Community- Acquired Pneumonia Caitlin Darby Florida Hospital
Tampa November 14, 2012
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Objectives 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
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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)
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Pneumonia Pathophysiology Video
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Most Common Bacterial Microbes Responsible for Pneumonia
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)
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Routes of Entry Inhalation of airborne pathogens 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)
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Risk Factors for Pneumonia Age 65 and older Very young children
whose immune systems havent 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)
Prevalence of Pneumonia in the United States 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 6 th leading cause of death
worldwide CAP= 350,000-620,000 hospitalizations each year
(Loebinger & Watson, 2012) & (Huether & McCance, 2012
)
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Medical Interventions From 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 patients
signs/symptoms Continuous IV fluids
http://health.nytimes.com/health/guides/disease/pneumonia/overview.html
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Nursing Interventions From current research 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 semi- fowlers 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
Prevention of Pneumonia 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 doesnt 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
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Patient Scenario 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.
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
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Medical Interventions What was done while the patient was in
the hospital 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
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Nursing Interventions What was done while the patient was in
the hospital 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
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Outcomes 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
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NCLEX Question #1 A diagnosis of pneumonia is typically
achieved by which of the following diagnostic tests? a. ABG
analysis b. Chest x-ray c. Blood cultures d. Sputum culture and
sensitivity
http://amy47.com/nclex-style-practice-questions/airway-pneumonia-and-tb/
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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. Bronchial b.
Bronchovestibular c. Tubular d. Vesicular
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NCLEX Question #3 An elderly client with pneumonia may appear
with which of the following symptoms first? a. Altered mental
status and dehydration b. Fever and chills c. Hemoptysis and
dyspnea d. Pleuritic chest pain and cough
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NCLEX Question #4 Which of the following organisms most
commonly causes community-acquired pneumonia in adults? a.
Haemiphilus influenzae b. Klebsiella pneumoniae c. Streptococcus
pneumoniae d. Staphylococcus aureus
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NCLEX Question #5 Clients with chronic illnesses are more
likely to get pneumonia when which of the following situations is
present? a. Dehydration b. Group living c. Malnutrition d. Severe
periodontal disease
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References 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). 285- 290. 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-interventions-
for-pneumonia.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