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37 Cards in this Set
- Front
- Back
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How can microorganisms enter the lower resp. tract?
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Inhalation of small airborne droplets carrying the organisms
Aspirations -secretions from upper airway -gastric contents -foreign objects Bloodstream |
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Contamination
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The presence of organisms in an otherwise sterile area
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Colonization
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The growth of an organism in an area where it is not normally present
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Infection
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An inflammatory process resulting from the precense and growth of a pathogenic organism
*usually produces clinical signs and symptoms |
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Normal defense mechanisms for the lower resp tract
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Intact upper airway protective reflexes
Intact mucociliary blanket/transport Intact immune system No underlying pulm disease |
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Pts at risk for a pulm infection have...
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abnormal defense mechanisms for the lower resp tract
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Clinical Findings for Infectious Pulm. Disease
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Elevated Body Temp
Elevated WBC Positive ID of microrganism in sputum ID on a chest x-ray |
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Elevated Body Temp
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Bacterial or Viral
Bacterial infections cause higher temps than viral |
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Positive ID of microorganisms in sputum
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Gram stain
-Positive (purple) -Negative (pink) -Cocci (spherical) -Bacillus (rod) -other Culture and Sensitivity |
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ID on a chest x-ray
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Infiltrate
Areas of Consolidation (white) |
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Types of Pulm Infectious Disease
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Pneumonia
Lung Abscess TB Fungal Disease of the Lung |
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Pneumonia
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An acute inflammatory process of the gas exchange areas of the lungs
Alv. will fill with... -Fluid -RBC's -WBC -Macrophages (Only where the infection is located) |
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Abscess
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Infection filled puss pocket
Fluid will harden to a gel like substance (consolidation) |
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Consolidation
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When fluid filled alv become solid
Causes congestion |
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Pneumonia Stats
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6th leading cause of death in America
3 Million people in USA/yr 600,000 require hospitalization 60,000 deaths/yr in US 5 million deaths/yr world wide |
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Pneumonia Etiology
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Microorganisms
-bacteria, viruses, fungi, TB Aspiration of foreign substances (vomit) Inhalation of irritating chemicals (chlorine) |
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Lobar Pneumonia
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Pneumonia which involves an entire lobe of the lung
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Community- Acquired Pneumonias
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pneumonias contracted outside the hospital environment
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Hospital-Acquired (Nosocomial) Pneumonias
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Pneumonias the develop 48 hrs or more after admission to the hospital
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Vent.-Associated Pneumonias
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Pneumonias that develop after 48 hrs or more of mech. vent.
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Things to do to avoid VAP
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Elevate pt head to 35 degress
Suctioning Cuff pressure monitoring Closed suctioning catheter |
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Pneumonia Pathophysiolgy
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Pathogenic organism reaches distal airway
Inflammatory response of surrounding tissues in alv and interstitium Production of inflammatory exudate draining in alv -WBC -ALV macrophages -RBC Release of more immunologic mediators to attract additional inflammatory cells Interstitial tissues and alv spaces fill with fluid and cellular debris Consolidation |
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Pneumonia: Gas Exchange
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Shunt like effect or True Shunt
Leads to Hypoxemia Leads to PCR stimulation -increased RR, MV -Hyperventilation -increased HR, BP |
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Pneumonia: Lung Mechanics
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Lung vols are decreased in areas involved
-Consolidation -Atelectasis leads to increased lung density in areas involved leads to decreased lung compliance in area involved |
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Why does a pt with pneumonia WOB increase?
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PCR stimulations and decreased lung compliance
MAY lead to acute vent. failure |
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Signs and Symptoms of Pneumonia
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Sudden or gradual
-Malaise -Fever -Chills -Cough -Chest Pain -Dyspnea -Prior upper resp tract infection -confusion/disorientation (elderly) -sputum production |
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Sputum Production in Pneumonia
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varies with organism involved
varies in stages of disease host factors (prev pulm disease) Increases as infection progresses -often purulent -blood streaked -rusty in color (pneumoccal) -odor (sweet - gram neg) |
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Pneumonia: Physical exam
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Appear quite ill
Fever Tachycardia Increased BP Tacypnea |
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Pneumonia: Exam of chest
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Palpation
-decreased movement on affected side -increased tactile fremitus Percussion -dull sound in areas involved Auscultation -bronchial breath sounds in areas involved -insp crackles |
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Necrotizing pneumonias
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clear dark areas on chest x-ray
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Diagnosis of Pneumonias is based on...
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History
PE CXR Lab studies |
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Lab Studies
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Blood Cultures
Help in diagnosing Streptococcus |
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Treatment of Hypoxemia in Pneumonia pt
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O2 Therapy
-decrease pcr stimulation -decrease WOB -decrease WOH |
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Treatment of dec. lung comp. in pneumonia pts
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Consider BHT if pt is unable to clear secretions (mucomist)
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Treatment of increased WOB in Penumonia pt
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O2 Therapy
BHT |
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Treatment of Acute Vent. Failure caused by increased WOB in Pneumonia Pt
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Mech Vent
O2 Therapy BHT |
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Treatment for clinical problems in Pneumonia Pt
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Fever
-Anti-pyretic Pleuritic Chest Pain -Anagesic Infection -Antibiotics Aspiration -aspiration precautions |
