Professional Documents
Culture Documents
Cortez,
RN, MAN
IUDMC
D R O E R
Introducti
on
R
E
L
L
I
K
P
O
T
Region II:
600
Region I: 400
Region III: 250
Region V: 3200
NCR: 450
Region IV-A: 700
CARAGA: 450
Region X: 600
Region XII: 1200
2008
Region IX:
650
ARMM:
Types
Hospital-acquired Pneumonia(HAP)
Occurring 48 hrs or longer after
hospitalization
Aspiration pneumonia
Pneumonia caused by opportunistic
organisms
Pneumocystis Carinii
DIAGNO
ASSESSMENT
TAKE IT OFF???!!
ASSESSMENT
Fevers, chills,
anorexia
Pleuritic chest pain
SOB
Crackles/wheezes
Cough, sputum
production
Tachypnea
Chest
Retractions
Seen in severe
pneumonia
Bacterial vs.
Viral
Features
Bacterial
Viral
Fever
T>38.5C
T<38.5C
Wheeze
Absent
Present
DIAGNOSTICS
Pulse Oximetry
Chest X-Ray
Computed Tomography (CT scan)
Bronchoscopy
Thoracentesis
Pulmonary Function Tests
Sputum Specimen and Cultures
PULSE
Measures arterial oxygen
saturation
OXYMETRY
Pulse oximetry probe on
CHEST X-RAY
Screen, diagnose,
evaluate treatment
Instructions: No
metals/jewelry
NORMAL CHEST
Lateral View
Bronchial
Pneumonia
Lobar
Pneumonia
SPUTUM
To diagnose; evaluate
SPECIMEN
treatment
Specimen: ID organisms or
abnormal cells
Culture & Sensitivity (C&S)
Cytology
Gram stains
(e.g. Acid Fast Bacilli)
Computed
Images in cross-section
Tomography
(CT)
view
Instructions:
Bronchoscopy
Pulmonary
Evaluate lung function
Function
Observe for increased
Test(PFTs)
dyspnea or
bronchospasm
Instructions:
No bronchodilators 6
hours prior
Thoracentesis
Specimen from pleural
fluid
Treat pleural effusion
Assess for
complications
Post-Procedure care:
CXR after procedure
Positions
Sitting on side of bed over
bedside table chest
elevated
Lying on affected side
Straddling a chair
HEMATOLOGY
MICROBIOLOGY
Blood C/S
Plueral fluid C/S
Tracheal aspiration C/S
Sputum C/S
considered as
having
communityacquired
For ages
3 months to 5 years are
tachypnea and/or chest indrawing
Pneumonia?
For ages 5 to 12 years are fever,
tachypnea, and crackles
considered as
having
communityBeyond
12 years of ages are the
acquired
presence of the following features:
Fever,
tachypnea, and tachycardia
Pneumonia?
Who will
require
A patient who is at moderate to high
admission?
risk to develop pneumonia-related
Risk
Classification of
Pneumonia
Variables
PCAP A
Minimal risk
PCAP B
Low risk
PCAP C
Moderate risk
PCAP D
High risk
None
Present
Present
Present
Yes
Yes
No
No
Possible
Possible
Not possible
Not possible
Presence of dehydration
None
Mild
Moderate
Severe
Ability to feed
Able
Able
Unable
Unable
Age
>11 mos
>11 mos
<11 mos
<11 mos
Respiratory rate
2-12mos
1-5years
>5 years
50/min
40/min
30/min
>50/min
>40/min
>30/min
>60/min
>50/min
>35/min
>70/min
>50/min
>35/min
Co-morbid illness
Compliant caregiver
Ability to follow up
RESPIRATORY
RATE CRITIA
Variables
Respiratory rate
2-12mos
1-5years
>5 years
PCAP D
High
risk
50/min
40/min
30/min
>70/min
>50/min
>35/min
>50/min
>40/min
>30/min
>60/min
>50/min
>35/min
Risk
Classification of
Pneumonia
Variables
Signs of respiratory
failure
a. Retraction
b. Head bobbing
c. Cyanosis
d. Grunting
e. Apnea
f. Sensorium
Complication
(effusion,
pneumothorax)
Action Plan
PCAP A
Minimal risk
PCAP B
Low risk
PCAP C
Moderate risk
PCAP D
High risk
None
None
None
None
None
Awake
None
None
None
None
None
Awake
Intercostal/Subcostal
Present
Present
None
None
Irritable
Supraclavicular/Interco
stal/Subcostal
Present
Present
Present
Present
Lethargic/Stuporous/
Comatose
None
None
Present
Present
OPD follow up
at end of
treatment
OPD follow up
after 3 days
Admit to ICU
Refer to specialist
RHONCHI
These are low
pitched, snore-like
sounds.
They are caused
by airway
secretions and
airway narrowing.
They usually clear
after coughing.
HEAD BOBBING
What diagnostic
aids are requested
for a patient
classified as PCAP
No
aids are initially
Adiagnostic
or PCAP
B?
requested for a patient classified
as either PCAP A or PCAP B who
is being managed in an
ambulatory setting
When is
antibiotic
For a patient classified as either PCAP A or
recommended?
B and is:
Etiology
INTERVENTION/T
Treatment
REATMENT
Antibiotics choose based on age,
MEDICATION
(BACTERIAL)
MEDICATION
(BACTERIAL)
If a primary immunization againts Hib
has not been completed, intravenous
Ampicillin (100mg/kg/day in 4
divided doses) should be given
DURATION OF
TREATMENT
5 -7 days - outpatients
MANAGEMENT
(VIRAL ETIOLOGY)
patient be
considered as
RESPONDING TO
THE
Decrease CURRENT
in respiratory signs
(particularly tachypnea) and
defervescence
within 72hours after
ANTIBIOTIC?
initiation of antibiotic
should be
done if a
patient is
NOT
RESPONDI
NG to
current
antibiotic
PCAP A or B
PCAP C
pneumoniae
Presence of complication (pulmonary or
extrapulmonary)
Other diagnosis
PCAP D
If an inpatient classified as
PCAP D is not responding
within 72hours, consider
IMMEDIATE re-consultation
with a specialist
IV to Oral
Antibiotics
NURSING ACTIONS:
Ancillary
Treament
Among inpatient,
oxygen and
herbal
medicines
are not
routinely
given in
communityacquired
pneumonia
COMPLICATIONS
Hypoxemia
Pleural effusion
Atelectasis
Pleurisy
Atelectasis
Pleurisy
Pleural Effusion
PREVENTION
Influenza vaccine
Pneumococcal Vaccine
PREVENTION
Isolation
(ICU
Patients)
of patients with resistant
respiratory tract infections
Enteral nutrition
Choice of GI prophylaxis
Subglottic secretion removal
HIGLY
CONTAGIOUS
STAY HEALTHY
Any
Questions?