Professional Documents
Culture Documents
that normally reside in upper airways Common bacteria: Staphylococcus pneumonia Haemophilus influenzae, S. aureus
Upper airway
characteristics normally prevent potential infectious particles from reaching the lower respiratory tract.
normal flora present in the oropharynx or food particles from the stomach
one of the mechanical blockage of the airways and secondary infection. Particles from stomach contains acidic juice, if aspirated may be very destructive to the alveoli and capillaries Aspiration of gastric contents causes a chemical burn of the tracheobronchial tree and pulmonary parenchyma Inflammatory response occur.
outpouring of protein-rich fluids into the interstitial and intra-alveolar spaces. Surfactant is lost causing airways to close and the alveoli to collapse Impaired exchange of oxygen and carbon dioxide causes respiratory failure.
(sputum) With sputum containing pus or blood A physical examination may reveal: With greenish sputum
Fatigue
Fever
Shortness of breath Wheezing
Risk factors for aspiration or breathing in of foreign material into the lungs are: Being less alert due to medicines, illness, or other reasons Coma Disorders of the esophagus, the tube that moves food from the mouth to the stomach (esophageal stricture, gastroesophageal reflux) Drinking large amounts of alcohol Medicine to put you into a deep sleep for surgery (general anesthesia) Old age Poor gag reflex in people who are not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing
Blood culture
Bronchoscopy Chest x-ray
Normal Lungs
and demand, possibly evidenced by reports of fatigue, dyspnea, and abnormal vital sign response to activity.
Acute Pain may be related to localized inflammation, persistent cough,
aching associated with fever, possibly evidenced by reports of discomfort, distraction behavior, and facial mask of pain.
Impaired Gas Exchange may be related to inflammatory process,
collection of secretions affecting O2 exchange across alveolar membrane, and hypoventilation, possibly evidenced by restlessness/changes in mentation, dyspnea, tachycardia, pallor, cyanosis, and ABGs/oximetry evidence of hypoxia.
consciousness, depressed cough and gag reflexes, presence of tracheostomy or endotracheal tube, gastrointestinal tube, enteral tube feedings, decreased gastrointestinal motility, impaired swallowing
Hyperthermia Imbalanced nutrition: Less than body requirements Impaired gas exchange
-removing secretions, because retained secretions interfere with gas exchange -humidification may be used to loosen secretions and improve ventilation -coughing can be initiated either voluntarily or by reflex -oxygen therapy as prescribed -adequate oxygenation values are measured by pulse oximetry or ABG analysis
-Position patient during NGT feeding in an at least 30 degree head elevation and should be maintained only after 30-60 minutes. -Monitor NGT patency and placement regularly.
Promote rest and conserve energy
Includes administration of the appropriate antibiotic as determined by the results of the Gram-stain -Erythromycin -Macrolide -Cefuroxime -Amoxicillin -Antipneumococcal fluorquinone
Bronchodilators may be useful in situations associated
with bronchospasm
Antipyretics may be used to treat headache and fever Antihistamines may provide benefit with reduced
Metronidazole
500mg IVT q6hr Brand Name: Flagyl Classification: Trichomonacide, amebicide
-serious infections due to susceptible anaerobic bacteria and due to Bacteroides species and Clostridium species
Contraindications: -Blood dyscrasisas, trichomoniasis during first trimester and lactation, Action/Kinetics: carcinogenic in rodents (avoid -effective against anaerobic bacteria and unnecessary use) protozoa -inhibits growth of trichomonae and amoebae by binding to DNA, resulting in loss of helical structure, strand breakage, inhibition of nucleic acid synthesis and cell death -well absorbed in the GI tract and widely distributed in body tissue -eliminated primarily in urine (redbrown in color) Indications:
Side effects: GI: Nausea and vomitting , diarrhea, abdominal discomfort, constipation CNS: Headache, dizziness,vertigo, incoordination, ataxia, weakness, irritability, confusion, depression Others: Leukopenia, dark brown urine, furry tongue (due to overgrowth of candida) UTI
IV infusion during infusion of Metronidazole -Administer with food or milk to minimize GI irritation -Instruct patient to take medication exactly as directed even if feeling better -May cause dizziness, caution patient not to do activities requiring alertness -Inform patient that medication cause urine to be dark in color. -Monitor for any superinfections Dosage: IV anaerobic infections (black furry overgroth in 7.5 mg/kg q6hr (should not tongue) exceed 4 g/day) Nursing Considerations: -Do not give IV bolus, administer over 1 hr, discontinue primary
Citicholine Na
1gm IVT q 12hr Brand Name: Zynapse, Somazine, Cholinerve Classification: CNS Stimulant, Peripheral vasodilator, Cerebral Activators
face or hands, chest tightness, tingling in mouth and throat Dosage: 100mg/ml
Nursing Considerations: -Monitor patients neurologic status -Note any signs of slurring speech Action/Kinetics: Increases blood flow -Note for any adverse reactions and Oxygen consumption in the brain thus stimulates brain function
Indications: CVD in acuter recovery phase in sever of cerebrovascular insufficiency and their sequallae
Contraindications: -Allergy to drug, pregnant and lactating, patient with renal and hepatic damage Adverse effect: -low blood pressure, itching, swelling in
-treat mild to moderate hypertension 4 ampule if MAP> 110-130mmHg -spasticity, ADHD, Tourrettes Brandnames: Catapres, Kapvay syndrome, psychosis in Catapres-TTS, Clonidine ER schizophrenia
Clonidine HCL
Classification: Antihypertensive
Action/Kinetics: -stimulates alphaadrenergic receptors of the CNS inhibition of the sympathetic vasomotor centers and decreases Nerve impulses (fall of BP)
Indications:
Contraindications: Presence of Injection site infection, anticoagulant therapy, caution during pregnacy and lactation, recent MI, chronic renal failure
Side effects: CNS: Drowsiness, sedation, dizziness, headache, fatigue, insomnia, hallucination GI: Dry mouth, constipation, anorexia Respiration: Hypoventilation, dyspnea Others: Weakness, gynecomastia, increase in blood glucose
Nursing Considerations: -obtain baseline date, document indications for therapy, onset -instruct patient not to change or discontinue drug abruptly -inform patient that drug may interfere with work -Change positions slowly to prevent any sudden drop of BP and associated dizziness
Paracetamol
300mg if T>38 degree Celcius
Classifications: Analgesic, Antipyretic Brand name: Aeknil, Biogesic, Calpol, Tempra Action/Kinetics: Inhibits prostaglandin synthesis in the CNS and blocks pain impulse through a peripheral action. Acts on the hypothalamic heatregulating center, producing peripheral vasodialtion
Indications: Fever, relief of mild to moderate pain like headache, toothache, colds, vaccinations
(2008). Brunners & Suddartgs Textbook of Medical Surgical Nursing, 11th ed., Lippincott Williams & Wilkins, Philadelphia (pp. 520-532)
Donowitz GR. Acute pneumonia. In: Mandell GL, Bennett
JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 64.
http://www.pspinformation.com/disease/aspiration/pneu.
shtml