Table 31-2 Risk factors Pneumonia

Table 31-2 Risk factors Pneumonia

Community – Acquired Pneumonia
older adult
CAP
has never received pneumococcal vaccination or, received > 5 yrs ago
CAP
Did not receive influenza vaccine in previous year
CAP
Has chronic health problem or other coexisting condition that reduces immune response
CAP
recent exposed to resp. viral/influenza infections
CAP
Uses tobacco/alcohol or is exposed to high amounts of 2nd hand smoke
Health Care Acquired Pneumonia
Older adult
HCAP
has chronic lung disease
HCAP
presence of gram-negative colonization in mouth, throat and stomach
HCAP
altered LOC
HCAP
experienced recent aspiration
HCAP
presence of Endotracheal, tracheostomy or NG tube
HCAP
poor nutritional status
HCAP
immunocompromised status (from disease or drug)
HCAP
uses drugs that increase gastric pH (histamine H1 blockers/antacids) or alkaline tube feeds
HCAP
current receiving mechanical ventilation
VAP – Ventilator-Assoc Pneumonia
Community acquired pneumonia
contracted outside health care setting; acquired in community
CAP
complication of inflluenza (haemophilus) Strep Pneumoniae
CAP
more prevalent than HAP
mortality increased 20-50%
especially if agnet is pseudomonas aeruginosa, Acinetobacter, klebsiella
Who gets PPSV23 Vaccine
Anyone 2-64 yrs of age esp those w/ chronic illness, cellular disease, alcoholics, cancer pt’s, immunosuppressed, Nursing home residents
PPSV23
not effective w/ ear/sinus infections or other resp. diseases/conditions
Ventilator “BUNDLE” – VAP
hand hygiene – Critical!
PO Care – Not just swabs, Chlorehexidine rinse/swabs
HOB @ least 30 degrees
Daily sedation ‘vacation’ to arouse/awaken
DVT prohylaxis
Stress ulcer prohylaxis
PRN suction or continuous subglottal suction
empyema
collection of pus in pleural cavity
results from infection reaching pleural space
arterial O2 falls = hypoxemia
consolidation
solidification, lack of air spaces
lobar pneumonia
w/ consolidation in a segment or entire lobe of lung or as bronchopneumonia w/ diffusely scattered patches around bronchi. Tissue necrosis results if abscess forms and perforates bronchial wall
Health Care Assoc Pneumonia
onset/diagnosis occurs <48 hrs after admission in pt. w/ specific factors: in hospital for >48 hrs in past 90 days
SNF/Assisted-living resident, received IV therapy, wound care, antibx, chemo in last 30 days
Seen @ hospital of dialysis clinic w/in last 30 days
HCAP mgmt
may have multidrug-resistant organisms
Hand hygiene = CRITICAL
Hospital Acquired Pneumonia
Onset/diagnosis of pneumonia >48 hrs after admission to hospital
HAP
encourage pulmonary hygiene/progressive ambulation
provide adequate hydration,
assess risk for aspiration w/ evidence based tool
monitor early signs of sepsis
HAND HYGIENE
Ventilator Associated Pneumonia
Onest/diagnosis of pneumonia w/in 8-72 hrs after endotracheal intubation
VAP mngmt
presence of ET tube increases risk for pneumonia by bypassing protective airway mechanisms and allowing aspiration of secretions from oropharynx/stomach, dental plaque increases risk!
VAP BUNDLE
Patient Centered Care QSEN
older adult w/ pneumonia has weakness, fatigue, lethargy, CONFUSION, and poor appetite, fever and cough may be present but hypoxemia is often present most common manifestation of pneumonia in elderly is acute confusion r/t hypoxia. WBC count may not be effected until infection is severe. Waiting to treat disease until more typical manifestations arise greatly increases risk for SEPSIS and DEATH

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