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ASPIRATION PNEUMONIA

Aspiration Pneumonia

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Page 1: Aspiration Pneumonia

ASPIRATION PNEUMONIA

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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

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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

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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.

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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.

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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 

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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:

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Arterial blood gasBlood cultureBronchoscopyChest x-rayComplete blood

count (CBC)CT scan of the

chestSputum cultureSwallowing studies

Diagnostic tests:

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Normal Lungs

Lungs with Pneumonia

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Laboratory Results

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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:

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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

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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:

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-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

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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:

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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

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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)

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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

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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

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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

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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

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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

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Shock and Respiratory Failure

Atelectasis and Pleural Effusion

Superinfection

Complications

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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

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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.

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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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