Pneumonia

Pneumonia

Lung inflammation caused by bacterial or viral infection
1. Community acquired (CAP)
  1. invading organisms from the environment causing infection upon inhalation
    1. Risk Factors: elderly, no pneumococcal (or 6+ years since) vaccine, no flu vaccine, chronic health problems/preexisting condition, exposure to viral or flu infections, tobacco alcohol secondhand smoke exposure (high amounts of smoke).
      1. more common than HAP (late fall and winter as a flu complication)
  2. prevention
    1. know if at risk (health problems? limited mobility, 65+), annual flu shot, pneumococcal vaccine, season crowd avoidance, turn, cough, move, deep breathe, clean at-home resp. equip., no smoke & aerosols, sleep, balanced diet, 3 litres water daily.
2. Healthcare acquired (HAP)
  1. PT becomes resistant to Abx and/or invasive devices (ex. intubation), equipment (ex. ventilator) and supplies, staff, or other people.
    1. Risk factors: elderly, chronic lung disease, gram (-) bacteria in mouth throat or stomach, altered consciousness, aspiration event, tracheal or nasogastric tube, poor nutrition, immunocompromised, using histamine blockers antacids or alkaline tube feedings, mechanical ventilation
      1. commonly acquired at hospitals by transmission with 20-50% mortality rate
        Ventilator associated pneumonia
        NURSE prevention: ventilator bundle, oral care b4 intubation, no jewelry, wash hands, oral care every 12 hrs., remove subglottic secretions every 2. hrs, x-ray ensure proper tube placement, no turning/supine 1 hr. after bolus feed, wean from ventilator asap.
        assess, suction, clean oral cavity, moisten every 6 hrs. teeth brush every 12 hrs. PT on side for oral care.
        risk: PTs with pseudomonas Aeruginosa, acinetobacter, Klebsiella, secondary bacteremia
  2. prevention
    1. flu vaccine annually, patient ed., hand hygiene, avoiding large gatherings in flu season, 24+ hr. fever=see HCP, pneumonia week+=see HCP, ventilator bundle (to prevent VAP).
3. Noninfectious pneumonia
  1. inhalation of toxic gases, chemical fumes or smoke or aspirating water, fluid, food and vomitus
4. Infectious Pneumonia
  1. bacteria, viruses, mycoplasmas, fungi, rickettsiae, protozoa and worms
    1. lobar pneumonia: infection in one or more of the lungs typically caused by streptococcal infection.
pneumonic inflammation
1. Organisms enter airway, multiply in alveoli
  1. WBCs to infected area to combat
    1. capillaries leak fluid and exudate into lungs causing impaired oxygenation and consolidation
      1. capillary leak spreads infection to other areas of lungs with the possibility of moving the infecting organisms into the bloodstream
        Sepsis occurs
        pneumonia spreads to pleural cavity causing a collection of pus in the cavity
        empyema
      2. hypoxemia (life threatening)
      3. (Atelectasis) alveolar collapse as a result of lung stiffening and poor blood oxygenation.
incidence
1. highest risk of contraction in elderly, nursing home residents, hospitalized PTs, mechanically ventilated.
Nurse assess for risk factors
1. PT history (esp. age, living/work conditions, diet, exercise, sleep routine.
  1. swallowing probs., GI tubes, tobacco/alcohol/street drug use, past resp infection/flu exposure, bug bites, rash, animal exposure, when did PT last have flu/pneumonia vaccine? home and home resp. equip clean enough?
physical manifestations
1. flushed cheeks, bright eyes, anxious expression. Chest (pleuritic) pain, discomfort, muscle pain, headache, chills, fever, cough, tachycardia, dyspnea (labored breathing), tachypnea (rapid breathing), hemoptysis (cough blood), sputum.

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	Created by brosenb1 about 11 years ago