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104 Cards in this Set
- Front
- Back
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What are the different types of classification of pneumonia
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CAP - community acquired
HAP - hospital acquired PCP - pneumocystis pneumonia (immunosuppressed) Aspiration |
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is pneumonia an upper or lower airway infection?
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lower
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What are the core measures for pneumonia
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PN 1-7
1-O2 assessment 2 - screening for pna and/or vaccination 3 - blood culture w/in 24 hr PRIOR to antibiotics 4 - smoking cessation 5 - antibiotic w/in 4-8 hrs on arrival 6 - immoCompetent pts antibiotics withing first 24 hrs. 7-Flu vaccine |
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Tx for pneumonia
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supportive tx: fluids, O2 for hypoxia, antipyretics, antitussives, decongestants and antihistamines
adm of antibiotics if etiologic agent is not identified - use empiric (observation/experiment) antibiotic therapy antibiotics are only for 2ndary bacterial infections |
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s/s of bacterial infection (pneumonia)
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productive cough (green, yellow, mucous) and increased fever
SOB, chills |
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s/s of viral infection (pneumonia)
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non productive cough and low fever
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onset of HAP is usually....
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greater than 48 hrs after admission
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symptoms of pleural effusion
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increased fever
tachycardia are common |
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what are nsg diagnosis for pneumonia
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ineffective airway clearance RT
activity intolerance RT risk for deficient fluid volume imbalanced nutrition: less than body requirements deficit knowledge |
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what is this Breath Sound, what is the intensity, pitch and location where heard normally
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Broncho-vesicular, the inspiration and expiratory sounds are about equal
intensity = intermediate Pitch = intermediate found - between 1st and 2nd inter spaces anterior and between the scapulae over the main bronchus |
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what is this Breath Sound, what is the intensity, pitch and location where heard normally
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Bronchial
exp last longer than insp. ones intensity - loud pitch - relatively high found- over the manubrium if hear at all |
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what is this Breath Sound, what is the intensity, pitch and location where heard normally
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Tracheal
duration- insp and exp are about equal intensity - Very loud pitch - Relatively high Location - over the trachea in the neck |
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what is this Breath Sound, what is the intensity, pitch and location where heard normally
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Vesicular
insp last longer than exp intensity - soft pitch - low location - entire lung field except over the upper sternum and between the scapulae |
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during an assessment of a pt with pneumonia what would you be looking for?
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changes in temperature and pulse
secretions cough tachypnea and SOB changes in physical assessment, CXR and other things elderly pts. |
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What are the assessment items you would look for in an elderly patient with pneumonia
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fatigue, dehydration and concomitant (Naturally accompanying or associated) heart failure
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ABGs on a pt with pneumonia would show
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hypoxemia
(decreased partial pressure of oxygen in blood, sometimes specifically as less than 60 mmHg, or causing hemoglobin oxygen saturation of less than 90% ) |
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Why are fluids important for pts with pneumonia
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enables liquidation of mucous trapped in the bronchioles and alveoli, facilitating expectoration. for fever; and non-sensible loss.
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why does high fowlers position facilitate cough and comfort.
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lessens pressure on diaphragm by abdominal organs.
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what is a pink puffer
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barrel chest, emphysema, 02 adequate to oxygenate
but must use accessory muscles to breathe. |
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what is a blue bloater
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insufficient o2 occurs with chronic bronchitis
and leads to generalized cyanosis and often right sided heart failure (cor pulmonale) |
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Acute Pneumonia may lead to.....
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Pleural effusion (fluid in pleural space, 40% will get)
Atelectasis super-infection |
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What are 6 different ways to improve airway clearance
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encourage hydration
humidification by face mask or w/02 Coughing techniques chest physiotherapy O2 therapy administered as pt needs |
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what is pleurisy
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inflammation of both layers of the pleurae
causes pain and SOB in large effusion |
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what is pleural effusion
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collection of fluid in the pleural space, usually secondary to another disease process
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What is empyema
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accumulation of thick, purulent fluid in the pleural space.
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what are the clinical findings of pleural effusion
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decreased or absent breath sounds
decrease fremitus (vibratory tremors) dull/flat percussion. Large effusion - Acute Resp. Distress and Tracheal deviation away from affected side |
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What is the nsg mgt for pleural effusion
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record thoracentesis fluid amount
drain from chest tube pain management positioning on AFFECTED side, splinting |
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what is pulmonary edema
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accumulation of fluid in lung tissue, alveolar space or both
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pathophysiology of pulmonary edema
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results from increased microvascular pressure from abnormal cardiac function.
(back up into pulmonary system) |
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what are clinical manifestations of pulmonary edema
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respiratory distress
dyspnea air hunger central cyanosis anxious or agitated fluid in alveoli - FOAM (pt coughs up frothy foamy blood tinged secretions) confusion or stupor crackles in bases progressing to apices of lungs tachycardia O2 falls ABG continue worsening to hypoxemia. |
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mgmt for pulmonary edema
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correct underlying disorder
if cardiac - L ventricular function is goal vasodilators, inotropic meds, afterload/preload meds or contractility (digoxin), O2, intubation mechanical ventilation. Extremely anxious = morphine to relax and control pain |
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what is afterload
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the "load" that the heart must eject blood against -
peripheral vascular resistance |
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what is the preload
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end-diastolic stretch of myofibers
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what is VAP
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Ventilator - associated pneumonia
bacterial pneumonia that develops in pts with acute respiratory failure who have been receiving mechanical ventilation for at least 48 hr. |
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What is the most common form of aspiration pneumonia
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bacterial infection from aspiration of bacteria from upper airways. S. pneumonia, H. influenzae S. aureus.
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what is thoracentesis for
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it is to remove fluid, to obtain a specimen and to relieve dyspnea and respiratory compromise.
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pain on inspiration may be:
pleurisy pleural effusion pulmonary hypertension |
pleurisy
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decreased or no breath sounds:
pleurisy pleural effusion pulmonary hypertension |
pleural effusion
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dyspnea upon exertion, rest and substernal chest pain may be:
pleurisy pleural effusion pulmonary hypertension |
pulmonary hypertension
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normal plueral fluid is ___ to ___ ml
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5 to 15 mL
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What is empyema
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a pus pocket. accumulation of thick, purulent fluid within the pleural space, often with fibrin development and a walled off area where infection is located.
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why does empyema occur
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complication of bacterial pneumonia or lung abscess
chest trauma hematogenous infection of pleural space nonbacterial infections iatrogenic causes (after thoracic surgery or thoracentesis) |
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Loculated empyema
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fluid in the pelural space starts thin with low WBC but becomes fibro-purulent and last stage where the lung is enclosed in a thick exudative membrane. loculated empyema.
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tx empyema
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drainage of fluid by needle aspiration
tube thoracostomy with fibrinolytic (clot busters) instilled through chest tube open chest drainage via thoractomy to remove pus |
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mgmt for pulmonary edema if the problem is cardiac in origin would be
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improvement in left ventricular function
by vasodilators, inotropic meds afterload or preload meds, contractility meds. |
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mgmt for pulmonary edema if the problem is fluid overload in origin would be...
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diuretics and fluids are restricted.
O2 for hypoxemia, intubation and mechanical vent if necessary. morphine may be prescribed to reduce anxiety and control pain |
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what is MAP stand for
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mean arterial pressure
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What is mean arterial pressure?
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usually the average. should be over 60 to sustain body organs. normal is 70-110
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When you have high pulmonary artery pressure you get hypertrophy and risk of....
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backing up - then edema. Leads to R HF and death.
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After pulmonary artery pressure increases you get a ______ in pulmonary vascular resistance
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increase
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pulmonary resistance affects the ____ ventricular function
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right
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what is idiopathic pulmonary arterial hypertension
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this is primary hypertension of unknown cause.
rare but most often in women 20-40. usually fatal with 5 years. |
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is pulmonary arterial hypertension primary or secondary
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secondary. It is due to a known cause either existing cardiac or pulmonary diseases.
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what is the prognosis of Pulmonary HTN
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depends on the severity of the underlying disorder
and the changes in the pulmonary vascular bed. |
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what are common cause of pulmonary artery constriction due to hypoxemia
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COPD or Cor Pulmonale
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what are the symptoms of Pulmonary hypertension
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hypoxemia
signs of right heart failure (vein distension, edema Tall peaked P waves in inferior leads II, III, AVF) |
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Tx of pulmonary HTN
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supplemental O2
Fluid limit Diuretics Cardiac glycosides CCB, Prostaglandins, Anticoagulants |
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what is ARDS
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Acute Respiratory Distress Syndrome a severe form of acute lung injury.
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ARDS and aspiration is to Silent as Pulmonary Embolism is to...
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dead space VQ imbalance
increase V (ventilation) decrease Q (perfusion) |
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pulmonary embolism is to dead space as pneumonia is to...
(also atelectasis, tumor or mucus plug) |
shunting VQ imbalance
decreased V (ventilation) decrease Q (perfusion) |
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Pneumonia is to shunting, as ARDS and aspiration is to...
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dead space VQ imbalance
decrease V (ventilation) increase Q (perfusion) |
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shunting is a ___________ in ventilation and a ____________ in perfusion ratios
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decrease in ventilation and increase in perfusion ratios
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dead space is a ___________ in ventilation and a ____________ in perfusion ratios
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increase in ventilation and a decrease in perfusion ratios
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silent is a ___________ in ventilation and a ____________ in perfusion ratios
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decrease in ventilation
decrease in perfusion |
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if the V is equal to Q then it is....
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normal
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if V is > than Q then it is ....
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dead space
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if V is < Q then it is....
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shunting
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if V and Q are both decreased then it is....
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silent
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ventilation is better in zone_________
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zone 1 or apices
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perfusion is better in zone______
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zone 3 the bases
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what is diffusion
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gas exchanges
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what is perfusion
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blood moving through carrying air
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what is ventilation and perfusion.
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movement of air related to the blood moving through to carry the air
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what are examples of airway resistance related to ventilation
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obstructive diseases COPD and Asthma
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if the pt has poor ventilation what would be clinical symptoms
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lung sounds, movement of chest
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if pt has poor perfusion, what would be clinical symptoms to look for
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capillary refill, cyanosis, skin temperature
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which is more serious, ventilation or perfusion failure
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ventilation
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acute respiratory acidosis deteriorates into
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systemic acidosis
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What are complications of V/Q imbalance
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Organ hypoxia
ventilation failure Acute respiratory acidosis into systemic acidosis result is impaired cellular function |
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what is the resulting complication of V/Q imbalance
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impaired cellular function
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what is ARF
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acute respiratory Failure
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what is acture respiratory failure
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sudden life threatening deterioration of the gas exchange function of the lung. (not cardiac)
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If PaO2 is < 50mmhg you have
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hypoxemia
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PaCO2 > 50 mmhg you have
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hypercapnia
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Someone with Acute Respiratory Failure will have a PaO2 of _____ and a PaCo2 of ____ and a pH of ______-
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< 50 mm Hg
> 50 mm Hg < 7.35 |
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with acute respiratory failure what is the 1st intervention, then 2nd
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1st Oxygen
2nd Id underlying cause |
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What is the pathophysiolgy of ARF
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injury that interferes with the VQ . increased O2 demands
Progressive increase in CO2 and decrease O2 Work of breathing increases with resultant muscle fatigue |
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describe what work of breathing looks like
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how fast, retractions, positioning, shoulders going up/
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What are four categories of ARF
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Decreased respiratory drive
dysfuntion of the chest wall dysfunction of the lung parenchyma complication of major thoracic, ABD surgeries |
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When most people have a respiratory drive driven by high CO2, COPD is driven by
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hypoxic drive or low O2
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what are the signs and symptoms of ARF
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Dyspnea - tachypnea
restless (due to low O2 to brain) cyanosis (late sign) dysrhythmia (due to low O2 for heart muscle) altered LOC (brain) |
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What is ventilation failure
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inability to move air adequately in and out of alveoli = increased CO2 (alveolar hypoventilation)
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What is hypoventilation
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increased CO2
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what are causes of Alveolar Hypoventilation
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Neuromuscular D/O
Respiratory muscle fatigue COPD |
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If you have a problem with ventilation failure, do you have respiratory alkalosis, acidosis, metabolic....
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acute respiratory acidosis
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What is the paco2 and ph of acute respiratory acidosis
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paco2 of 50mm Hg or greater with pH < 7.3
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What are the 2 different failures of ARF
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ventilation failure and oxygenation failure
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what is oxygenation failure
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impairment in diffusion across alveolar capillary membrane
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What are the causes of Oxygenation Failure
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ARDS
PE Acute Asthma Attack Pneumonia |
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hypoxemia is a PaO2 of
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< 60 mmHg on room air
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if your PaOx is > 80, do you have severe, moderate, mild or normal O2 in blood gasses
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normal
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if your PaOx is < 80, do you have severe, moderate, mild or normal O2 in blood gasses
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< 80 > 60 is mild
at 60 it is a SatO2 of 90% |
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if your PaOx is < 60, do you have severe, moderate, mild or normal O2 in blood gasses
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< 60 and > 40 is moderate
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if your PaOx is < 40 , do you have severe, moderate, mild or normal O2 in blood gasses
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< 40 is severe
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