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Lower Respiratory ProblemsMedical Surgical Nursing

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A patient comes to the clinic complaining that they had a persistent dry cough for a few days, but now she has a horrible headache, muscle pains, a sore throat and she's really tired. She also complains of feeling nauseous. You listen to her lungs and hear crackles. You suspect she has pneumonia cause by one of the following organisms:
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Mycoplasm pneumoniae, Legionella or Chlamydia pneumoniae All three of these organisms cause the classic symptoms above. They can also present with diarrhea or vomiting
T/F Viral pneumonia can be caused by measles, varicella-zoster or herpes simplex.
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True
_________, an inflammation of the pleura, is a common complication of pneumonia.
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Pleurisy
T/F Pleural effusion is typically not sterile and requires a thoracentesis to aspirate the contents.
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False, it is typically sterile. It typically resolves on its own within 1-2 weeks. A thoracentesis is used to remove excess fluid if it is causing respiratory distress.
What are the 9 general complications of pneumonia?
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Pleurisy, pleural effusion, atelectasis, bacteremia, lung abscesses, empyema, pericarditis, meningitis, and endocarditis
________ occurs in 30% of patients with pneumococcal pneumonia and has a 60% mortality rate in elderly patients.
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Bacteremia
What types of pneumonia-causing organisms are associated with development of lung abscesses?
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S. aureus and gram negative pneumonias
________ is a complication of pneumonia that involves an accumulation of purulent exudate in the pleural cavity.
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Empyema
T/F Empyema is typically sterile and requires a thoracentesis to aspirate the contents only if it is impacting respirations.
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False, it is purulent exudate in the pleural cavity and requires a chest tube or open surgical drainage along with antibiotic treatment
_________ is a complication of pneumonia spread via a hematgenous route to the pericardium.
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Pericarditis
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You have a patient with pneumonia who has become disoriented and somnolent. You know that a ________ should be requested immediately.
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A lumbar puncture, the symptoms are indicative of meningitis
What pneuomonia-causing organism can also cause meningitis?
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S. pneumoniae
Endocarditis is a complication of pneumonia that occurs when organisms attack the endocardium and heart ________.
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Valves
T/F It is very difficult to diagnose pneumonia without laboratory tests.
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False, it is possible to dx with a history, Xray and physical exam
T/F It is difficult to diagnose pneumonia without a chest Xray
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True
Lobar or segmental consolidation of the lungs on a chest Xray suggests a __________ cause of pneumonia.
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Bacterial, like S. pneumoniae or Klebsiella
Diffuse pulmonary infiltrates on a chest Xray suggest a ________ cause of pneumonia.
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Viral, Legionella or pathogenic fungi
Cavitary shadows on an Xray suggest necrotizing infection with destruction of lung tissue commonly caused by...
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S. aureus, gram negative bacteria or M. tuberculosis
Sputum Gram stains and cultures aren't always a reliable diagnostic tool. When is obtaining a sputum sample before initiating antibiotic therapy in a patient with pneumonia suggested?
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When the patient is hospitalized
Why should a sputum sample be sent to a lab immediately after collection?
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Incubation that occurs 2-5 hours after collection yields unreliable results
T/F Antibiotic therapy for pneumonia is usually started in a hospitalized patient before blood cultures, sputum cultures or gram stains are interpreted.
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True, initiation of antibiotics should not be delayed to maximize effectiveness
  
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