Question

Pneumonia-Diagnosis, pathophysiology related to client problem, health promotion and disease prevention, risk factors, expected findings, Lab tests, diagnostic procedures, nursing care, medications , client education,Therapeutic procedures , lnterprofessional care, safety considerations, complications.

Answer 1

#. Pneumonia :-

Excessive fluid in lungs from inflammation. May cause decrease in gas exchange (hypoxemia, decrease oxygenation)

#. Stages of pneumonia :-

Stage I-Consolidation:first 24hrs; exudates containing WBCs, leukocytes, and fibrin replace alveolar air; pleurisy [S/S coughing, deep breathing

Stage II- Red Hepatization: 2-3days after consolidation; incr. blood flow to lungs; alveolar capilaries engorged with blood; fibrinous exudate

Stage III-Grey Hepatization: 2-3 days after red hepatization; lungs grey/yellow color; RBCs desintergrate; exudate pressure=capillary pressure

Stage IV-Resolution:macrophages enter alveolar spaces/phagocytosis; [S/S pleural rub, sputum]

#. Causes :-

Can be caused by a variety of microorganisms, infectious or non infectious mechanisms. Defense mechanisms become incompetent or overwhelmed.

Cigarette smoking

Pollution or irritating fumes

Upper respiratory infections

Tracheal intubations

Aging, chronic or debilitating illnesses

Tube feedings

#. Pathophysiology of pneumonia

-Exudate decreases both ventilation and diffusion: Secretions cause partial occlusion of bronchi or alveoli

-Thickening of alveolar wall

-Hypoventilation because ventilation/perfusion mismatch- blood leaves lungs poorly oxygenated resulting in arterial hypoxemia.

-Fibrin and edema from inflammation may lead to stiff lung with decreased compliance and decreased vital capacity/scarring of the lung

#. Assessment for pneumonia :-

-Changes in temperature and pulse

-Secretions

- Cough

-Tachypnea, shortness of breath

-Changes in physical assessment especially with inspection and auscultation of chest

-Changes in CXR

-Changes in mental status

-fatigue

-dehydration

-concommitment heart failure, especially in elderly patients

#. Common Manifestations of pneumonia

-Fever

-Orthopnea

-Poor appetite

-Diaphoresis

-Fatigue

-Hypoxemia

#. Medical workup to diagnose pneumonia

-Gram stain and sputum culture and sensitivity (Done before beginning antibiotics)

-Urine culture for septic patient

-Pulse oximetry or ABGs

-CBC (WBC typically between 15,000 to 30,000)

-Blood cultures

-Differentials and chems

#. Medical treatment of pneumonia

-Administration of antibiotic therapy determined by Gram stain results.

-If etiologic agent is not identified, utilize empiric antibiotic therapy

-Antibiotics not indicated for viral infections but are used for secondary bacterial infections

-Supported treatments include fluids, oxygen for hypoxia, antipyretics, antitussives, decongestant and antihistamine.

#. Complications of Pneumonia :-

- pleural effusion -- empyema -- lung abscess- secondary infection -- bacteremia -- septicemia -- meningitis -- septic arthritis -- endocaritis or pericarditis

#..Preventing Pneumonia :-

- WASH YOUR HANDS --flu vaccine -- pneumococal vaccine - diet and exercise - seek treatment early - smoking cessation --llimit alc - rest

#. Nursing interventions :-

A. Assess sputum for volume, color, consistency, & clarity

B. Assist client to cough productively by deep breathing q2h (incentive spirometer), using humidity to loosen secretions (may be oxygenated), suctioning the airway if necessary, chest physiotherapy

C. Provide fluids up to 3L/day unless contraindicated (helps liquefy secretions)

D. Assess lung sounds before & after coughing

E. Assess rate, depth, and pattern or respirations regularly

F. Monitory ABGs (PO2>80, PCO2<45)

G. Monitor O2 sat.

H. Assess skin color

I. Assess mental status, restlessness, irritability

J. Administer O2 as prescribed

K. Monitor temp regularly

L. Provide adequate rest periods, including uninterrupted sleep

M. Administer antibiotics as prescribed

N. Teach about risk factors & preventive measures to high risk clients and their families

O. Encourage at risk groups to get annual pneumonia & flu vaccinations

P. Promote rest & conserve energy