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2012-07-17 11:18:44
AMS1T1 Pneumonia

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  1. 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
  2. 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
  3. Pathophys of pneumonia
    • Congestion outpouring of fluid into alveoli
    • Microrganism multiplication & spread of infection
    • Overwhelm with growth & interfere with function of lung(s)
  4. pathophys of pneumonia
    • 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
  5. Pathophys pneumonia
    • 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
  6. 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.
  7. 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
  8. 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
  9. 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
  10. Nursing intervensions for pt w/pneumonia
    • ABCs
    • Assessment/reassessment
    • Positioning
    • TCDB, IS
    • VS (vital signs), ABGs
    • Rest
    • Hydration/Nutrition
    • I/O
    • Education