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

Miscellaneous Pneumonia Risk Factors

LOS: CAP ≤ 48H LOS: HCAP ≤ 48H WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample LOS: *EARLY* ONSET HAP +/- HCAP RISK FACTORS ≤ 4 DAYS LOS: *EARLY* …

Pneumonia Definitions and Acronyms

5 kinds of possible pneumonia 1. CAP 2. Aspiration 3. Hospital Acquired 4. Ventilator Acquired 5. Health Care Acquired What is CAP? Pneumonia acquired outside an healthcare facility WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR …

ID-Pneumonia Most Common Causes

CAP by site of care after diagnosis CAP: Outpatient Outpatient S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, respiratory viruses CAP by site of care after diagnosis CAP: Non-ICU Non-ICU S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, respiratory viruses, …

Organisms Associated with Community-Acquired Pneumonia Risk Factors

Smoker/COPD S. pneumoniae, H. influenza, M. catarrhalis, Legionella Alcoholics S. pneumoniae, K. pneumoniae, Anaerobes WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample IV drug abuse S. aureus, anaerobes Influenza …

R. Part 6 – Ventilator Associated Pneumonia (VAP)

Ventilator Associated Pneumonia (VAP) we ventilate them and they get pneumonia – happens due to poor hand hygiene and not using proper protocol VAP: Pneumonia that develops while a patient is intubated WE WILL WRITE A CUSTOM ESSAY SAMPLE ON …

ID pneumonia

What do the following abbreviations mean: CAP, HAP, HCAP, VAP, and ASP? CAP- community acquired pneumonia HAP- hospital acquired pneumonia HCAP- Health care-associated pneumonia VAP- Ventilator-associated pneumonia ASP- Aspiration pneumonia What patients are at risk for acquiring HCAP? Non-hospitalized patients …

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