hey everyone it's Sarah registered nurse Orion comm and in this video I'm going to be going over part two of an in clicks review over pneumonia what I want to be covering are the nursing interventions and the medications used to treat pneumonia now be sure to watch part 1 because that builds upon this video I discussed the path oh the risk factors the different types and the signs and symptoms of pneumonia and as always over here on the side or in the description below you can access the notes and the quiz that go along with this lecture so let's get started first let's talk about nursing interventions what are you going to do for this patient as the nurse okay first thing you want to do is you want to monitor that respiratory system because with pneumonia our respiratory system is what is having trouble so what you're going to do is you're going to be auscultate 'knows lung sounds typically with pneumonia we learned this in part one you could expect to hear maybe some coarse crackles or wheezing also known as rhonchi or bronchial breath sounds which are normal breath sounds if heard in the tracheal area but if heard in the peripheral lung fields this could represent lung consolidation so you want to be listening to that you want to see if they're improving or if they're getting worse another thing is you want to monitor those bottle signs how is that respiratory rate are they talk of peening and what's that AUSA Ginn saturation is it less than 95 percent or 90 where do we want them all so you want to not only look at that but you want to see how their skin color is are they sign on it one thing that if a patient is not getting good oxygen supply the first thing that you will notice I have seen it many times as a nurse is where they start to turn blue is in their lips the pink color of their lips all of a sudden you'll start seeing the lips start turned lightly purple purple and then they'll start to turn blue and you give them more oxygen and then they'll turn a nice rosy red color again so assess those lips and especially the skin to see if they're getting enough oxygen because that's a telltale sign also monitor their arterial blood gas results physicians will order this it'll come up in your computer you need to report if anything is getting too abnormal are they retaining way too much carbon dioxide and they're super hypoxemic where they have low oxygen in the blood they may need to be placed on BiPAP or mechanical ventilation so you always want to look at their arterial blood gases and compare it with the previous ones that they had also your job if ordered is to collect a sputum culture a lot of times if a patient is admitted with pneumonia there will be an order set that says collect sputum culture and you'll give them something to cough and spit their sputum in you'll send it off so they can see what is causing this pneumonia also as a nurse you'll be watching the rest for a system but you'll need to assess when they need suction a lot of times you may have to do it nasotracheal ii go in through the nose down through the trachea and suction them especially if all of a sudden there's so much mucus so much going on they can't breathe and you need to go in there and get it out really fast so they can breathe and um assess their need for respiratory breathing treatments a lot of places have respiratory therapists that will administer those but as a nurse it's your responsibility to make sure if the patient needs one that you call them if the breathing treatments ordered as needed a lot of times with patients with pneumonia they will be scheduled so the respiratory therapist will be on the floor routinely giving your patient whatever the doctors ordered a lot of times what will be ordered is like bronchodilators sometimes chest percussion therapy may be ordered but respiratory therapy will do that for you and another thing you want to do is educate educating the patient about the following incentive spirometer usage I did a hole in CLECs review on incentive spirometer you can access it in a card above if you want to watch how to use an incentive spirometer and what to expect what kind of test questions you may be tested on with an is but within sim spirometer this helps the patient and deep breathe and what will hopefully happen it will pop open those sacs get that air moving get that mucus out so we can help the get better they'll want to use that ten times every one to two hours while awake another thing is that they want you want to keep them hydrated and they'll be running a fever so that causes dehydration and respiratory alone and causes a person to lose about 300 to 400 milliliters of water per day and this will help keep the secretions thin because if they come and do you become dehydrated those mucus it that mucus will become thick and hard to COFF and get up however patients with contraindications like heart failure renal failure you would not want to give them this much fluid so you need it's based on per patient what's going on with them so always assess that another thing is if you have a patient who's immobile you want to make sure you're turning them frequently to keep secretions moving and have their head of the bed up at least thirty degrees especially why eating because of their risk for aspiration aspirating their GI contents or food that they're eating into the lungs which can cause pneumonia in itself but makes the pneumonia a lot worse another thing big thing is make sure that they are aware and they are up to date with their vaccines they're getting the annual flu shot because as we learn in part one viruses can cause pneumonia a lot of times a patient will have the flu and it's hard their immune system it's made them more susceptible to the germs in the environment and they developed pneumonia also for patients who are 65 or older or from 19 to 64 with risk factors like they live in a long-term care facility they have issues where they're more susceptible catching pneumonia there's an accent called Pneumovax where they can get that every five years to help prevent from some forms of pneumonia so let them know that also for your patients who smoke and help them figure out ways to quit smoking because this increases the chances of recurrent and yeah and also educate them about avoiding sick people and especially during peak seasons of flus going out and crowds will increase their chances and the importance of hand hygiene always washing the hands using hand sanitizer whether out in the public especially before they eat and another thing we will be doing as a nurse is administering medications whatever the doctor ordered and this typically includes antipyretics keep the fever down flu IV fluids to keep them hydrated and if it's a viral cause they will not be ordered antibiotics because antibiotics are for bacterial forms of pneumonia but you may be giving antivirals like Tamiflu or something like that now let me talk more in depth about the antibiotics that are used to treat pneumonia the categories of the category of drugs there are various antibiotics that are used to treat pneumonia and the drive use depends on the type of bacteria that is causing the infection if the patient can tolerate it or if they're allergic to it or something like that so here are the drug categories that are typically used to treat various cases of bacterial pneumonia and to help you remember those I have developed this mnemonic to help you remember them in each letter at the beginning of the word correlates with its drug category so remember various medications frequently treat pneumonia cases okay the first one is vancomycin this isn't a drug category the name of a drug specifically and it's the only one out of these but vancomycin is used to treat severe cases because it's one of the antibiotics left that can treat resistant bacteria however and it's rare but this drug can cause what's called odo toxicity where it can cause hearing loss so monitor your patients listen to your patients if your patient starts complaining of I'm hearing this loud ringing in my ears all of a sudden or roaring or something like that it could be um the beginning of hearing loss caused by this medication so remember that insects purposes nursing lectures that's a big one that always stands out okay next drug the end for micro lids some drugs included in this are like z pegs zithromax this is a narrow spectrum antibiotic and it treats mainly gram-positive and it's used in patients who have a Peniston a penicillin allergy so if they're allergic to penicillin chances are they'll be prescribed this medication another drug use or call are called tetracyclines and a popular one and is called doxycycline and this is a broad a broad spectrum antibiotic treat spoke gram-positive and gram-negative has a broader range however and this is not for pregnant patients because it can cause fetal retardation of growth can discolor teeth and it's all for children less than eight because the discoloration of teeth also it can increase the to your patients chances of getting a sunburn outside it makes the skin very photosensitive so educate them about that also educate your patients who are taking birth control ask them if they're on doxycycline they're young or within childbearing age ask them with their own birth control because this can decrease the effectiveness of birth control they need to use another method to prevent pregnancy also when taking this medication do not take milk products or antacids while taking the medication because it can affect the absorption of the tetracycline antibiotic okay another one is called 4o quinolones popular one use is called levaquin this is a broad-spectrum antibiotic as well treats both gram positive and gram negative it is used to treat severe infections just like the Bangko myosin and especially those resistant forms however this drug has a lot of black box warnings from the FDA on it because it can cause some really nasty side effects so watch the following any type of infections like seed if this is a gastrointestinal infection we're pretty much the same body because just kill every your normal flora of your gut and has allowed this Clostridium bacteria to invade the patient and we'll have profuse diarrhea frequent frequent episodes of it and it will have a horrific smell so if your patient starts having that may want to let the physician know so they can send it off for a sample if they're taking this medication because it could be what has caused it another thing that has been seen with this drug is tendon rupture of the tendons say a patient's been taking this all of a sudden and their tendon ruptures happens in young healthy people there on this drug has been linked to that and QT interval prolonged as well another drug category called cephalosporins and some drugs that fall into this or like k flexor Rocephin and there's different generations of cephalosporins you have one and two three and four generations three and four tend to be broad-spectrum where they target grande positive and gram negative compared to the first and second generations and however if a patient is allergic to penicillin and they may be allergic to seselis porns as well there's been a relationship between that so monitor your patient if they are prescribed this and the physician wants to prescribe this to them all even though they may be allergic to penicillin you want to watch that because they may be allergic to this as well and the last drug is penis sealant I'm popular one is penicillin G this is a narrow spectrum drug so you're only narrow spectrums out of this is your micro lids and your penicillins and the early generations of your cephalosporins and then everything else third for generations and everything else would be broad-spectrum and you want to monitor them if they if they say they're allergic to seselis morons probably won't be prescribed like with the cephalosporin priscila penicillin they may go ahead and prescribe them like a micro lid just in case but sometimes they'll so prescribe it because they don't know if it's a true penicillin allergy so watch that and this also decreases the effectiveness of birth control so and make sure you assess if your patient is on birth control medicine so that is part two of pneumonia specifically the nursing interventions and medications be sure to watch part watch part one and thank you so much for watching and please consider subscribing to this YouTube channel