PNEUMONIA_MICROBIAL - PNEUMONIA: MICROBIAL Pneumonia is an...

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PNEUMONIA: MICROBIAL Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that impair gas exchange. Primary pneumonia is caused by the patient’s inhaling or aspirating a pathogen. Secondary pneumonia ensues from lung damage caused by the spread of bacteria from an infection elsewhere in the body. Likely causes include various infectious agents, chemical irritants (including gastric reflux/aspiration, smoke inhalation), and radiation therapy. This plan of care deals with bacterial and viral pneumonias, e.g., pneumococcal pneumonia, Pneumocystis carinii, Haemophilus influenzae, mycoplasma, and Gram-negative microbes. CARE SETTING Most patients are treated as outpatients; however, persons at higher risk (e.g., with ongoing/chronic health problems) are treated in the hospital, as are those already hospitalized for other reasons. RELATED CONCERNS AIDS Chronic obstructive pulmonary disease (COPD) and asthma Psychosocial aspects of care Sepsis/septicemia Surgical intervention Patient Assessment Database ACTIVITY/REST May report: Fatigue, weakness Insomnia May exhibit: Lethargy Decreased tolerance to activity CIRCULATION May report: History of recent/chronic heart failure (HF) May exhibit: Tachycardia Flushed appearance or pallor EGO INTEGRITY May report: Multiple stressors, financial concerns FOOD/FLUID May report: Loss of appetite, nausea/vomiting May exhibit: Distended abdomen Hyperactive bowel sounds Dry skin with poor turgor Cachectic appearance (malnutrition) NEUROSENSORY May report: Frontal headache (influenza) May exhibit: Changes in mentation (confusion, somnolence) PAIN/DISCOMFORT May report: Headache Chest pain (pleuritic), aggravated by cough; substernal chest pain (influenza) Myalgia, arthralgia May exhibit: Splinting/guarding over affected area (patient commonly lies on affected side to restrict movement)
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RESPIRATION May report: History of recurrent/chronic URIs, tuberculosis or COPD, cigarette smoking Progressive dyspnea Cough: Dry hacking (initially) progressing to productive cough May exhibit: Tachypnea; shallow grunting respirations, use of accessory muscles, nasal flaring Sputum: Scanty or copious; pink, rusty, or purulent (green, yellow, or white) Percussion: Dull over consolidated areas Fremitus: Tactile and vocal, gradually increases with consolidation Pleural friction rub Breath sounds: Diminished or absent over involved area, or bronchial breath sounds over area(s) of consolidation; coarse inspiratory crackles Color: Pallor or cyanosis of lips/nailbeds SAFETY May report: Recurrent chills History of altered immune system: i.e., systemic lupus erythematosus (SLE), AIDS, steroid or chemotherapy use, institutionalization, general debilitation Fever (e.g., 1028F–1048F/398C–408C) May exhibit: Diaphoresis Shaking Rash may be noted in cases of rubeola or varicella TEACHING/LEARNING May report: History of recent surgery; chronic alcohol use; intravenous (IV) drug therapy or abuse;
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PNEUMONIA_MICROBIAL - PNEUMONIA: MICROBIAL Pneumonia is an...

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