Pneumonia
Pneumonia Causes and Risk Factors
Causes
- Chronic Lung Diseases (COPD)
- Immunosuppression
- Ventilators and sedation
- Decreased gag/cough reflex
- Surgery (e.g., abdominal)
- RSV in children
- Bedrest
- Age > 65
- Malnutrition
- Smoking
- Diabetes
- Dysphagia (risk for aspiration)
Risk Factors
- Infection that obstructs the alveoli and impairs gas exchange
- Caused by viruses, fungi, chemicals and bacteria
- Mycoplasma pneumoniae “walking pneumonia. It is mild and rarely needs hospitalization.
- Hospital-Acquired pneumonia- due to hospitalization.
Diagnosis
- Chest X-Ray (gold standard)
- Sputum Culture (infectious organism is isolated)
- CT Scan
- Bronchoscopy
Symptoms
- Tachypnea
- Fever/chills/sweating
- Productive Cough & SOB
- Crackles/Rales
- Bronchial sounds at the bases of the lungs
- Pleuritic Pain
- Confusion in the elderly
- Tachycardia
- ↑ WBCs
- Hypoxia/↓ Saturations
- Anorexia
- ABG with respiratory acidosis and hypoxemia
- pH 7.29Â pCO2 55Â pO2 60
- High pCO2 and low pO2
Treatment
- Oxygenation #1
- Sputum cultures before starting antibiotics
- Antibiotics if bacterial
- Fluids to keep secretions thin (If client does not have CHF)
- Bedrest with HOB elevated
- Pain meds
- Antipyretics for fever
- Coughing and Deep Breathing
- Incentive Spirometry
- Pneumonia vaccine
- Quit smoking
- Handwashing
Antibiotics
- Narrow spectrum: Penicillin and Macrolides (Azythromycin = Z pack).
- Doxycycline (a tetracycline): Broad spectrum.
- Vancomycin: check levels, check kidney function, monitor for ototoxicity.
- Fluroquinolones: can cause tendon rupture along with c.diff infection and cardiac arrhythmia such as prolonged QT interval.
Vaccinate
Incentive Spirometry
Incentive Spirometry:Â The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales. NCLEX Alert
70-year-old male client is admitted to the ED with a history of COPD and diabetes. Client lives in a nursing home and was found wandering the hallways confused and combative. Client was also noted to have SOB and cough with thick yellow secretions.Â
Temp 101.4 °F, BP 102/55, HR 120, RR 28, Oxygen saturation on room air 88%.
Client answers questions, but is confused. Does not know where he is and what day and what month it is. Chest barrel-shaped. Lungs with bilateral crackles at the bases. Coughing thick yellow secretions. S1 S2 present, no murmurs. All peripheral pulses palpable. Bowel sounds active x 4 quadrants. skin without rashes
- EKG: Sinus tachycardia
- Chest Xray: bilateral lower lobe infiltrates
- ABG: pH 7.32, pCO2 49, pO2 69, HCO3 23
- Sodium 135
- Potassium 3.9
- Chloride 101
- Creatinine 2.2
- BUN 30