Medical Surgical Nursing – Respiratory Lecture 12

Pneumonia · Acute inflammation of the lung parenchyma. · 6th leading cause of death. · Likely to occur when defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents. Organisms that cause pneumonia reach the lung by · Aspiration from the nasopharynx or oropharynx. · Inhalation of microbes present in the air. · Spread from a primary infection elsewhere. Types of pneumonia · Community-acquired pneumonia · Hospital -acquired pneumonia · Fungal pneumonia · Aspiration pneumonia · Opportunistic pneumonia Clinical Manifestations Typical · Sudden onset of fever · chills · cough productive of purulent sputum · pleuritic chest pain · crackles Atypical · dry cough · headache · fatigue · sore throat · nausea · vomiting dirrhea Complications · Pleurisy (inflammation of the pleura) · Pleural effusion (usually reabsorb 1 to 2 weeks but occasionally it requires an aspiration. · Atelectasis (collapsed, airless alveoli)ofone or more part of the lobe. May disappear with effective and deep breathing. · Delayed resolution results from persistent infection and is seen on x-ray as residual consolidation. Usually returns to normal 2-4 weeks. · Lung abscess (not common) seen withS. Aureusandgram negative. Con’t complications · Empyema (accumulation of purulent exudate in the pleural cavity) is relatively infrequent but requires antibiotic therapy. · Pericarditis infection in the pleura in the pericardium. · Arthritis · Meningitis · Endocarditis Diagnostic studies · History and physical · CXR · Gram’s stain sputum · Sputum culture and sensitivity test · ABG’s · CBC · Blood cultures Collaborative Care · Appropriate antibiotic therapy · Increased fluid intake · Limited activity and rest · Analgesics · O2 therapy (if needed) Nursing Management Health Promotion · Teaching: Good health habits; such as proper diet and hygiene, adequate rest, and regular exercise. · Avoidance of exposure to URI’s · Prompt treatment of URI’s (fluids, rest) · Vaccinations for high-risk individuals Con’t Nursing Management Prevention of at-risk inpatients · Proper positioning for patients with altered LOC to minimize aspiration risk. · Turning/repositions, coughing, deep breathing q2h. · Proper care of patients with feeding tubes to prevent reflux. · Help with feeding & meds for patients with dysphasia. · Avoid overmedication with narcotic analgesics. · Make sure gag reflux is present before admin. Food or fluids. Acute intervention · Monitor VS and auscultate lungs q2-4. · Position pt. In Semi-Fowler’s position. · Administer O2 PRN · Monitor ABG’s · Assist pt. To cough using splint · Maintain fluid intake of 3L q24h · Assess pain level and location · Administer expectorants, cough suppressants, analgesics PRN · Provide frequent, small meals · Administer antipyretics Nurse Diagnosis · Ineffective breathing pattern · Ineffective airway clearance · Pain r/t pleuritis…….. · Risk for altered health maintenance · Altered nutrition: Read More