Aspiration Pneumonia
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Transcript of Aspiration Pneumonia
ASPIRATION PNEUMONIA
is inflammation of the lungs and airways to the lungs (bronchial tubes) from breathing in foreign material.
ASPIRATION PNEUMONIA
Aspiration of bacteria 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.
Results from aspiration of normal flora present in the oropharynx or food particles from the stomach
PATHOPHYSIOLOGY
Aspirated particles become 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.
Destruction of alveolar-capillary endothelial cells---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.
Bluish discoloration of the skin caused by lack of oxygen
Chest painCough
With foul-smelling phlegm (sputum)
With sputum containing pus or blood
With greenish sputumFatigueFeverShortness of breathWheezing
Signs and Symptoms:
A physical examination may reveal:
Crackling sounds in the lungs
Decreased oxygenRapid pulse
Risk factors for aspiration or breathing in of foreign material into the lungs are:
Being less alert due to medicines, illness, or other reasonsComaDisorders of the esophagus, the tube that moves food from
the mouth to the stomach (esophageal stricture, gastroesophageal reflux)
Drinking large amounts of alcoholMedicine to put you into a deep sleep for surgery (general
anesthesia)Old agePoor gag reflex in people who are not alert (unconscious
or semi-conscious) after a stroke or brain injuryProblems with swallowing
Causes/risk factors:
Arterial blood gasBlood cultureBronchoscopyChest x-rayComplete blood
count (CBC)CT scan of the
chestSputum cultureSwallowing studies
Diagnostic tests:
Normal Lungs
Lungs with Pneumonia
Laboratory Results
Ineffective Airway Clearance may be related to excessive, thickened mucous secretions, possibly evidenced by presence of tachypnea, and ineffective cough.
Activity Intolerance may be related to imbalance between O2 supply 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.
Possible Nursing Diagnoses:
Risk for aspiration related to reduced level of 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
Improving Airway Patency-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
Nursing interventions:
-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
Promote fluid intake
Maintain Nutrition
Monitor signs of complications
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 sneezing and rhinorrhea
Nasal congestants treat symptoms and improve sleep
Medical interventions:
Metronidazole500mg IVT q6hrBrand Name: FlagylClassification: Trichomonacide, amebicide
Action/Kinetics:-effective against anaerobic
bacteria and 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 (red-brown in color)
Indications:-serious infections due to
susceptible anaerobic bacteria and due to Bacteroides species and Clostridium species
Contraindications:-Blood dyscrasisas, trichomoniasis
during first trimester and lactation, carcinogenic in rodents (avoid unnecessary use)
Drug Study
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
Dosage: IV anaerobic infections 7.5 mg/kg q6hr (should not exceed 4 g/day)
Nursing Considerations:-Do not give IV bolus,
administer over 1 hr, discontinue primary 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 (black furry overgroth in tongue)
Citicholine Na1gm IVT q 12hrBrand Name: Zynapse, Somazine,
CholinerveClassification: CNS Stimulant,
Peripheral vasodilator, Cerebral Activators
Action/Kinetics: Increases blood flow 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 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-Note for any adverse reactions
Clonidine HCL4 ampule if MAP> 110-
130mmHg
Brandnames: Catapres, KapvayCatapres-TTS, Clonidine ER
Classification: Antihypertensive
Action/Kinetics:
-stimulates alpha-
adrenergic receptors of the CNS– inhibition of the sympathetic vasomotor centers and decreases Nerve impulses (fall of BP)
Indications:
-treat mild to moderate hypertension
-spasticity, ADHD, Tourrette’s syndrome, psychosis in schizophrenia
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
Dosage: 0.1-0.2 mg; then 0.050-0.1 mg q hr to a maximum of 0.8mg
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
Paracetamol300mg 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 heat-regulating center, producing peripheral vasodialtion
Indications: Fever, relief of mild to moderate pain like headache, toothache, colds, vaccinations
Side effects: Cramping, heartburn, abdominal distention
Adverse reactions: Anorexia, nausea, diaphoresis, generalized waekness
Dosoage: 325-650 mg q4-6h or 1gm 3-4times per day
Nursing Considerations:-Assess onset, type location of pain-assess temperature directly before and 1 hour
after giving medication-if RR is,12/min, with hold medication and contact
physician-can be given without regards to meals, tablets can
be crushed
Shock and Respiratory Failure
Atelectasis and Pleural Effusion
Superinfection
Complications
Test aspirate for glucose content to identify gastric fluid
-Relying on pH alone is not recommended-Glucose strips can help identify if fluid aspirated
from NGT or NIT is pulmonary or gastrointestinal.
-Non-bloody pulmonary fluid normally contains no glucose.
-Kingston and colleagues (2009) conclude that subclinical aspiration, as detected by non-bloody glucose positive endotracheal aspirate, is associated with the development of nosocomial pneumonia
Updates
Monitor the outcome of antibiotics because their usefulness is uncertain.
-The use of antibiotics as prophylaxis against subsequent bacterial pneumonia in patients with aspiration has not been shown to affect the incidence of infection or to alter mortality.
-Therapy for aspiration pneumonia is based upon the adequate drainage of infected material, which can be accomplished by patient cough and chest physical therapy with postural drainage.
-Request bronchodilator therapy in patients with evidence of obstructive airway disease. It has been found to be effective in increasing oxygen exchange following aspiration.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H., (2008). Brunners & Suddartg’s 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
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