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Pneumonia (Lecture3)
Pneumonia (Lecture3)
Pneumonia (Lecture3)
28/10/2009
Pneumonia
Acute inflammation of lung (lower
respiratory tract) caused by
microorganism, comes with fever,
focal chest symptoms, shadowing
on CXR
Leading cause of death until 1936
Discovery of sulfa drugs and
penicillin
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Classification
Community Acquired Pneumonia
Occur within 48 hrs of admission or in
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Types of Pneumonia
Hospital-acquired pneumonia (HAP) (Nasocomial Infection)
Develops 2
Causes of HAP
Pseudomonas
Enterobacter
S. aureus
S. pneumoniae
Immunosuppressive therapy
General debility
Endotracheal intubation
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Acquisition of Organisms
Aspiration from nasopharynx,
oropharynx
Inhalation of microbes
Hematogenous spread from
primary infection elsewhere
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Clinical Manifestations
CAP symptoms
Sudden onset of fever
Chills
Cough productive of purulent
sputum
Pleuritic chest pain
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Pathophysiology:
Pneumococcal Pneumonia
Congestion from outpouring of
fluid into alveoli
Microorganisms multiply and
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Pathophysiology:
Pneumococcal Pneumonia
Red hepatization
Massive dilation of capillaries
Alveoli fill with organisms,
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Complications
Pleurisy (pain with breathing)
Pleural effusion
Usually is sterile and reabsorbed in 1-2
Atelectasis
Usually clears with cough and deep
breathing
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Complications
Delayed resolution
Persistent infection seen on x-ray as
residual consolidation
exudate
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Complications
Pericarditis
From spread of microorganism
Arthritis
Systemic spread of organism
Exudate can be aspirated
Meningitis
Patient who is disoriented, confused, or
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Complications
Endocarditis
Microorganisms attack endocardium and
heart valves
Manifestations similar to bacterial
endocarditis
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Diagnostic Tests
History
Physical exam
Chest x-ray
Gram stain of sputum
Sputum culture and sensitivity
Pulse oximetry or ABGs
CBC, differential, chems
Blood cultures
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Collaborative Care
Antibiotic therapy
Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics
Influenza drugs
Influenza vaccine
Fluid intake at least 3 L per day
Caloric intake at least 1500 per day
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Collaborative Care
Pneumococcal vaccine
Indicated for those at risk
Chronic illness such as heart and lung
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Nursing Assessment
History of Predisposing/Risk Factors
Lung cancer
COPD
Diabetes mellitus
Debilitating disease
Malnutrition
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Nursing Assessment
History of Predisposing/Risk Factors
AIDS
Use of antibiotics, corticosteroids,
chemotherapy, immunosuppressants
Recent abdominal or thoracic
surgery
Smoking, alcoholism, respiratory
infections
Prolonged bed rest
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Nursing Assessment
Clinical Manifestations
Dyspnea
Nasal congestion
Pain with breathing
Sore throat
Muscle aches
Fever
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Nursing Assessment
Clinical Manifestations
Restlessness or lethargy
Splinting affected area
Tachypnea
Asymmetric chest movements
Use of accessory muscles
Crackles
Green or yellow sputum
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Nursing Assessment
Clinical Manifestations
Tachycardia
Changes in mental status
Leukocytosis
Abnormal ABGs
Pleural effusion
Pneumothorax on CXR
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Nursing Diagnoses
Ineffective breathing pattern
Ineffective airway clearance
Acute pain
Imbalanced nutrition: less than body
requirements
Activity intolerance
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Planning
Goals: Patient will have
Clear breath sounds
Normal breathing patterns
No signs of hypoxia
Normal chest x-ray
No complications related to pneumonia
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Nursing Implementation
Teach nutrition, hygiene, rest, regular
exercise to maintain natural resistance
Prompt treatment of URIs
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Nursing Implementation
Encourage those at risk to obtain
influenza and pneumococcal
vaccinations
Reposition patient q2h
Assist patients at risk for aspiration
with eating, drinking, and taking meds
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Nursing Implementation
Assist immobile patients with turning
and deep breathing
Strict asepsis
Emphasize need to take course of
medication(s)
Teach drug-drug interactions
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Evaluation
Dyspnea not present
SpO2 > 95
Free of adventitious breath sounds
Clears sputum from airway
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Evaluation
Reports pain controlled
Verbalizes causal factors
Adequate fluid and caloric intake
Performs ADLs
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Tuberculosis
Famous people who have had TB
Fredric Chopin*
Eleanor Roosevelt*
Nelson Mandela
Ringo Starr
Tom Jones
Tina Turner
*Died of TB
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Tuberculosis
5-10% become
active
Only contagious
when active
Primarily affect
lungs but
Kidneys
Liver
Brain
Bone
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How is TB spread?
Through the air from person to
person by coughing
Usually attacks lungs
Two stages
Latent TB
asymptomatic and not contagious
can take medication to prevent development of
disease
Active TB Disease
May
spread to others
May have abnormal chest x-ray
Usually have positive skin test
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Symptoms of TB
Chills
Fever
Weakness or fatigue
Sweating while sleeping, Night sweats
Cough that lasts longer than 2 weeks
Pain in chest
Coughing up blood or sputum
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Risk Factors
Close contact with someone who is infected
with TB
Traveling to a country where TB is common
Foreign-born individuals and minorities
have a higher incidence of developing TB
2002: 50% of US cases were in foreignborn individuals.
2002: 80% of all US TB cases were in
ethnic and racial minorities.
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Risk Factors
Immunocompromise
Substance abuse
Indigent (POVERTY)
Living in overcrowded, substandard housing
Health care workers performing high risk
activities
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Tuberculosis
Diagnostic exams
PPD
Mantoux skin test
> 10mm in diameter
induration
Indicates:
Latent TB
Read
48-72 after
Intradermal: 15-degrees
Do not rub
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Confirmation of Disease
Positive reaction does not
necessarily mean active disease.
May indicate exposure to TB
Diagnosis confirmed by:
Positive smear for AFB and
Sputum culture of
Mycobacterium tuberculosis
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Interventions
Combination drug
therapy
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol or
streptomycin
Education
Must follow
exact drug
regimen
Proper
nutrition
Reverse weight
About disease
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Tuberculosis Treatment
INH
Isonicotinyl Hydrazine
Isoniazid
Toxic to the liver
Rifampicin
Turns urine red
Streptomycin
Causes 8th cranial nerve
damage
Acoustic nerve
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CLASSIFICATION
Class 0no exposure
Class 1exposure, no infection
Class 2latent infection; no disease (positive
PPD but no evidence of active TB
Class 3disease; clinically active
Class 4disease; not clinically active
Class 5suspected disease; diagnosis
pending
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MEDICAL MANAGEMENT
Treated with chemotherapeutic agents for 6-12
months
Resistance increasing. May be primary, secondary,
or multidrug resistant.
Primaryresistance to one of first line drugs in
those who have not had prior treatment
Secondaryresistance to one or more anti-TB
drugs in patients undergoing tx
Multidrug resistanceresistance to two agents,
INH and Rifampicin.
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Tuberculosis
Complications
Pleurisy
Pericarditis
Meningitis
Bone infections
Malnutrition
Drug-toxicity
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Tuberculosis
Nursing Dx
Impaired gas exchange
Ineffective airway clearance
Anxiety
Knowledge deficit
Alt. nutrition
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Tuberculosis
Preventative measures
Clean well ventilated living areas
Resp. isolation
Vaccine?
BCG
Does not prevent TB
Causes a + PPD
If exposed take
INH
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Tuberculosis Summary
Chronic bacterial infection
spread through the air
Fever, chills, sweating while sleeping,
persistent cough, coughing up blood or
sputum
Multi-drug-resistant tuberculosis MDR
TB
Use proper PPE and get PPD test if
exposed
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