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is inflammation of the lungs and

airways to the lungs (bronchial tubes) from breathing in foreign material.

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.
normal flora present in the oropharynx or food particles from the stomach

Results from aspiration of

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 pain Cough

With foul-smelling phlegm

(sputum) With sputum containing pus or blood A physical examination may reveal: With greenish sputum


Shortness of breath Wheezing

Crackling sounds in the lungs Decreased oxygen Rapid pulse

Risk factors for aspiration or breathing in of foreign material into the lungs are: Being less alert due to medicines, illness, or other reasons Coma Disorders of the esophagus, the tube that moves food from the mouth to the stomach (esophageal stricture, gastroesophageal reflux) Drinking large amounts of alcohol Medicine to put you into a deep sleep for surgery (general anesthesia) Old age Poor gag reflex in people who are not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing

Arterial blood gas

Blood culture
Bronchoscopy Chest x-ray

Complete blood count

(CBC) CT scan of the chest Sputum culture Swallowing studies

Normal Lungs

Lungs with Pneumonia

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.

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

-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

500mg IVT q6hr Brand Name: Flagyl Classification: Trichomonacide, amebicide

-serious infections due to susceptible anaerobic bacteria and due to Bacteroides species and Clostridium species

Contraindications: -Blood dyscrasisas, trichomoniasis during first trimester and lactation, Action/Kinetics: carcinogenic in rodents (avoid -effective against anaerobic bacteria and unnecessary use) 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 (redbrown in color) Indications:

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

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 Dosage: IV anaerobic infections (black furry overgroth in 7.5 mg/kg q6hr (should not tongue) exceed 4 g/day) Nursing Considerations: -Do not give IV bolus, administer over 1 hr, discontinue primary

Citicholine Na
1gm IVT q 12hr Brand Name: Zynapse, Somazine, Cholinerve Classification: CNS Stimulant, Peripheral vasodilator, Cerebral Activators

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 Action/Kinetics: Increases blood flow -Note for any adverse reactions 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

-treat mild to moderate hypertension 4 ampule if MAP> 110-130mmHg -spasticity, ADHD, Tourrettes Brandnames: Catapres, Kapvay syndrome, psychosis in Catapres-TTS, Clonidine ER schizophrenia

Clonidine HCL

Classification: Antihypertensive

Action/Kinetics: -stimulates alphaadrenergic receptors of the CNS inhibition of the sympathetic vasomotor centers and decreases Nerve impulses (fall of BP)

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

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

Dosage: 0.1-0.2 mg; then 0.050-0.1 mg q hr to a maximum of 0.8mg

300mg 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 heatregulating 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

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

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 & Suddartgs 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.