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NUR 3225 Study Guide Pneumonia Latest & Updated A+
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lNUR 3225
Study GuidePneumonia
Latest & Updated
1. What is pneumonia?
Pneumonia is an acute infection of the lung parenchyma. Pneumonia occurs when the defense
mechanisms of the airways become incompetent or overwhelmed by the virulence of quantity of
infectious agents.
2. Normally, what respiratory mechanisms protect the airways form infections?
Normally, airways distal to the larynx are protected by the body’s defense mechanisms such as: air
filtration, epiglottis closure, cough reflex, mucociliary escalator mechanism, and reflex
bronchoconstriction.
Organisms reach the lungs in 3 ways: (1) aspiration from nasopharynx or oropharynx (normal flora
can cause pneumonia), (2) inhalation of microbes present in air (mycoplasma pneumonia and
fungal pneumoniae), or (3) hematogenous spread from primary infection elsewhere in body
(streptococci and staph aureus from infective endocarditis)
3. Identify the factors that predispose a person to pneumonia.
• Decreased consciousness weakens cough and epiglottal reflex which may allow aspiration
• Tracheal intubation bypass the normal filtration process and interferes with cough reflex and
mucocilliary escalator mechanism.
• Mucociliary escalator can also be impaired from: air pollution, cigarette smoke, viral URI’s, and
aging
• Other risk factors include: Abdominal or thoracic surgery; age over 65; altered consciousness
due to alcohol, head injury, seizures, anesthesia, OD, or stroke; bed rest and prolonged
immobility; exposure to bats, birds, rabbits, and farm animals; immunosuppressive disease or
treatment (corticosteroids, chemo, HIV, organ transplant); resident of a LTC facility.
4. Differentiate between the types of pneumonia.
Community Acquired Pneumonia
, • An acute infection of the lungs, occurring in patients who haven’t been in hospitalized or
resided in a LTC facility within 14 days since the onset of Sx.
• Can be treated at home or at the hospital, this depends on the pt’s status (age, VS, mental
status, presence of co-morbidities) o CURB 65 scale may be helpful assessment
C-confusion (compared to baseline
U- BUN>20
R- RR>30
B- Systolic BP under 90, diastolic under 60
65- over 65 age
• Empiric therapy started ASAP, before a definitive Dx or causative agent is confirmed
Hospital Acquired Pneumonia AKA: nosocomial pneumonia, is pneumonia that occurs
in a non-intubated pt 48 hours or longerafter hospitalization and not present at time of
admission.
• Ventilator acquired pneumonia occurs more than 48hrs after ET intubation
• Once Dx of VAP or HAP is made, Tx is initiated based on RFs, early vs. late onset, and probable
organism. Then readjusted once pathogen is confirmed.
• Both VAP and HAP are associated with longer hospital stays, increased costs, sicker pts, and
increased risk of morbidity and mortality.
5. What is aspiration pneumonia?
• Aspiration pneumonia results from the abnormal entry of secretions into lower airways
• Risk factors for aspiration pneumonia= (1) decreased LOC (2) difficulty swallowing and (3)
insertion of NG-tube with or without tube feeding.
• The aspired material trigger inflammatory response
• Primary bacterial infection is most common form of aspiration pneumonia, initial empiric
therapy is based on severity of illness, probable causative organism, and where the infection
was acquired (ex. If aspired in hospitals, Ab include coverage for MRSA and gram -)
• Aspiration of gastric contents can cause a chemical, noninfectious pneumonitis, which may not
require Ab therapy initially, but secondary bacterial infection may occur in 48-72 hrs.
6. What nursing measures are used to help prevent patients from getting aspiration pneumonia? If
pt w/ altered consciousness, place in side-lying or upright position to prevent aspiration
• If pt has difficulty swallowing or needs assistance with feedings, elevate HOB 30 degrees and
have pt sit up
• Assess for gag reflex before giving foods/liquids
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