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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


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


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?




Adventitious Breath Sounds

 Crackles Rhonchi Wheezes Rubs

Pneumonia Patho, assessment, interventions and evaluation


Excess fluid in lung from an inflammatory process Triggered by bacteria, fungus, viruses, irritating agents 7th leading cause of death


 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


 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 Ventilation



Upper Respiratory Structure

 Nose Sinuses Pharynx (throat) Larynx

Lower Respiratory System

 Structures: Trachea Bronchi Bronchioles- Terminal bronchioles


Located in pleural cavity Sits on top of diaphragm Divided into lobes alveoli Bronchioles bronchi

Alveolar Sacs and Alveoli 

Basic unit of gas exchange


 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


Cough Productive-color, amount, consistency, odor Nonproductive Hydration status Dehydration common in elderly I & O Orthostatic hypotension


 Assess for anxiety Provide for comfort and rest Assist with ADLs Promote nutrition & hydration Assess for changes or worsening of condition and intervene early