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What are some common etiologies of pneumonia?
- Lack of normal defense mechanisms
- Predisposing factors
- Acquisition of infectious organisms, ie Bacteria, Viruses,Mycoplasma, Fungi, Parasites, Chemicals
Treated with sulfa drugs, PCN, and new antibiotics
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Classifications of Pneumonias
- Community-acquired: Onset in community or within 2 days of hospitalization. It is assumed that it was aquired within the community and only displayed symptoms after admission.
- --S. pneumoniae
- --H. influenza
- Hospital-acquired: Occurs after 48 hours of hospitalization
- Aspiration: inhaled pathogen or obstruction-->accumulation of mucous/area of opportunity for pathogen.
- Opportunistic: depressed immune system-->opportunity for nfxn.
- --Malnutrition
- --Deficient immune system
- --Immunosuppressed
- --Radiation, chemotherapy or steroids
- --Stress
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Pathophys of pneumonia
congestion
- Congestion outpouring of fluid into alveoli
- Microrganism multiplication & spread of infection
- Overwhelm with growth & interfere with function of lung(s)
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pathophys of pneumonia
hepatization
- Red hepatization: Dilation of capillaries
- --Alveoli fill with microrganisms, neutrophils, RBCs, & fibrin
- --Lung appears liver-like, red & granular
- Gray hepatization: Decreased circulation
- --Consolidation of leukocytes & fibrin
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Pathophys pneumonia
resolution
- If no complications, recovery will progress
- Exudate is lysed & removed by macrophages and expelled via ciliary movement and cough.
- Normal lung tissue restored, very resilient.
- Gas exchange returns to normal
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SnSs of pneumonia
- Acute onset: fever, chills, dyspnea, productive cough
- Pleuritic chest pain. Unique to pneumonia. Pain upon deep breathing.
- Discomfort, myalgia
- Adventitious breath sounds, ie wheezes, deminished breath sounds. With flu, lung sounds are typically clear.
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Diagnostics for pneumonia
- H&P (Hx and physical), ie "have you been out of the country recently?"
- CXR: best diagnostic tool.
- Sputum C&S (culture and sensitivity)
- Pulse oximetry, ABGs
- WBC, ESR (Erythrocyte Sedementation Rate), CBC
- Blood cultures
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Collaborative care of pt with pneumonia
- Antibiotics
- O2
- Analgesia & Antipyretics
- Influenza meds & vaccine
- Pneumococcal meds & vaccine
- Nutrition
- --^fluid intake to loosen mucous. >3L/day.
- -- >1500 cal/day
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Antibiotic treatment for pt with pneumonia
- Many can be treated w/oral antibiotics as outpatients
- Some need inpatient care & IV therapy (esp fluids).
- Caution: Multidrug resistant microorganisms
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Nursing intervensions for pt w/pneumonia
- ABCs
- Assessment/reassessment
- Positioning
- TCDB, IS
- VS (vital signs), ABGs
- Rest
- Hydration/Nutrition
- I/O
- Education
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