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Pneumonia (Co-Morbidities (UpToDate, 2018) (immunosuppression (AIDS,…
Pneumonia
Co-Morbidities (UpToDate, 2018)
immunosuppression (AIDS, chemotherapy, cancer, immunosuppressive medications)
cystic fibrosis - may often be associated with sinus infections, bronchitis or pneumonia
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kidney disease - impaired macrophage and neutrophil function, reduced humoral immunity
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heart failure - Edema fluid, impaired lymphatic drainage
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Nursing Diagnoses
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Risk for deficient nutrient/fluid volume related to increased metabolic needs due to disease process and decreased intake
Provide small, frequent meals
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Assess VS, skin turgor; monitor input/output; force fluids to individual tolerance, maintain IV fluids
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Impaired gas exchange related to alveolar capillary membrane changes as evidenced by dyspnea and cyanosis
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Elevate head to high Fowler's, encourage frequent position changes
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Ineffective airway clearance related to edema and sputum formation as evidenced by abnormal breath sounds
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Expected Outcomes
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patient demonstrates optimal gas exchange with no symptoms of respiratory distress. ABG's are within patients normal baseline
patient demonstrates adequate nutritional status/hydration with normal skin turgor, mucous membranes, and balanced input and output
patient verbalizes relief/control of pain, demonstrates relaxed demeanour, and engages in activities
patient maintains airway with clear breath sounds, minimal coughing or suctioning, and absence of any dyspnea or cyanosis
Physiology (Thompson, Wittman-Price & Sutton, 2012)
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Common Risk Factors
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Susceptible individuals include those that are elderly, very young or immunocompromised
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Medications
(Skidmore- Roth, 2018)
Mosyby's 2018 Drug Reference
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Lab/Diagnostic Findings
Lab Tests: CBC with differential, electrolytes, Hgb/Hct, BUN, serum albumin, prealbumin, urinlysis
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Chest x-ray, pulmonary function studies, bronchoscopy
Gram stain and cultures (sputum, empyema, pleural, transtracheal or transthoracic fluid), lung biopsies, blood cultures
Anticipated Assessment Findings
(Jarvis, 2009)
For Pneumonia associated with AIDS caused by Pneumocystis jiroveci: is found in immunocompromised patients: cysts containing the organism attract macrophages causing the thickening of alveolar walls; the infection spreads through bilateral interstitial infiltrates
Inspection: anxiety, SOB, dyspnea with exertion, tachypnea, fever, cough, cyanosis, use of accessory muscles for breathing
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Adventitious sounds: sometimes crcakles are evident, but usually they are absent
For Lobar Pneumonia: an infection in the lung parenchyma causing edema of alveoli as they fill with rbc, wbc, bacteria, solid cellular debris and fluid resulting in a decreased surface area leaving minimal room for air; hypoxemia
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Auscultation: breath sounds are louder with a patent bronchus
Voice sounds- increased clarity, bronchophony, egophony, whispered pectoriloquy
Palpation: decreased chest expansion, tactile fremitus increased for bronchus patent and decreased for bronchus obstruction
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Insepction: increased RR, guarding and lag on expansion