This vaccine is recommended for people over 65; those with chronic respiratory, cardiac, or neuromuscular diseases; and patients with diabetes mellitus or renal failure. TREATMENT Treatment is based on the clinical presentation such as community-acquired versus nosocomial , results of the Gram stain of sputum specimens, the radiographical appearance of the pneumonia, the degree of respiratory impairment, and the results of cultures.
Many patients hospitalized with pneumonia require supplemental oxygen and analgesics. Initial antibiotic treatments for pneumonia should be given without delay and typically involve powerful, broad-spectrum drugs. The antibiotic used for subsequent therapy is guided by the results of cultured specimens taken on presentation. However, older adults, people with serious chronic diseases, and those with evidence of organ dysfunction, poor oxygenation, or acute decompensation may need hospitalization to reduce the risk of injury or death.
Supportive care is provided to the patient to remove secretions and improve gas exchange. Such care includes position changes, deep breathing and coughing exercises, incentive spirometry, active and passive limb exercises, and assistance with self-care. The patient is assessed for signs and symptoms of respiratory failure, sepsis, and shock.
Mechanical ventilation is required in patients with respiratory failure. Analgesics are provided as prescribed to manage pain and discomfort and encourage good pulmonary toilet. A large percentage of patients receive care to remove secretions and to improve gas exchange. Such care includes position changes, deep-breathing, and coughing exercises. The patient is encouraged to verbalize concerns; diagnostic studies and therapeutic measures are explained, and the patient is taught about the importance of follow-up care.
Outpatient therapy of community-acquired pneumonia can be recommended for selected patients who are young, otherwise healthy, and not hypoxic, hypotensive, hypothermic, or in renal failure. Activities are scheduled to allow for plenty of rest. The patient is taught hand hygiene and encouraged to wash hands with soap and water or use an alcohol-based hand wipe entirely over both hands after blowing the nose, coughing, using the bathroom, or eating or drinking.
Only disposable tissues are used for sneezing and coughing. Used tissues are deposited in a lined bag taped to the bedside and are disposed of frequently according to agency policy. Unless otherwise restricted, the patient should drink eight ounce glasses of water daily to help thin and loosen mucous secretions.
Emotional support is provided, and all procedures and treatments are explained. Social Media Events. Cancer Currents Blog. Contributing to Cancer Research. Strategic Planning.
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Pulse oximetry. Sputum test. What does a PNA do? What is a PNA job? Job Summary : The Psychiatric Nurse Aide provides patient care services under the clinical supervision of the Unit Manager in order to provide quality psychiatric direct care in the inpatient setting. Safe, effective, performance of direct patient care duties.
What is a PNA in nursing? What is the ICD 10 code for pneumonia? Pneumonia, unspecified organism J What does PX mean in medical terms? Because of the need to ensure in vitro activity, and given that one may not know culture results for several days, it is important to design empiric and protocolized regimens based on the nature of the pneumonia and local susceptibility data.
Failure to administer initially appropriate antibiotic therapy can increase the risk of death up to four-fold. Thus, in patients with CAP, it remains crucial to use regimens against S. However, many strains of S.
The clinical implications of this resistance are unclear at best. The importance of these pathogens is difficult to establish, and in some nations, treatment for these organisms is not considered routine.
Note that compliance with national guidelines with respect to antibiotic decision making has also been shown to lead to improved outcomes. For patients at risk for bacteria such as P. Often multiple agents are needed as part of the initial treatment regimen to ensure that at least one of them is active in vitro against what is eventually found to be the primary organism.
It is crucial to narrow therapy when cultures return. This helps limit the development of resistance and contains cost. Selected patients may be at risk for pathogens such as but not limited to cytomegalovirus, filamentous molds, and PJP. In patients with risk factors for these organisms, empiric treatment is recommended pending cultures.
Corticosteroids should also be given if there is significant hypoxemia. On average, patients require days to achieve clinical stability after initial antibiotic treatment for pneumonia.
In addition, there may be an undrained empyema that requires drainage. If the patient has developed diarrhea there is the possibility that he or she is becoming more ill because of antibiotic-associated colitis. If the presentation is confusing, it may be that with time the situation will become more clear and an alternate diagnosis will become evident, such as pulmonary embolism or heart failure. Given the diagnostic limitations of the approach to pneumonia, it is crucial to constantly re-evaluate the clinical situation and to have a low threshold for questioning the original diagnosis.
Often part of the re-evaluation requires new chest imaging. For example, infiltrates that resolve in a few days are not likely to have been due to infection. Prognosis is best determined based on traditional measures of outcome prediction. Specifically, the presence or absence of key organ failures eg, respiratory, shock is a major determinant of outcome.
For both CAP and HAP, severity of illness scoring tools perform moderately well at predicting outcomes but have certain limitations. Patients require several days to improve. Multiple biomarkers correlate with outcomes; however, these tend to be nonspecific. First steps include repeat culturing along with re-imaging.
The recommended follow-up varies based on the pneumonia type. For CAP, guidelines recommend a follow-up radiograph at 6 to 8 weeks after onset to ensure that the infiltrate has resolved and that there is not a confounding malignancy. For VAP, no specific follow-up is recommended. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
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