1 / 42

Infection: Pneumonia and Influenza

Infection: Pneumonia and Influenza. Lewis ch. 27, 28. Objectives (pp.5-6). The Infection concept will be reviewed in this presentation. Pneumonia and influenza are the exemplars for the Infection concept and are included in this presentation. Infection Concept Review.

sivan
Download Presentation

Infection: Pneumonia and Influenza

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Infection: Pneumonia and Influenza Lewis ch. 27, 28

  2. Objectives (pp.5-6) • The Infection concept will be reviewed in this presentation. • Pneumonia and influenza are the exemplars for the Infection concept and are included in this presentation.

  3. Infection Concept Review • Infection—disease state resulting from the presence of pathogens in the body. May be acute or chronic • Pathogens—disease-producing microorganisms—bacteria, viruses, fungi, parasites. The presence of these pathogens usually produces an inflammatory response as well.

  4. Course of Infection • Incubation period—time between entry of pathogen and onset of sx • Prodromal stage—nonspecific sx, most infectious • Illness stage—worst sx • Convalescence—recovery time • Length of each stage depends on type of infection—may be local or systemic

  5. Chain or Cycle of Infection • Infectious agent (pathogen) • Reservoir (place it lives) • Portal of exit (orifices or breaks) • Mode of transmission (how it moves) • Portal of entry (orifices or breaks) • Susceptible host (stressors)

  6. Defenses Against Infection • Normal body flora • Body system defenses • Inflammatory response • Vascular and cellular responses • Formation of exudates • Tissue repair

  7. The SusceptibleHost • Changes in normal body flora • Breakdown in body systems • Flawed inflammatory response • Problems with tissue repair • Stressors

  8. Localized Warmth Swelling Redness Drainage Pain/tenderness Restricted movement Systemic Changes in VS Fatigue N/V/D Malaise Lymphadenopathy Confusion Clinical Appearance of Infection

  9. Laboratory Data • WBC(Totals and differentials) Amount elevated usually indicates severity. • “Left shift” (high neutrophils) usually indicates a severe infection. • Total elevation not seen in viral infections. May see a “right shift” (high lymphocytes) in some viral infections • +Cultures and gram stains

  10. Interventions • Protect clients • Educate clients • Maintain own worker health • Give antimicrobials • Be aware of S&S of infection • Practice medical and surgical asepsis

  11. Exemplar # 1: Influenza p. 538 • Caused by different strains of A or B virus • A leading cause of morbidity and mortality; most deaths occur in over 60 age group • Most could be prevented with vaccination-need new one each year. Inactivated in >50 and live, attenuated in younger groups • Table 27-3, p. 539 shows hi-risk groups and those who could transmit to them

  12. Manifestations • Abrupt onset with cough, fever, myalgia, HA, sore throat • Resolution within 7d unless complications develop. Most common complication is PN • Convalescent phase may include malaise and hyperactive airways

  13. Collaborative Care • Relieve sx with mild analgesics and cough meds and prevent pneumonia • Antivirals shorten course of illness and inhibit spread of virus to other cells—should be given within 2d of onset of sx or can be given prophylactically • Older adults may be hospitalized • Encourage flu and PN vaccines esp. in high-risk groups

  14. Exemplar # 2: Pneumonia (PN) p. 561 • Acute inflammation of lung caused by microbial organism • Leading cause of death in the United States from infectious disease • Most common type is pneumococcal (strep) • Causes: aspiration, inhalation of microbes, or spread thru blood from a primary infection site

  15. LLL Pneumonia

  16. Risk Factors • Impaired immunity • ↓ Cough and epiglottal reflexes • Impaired mucociliary mechanism by pollutants, infection, intubation • Malnutrition • Increased presence of bacteria in leukemia, diabetes, alcoholism

  17. Types of PN • Community-acquired (CAP)—usually pneumococcal • Hospital-acquired • Aspiration • Opportunistic (fungal, PCP)

  18. Pathophysiology of Pneumococcal Pneumonia • Strep enters respiratory tract and releases toxins causing inflammation • In alveoli, serous fluid is released and bacteria multiply rapidly in the fluid • Capillaries dilate adding red cells to alveolar fluid along with bacteria, white cells, and fibrin (red hepatization) • Consolidation of white cells and fibrin in one part of lung (gray hepatization) • Resolution

  19. Clinical Manifestations • CAP symptoms • Sudden onset of fever (atypical-gradual) • Chills • Cough productive of purulent sputum (atypical-dry cough) • Pleuritic chest pain • Confusion or stupor in elderly/debilitated

  20. Clinical Manifestations • Lung examination findings • Dullness to percussion • ↑ Fremitus • Bronchial breath sounds • Crackles

  21. Diagnostic Tests • Chest x-ray • CBC, differential • Chemistries (if indicated) • Gram stain and C&S of sputum • Pulse oximetry and/or ABGs • Blood cultures

  22. Most Common Complications • Pleurisy—pain with inflammation • Atelectasis—partial or full(partial may clear with C&DB) • Pleural effusion—fluid in pleural space. Usually is sterile and reabsorbed in 1 to 2 weeks or may require thoracentesis. Occurs in 40% of cases. • Bacteremia (sepsis)

  23. Atelectasis

  24. Pleural Effusion

  25. Other Complications • Pericarditis and Endocarditis • Spread of microorganism to heart • Meningitis • Patient with pneumonia who is disoriented, confused, or somnolent should have lumbar puncture

  26. Collaborative Care • Three-step approach to treatment • Assess ability to treat at home • Calculate Pneumonia Severity Index (PSI) Table 28-3, p. 562 • Clinician decision for inpatient or outpatient

  27. Collaborative Care • Antibiotic therapy • Oxygen for hypoxemia • Analgesics for chest pain • Antipyretics for fever • May need nebulizer treatments • Fluid intake at least 3 L per day • Caloric intake at least 1500 per day

  28. Collaborative Care • Influenza drugs and influenza vaccine • Pneumococcal vaccine indicated for those at risk: • Chronic illness such as heart and lung disease, diabetes mellitus • Recovering from severe illness • 65 or older • In long-term care facility

  29. Nursing Assessment on Admission: Subjective Info • Lung cancer • COPD • Diabetes mellitus • Debilitating disease • Malnutrition • AIDS

  30. History cont’d • Use of antibiotics, corticosteroids, chemotherapy, immunosuppressants • Recent abdominal or thoracic surgery • Smoking • Alcoholism • Respiratory infections

  31. History cont’d • Prolonged bed rest • Dyspnea • Nasal congestion • Pain with breathing • Sore throat • Myalgias • Fever • Restlessness

  32. Objective Nursing Assessment • Splinting affected area • Tachypnea • Asymmetric chest movements • Use of accessory muscles • Crackles • Green or yellow sputum • Tachycardia

  33. Nursing Assessment • Changes in mental status • Leukocytosis • Abnormal ABGs • Pleural effusion • Pneumothorax (total atelectasis) on x-ray

  34. Analysis of Info: Formulating Nursing Diagnoses • Ineffective breathing pattern • Ineffective airway clearance • Acute pain • Imbalanced nutrition: Less than body requirements • Activity intolerance • Deficient fluid volume

  35. Planning: Outcome Criteria • Clear breath sounds • Normal breathing patterns • No signs of hypoxia • Normal chest x-ray • No complications related to pneumonia

  36. Interventions & Rationales • Maintain ongoing respiratory assessment: to prevent complications • Prompt treatment of URIs: to prevent spread • Increase fluid volume: to liquefy secretions and prevent dehydration • Strict asepsis: to prevent spread • Monitor and control pain: to promote increased activity

  37. Interventions & Rationales • Initiate and maintain oxygen supplementation: to improve oxygen status • Assist patients with turning and deep breathing, IS, and ambulation q2h: mobilize secretions • HOB up/overbed table positioned: improves oxygen status • Assist patients at risk for aspiration with eating, drinking, taking meds: to prevent aspiration and subsequent pneumonia

  38. Interventions & Rationales • Emphasize need to take course of medication(s): to ensure effective tx of current infection and prevent resistant strains from developing • Teach drug–drug, drug-food interactions: to ensure drug is as effective as possible • Encourage those at risk to obtain influenza and pneumococcal vaccinations and other preventative techniques: to prevent recurrence • Teach nutrition, hygiene, rest, regular exercise: to maintain natural resistance

  39. Evaluation • Dyspnea not present • SpO2≥ 95 • Free of adventitious breath sounds • Clears sputum from airway • Reports pain control • Verbalizes causal factors • Adequate fluid and caloric intake • Performs activities of daily living

  40. Developmental Issues • Very young and very old are more susceptible to the complications of PN and influenza. Both can become ill very quickly and mortality rates are generally higher • Both groups also become dehydrated quicker than adults. • Remember that elderly may have atypical symptoms. • Children have shorter, straighter passageways in their respiratory system, making spread of infectious organisms more rapid.

  41. Cultural and Socioeconomic Issues • Be sensitive to another cultures need to treat infections with alternative therapies and healers: herbal, acupuncture, hot-cold, prayer, charms, etc. • Be aware that $ play an important role today with limited access to health care and expense of prescriptions. HCPs should try to be sensitive to what they prescribe.

  42. Comparison of Nursing Care • Remember the concept of infection: regardless of where the infection is or what organism causes it, people have the same general manifestations: fever, malaise, myalgia, and sometimes elevated labs for systemic; and redness, swelling, and pain for localized infections. • We do treat viruses consistently with antivirals and other infections with other antimicrobials. • Nursing care is very similar: provide supportive care for symptoms, give meds, promote health, and do teaching.

More Related