Pneumonia Essentials: Patho, Nursing Care, & NCLEX Must-Knows

Hey everyone, nurse Mike here from

simple nursing.com. Today we're breaking

down pneumonia from the patho to

symptoms, interventions, and nursing

care that you'll definitely see on

exams. Now, for my simple nursing

members, download your study guides in

the membership area to help this

critical info stick when it matters

most. Let's dive in. Pneumonia is a

nasty infection causing severe

inflammation in the lungs and causing

the alvoli to fill with mucus, fluid,

and debris. Now, this extra fluid can

make it harder to breathe. So, the

memory trick, just think P for pneumonia

as P for a plague of inflammation inside

the lungs that fills the alvoli with

fluid. As you know, the alvoli is the

place where gas exchange occurs. So,

normally we breathe oxygen in and carbon

dioxide out. But with pneumonia, all

this fluid, mucus, and debris fills the

lungs and leads to impaired gas exchange

where CO2 can't get out and oxygen can't

get in. This results in hypoxia from

that low oxygen and acidosis from too

much carbon dioxide. So just think

carbon dia acid since too much CO2 can

put the body into acidosis and also

impaired ventilation as the body tries

desperately to get air through those

fluid mucus fili.

So write it down. Impaired gas exchange

is typically the most tested nursing

diagnosis for clients with pneumonia

which leads to ineffective breathing

pattern as the body fights for air. Now

for the signs and symptoms before you

start memorizing just think of the patho

here. Again P for pneumonia just think P

for a plague of infection inside the

lungs. Now write down these top six most

tested key terms here. Number one is

altered mental status. We see

restlessness, agitation, and confusion.

These three are the earliest signs of

hypoxia. So write them down because they

are critical since it can lead to deadly

respiratory failure. Now the brain is

very sensitive to oxygen. So these key

words also cross over for other

conditions where we have low oxygen in

the brain like increased ICP and even

strokes. Now number two is fever. Key

term here over 100.4 or 38° C. always an

enclelex favorite and that loves to show

up on exams. Number three is a

productive cough with yellow spudum from

that infection. So again, pneumonia,

just think that plague inside the lungs,

which leads to number four, fine or

coarse crackles upon oscultation from

fluid and mucusfilled lungs. And then

number five, dyspnneia, that shortness

of breath. Okay. Now the biggest sign

that pneumonia is getting worse is key

term pluritic chest pain with plural

friction rub that must be reported to

the HCP. It's described as a sharp chest

pain upon inspiration or breathing in or

upon coughing. Now sometimes it's

described as stabbing or burning pain

inside the chest that increases upon

inspiration or with the cough. Plurosy

is a major complication of pneumonia as

inflamed lung tissues rub together

sounding kind of like rocks rubbing

together. So we call it pebble friction

rub for plural friction rub or even

sounding like sandpaper rubbing together

kind of like this.

So Kaplan mentions a plural friction rub

is described as a gradient sound or

vibrations heard during inspiration and

expiration. Now other signs which are

not really key include unequal chest

expansion, bronchial breath sounds which

are high pitch sounds and tactile

fermitis. This presents as more

vibrations from a patient's back when

repeating certain phrases and indicates

denser or inflamed lung tissue. Now a

common enclelex question here a priority

patient of who to see first. So a

post-operative patient with suspected

pneumonia with a normal temperature and

a SPO2 of 94%.

Becoming key term here restless and

agitated. So remember the key terms

there for hypoxia restless and agitated

definitely mental status change. So

anytime you see the word posttop or

post-operative, you must think the worst

case scenario for priority patients is

acute respiratory failure. Even if the

temperature is not elevated and the

oxygen saturation is not drastically

low. So just look for the key terms

restless and agitated.

Looking for more tips and strategies for

questions like the ones we just covered?

Well, our simple nursing membership

includes exit prep lectures and

thousands of questions across all

nursing school and enclelex topics. Now,

don't let the enclelex trick you here on

select all that apply questions.

Pneumonia does not include tracheal

deviation. That's typically from tension

pneumothorax and it doesn't include

hyper resonance which is typical for a

regular pneumthorax that air inside the

plural space. And it's not dull

resonance, which is typical for a

hemoththorax, that blood inside the

plural space. But it can also happen in

fluid-filled spaces too, like a plural

eusion, a complication of pneumonia,

which we'll get into next. So the memory

tricks think T for tracheal movement as

T for tension pumothorax and the L's for

dull resonance think blood or fluid for

hemoththorax or plural eusion. And then

the H for hyper resonance just think

high air. Okay. Now for some key terms

that you must know for your

pathophysiology course. The main types

of pneumonia. First up is lowbar

pneumonia. This is described as an

infection of one or more loes of the

lung. Now it's caused by streptoccus

pneumonia bacteria and a big

complication is plural emphyma. This is

a collection of pus in the plural cavity

where bacteria migrates and creates sort

of a fluid-filled lung. It's one of the

various kinds of plural eusion which we

call plural e fluid that fluid in the

lung which we'll cover in great detail

in a moment. Now in terms of

manifestations and signs and symptoms

you should be sure to write this down.

Number one lowbar pneumonia has a sudden

onset and number two we hear rs or rails

and described as crackles. This abnormal

breath sound results from rumbling mucus

within the lower airways indicating that

there's fluid inside the lungs described

as a small clicking, bubbling, or even

rattling sound. So we typically say

rattling for rs.

And number three, a big key term here is

rusty colored sputum caused by exudates.

Now, it's just nasty lung butter that

you would normally expect with any lung

infection. It's basically pus-like

sputum. Now, to get deeper into the

patho here, it is due to the presence of

RBC's, those red blood cells, and WBC's,

those white blood cells, which get

caught up in fighting infection. Now,

moving on to bronco pneumonia. This is a

diffuse infection in both lungs. The key

term here is both lungs. And this is the

key difference from that of lowbar

pneumonia. So the memory trick, think B

for bronco pneumonia as B for both lungs

affected. Now for the causes, there's

several different microorganisms here

that cause this bronco pneumonia. And

the key manifestation or sign and

symptom is yellow or green sputum with a

productive cough. So clients with bronco

pneumonia present with this green yellow

colored sputum due to the presence of

multiple microorganisms affecting the

lungs here.

Now for the critical complications these

are priority for the enlex here. So

plural eusion just think plural e fluid

we see fluid that fills the plural space

that space between the lung itself and

the chest wall. Now this prevents full

lung expansion resulting in decreased

gas exchange. So we get less oxygen in

and less CO2 out. And this increased CO2

pushes the body into acidosis. So the

key signs to write down are the four Ds.

D for during inhalation we see chest

pain. D for dysmna that shortness of

breath. D for diminished breath sounds

upon oscultation. And then D for dull

resonance on percussion. Remember

fluidfilled is dull. So don't let the

enclelex trick you here. It's not hyper

resonance as that's high air trapping.

Now write down these four because these

key signs came up a few times on select

all that apply questions. Now the

priority intervention for a plural

eusion is a thorosentesis to drain that

fluid. The provider will stick a big

huge needle into the lung itself to

drain that lung fluid. So a big

complication is a popped lung or a

pneumoththorax where air accumulates

inside the lung space or even a

hemoththorax where blood accumulates

inside the lung cavity. So it's priority

to report asymmetrical chest expansion

and decreased breath sounds two big key

terms for thorosentesis.

Lastly the most deadly complication is

ARDS acute respiratory distress

syndrome. We're talking deadly stiff

lungs. So just think ARDS, we have hard

lungs. And the key signs include, write

this down, refractory hypoxmia.

We're talking low PO2 despite increased

oxygen delivery. So the memory trick

just thinks the body is resistant to

oxygen with refractory hypoxmia.

And again the first signs of low O2 is

that altered mental status and the top

three again number one is confusion

number two agitation and a big one for

number three is restlessness. Now we

cover ARDS in its own full video but

again these are the priority highly

tested key terms.

Now another complication is septic

shock. This can occur if infection gets

severe as the body releases chemicals

into the bloodstream to fight the

infection. In result, the total body

becomes inflamed which can damage

multiple organs within the body itself

causing them to fail and this is known

as mods multiple organ dysfunction

syndrome. Naturally we see

cardiovascular collapse with low blood

pressure and low profusion that low

oxygen. So the memory trick just think S

for shock as S for severely low blood

pressure and profusion. So the key signs

to know for septic shock is hypotension.

The key numbers here is systolic blood

pressure below 90 and MAP that mean

arterial pressure below 65. Anytime

these numbers get low, we know we got to

go go seek help from the primary care

provider and report these findings. So,

write that down. Huge Enclelex tip. Now,

some other findings is a cap refill over

3 to 4 seconds, tacocardia,

and early signs we'll see a fever over

100.4 as the body fights the infection.

Now, a late sign is hypothermia

under 96.8.

As shock worsens, we get more severely

low blood pressure and worsened

perfusion. So, the core body temperature

goes down. And we also see elevated

WBC's and decreased urinary output. And

the key to know for this is 30 mls per

hour or less typically means the kidneys

are in distress. Now, write these down.

We cover it more in the full video for

septic shock, but these are the most

tested signs and always love to show up

on select all that apply questions. Make

sure to pull out this study guide for

this section so you can follow the key

points. Now, in terms of risk factors

and causes, the greatest risk factor for

pneumonia, number one, write it down, is

advanced age. And the key number used on

most exams is over 65 years old. Now,

common exam questions love to give

scenarios about an elderly population

getting a respiratory tract infection or

even the common flu that develops into

pneumonia. This is called community

acquired pneumonia since it was caught

inside the community. Now, don't let the

enclelex trick you here. Environmental

exposures are not the greatest risk

factor than advanced age here for

pneumonia and neither is nutritional

deficit or even obesity. So always think

here advanced age over the key number 65

years old is the number one risk factor

for pneumonia. Now another highly tested

cause is for clients on ventilators who

get VIP ventilator associated pneumonia.

This happens when secretions in the

mouth and throat contain bacteria that

cause pneumonia. So it's critical to

number one reposition the client side to

side every 2 hours. This helps to

mobilize secretions. We do oral care and

suctioning again every two hours with

chlorohhexodine.

These three key points are always on

select all that apply questions for VAP.

Now the best indicators for VAP is write

it down positive sputum culture and

fever and we also saw chest X-ray with

new infiltrates. Now don't let the

enclelex trick you here. not lung sounds

and not blood cultures. The best

indicators here are diagnostics for VAP.

Now, in general, prolonged immobility is

another huge risk factor since

secretions are not mobilized and then

get stuck in the body as well as chronic

diseases like COPD and clients who are

immunosuppressed. But really, a big one

here is post-operative or in other

words, clients who have recently been

out of surgery. We basically put the

body to sleep with anesthesia making the

lungs low and slow and now the alvoli

are low and slow or sleepy too. So we

need to reexpand them to prevent

collapse that adalcttois and prevent

infection from settling in and getting

trapped there. That's why we always turn

cough and deep breathe and always early

ambulation after surgery as well as use

of the incentive sperometer to reexpand

those closed lvoli. So a common exam

question asks for the best indicator for

VAP that ventilator associated pneumonia

and again the best indicator is positive

sputum culture. So once again, it's not

elevated WBC's and it's not even those

blood cultures. So yes, those might be

present too, but again, the best

indicator for diagnosing VAP was the key

term positive sputum culture. So write

that down. Now, speaking of diagnostics,

we can always do a chest X-ray that

shows infiltrates. We're going to see

elevated WBC's, that white blood cell

count over 10,000. And once again, a

sputum culture will be positive. So a

big test tip here, cultures are always

taken first before starting antibiotics.

So just think of the double A's. A for

antibiotics are given after cultures are

taken. This is done to better identify

the organism causing the problem. So we

can choose the best drug to kill it. And

another common exam question here, the

best blood lab value shows effective

treatment of pneumonia after IV

antibiotics and the key term was white

blood cell count. So for this particular

question, it's not a sputum culture and

it's not lung sounds. This question asks

for a lab value for the key term after

IV antibiotics.

This will reflect a killing off of the

infection inside the blood. So, the best

lab value reflects a decrease in WBC's,

meaning a decrease in the army or

defenses the body needs to fight the

infection since the antibiotics kill the

enemy invaders. Thanks for watching. Did

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