan Considerations

Symptoms may vary from person to person
Elderly may not have a fever
Children can also have earaches, nausea, vomiting, and diarrhea
Cough and fatigue can persist for up to several weeks

4

complications influ

Pneumonia
Death
**especially in elderly, immunocompromised, debilitated

5

Transmission

Contagious 24 hrs before symptoms occur and up to 7 days after
Immunocompromised pts may remain contagious for several weeks
Spread through coughing, sneezing, talking and direct contact with infected surfaces

6

Prevention influ

• Influenza vaccine annually based on specific viral strain most likely
o No longer contraindicated if allergic to eggs-use low dose test first
• especially important for high risk groups
• Handwashing
• Sneeze or cough into sleeve
• Avoid those who are ill
• Avoid large gatherings of people
• Administer in the Fall to develop antibodies for winter season

7

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8

assessment influ

**monitor for dehydration
**monitor fever
**assess ability for self-care

9

Interventions

• take basic pain or fever relievers
• Rest
• ++ fluids (unless fluid restricted), avoid caffeine
• apply heat for short periods of time using a hot water bottle or heating pad to reduce muscle pain
• take a warm bath
• gargle with a glass of warm water or suck on hard candy or lozenges
• use saline drops or spray for a stuffy nose
• avoid alcohol and tobacco
• Antivirals
o May shorten duration if taken within 24-48 hrs after onset
o May be used for prevention

do not give acetylsalicylic acid (ASA or Aspirin®) to children or teenagers under the age of 18

10

Children

• Take child to emergency department if:
• fast or difficult breathing
• bluish or dark-coloured lips or skin
• drowsiness to the point where he or she cannot be easily wakened
• severe crankiness or not wanting to be held or
• dehydration – not drinking enough fluids and not going to the bathroom regularly

11

Pneumonia

• Excess fluid in the lungs resulting from acute inflammation
• Triggered by infectious organisms and inhalation of irritating agents
• Significant cause of hospital admission and death from infectious disease in Canada
• Leading cause of death of children worldwide (WHO, 2013)
o 1.2 million annually

12

Etiology

• Immune system cannot combat invading organism from:
o Environment
o Invasive devices (ie: intubation)
o Equipment/supplies
o People

13

Types of Pneumonia

Organisms implicated
S. pneumoniae* most common
Legionella
Mycoplasma
Chlamydia
S. aureus
Respiratory viruses

14

Types of pneumonia

Community-acquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)

15

Community-Acquired Pneumonia (CAP)

Highest incidence in winter
Smoking important risk factor
Usually abrupt onset of fever and chills
Causative agent only identified in 50% of cases

16

Risk Factors for CAP

Older adult
Never received pneumoccal vaccine or > than 6 years ago
No influenza vaccine in previous year
Chronic or coexisting health problem
Recent exposure to respiratory viral or flu infections
Tobacco or ETOH use

17

Hospital-Acquired Pneumonia (HAP)

Occurring 48 hours or longer after admission and not incubating at time of hospitalization
High mortality and morbidity rate
Second most common nosocomial infection

18

Risk Factors for HAP

 Older adult
 Chronic lung disease
 Gram negative colonization of mouth, throat or stomach
 Altered LOC
 Recent aspiration
 ET, trach or NG tube
 Poor nutritional status
 Immunocompromised
 Drugs/tube feeds that increase gastric pH
 Mechanical ventilation

19

Aspiration Pneumonia

• Causes widespread inflammation if from acidic source (gastric acid, vomitus)
o Usually history of loss of consciousness
 Gag and cough reflexes suppressed
o Tube feeding a risk factor
 Nursing considerations?
o Steroids and NSAIDs reduce inflammation

20

Pneumonia: Clinical Manifestations

Flushed cheeks
Bright eyes
Anxious expression
Chest or pleuritic pain
Sharp,stabbing with deep inspiration or cough
Myalgia
Headache
Chills
Fever
Hypoxemia
Cough
Tachypnea
Tachycardia
Dyspnea
Sputum
Purulent, blood-tinged or rust coloured
Chest muscle weakness
Wheezing (most common with viral)
crackles

21

Older Adult Considerations

Often has:
Weakness
Fatigue
Lethargy
Confusion
Poor appetite
Hypoxemia
***fever and cough may NOT be present
***may NOT have elevated WBC

22

Complications

Pleurisy-inflammation of the lining of lungs and chest---sharp inspiratory pain
Pleural effusion- a buildup of fluid between the layers of tissue that line the lungs and chest cavity.
Usually is sterile and reabsorbed in 1-2 weeks or requires thoracentesis
Atelectasis
Usually clears with effective coughing and deep breathing
Delayed resolution
Persistent infection seen on x-ray as residual consolidation
Lung abscess
Seen when caused by S. aureus and gram-negative pneumonias
Empyema
Requires antibiotics and drainage of exudate
Pericarditis
From spread of micro-organism
Arthritis
Systemic spread of organism
Exudate can be aspirated

Meningitis
Caused by S. pneumoniae
Client who is disoriented, confused, or somnolent should have lumbar puncture to evaluate meningitis
Endocarditis
Micro-organisms attack endocardium and heart valves
Manifestati

23

Assessment pnu

Breathing pattern
Position
Accessory muscle use
Unequal chest expansion
Cough
Sputum
Colour, amount, consistency, odour

Breathing pattern
Position
Accessory muscle use
Unequal chest expansion
Cough
Sputum
Colour, amount, consistency, odour


24

Collaborative Care pneu

• Medications
o Antibiotic therapy (unless viral)
 IV x 2-3 days then switch to PO if stable and afebrile
o Analgesics
o Antipyretics
o Bronchodilators (if bronchospastic)
o Inhaled steroids (if asthmatic)
• Vaccinations (not while ill)
o Influenza vaccine
o Pneumoccal vaccine

25

collab care pneu

Fluid intake at least 3 L per day
Balanced diet with adequate caloric intake
Limited activity and increased rest

26

Impaired Gas Exchange

• Oxygen for hypoxemia
• keep sat 94-98% (or pt norms)
o Monitor for cyanosis
o Monitor cognitive status
o O2 via NP or facemask
o May not tolerate O2 mask if confused
o Monitor for skin breakdown (ears)
• Incentive spirometry q 1h, 5-10 X/hr
• DB & C q1-2h
• Elevate head of bed (HOB)

27

Potential Problems: Expected Outcomes

• Potential for Sepsis:
o Absence of fever
o Blood and sputum cultures neg
o WBC and diff within normal limits
• Ineffective Airway clearance
o Effective cough
o Absence of pallor or cyanosis
o No crackles or wheezes

28

Implementation pneu

• Calm, slow approach to assessment
• Closed-ended questions if dyspneic
• Teaching
o Nutrition
o Hygiene
o Rest
o Infection control (handwashing, sputum)

29

Nursing Implementation

• Reposition client q2h
• Assist clients at risk for aspiration with eating, drinking, and taking meds
• Assist immobile clients with turning and deep breathing
• Teach how to use incentive spirometer
• Strict asepsis
• Push fluids (3L/day if no contraindications)
• IV –for abx or fluid therapy prn
• Monitor WBC and differential
• Monitor temperature
• Assess for S & S of sepsis
• Administer abx, analgesics, antipyretics, inhaled steroids and/or bronchodilators as ordered
• Emphasize need to take full course of medication(s)
• Encourage those at risk to obtain influenza and pneumococcal vaccinations

30

Evaluation pneu

Dyspnea not present
SpO2 > 95%
Free of adventitious breath sounds
Clears sputum from airway
Reports pain controlled
Verbalizes causal factors
Adequate fluid and caloric intake
Performs ADLs