Transcript File - Caitlin Darby`s E

CommunityAcquired
Pneumonia
Caitlin Darby
Florida Hospital Tampa
November 14, 2012
Objectives
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Discuss the pathophysiology of pneumonia
Describe signs and symptoms of pneumonia
Discuss risk factors for pneumonia
Discuss the prevalence of pneumonia in our
society
Discuss medical and nursing interventions for
pneumonia from current research
Describe a patient case scenario
Discuss medical and nursing interventions,
treatments and outcomes for a hospitalized
patient with pneumonia
Pathophysiology
 Infection
of the lower
respiratory tract caused by
bacteria, viruses, fungi,
protozoa or parasites.
 The alveoli and interstitium
of the lung are filled with
inflammatory cells and fibrin
(Loebinger, 2012) and (Huether & McCance, 2012)
Pneumonia Pathophysiology
Video
Most Common Bacterial
Microbes Responsible for
Pneumonia
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Streptococcus pneumoniae (most common cause of CAP)
Chlamydia pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Legionella spp.
Chlamydia psittaci
Staphylococcus aureus
Moraxella catarrhalis
The causative microorganism influences how the individual
presents clinically, how the pneumonia is treated and the
prognosis
(Loebinger & Wilson, 2008)
Routes of Entry
 Inhalation
of airborne
pathogens
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Microorganisms that have
been released into the air
when we cough, sneeze or talk
 Aspiration
of gastric and
nasopharyngeal flora
 Spread from other infected
sites
(Loebinger & Wilson, 2012)
Risk Factors for Pneumonia
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Age
 65 and older
 Very young children whose immune systems haven’t
fully developed
Smoking
Compromised immunity
Underlying disease
Alcoholism
Altered consciousness
Impaired swallowing
Endotracheal intubation
Malnutrition
Immobilization
Underlying cardiac or liver disease
Residence in a nursing home
Poverty
Long term corticosteroid use
Exposure to certain chemicals or pollutants
(Huether, McCance, 2012)
Symptoms of Pneumonia
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Cough
Vomiting
Headache
Dyspnea
Thoracic/Pleuritic pain
Abdominal pain
Poor appetite
Diarrhea
Rhinorrhea
Malaise/Lethargy
Sputum production
Sweating
(Juven, Ruuskanen & Mertsola, 2003)
(Loebinger & Watson 2012)
(Thiem, Heppner & Pientka, 2011)
Signs of Pneumonia
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Fever > 37.5°C
Cough
Rhinorrhea
Vomiting
Malaise/Lethargy
Confusion
Dyspnea
Poor appetite
Diarrhea
Sputum production
Dehydration
Adventitious breath sounds (rhonchi,
rales/crackles, wheezing or decreased
sounds)
Respirations > 30/min
Consolidation on chest X-ray
Sweating
Low blood pressure
(Juven, Ruuskanen & Mertsola, 2003)
(Loebinger & Watson, 2012)
(Thiem, Heppner & Pientka, 2011)
Prevalence of Pneumonia in
the United States
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Bacterial pneumonia remains one of the
leading causes of morbidity and mortality
Estimated 450 million cases per year worldwide
Estimated 4 million deaths per year worldwide
6th leading cause of death worldwide
CAP= 350,000-620,000 hospitalizations each year
(Loebinger & Watson, 2012) & (Huether & McCance, 2012)
Medical Interventions
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current research
Antibiotic therapy
Chest x-ray and/or CT scan
Bronchoscopy
Thoracentesis
Daily blood tests/labs to
monitor status of illness
Oxygen therapy
Breathing treatments
Prescribing medication
based upon the patient’s
signs/symptoms
Continuous IV fluids
http://health.nytimes.com/health/guides/disease/pneumonia/overview.html
Nursing Interventions
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From current research
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Incentive spirometry (5-10 breaths) every 2 hours
Chest physiotherapy
Rhythmic breathing and coughing every 4 hours
Monitoring breathing pattern, rate, effort, use of accessory
muscles
Monitor O2 saturation and arterial blood gases
Assessing for changes in mental status, skin color and cyanosis
Administer antitussives, mucolytics and antibiotics as prescribed
Provide oxygen therapy
Reposition patient q2h and position them in fowlers or semifowlers position
Provide oral care after expectoration and provide tissues/bag
for disposal
Suction secretions if cough is ineffective
Increase fluid intake
http://nanda-nursinginterventions.blogspot.com/2011/05/nursing-interventions-for-pneumonia.html
Diagnostic Tests/Labs
 Non-laboratory
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Chest x-ray
Bronchoscopy
Throracentesis
Computed tomography scan (CT Scan)
 Laboratory
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tests
Complete Blood Count (CBC)
Arterial Blood Gas (ABG)
Basic Metabolic Panel (BMP)
 Tests
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tests
for suspected bacterial pneumonia
Sputum culture & gram stain
http://labtestsonline.org/understanding/conditions/pneumonia/start/3
Commonly Used Medications
Prevention of Pneumonia
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Smoking cessation
Frequent hand-washing
Coughing/sneezing into a tissue, elbow or
sleeve
Cleaning frequently touched surfaces
Vaccination against Streptococcus.
Pneumoniae
 Most common cause of community
acquired pneumonia
 The vaccine doesn’t completely prevent
pneumonia but it reduces the severity
 Recommended for:
 Patients over 5 years with
immunodeficiency and chronic
diseases
(Loebinger & Wilson, 2012)
http://labtestsonline.org/understanding/conditions/pneu
monia/start/4
Patient Scenario
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The patient is a 74 year old female who
complains of severe chest pain, difficulty
breathing and difficulty clearing secretions. She
complains of pain in her right lower chest. When
asked to describe the pain on a scale from 0-10
she reported the intensity as a 6/10. She
describes the pain as throbbing, sharp and
constant. Her pain and trouble breathing is
worse when she lays flat. Her symptoms
decrease when sitting up in a chair. The patient
was admitted to the hospital on October 30,
2012 where she is underwent treatment for
community acquired pneumonia caused by
Streptococcus pneumoniae.
Patient Scenario (cont.)
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Subjective Findings (Symptoms)
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Difficulty breathing
Dry mucous membranes
Fatigue (trouble sleeping)
Difficulty clearing secretions
Objective Findings (Signs)
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Tachypneic (RR: 28)
Adventitious breath sounds (crackles in
lower lobes)
Dry mucous membranes
Dyspnea
Pallor
Trouble clearing secretions
Temperature 100.6°F
Adventitious Lung Sounds
(Crackles)
Patient Medications
 Acetaminophen
 Mucinex
 ALPRAZolam
 HYDROcodone
 Amoxicillin
Nursing Diagnosis
 Ineffective
airway clearance r/t retained
secretions a.e.b adventitious breath
sounds
 Ineffective breathing pattern r/t body
position a.e.b orthopnea
 Chest pain secondary to pneumonia
a.e.b patient stating pain as a 6/10
Medical Interventions
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What was done while the patient was in the
hospital
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Physician ordered a sputum culture to determine
the virus or bacteria causing the pneumonia
(Streptococcus pneumoniae)
Physician ordered a chest x-ray to determine the
area where the consolidation is located
Prescribed pain medication (HYDROcodone)
Prescribed antibiotics (amoxicillin)
Prescribed Mucinex & ALPRAZolam
Ordered breathing treatments from respiratory
therapy
Nursing Interventions
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What was done while the patient was in the hospital
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Monitor respiratory rate, pattern, depth and ease of respiration
Supplemental Oxygen (O2 @ 2L)
Incentive spirometer use every hour
Turn, cough and deep breath exercises every hour
Pursed lip breathing exercises
Assisting the patient to the chair every 3 hours to sit up to loosen
lung secretions
Elevating the HOB to 45 degrees to allow the patient to sit up to
loosen lung secretions
Respiratory therapy to provide breathing treatments 2x a day
Administer medications as prescribed
Increase fluids to prevent dehydration
Outcomes
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The patient was able to clear lung secretions 2x
during my shift
The patient transferred herself with assistance to
the chair 3x during my shift
She tolerated the breathing treatments from
respiratory therapy well and was cooperative
with all interventions
Her breathing pattern and respiratory rate did
not change before my shift ended
The patient was not discharged during my shift
NCLEX Question #1
A
diagnosis of pneumonia is typically
achieved by which of the following
diagnostic tests?
a.
b.
c.
d.
ABG analysis
Chest x-ray
Blood cultures
Sputum culture and sensitivity
http://amy47.com/nclex-style-practice-questions/airway-pneumonia-and-tb/
NCLEX Question #2
 When
auscultating the chest of a client
with pneumonia, the nurse would expect
to hear which of the following sounds over
areas of consolidation?
a.
b.
c.
d.
Bronchial
Bronchovestibular
Tubular
Vesicular
NCLEX Question #3
 An
elderly client with pneumonia may
appear with which of the following
symptoms first?
a.
b.
c.
d.
Altered mental status and dehydration
Fever and chills
Hemoptysis and dyspnea
Pleuritic chest pain and cough
NCLEX Question #4
 Which
of the following organisms most
commonly causes community-acquired
pneumonia in adults?
a.
b.
c.
d.
Haemiphilus influenzae
Klebsiella pneumoniae
Streptococcus pneumoniae
Staphylococcus aureus
NCLEX Question #5
 Clients
with chronic illnesses are more
likely to get pneumonia when which of
the following situations is present?
a.
b.
c.
d.
Dehydration
Group living
Malnutrition
Severe periodontal disease
References
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Loebinger, M., & Wilson, R. (2008). Pneumonia. Medicine, Volume 40(6).329-334.
Retrieved from
http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/
S1357303912000576
Loebinger, M. & Wilson, R. (2012). Bacterial Pneumonia. Medicine, Volume 36(6). 285290. Retrieved from
http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/
S1357303908001059
Thiem, U., Heppner, H., & Pientka, L. (2011). Elderly patients with community
acquired pneumonia. Drugs and Aging, Volume 28(7). 519-537. Retrieved from
http://ehis.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer?
sid=26065f11-e162-4a8a-be31-de89dd979930%40sessionmgr4&vid=3&hid=1
Juven, T., Ruuskanen, O., & Mertsola, J. (2003). Symptoms and signs of community
acquired pneumonia in children. Scandinavian Journal of Primary Health Care,
Volume 21. 51-56. Retrieved from http://
ehis.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer?
sid=5a884c7c-680a-450b-a81a-85b6d41b2d09%40sessionmgr12&vid=3&hid=1
Student Nursing Study Blog. [Web post]. Retrieved from
http://amy47.com/nclex-style-practice-questions/airway-pneumonia-and-tb/
Nursing Interventions for Pneumonia. [Web Post}. Retrieved from
http://nanda-nursinginterventions.blogspot.com/2011/05/nursing-interventionsforpneumonia.html
Hadjiliadis, D. (2012, May 29). Pneumonia-adults community acquired. The New York
Times. Retrieved from http://health.nytimes.com/health/guides/disease/
pneumonia/overview.html
Questions??