Enlex RN Review: Aspiration Pneumonia and Infectious Pneumonia

Jul 17, 2024

Enlex RN Review - Day 19

Introduction

  • Welcome to the 19th day of 90-day Enlex RN review session.
  • Comprehensive explanation and dissection of 2,000 Enlex questions.
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  • Visit StankX Coaching for tailored assistance.

Overview of Today's Session

  • Focus: Nursing management for aspiration pneumonia and infectious pneumonia.

Aspiration Pneumonia

Definition

  • Serious condition where oral/stomach contents are inhaled into lungs, leading to pneumonia.
  • Prevalent among the elderly and individuals with certain medical conditions.

Underlying Causes and Mechanisms

  • Oropharyngeal Dysphasia: Difficulty swallowing.
  • Lack of Protective Airway Reflexes: Swallowing/coughing reflexes may be lost post-surgery or due to altered consciousness.
  • Neurological Conditions: Seizures, stroke, multiple sclerosis, dementia, Parkinson’s disease, Myasthenia Gravis.
  • Gastrointestinal Issues: Strictures, diverticula, tracheoesophageal fistula, acid reflux, hiatal hernia.
  • Severity Factors: Dependent on the volume and type of content aspirated (e.g., gastric acid, bacteria, vegetable oil).

Pathogens Involved

  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Gram-negative bacteria

Manifestations

  • Increase in Heart Rate: Tachycardia
  • Fever: Elevated body temperature.
  • Shortness of Breath: Difficulty in breathing due to inflammation and fluid in the lungs.
  • Cough: Body's attempt to clear aspirated substance.
  • Rapid Breathing: Compensate for reduced oxygen intake.
  • Cyanosis: Bluish discoloration of skin, especially around lips/fingertips, indicating hypoxemia.
  • Decreased Breath Sounds: Fluid or pus in lungs.
  • Crackles: Indicative of fluid in small airways.
  • Pleural Friction Rub: Inflammation sound in lungs.
  • Percussion Dullness: Fluid/solid material in lungs.
  • Thick Pus-filled Mucus: Indicates significant infection.

Diagnostic Tests

  • Chest X-ray: Key tool; shows consolidation and abnormalities over time.

Treatment Steps

  • Clearing Blocked Airway: Use of suctioning and manual removal.
  • Antibiotic Therapy: Address bacterial infections.
  • Laryngoscopy/Bronchoscopy: Assess and clear airways.
  • Oxygen Therapy: Administration and potential mechanical ventilation.
  • Fluid Volume Replacement: Stabilize blood pressure during shock.
  • Correction of Acidosis: Manage respiratory acidosis.

Nursing Care

  • Assess/Maintain Patent Airway: Clear airway and monitor continuous pulse oximetry.
  • Monitor for Infection Signs: Fever, foul-smelling sputum, lung congestion.
  • Evaluate Level of Consciousness and Gag Reflex: Determine swallowing ability and aspiration risk.
  • Elevate Head of Bed: Prevent aspiration in patients with decreased consciousness.
  • Screen for Dysphagia: Use bedside assessment and make referrals if needed.
  • Tube Feeding Safety Practices: Correct tube placement, slow feeding administration.

Infectious Pneumonia

Types and Pathogens

  • Community-Acquired Pneumonia (CAP): Streptococcus pneumoniae, Haemophilus influenzae, Aerobic Gram-negative bacteria, Staphylococcus aureus.
  • Hospital-Acquired Pneumonia (HAP): Gram-negative rods, Staphylococcus aureus (including MRSA).
  • Atypical Pneumonia: Mycoplasma pneumoniae, Legionella species, Influenza A and B, RSV.

Risk Factors

  • CAP: Altered mental status, smoking, alcohol, hypoxemia, toxic inhalations, pulmonary edema, uremia, malnutrition, immunocompromised conditions.
  • HAP: Recent hospitalization, living in long-term care facilities, intravenous antimicrobial therapy, chemotherapy, wound care.

Manifestations of Pneumonia

  • General: Fatigue, productive cough, pleuritic chest pain, dyspnea, use of accessory muscles, tachycardia.
  • Diagnostic Tests: Chest X-ray, sputum analysis, blood cultures.

Treatment and Nursing Interventions

  • Antibiotics: Empiric therapy initially, tailored according to culture results.
  • Oxygen Therapy: Monitor oxygen levels, humidify at >4L/min, cautious administration for COPD patients.
  • Early Ambulation: Shorten hospital stay, improve recovery.
  • Vaccination Status: Ensure influenza and pneumococcal vaccines.
  • Smoking Cessation and Respiratory Hygiene: Prevent recurrence and spread of infection.

Complications

  • Pleural Effusion: Fluid buildup between lungs and chest wall.
  • Shock: Persistent low blood pressure due to sepsis.
  • Empyema: Collection of pus in pleural cavity.
  • Superinfections: Pericarditis, bacteremia, meningitis.
  • Delirium: Acute confusion, marker of severe infection.
  • Atelectasis: Lung collapse due to mucus plugging.

Patient Education

  • Antibiotic Compliance: Prevent resistance.
  • Fatigue and Gradual Activity Increase: Post-recovery care.
  • Lung Clearing Exercises: Enhance lung function.
  • Follow-up Chest X-ray: Reassess lung clearance.
  • Vaccination and Preventive Measures: Enhance immunity.
  • Hand Hygiene and Avoiding Close Contact: Prevent spread.

Conclusion

  • Regular assessment, administration of antibiotics, respiratory support, and patient education are crucial.
  • Encourage caregiver involvement and ensure adherence to treatments and follow-up appointments.

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