Pneumoniae

Annotations:

• Medical-Surgical Nursing (Lewis) pg. 522-528

1. Signs & Symptoms
   1. Dyspnea
   2. Fever
   3. Nonproductive cough
   4. Hypoxic
   5. Crackles, Ronchi, diminished BS, dullness Percussion?
   6. Ventilation Perfusion mismatch
   7. Consolidation= Fluid or Pus
   8. Diagnostics
      1. Gold standard: Chest X-ray

         Annotations:

         • Looking for Infiltration of chest over affected areas, small pleural effusion, Density changes in lower lung fields, Pneumothorax (Could be shown on x-ray) 
      2. Pro-Calcitionin: Biomarker Increase Bacteria, decreased Viral
      3. CXR- Gold Standard
      4. Blood & Sputum Culture Sensitivity before starting antibiotics
         1. color/volume/clarity/consistency
      5. WBC's (Shift to the left) 5,000-10,000 seen with Bacteria

         Annotations:

         • Leukocytosis
      6. Sputum is NOT spit [deep into the lungs]
         1. Hough Cough
      7. ABG's
   9. Chest Pain
   10. Viral

       Annotations:

       • Sore Throat, Muscle Soreness, Fatigue, dry cough, Mucoid Sputum, Generally do not experience fever or chills (VIral Most common Cause of Atypical Pneumonia) 
       • Types of Viruses: Haemophilus Influenza, RSV (children)  Immunocompromised: Cytomegalovirus, Varicella zoster virus. (others: hantavirus, avian virus, SARS) 
       1. WBC's Depressed

          Annotations:

          • <10,000 WBC's
       2. Gradual
       3. Little to no evidence of consolidation
       4. Treatment Limited to Supportive
       5. Scattered Wheeze, Crackles, Little or no evidence of consolidation, CXR- Minimal to substantial Bilaterlal Infilatration
   11. Tachypnea & Tachycardia
   12. Bacterial

       Annotations:

       • Shaking, chills, cough causing chest pain, Purulent Sputum, Pleuritic Type of Chest pain
       1. Abrupt onset of fever
       2. WBC's Increased
       3. Consollidation of Lungs, Dullness over precussion area with fremitus, Bronchophony, egophony "EE" to "AY", Bronchial Breath Sounds (Crackles most Common)
   13. Splinting affected area
   14. Asymmetric Chest wall movement
   15. LOC changes
2. Inflammation of the Lower Respiratory Tract with exudate & Consolidation
3. Patients at Risk

   Annotations:

   • Lung caner, COPD, Asthma, DM, CHF, Debilitating Disease, Malnutrtion, Aids, Smoking, Use ofAntibiotics/corticosteroids/Chemo, Recent abd./throacic  surgery, Alcoholism/drug abuse, Respiratory infection, Neurological Problems: impaired Gag reflex & Older age.
   1. Elderly

      Annotations:

      • Decrease cough reflex  Decrease mobility 
      1. Aspiration Risk
      2. Asymptomatic
      3. Thymus shrinks
      4. Confusion (Hypoxemia)
      5. Will not present Typical Picture: NO FEVER or Pulmonary symptoms

         Annotations:

         • The patient may only have mental status changes and dehydration. (Increased HR & RR) 
   2. Cigarrette smoking (destroy cilia)

      Annotations:

      • Destroys mucociliary mechanism
   3. Alcoholics
      1. Folic acid & Thyamine
   4. Diabetes
   5. Steroids
   6. Immunocompromised
4. Interventions
   1. Drugs (Penicillin & Sulfa Drugs)
      1. Hospital Acquired: Vancomycin
      2. Levaquin
         1. Prolong QT interval
         2. Tendon Rupture
      3. Ceftriaxone (Rocephin)
      4. Azithromycin
      5. another form of birth control?
   2. Droplet Precautions
      1. Mask
   3. CURB65
      1. Confusion
      2. BUN greater than 19
      3. BP less than 90/60
      4. Respiration greater than 30
   4. Vaccine
      1. Flu Vaccine

         Annotations:

         • Do not get vaccine while sick, check if allergic to eggs, available as ID, IM & nasal less reccommended, October each year
      2. Pneumovax-PCV13 & PCV23

         Annotations:

         • PCV13 at 2,4,6 &12 months [high risk at 5yrs]  PCV23 usually 1 dose [over 65 & immunocompromised] develops immunity 2-3w *Protects against bacterial
      3. Pertussis - DTaP & Tdap

         Annotations:

         • Purtussis- whooping cough [gram negative bacillus] DTap is for infants and booster Tdap for teens, preteens & adults
         1. No ASA in children

            Annotations:

            • Reye's Syndrome
      4. Meningitis-MC4, MPSV4, Serogroup B

         Annotations:

         • MC4: IM  11-12yrs & 16-18yrs(booster)  MPSV4-1 dose ID only suitable for 55yrs and older Serogroup B 10-24yrs old 2-3x 
      5. infants: hib, MMR & PCV
   5. Incentive Spirometer: Blow out all the air, Suck in deep, 10x every hour!!
   6. Reduce Dyspnea

      Annotations:

      • Limited physical Exertion, Maintain pt. Airways, Bronchodilators PRN, Suction PRN
      1. Pursed Lip breathing
      2. Elevate the head of the Bed
      3. O2 if immediate 2L 1st then obtain dr. Order because if COPD will cause Hypoventilation
   7. Heart Pillow/Splinting (Post Op)
   8. Decreae immbolization secretions
      1. Deep Breath & Cough
      2. Chest physiotherapy & Postural Drainage
      3. "Huff Cough"
   9. Monitor
      1. Hydration: 2-3L Fluids Increase unless Contraindicated
      2. Monitor Temp. in the Room
      3. Nutrition: 1500cal/day
      4. Anxiety, comfort, Sleep/rest
   10. WHAT IS IPPB, Mist tent & Aerosal
   11. Supportive Measures
       1. Antitussives, Antipyretics & Analgesic
       2. Increased Activity w/ planned periods of rest
5. Causes
   1. Community Acquired

      Annotations:

      • Acquired less than 48 hours of hospitalization and has not been a resident in a hospital for the past 14 days:  1) Streptococcus Pneumoniae 2) Mycoplasm Penumoniae
   2. Hospital Acquired

      Annotations:

      • Acquired 48 hours after hospitalization * Includes VAP 1) S. Aureus  2) Pseudomonas
      1. JACO records these #'s
      2. HIV (Opportunistic)
      3. Inactivity
         1. Incentive Spirometer
      4. Ventilators
         1. Chloahexadine
   3. Types of Bacteria
      1. Mycobacteria
         1. Malaise
         2. Not symptomatic
      2. Bacteria
         1. Streptococcus Pneumoniae
         2. Atypical

            Annotations:

            • Atypical: Legionella, Chlamyida & Mycoplasma. (Cannot be culture on typical gram stain) 
      3. Fungi
      4. Viruses
      5. Pneumocystitis
      6. walking pneumoniae
         1. Just malaise
   4. Routes

      Annotations:

      • Vomitus, Chemicals, Gases, oily substances, Foreign Bodies
      1. Circulatory

         Annotations:

         • Pre-existing disease: Septecemia, Lung disease, endocarditis
      2. Aspiration

         Annotations:

         • example Bacteria: Legionella Cause: Decreased Gag reflexEET/NGT
      3. inhalation

         Annotations:

         • Example Bacteria: Mycoplasma Pneumonia. (Often Viral) Spread through coughing, sneezing, Talking
6. Complications
   1. Pneumothorax
   2. Hypoxemia

      Annotations:

      • Ventilation-Perfusion mismatch,  Rapid Weak Pulse, Rapid Shallow Respiratiors, O2 Adequacy assessment: ABG analysis, Pulse Oximetry, RR, HR, VS, LOC, Prolonged Bedrest, Dyspnea, Nasal Congestion, Pain with breathing, sore throat, muscle ache, Restlessness. 
   3. Ventilatory Failure
   4. Atelectasis
   5. Pleural Effusion
   6. Pleurisy
   7. Bacteremia
   8. Lung abscess
   9. empyema
   10. Pericarditis
   11. Meningitis
   12. Sepsis