Pneumonia Causes & Treatment – Microbiology
This chapter of microbiology covers Pneumonia causes and treatment and death.
Geriatric Assessment
Most common manifestation from hypoxia is ____________ Fever and cough may be absent Fatigue Weakness Lethargy
Nursing Interventions
Support oxygenation Assess Administer 02 therapy as ordered TCDB Administer medications as ordered Bronchodilators, mucolytics, cough suppressants Antibiotics Collaborate with respiratory therapy as needed Antipyretics
Health Teaching >
65 pneumovac/ annual flu vaccine Handwashing Avoid crowded areas/sick people during Instruct in deep breathing and cough techniques Clean all home respiratory equipment
Health Teaching
Medications When to seek medical attention Do not smoke Get enough rest/eat balanced diet 3 L fluids a day Unless restricted by another health problem
Nursing Diagnoses
Impaired gas exchange Ineffective airway clearance Acute pain Deficient fluid volume Impaired sleep Fatigue Activity intolerance
Respiratory System Function
Supplies body with oxygen Rids body of carbon dioxide Influences: Acid-base balance Temperature control Speech Smell
Respiratory Changes With Aging
Associated: Underlying diseases Hereditary factors Lifetime of exposure environmental stimuli
Physiological Changes With Aging
Chest wall Lungs Alveoli Pharynx and Larynx Pulmonary circulation decrease exercise tolerance decrease muscle strength
Pulse Oximetry
Identifies hemoglobin saturation Ideal: 95-100% < 91% concern < 86% urgent < 70 % life threatening Sensor locations Causes for low readings
Diagnostic Laboratory Tests
CBC ABG (arterial blood gases) Sputum Specimen Identification of organisms or abnormal cells C&S Cytology Gram Stains
Sputum Collection Procedure
Collection sterile container Instruct patient to take a deep breath and cough Specimen expectorated into a sterile container Collection of respiratory secretions in a sterile container Best collected in morning before breakfast if possible Instruct patient to take a deep breath and cough Sitting in upright position will facilitate deep breathing and coughing effort Specimen expectorated into a sterile container Need aprox. 1 tsp Saliva is not acceptable Seal tightly, time, date, name, patient and lab request slip, place in hazardous waste lab bag and send to lab Should not be allowed to sit for hours
Chest Xray
Screen, diagnose, evaluate treatment PA and lateral views Instructions No metal/jewelry
CT Scan: Computerized Tomography
Images in Cross-Section View Requires contrast agents Nursing role:
MRI: Magnetic Resonance Imaging
Use of magnetic fields Assess/Instructions No metal objects allowed in MRI room Notify radiologist of metal devices and tattoos No follow-up care
Lung Scans: Ventilation Perfusion Scans
Inhalation of radioisotopes Identifies areas of lung being ventilated/perfused Assesses lung function with suspected or advanced lung disease Radioactive isotope excreted in urine within 8 hours
Pulmonary Function Tests: PFTs
Screens for lung disease and progression Evaluates Lung volumes Flow rates Capacities Gas exchange Airway resistance Noninvasive
Bronchoscopy
Tube inserted into bronchi under conscious sedation Can be done in room or in procedure area Patient prep: NPO Ensure informed consent Document allergies IV access Post-procedure Protect airway Monitor VS, oxygen sat. Assess for complications: bleeding, hypoxemia
Thoracentesis
Specimen from pleural fluid Treat pleural effusion
Thoracentesis Patient Preparation
Explanation of procedure by MD Explain need to stay still Area will be anesthetized by local infiltration RN role:
Follow-up Care
Monitor VS Encourage deep breathing to promote expansion of lung Assess for possible complications:
What are the three hallmark signs of respiratory problems?
Dyspnea
Cough
Sputum
Adventitious Breath Sounds
Crackles Rhonchi Wheezes Rubs
Pneumonia Patho, assessment, interventions and evaluation
Pneumonia
Excess fluid in lung from an inflammatory process Triggered by bacteria, fungus, viruses, irritating agents 7th leading cause of death
Pathophysiology
Organisms invade airway mucosa and multiply WBCs migrate to area of infection results in: Capillary leak, edema and exudate Fluid collects in alveoli and walls thicken Reduce gas exchange Capillary leak causes spread to other areas of lung Consolidation of lung tissue
Causes
Bacteria (75%) Viruses Fungi Protozoa & worms Inhalation of toxic gases, chemicals Smoke Aspiration of food, fluid, vomit
Pneumonia: Classifications
Community-acquired pneumonia (CAP) Onset in community or during 1st 2 days of hospitalization Hospital-acquired Pneumonia (HAP/nosocomial) Occurring 48 hrs or longer after hospitalization Aspiration pneumonia Pneumonia caused by opportunistic organisms Pneumocystis Carinii
Risk Factors
Older adult Never received pneumococcal vaccine or > 6 years, No flu vaccine Chronic health condition Recent exposure Tobacco or ETOH use Altered LOC, Aspiration risk Poor nutrition, Immunocompromised NGT, airway tube
Respiration
Respiration Ventilation
Perfusion
Diffusion
Upper Respiratory Structure
Nose Sinuses Pharynx (throat) Larynx
Lower Respiratory System
Structures: Trachea Bronchi Bronchioles- Terminal bronchioles
Lungs
Located in pleural cavity Sits on top of diaphragm Divided into lobes alveoli Bronchioles bronchi
Alveolar Sacs and Alveoli
Basic unit of gas exchange
Pleura
Double layered serous membrane lines the thoracic cavity
Mechanics of Breathing
Inspiration Ribs rise and diaphragm flattens Volume increases and pressure decreases Air enters the lungs from the higher external pressure to the lower pressure in the lungs Expiration Ribs fall and diaphragm domes Volume decreases and pressure increases Air leaves the lungs from the higher pressure in the lungs to the lower external pressure
Clinical Manifestations
Dyspnea, increased respiratory rate Fever Chills Hypoxemia Cough Blood tinged sputum Crackles, rhonchi Pleuritic chest pain Fatigue & generalized weakness Anorexia
Nursing Assessment
General appearance & VS Oxygenation-pulse oximetry Assess pain Breathing pattern, position and use of accessory muscles, dyspnea Breath sounds – – Fever, chills
Assessment
Cough Productive-color, amount, consistency, odor Nonproductive Hydration status Dehydration common in elderly I & O Orthostatic hypotension
Interventions
Assess for anxiety Provide for comfort and rest Assist with ADLs Promote nutrition & hydration Assess for changes or worsening of condition and intervene early