NRS 210 Pneumonia and Infection

a. Assist the patient to splint the chest when coughing. Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance.

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurses most appropriate action to promote airway clearance? a. Assist the patient to splint the chest when coughing. b. Teach the patient about the need for fluid restrictions. c. Encourage the patient to wear the nasal oxygen cannula. d. Instruct the patient on the pursed lip breathing technique.

b. Gown c. Gloves Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

a. Weak, nonproductive cough effort The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern.

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak, nonproductive cough effort b. Large amounts of greenish sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%

Hepatitis D

Hepatitis B virus must preceded this

Hepatitis B/C

Hepatitis virus passed by blood/blood products, sexual contact, and/or perinatal route

d. provide oral care and suctioning to the patient

In order to prevent ventilator associated/acquired pneumonia (VAP) in an intubated patient, the healthcare provider should: a. give prophylactic antibiotics b. maintain intubation for no more than 72 hours c. discourage patient visitors d. provide oral care and suctioning to the patient

a. Increased tactile fremitus Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia.

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. Dry, nonproductive cough c. Hyperresonance to percussion d. A grating sound on auscultation

b. Place patients with altered consciousness in side-lying positions. The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side-lying or upright position. Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients, but it will not decrease the risk for aspiration. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-reducing medications.

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Insert nasogastric tube for feedings for patients with swallowing problems.

a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. e. Hand washing is effective in preventing many viral and bacterial infections. All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza.

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.

b. I will continue to do the deep breathing and coughing exercises at home. Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. I will call the doctor if I still feel tired after a week. b. I will continue to do the deep breathing and coughing exercises at home. c. I will schedule two appointments for the pneumonia and influenza vaccines. d. Ill cancel my chest x-ray appointment if Im feeling better in a couple weeks.

-side lying -sitting up

To prevent aspiration how should patient be positioned in hospital setting?

-aspiration -inhalation -hematogenous spread

What are 3 ways organisms reach the lungs?

-private room with negative air pressure -war N95 respirator when entering room -transport patient outside only when necessary with them wearing a mask

What are airborne precautions?

-private room -wear mask when within 3 feet of patient -move client only when necessary with them wearing a mask

What are droplet precautions?

fine or coarse crackles bronchial breath sounds increase fremitus dullness to percussion if pleural effusion present

What are some physical examination finding for a patient with pneumonia?

-wash hands -PPE (masks, gloves, eye protection, gowns) -clean disinfect soiled equipment -prevent transfer of organisms with soiled linen -transmission based precautions

What are standard precautions?

-community-acquired -hospital-acquired -ventilator-associated

What are the 3 clinical classifications of pneumonia?

fever (temp over 100.9 degrees F) hypothermia (core temp <97 degrees F) heart rate >90 beats/min tachypnea (respiratory rate >=22/min) SBP <100 mm Hg altered mental status edema hyperglycemia (>=140) with no diabetes

What are the diagnostic criteria for sepsis?

For puncture, encourage bleeding, clean with soap and water then report the incident

What are the first steps with needle stick incidents?

measles, tuberculosis, varicella

What illnesses require airborne precautions?

-influenza, mumps, rubella diphtheria, mycoplasma pneumonia, pertussis

What illnesses require droplet precautions?

hand hygiene

What is the first line of defense in medical asepsis?

increased hydration to thin and loosen secretions high calorie, small, frequent meals

What should the nutrition be for someone who has pneumonia?

when hands are not visibly soiled

When is it appropriate to use alcohol-based hand rubs?

when defense mehanisms (cough, epiglottal reflexes) become incomplete or overwhelmed

When is pneumonia most likely to occur?

all patients

Who are standard precautions used for?

sepsis

a constellation of symptoms or syndrome in response to an infection

pneumonia

acute infection of lung parenchyma

pleural effusion

an accumulation of fluid in the pleural cavity

-cough -fever, chills -dyspnea, tachypnea -pleuritic chest pain -green, yellow, or rust-colored sputum -change in mentation for older or debilitated patients

clinical manifestations of pneumonia

Hepatitis A

hepatitis virus primarily passed from fecal/oral route

hospital-acquired pneumonia (HAP)

pneumonia occurring 48 hours or longer after hospitalization and not present at the time of admission

aspiration pneumonia

pneumonia resulting from abnormal entry of secretions into lower airway

community acquired pneumonia (CAP)

pneumonia that occurs in patients who have not been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms

ventilator associated pneumonia (VAP)

pneumonia that occurs more than 48 hours after endotracheal intubation

medical asepsis

protective practices intended to limit the number, growth, and transmission of microorganisms