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Aspiration Pneumonia Medical Diagnosis

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LOUISIANA STATE UNIVERSITY EUNICE DIVISION OF HEALTH SCIENCES AND BUSINESS TECHNOLOGY ASSOCIATE OF SCIENCE IN NURSING DEGREE PROGRAM N1135 MEDICAL DIAGNOSIS OUTLINE

STUDENT NAME: Ellen Hennings Patient Initials: G.S. Age: 75 Room#: 537 Diagnosis: Aspiration Pneumonia DEFINITION / ETIOLOGY / PRE-DISPOSING FACTORS

DATE: 11/06/14

Aspiration pneumonia, occurring as either CAP or MCAP, results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes ar e depressed, and aspiration is more likely to occ ur. Other high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-r educing medications. (Lewis, 2014, p. 524) References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Medical-Surgi cal Nursing: Assessment and Management Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

PATHOPHYSIOLOGY The aspirated material (food, water, vomitus, or oropharyngeal secretions) triggers an inflammatory response. The most common form of aspiration pneumonia is a primary bacterial infection. Typically, more than one organism is identified on sputum culture, including both aerobes and anaerobes, since they comprise the flora of the oropharynx. Until the cultures are completed, the choice of antibiotic therapy is based on an assessment of the severity of illness, where the infection was ac quired (community versus medical care), and the probable causative organism. In cont rast, aspiration of acidic gastric contents causes chemical (noninfectious) pneumonitis, which may not require antibiotic therapy. However, secondary bacterial infection can occur 48 to 72 hours later. (Lewis, 2014, p. 524) References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Medical-Surgi cal Nursing: Assessment and Management Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pag eburstls.elsevier.c om/books/9780323086783

DIAGNOSTIC TESTS History and physical examination, Chest x-ray, Gram stain of sputum, S putum culture and sensitivity test, Pulse oximeter or ABGs (if indicated), Complete blood count, WBC differential, and routine blood chemistries (if indicated), Blood cultures (if indicated) (Lewis, 2014, p. 525 ) References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Medical-Surgi cal Nursing: Assessment and Management Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pag eburstls.elsevier.c om/books/9780323086783

CLINICAL MANIFESTATIONS (Place an * next to areas specific to patient.) The most common presenting symptoms of pneumonia are cough*, fever*, shaking chills, dyspnea*, tachypnea, and pleuritic chest pain. The cough may or may not be productive. Sputum may appear green, yellow, or even rust colored (bloody). Viral pneumonia may initially be seen as influenza, with respiratory symptoms appearing and/or worsening 12 to 36 hours after onset. The older or debilitated patient may not have classic symptoms of pneumonia. Confusion or stupor (possibly related to hypoxia) may be the only finding. Hypothermia, rather than fever, may also be noted with the older patient. Nonspecific clinical manifestations include diaphoresis, anorexia, fatigue*, myalgias, headache, and abdominal pain.

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On physical examination, rhonchi and crackles* may be auscultated over the affected region. If consolidation is present, bronchial breath sounds, egophony, and increased fremitus (vibration of the chest wall produced by vocalization) may be noted. Patients with pleural effusion may exhibit dullness to percussion over the affected area. (Lewis, 2014, pp. 524-525) References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgi cal Nursing: Assessment and Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.c om/books/9780323086783

COMPLIATIONS THAT MAY DEVELOP (Identify patient complications with an *.) *Pleurisy (inflammation of the pleura) is relatively common. Pleural effusion (fluid in the pleural space) can occur. In most cases, the effusion is sterile and is reabsorbed in 1 to 2 weeks. Occasionally, effusions require aspiration by thoracentesis. *Atelectasis (collapsed, airless alveoli) of one or part of one lobe may occur. These areas usually clear with effective coughing and deep breathing. Bacteremia (bacterial infection in the blood) is more likely to occur in infections with Stre ptococcus pneumoniae and Haemophilus influenzae. Lung abscess is not a common complication of pneumonia. However, it may occur with pneumonia caused by S. aureus and gram-negative or ganisms. Empyema, the accumulation of purulent exudate in the pleural c avity, occurs in less than 5% of cases and requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage. Pericarditis results from spread of the infecting organism from infected pleura or via a hematogenous route to the pericardium. Meningitis can be caused by S. pneumoniae. The patient with pneumonia who is disoriented, confused, or drowsy may have a lumbar puncture to evaluate the possibility of meningitis. Sepsis can occur when bacteria within alveoli enter the bloodstream. Severe sepsis can lead to shock and multisystem organ dysfunction syndrome (MODS) Acute respiratory failure is one of the leading causes of death in patients with severe pneumonia. Failure occurs when pneumonia damages the lungs' ability to exchange oxygen for carbon dioxide. Pneumothorax can occur when air collects in the pleura space, causing the lungs to collapse (Lewis, 2014, p. 525) References: References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgic al Nursing: Assessment and Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.c om/books/9780323086783

MEDICAL TREATMENT (Identify patient treatments with an *.) Once the pneumonia is classified, the health care provider bases empiric therapy on the likely infecting organism (see Table 28-2). Table 28-6 presents the drug therapy for bacterial CAP. For HAP, VAP, and HCAP, empiric antibiotic therapy is based on whether the patient has risk factors for MDR organisms. The prevalence and resistance patterns of MDR pathogens vary among localities and institutions.

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Therefore the antibiotic regimen needs to be adapted to the local patterns of antibiotic resistance. Appropriate initial antibiotic therapy for HAP, VAP, and HCAP may also v ary markedly. Multiple regimens exist, but all should include antibiotics that are effective against both resistant gram-negative and gram-positive organisms. Clinical improvement usually occurs in 3 to 5 days. Patients who deteriorate or fail to respond to therapy require aggressive evaluation to assess for noninfectious etiologies, complications, coexisting infectious processes, or pneumonia caused by a drug-resistant pathogen. *IV antibiotic therapy should be switched to oral therapy as soon as the patient is hemodynamically stable, is improving clinically, is able to ingest oral medication, and has a normally functioning gastrointestinal (GI) tract. Patients on oral therapy do not need to be observed in the hospital and can be discharged to home. Total treatment time for patients with CAP should be a minimum of 5 days, and the patient should be afebrile for 48 to 72 hours before stopping treatme nt. Longer treatment time may be needed if initial therapy was not active against the identified pathogen or complications occur. (Lewis, 2014, p. 526)

References: References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgic al Nursing: Assessment and Management of Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.c om/books/9780323086783

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