VENTILATION:
PNEUMONIA
Tricia Shephard
Ventilation
 The movement of air between the environment and lungs
through the inhalation of oxygen and exhalation of carbon
dioxide.
 Gas exchange: the process by which oxygen is
transported to the cells and carbon dioxide is transported
from the cells.
 Occurs in the alveoli
Hemoglobin carries the inhaled oxygen to the cells for
metabolism and to perfuse to the various tissues of the
body.
Risk Factors for Altered Ventilation
 Populations at Risk:
 Infants – Less alveolar surface
area available for gas
exchange; Fetal hemoglobin
stores which only last for
approx. 5 months and result in
shorter RBC lifespan
 Elderly – Anatomic and
physiologic changes associated
with advanced age
 Individual Risk Factors:
 Air pollution
Tobacco use
Allergies
Prolonged immobility
Chronic disease
Infection
Conditions Altering Ventilation
 Non-Pulmonary Conditions
 CHF
 Congenital Heart Defects
 Trauma/Paralysis
 Obesity
 Anemia
 Pulmonary Disorders
 Atelectasis
 Decreased surfactant
production
 Restrictive disorders
 Pneumothorax
 Blood or fluid in the pleural
space
 Obstructive Disorders
 Asthma
 Bronchitis
 Emphysema
 Foreign body
obstruction
Patient Application: Pneumonia
 Clinical Manifestations:
 Presented to the ER with complaints of fatigue, rapid heart rate, rapid
respirations, fever, SOB, and harsh cough.
 Chest X-Ray and CT completed
 Found dense L lower lobe consolidation with small bilateral pleural
effusions
 Diagnosis: Sepsis related to pneumonia
Assessment
 Patient’s Vitals upon
Admission:
 HR 118
 RR 22
 Temp. 103.1˚
 BP 133/63
 SPO2 90%
 Respirations shallow, labored
with unproductive cough
 SOB
 Breath sounds were diminished
in bilateral lower lobes, with
crackles in bilateral upper lobes
 Patient unable to clear
secretions
 S1S2 Regular
 Oriented x 4
 Extremities warm and pink
 Pulses 2+ bilaterally
 Experiencing intermittent fever
 Localized edema in legs and
scrotum
Labs
 Abnormal:
 WBC High 12.0
 RBC Low 2.94
 Hemoglobin Low 8.8
 Hematocrit Low 27.6
 MCHC Low 31.0
 RDW High 16.2
 PT High 13.6
 Ca Low 7.8
 CO2 High 32
 Iron Low 31
 TIBC Low 123
 Ferritin High 2,780
 Patient also found to have a
history of anemia, altering many
of the lab values along with his
diagnosis of sepsis related to
pneumonia.
Interventions
 Diagnostic Studies:
 Found by the Journal of
Primary Health Care as the
most definitive: Chest X-Ray
 CT
 Sputum Sampling
 Assessment
 Monitor respiratory status (rate,
depth, pattern, breath sounds)
 Quality of cough and clearing of
secretions
 Look for changes in mental
status
 Watch for perfusion
issues/cyanosis
 Interventions
 Oxygen therapy
 Pharmacologic Therapy
 Antibiotics
 Mucolytic
 Expectorant/
Antitussive
 Perform pulmonary
hygiene
 Encourage incentive
spirometry
 Encourage cough and
deep breathing
Interrelated Concepts
 Anxiety
 Acid-Base Balance
 Perfusion
 Nutrition
 Mobility
 Fatigue
NCLEX Questions
 In order to prevent ventilator associated/ acquired
pneumonia (VAP) in an intubated patient, the healthcare
provider should:
A) Provide oral care and suctioning to the patient
B) Maintain intubation for no more than 72 hours
C) Give prophylactic antibiotics
D) Discourage patient visitors
NCLEX Questions
Answer: A
Providing oral care and suctioning the airway is an important
intervention in order to prevent VAP. The patient should be repositioned
at least every 2 hours and assessed for readiness to be weaned from
the ventilator as soon as safely possible. Prophylactic antibiotics are
not recommended.
NCLEX Questions
 Which of the following is a normal finding when
assessing the respiratory system of an elderly client?
A) Decreased mobility of the thorax and increased
chest wall stiffness
B) A decreased anteroposterior diameter and
increased alveolar surface
C) Bronchovesicular breath sounds throughout the
lungs
D) Increased thoracic expansion and relaxation of
elastin tissues
NCLEX Questions
Answer: A
The normal aging process is accompanied by physiologic changes to
the respiratory system such as stiffening of elastin and collagen
tissues, increased alveolar diameter, decreased alveolar surface, and
increased chest wall stiffness. Bronchovesicular breath sounds are
heard over major bronchi where fewer alveoli are located.
NCLEX Questions
 When an elderly person is hospitalized with pneumonia,
what would be the best action by the nurse to encourage
eating?
A) Provide small, more frequent meals.
B) Secure an order for a daily multivitamin to
stimulate appetite.
C) Provide a high-calorie snack of the client’s
choice.
D) Make sure the client is adequately hydrated.
NCLEX Questions
Answer: A
An elderly person is more likely to eat if portions are small, more
frequent, and nutrient-dense, as opposed to a full meal tray three times
a day. A vitamin will not stimulate appetite. Snacks are not necessary if
small, frequent meals are provided. Hydration is always important, but
fluids do not provide the nutrients needed for healing.
NCLEX Questions
 A diagnosis of pneumonia is typically achieved by which
of the following diagnostic test?
A) ABG analysis
B) chest x-ray
C) blood cultures
D) nutritional intake
NCLEX Questions
Answer: B
The major diagnostic tests used to identify the extent of the lung tissue
affected by pneumonia is chest x-ray and to identify the causitive agent
is sputum culture and microscopy.
NCLEX Questions
 A patient has been hospitalized with pneumonia and is about
to be discharged. A nurse provides discharge instructions to a
patient and his family. Which misunderstanding by the family
indicates the need for more detailed information?
A) The patient may resume normal home activities as
tolerated but should avoid physical exertion and get
adequate rest.
B) The patient should resume a normal diet with
emphasis on nutritious, healthy foods.
C) The patient may discontinue the prescribed course of
oral antibiotics once the symptoms have completely
resolved.
D) The patient should continue use of the incentive
spirometer to keep airways open and free of secretions.
NCLEX Questions
Answer: C
It is always critical that patients being discharged from the hospital take
prescribed medications as instructed. In the case of antibiotics, a full
course must be completed even after symptoms have resolved to
prevent incomplete eradication of the organism and recurrence of
infection. The patient should resume normal activities as tolerated, as
well as a nutritious diet. Continued use of the incentive spirometer after
discharge will speed recovery and improve lung function.
References
Galanes, S. (n.d.). EHS: Nursing Diagnosis Care Plans, 4/e
- Gas Exchange, Impaired - Ventilation or Perfusion
Imbalance. Retrieved November 18, 2014, from
http://www1.us.elsevierhealth.com/MERLIN/Gulanic
k/archive/Constructor/gulanick23.html
Giddens, J. (2013). Concepts for nursing practice. St.
Louis, Mo.: Mosby/Elsevier.
Lieberman, D., Shvartzman, P., Korsonsky, I., & Liebennan,
D. (2003). Diagnosis of ambulatory communityacquired pneumonia. Scandinavian Journal Of
Primary Health Care, 21(1), 57.