If ICOUGH doesn’t work… INTERVENTIONS:PEEP (positive end expiratory pressure)- a simple mask and one-way valve system that provides varying amounts of expiratory resistanceContinuous positive airway breathing (CPAB)Chest physiotherapyNebulizer treatments with a bronchodilator or sodium bicarbonateBronchoscopy - acutely remove secretions/mucous and increase ventilationIF the cause of atelectasis is compression of lung tissue- the goalDecrease compression of alveoliLarge pleural effusion that is compressing lung tissue and causing alveolar collapseTX Thoracentesis - removal of the fluid by needle aspirationOr Insertion of a chest tubePneumoniaPneumonia can be classified into four types: chart 23-31. CAP: Community Acquired Pneumonia2. HCAP: Health Care Associated PneumoniaEx: nursing home, long term care facility, chemotherapy3. HAP: Hospital Acquired Pneumonia4. VAP: Ventilator Associated PneumoniaDevelops after endotracheal tube intubationRisk factors for developing pneumonia:
PNEUMONIA REVIEW –Acute care management need for fluids, signs of hypoxia (oxygen is given if hypoxemia develops),You want blood & sputum cultures, but you are not going to hold off on antibiotics if they are not producing sputumPneumonia vaccine can be prevented of?Orders sputum culture and sensitivity and pt does not have a productive cough you are not going to hold off antibiotics until pt produces sputum – YOU ARE GOING TO GIVE THE ANTIBIOTICS! MEDS TABLE 24-4 – inhale corticosteroid teaching (to prevent thrush), video from that lectureSPECFICS for pneumonia vaccines
Aspiration PneumoniaWhat are the Risk Factors? What are some preventative measures to take? Clinical Manifestations of pneumonia Varies, Can’t diagnose typebased on symptoms. Sudden onset of chills, rapidly rising feverPleuritic chest pain that is aggravated by deep breathing and coughingTachypneaBradycardiaUpper respiratory tract infection (nasal congestion, sore throat)
Gradual and nonspecificHeadache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitisSputumOrthopneaPoor appetite Diaphoretic Fatigues easilyStreptococcal (pneumococcal) pneumoniaMay present with:Sudden onset of chills, Rapidly rising fever (38.5° to 40.5°C [101° to 105°F])Pleuritic chest pain that is aggravated by deep breathing and coughingTachypnea (25 to 45 breaths/min) – in respiratory distressWhat are some of the other symptoms?diagnosis of pneumonia is made by:history – what is important to ask about?physical examination, chest x-ray, blood culture what are they looking for? Sputum collection for culture: what are the 4 steps?How can you prevent pneumonia? What are the recommendations?Medical ManagementAntibioticDo not delay for sputum cultureHydration why?Antipyreticsantitussive oxygen, if neededComplicationshypotension septic shock respiratory failurePleural effusion empyema
NURSING PROCESS - The Patient with PneumoniaAssessmentWhat is the nurse going to assess for?