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Pneumonia Mind Map Nursing
This pneumonia mind map nursing depicts the pneumonia treatment structure. Although most people with pneumonia respond well to treatment, pneumonia can be extremely serious and even fatal. Complications are more likely if you are an older adult with a weakened immune system or have a serious medical condition including diabetes or cirrhosis. Pneumonia is a bacterial, viral, or fungal infection of one or both lungs. There are over thirty different types of pneumonia, and they are classified according to the cause. Pneumonia is organized into three types: bacterial, viral, and mycoplasma pneumonia. The most common symptom of pneumonia is a cough that produces green, yellow, or bloody mucus. Other symptoms include fever, shaking, chills, and shortness of breath.
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Pneumonia Mind Map Nursing
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- Outline
Pneumonia
Pathophysiology
1. Acute infirammaton of lower lung parenchyma (aiveill andrespratory bronchioies, aspration, inhaiation, or contaminatedrespratory equipment
2. Classified viral versus bacterial,community-acquired versus hospital-acquiredatypical, or pneumocystis
3. Causative agent can be infectious (bacteria,viruses, fungi, and other microbes) ornoninfectious (aspirated or inhaled substances)
4. Most common organism for both community-acquired and hospital-acquired pneumonia isthe Gram-positive bacteria Streptococuspneumoniae
5. Other common organisms associated withcommunity-acquired pneumonia in-cludeKlebsiella pneumoniae, Pseudomonasaeruginosa. Escherichia con, haemophilusinfluenzae, and other influenzae viruses
6. Spread of microbes in alveoli activatesinflammatory and immune response
7. Antigen-antibody response damages mucousmembranes of bronchioles and alveoli resultingin edema
8. Microbe cellular debris and exudate fillalveoli and can impair gas exchange
Assessment
1. Viral
a. Fever: low-grade
b. Cough: nonproductive
C. White blood cell count: normal to lowelevation
d. Chest X-ray: minimal changes evident
e. Clinical course: less severe than pneumoniaof bacterial origing=
2. Bacterial
a. Fever: high
b. Cough: Productive
C. White blood cell count: high elevation
d. Chest x-ray: obvious infiltrates
e. Clinical course: more severe than pneumoniaof viral origin
Therapeutic management
1. Antibiotic terapy, analgesics. antipyretics
2. Oxygen therapy to treat hypoxemia, suctioningas necessary
3.Maintain patent airway: monitor respiratory andoxygenation status
4. Provide supplemental oxygen as indicated
5. Be prepared to initiate mechanical ventilatorysupport
6. Provide nutritional support and fluids(2 litersper 24 hours or greater if no trainclications) viaappropriate route
7. Provide adeuate opportunities for physical rest
8. For all hospitalized Clients, take measures toprevent Pneumonia
8.1 Identify clinents at high risk for pneumonia
8.2 Maintain appropriate infection control measures
8.3 Maintain adequate nutrition
8.4 Initiate aspiration precautions for clients at risk(ex: stroke)
8.5 Encourage activity and mobility as soon asfeasible
9. Macrolides: erythromycin, axithromycin;penicillin G: aminoglycosides or cephalosporins
10. Alternatives: Augmentin: doxycycline; Bactrim;Levaquin
11. Medication therapy: antibiotics or otherantimicrobials as indicated, analgesics,antipyretics
Blood Gasmanifestations
Respirations: Most PNA pts have hypoxemiaand respirator alkalosisHyperventilation = breathing too fast leadsto...Blowing off all your CO2 (acid loss) leads to...Acute alkalosis (left shift)Less intake of 02 combined with...Increased affinity for 02 = less tissueperfusion....Reduced 02. Increased affinity leads tohypoxemiaLess 02 starts hypotension, vasodilation leadsto....Lack of 02 to brain = confusion, headache,blurred vision leads toLow 02 to myocardium = bradycardia,arrhythmias = ischemia, coma
Interventions: VentsIncrease FiO2 (21% on RA) to obtain PO2 (ABG80-100 about 4-5 times FiO2)At 100% 02 and ratio of "21%" to "80 to 100%"PO2 should be 400-500!Increase minute ventilation to remove excessCO2 and increase TV to clear more CO2(16 BPM x TV 400 cc = 6400CC)High levels of FiO2 > 60% oxygen is consideredtoxic and causes fibrotic lung damageTrade PEEP for 02 reducing the amount ofoxygen given on a ventUse pressure-limited ventilation. Pressurecontrolled or Pressure support.
Impaired Gas Exchange
Signs and Symptoms
DyspneaDecreased PaO2Increased PaCO2CyanosisTachypneaDecreased activity toleranceRestlessnessDisorientation or confusion in older adults,functional decline with or without feverLoss of appetiteHypotensionLung conslidationcrackles
Nursing Interventions
Asscs repirations: note quality, rate, rhythm, depth: are of seecounrymodules
Assess VS charges
Assess skin color for cyarbis
Assess chages in ceienftion and increating resfeoree
Assess ABC and 02 sal
Mxintain 02. sveial high <>in COPD ptx
Pacc activies to reduce exygen need fstigue
Articipate need for intutation and needarical verlation if curaliftionvercering
Outcome
PI will mairtain eqtimal gas cncharge as cvidenceal eviddenceal repinstionbetween 12-24 min. ABCs WNI (specify ranges here); and no furtherreduction in mermal statex stste stabel ABG
Ineffective Airway Clearace
Signs and Symptoms
Adventitious lung soundscoughDyspneashortness of breathInfiltrates in C XrayPurulent Sputum
Nursing Interventions
Assess respiratory statusAssess CoughObserve sputum for color, amount,consistencyTeach re: positioning, coughing and deepbreathingSuction oropharynx prnAssist with ISTeach re: Pacing activitiesConsilt RT CPT and nebulizertreatments
Infection
Intervertions
Acess Vs tamp flactations Asseses purbo on Amess lung roundsAsses WRC countAsses hylaties Asses effecttveness of antibtacischect X ray Asses WBC countadminister abx administer antyhypyreticsadminister OZ and bronchodlation asneeded
Signs and Symptoms
farverincreated WBCs positive aputum culturetechycardechillachange in character of sputum