Pneumonia Symptoms, Pathophysiology, Nursing | Respiratory Disorders NCLEX Lecture Part 1

hey everyone its sales red sterner sorry and calm and in this video I want to be doing an ink Lex review over pneumonia this video is part of an interview series over respiratory disorders so be sure to check out the other videos in this series this video will be part one of pneumonia in part two I'm going to be covering the nursing interventions and the medication specifically antibiotics use and treating ammonia and I'm going to give you a clever mnemonic on how to remember that in this video I'm going to be hitting on the pathophysiology of pneumonia the definition the risk factors how's diagnosed and the signs and symptoms so as always over here on the side and in the description below you can access the quiz and the notes so let's get started first let's start out talking about the definition of pneumonia what is it in a nutshell it is a lower respiratory tract infection that causes inflammation of the alveoli stacks and remember the alveolar sacs are responsible for gas exchange and here on your diagram the purple areas that look like little grape sacks is where the gas exchange occurs and what they do is they in play in deflate and they transport through a capillary wall carbon dioxide out so you can exhale it because this is a waste product of metabolism and then it's going to take that fresh oxygen that you just inhaled and how that transported through the body and the heart will help play a role in that as well now the key players in pneumonia one key player are germs this has attacked the system which is called cause inflammation of that sac and this germ can be a bacteria a virus or a fungi or a fungus I'm very rare but it can happen with the fungus also the big thing that plays a part in pneumonia is your lung Parekh einem which I like to call the trio for gas exchange is your Abiola your ovular ducts and your bronchioles now let's talk about normal gas exchange and what's happening and then compare it to whenever one has the Monia and what's going on with them okay normal gas exchange occurs whenever you take in oxygen up through your upper respiratory system through the nose down through those sinuses beyond through the linux then it's going to hit the lower respiratory system which will include your trachea then the trachea will branch off at the quarry and up into your right bronchus and your left bronchus so your primary bronchi then it enters into the lungs of the hilum which also your pulmonary artery your pulmonary vein from the heart enter in at the hilum as well into the lungs because the heart again plays a big role in gas exchange and then it breaks off into your secondary bronchi your tertiary bronchi to the bronchioles to the alveolar ducts and then then into these a viola or sacs now the a viola lower sax here's one blown up so you can see it looks like normally has capillary setting on it from your pulmonary arteries and your pulmonary veins and remember the pulmonary artery from the heart takes uh Knox jaded blood to the lungs to become oxygenated and then the pulmonary vein takes that oxygenated blood back to the heart it's going to go through the aorta and be pumped through the system so you can get some oxygen to your body so that's what's happening constantly these stacks are inflating and deflating carbon dioxide is leaving these sacs you're going to exhale that out car oxygen is coming into the SAC being transom transported onto red blood cells and carried throughout the system so let's look at this up close so here's an a viola and here you have a capillary running this capillary is coming from the heart so it's pulmonary artery and it's an oxygen a that's why they're blue and these cells are exhausted and tired so they're getting rid of that waste buildup of carbon dioxide and putting that into this alveoli so you can get rid of that through exhaling then also at the same time oxygen that you just freshly inhaled is going through this capillary wall and attaching attaching to these exhausted red blood cells and they'll revived and ready to go back through the system so they red and they go through the heart through the pulmonary vein and do their dog now with pneumonia what's going on here okay well what's happened normally your respiratory system can normally fight off these germs that you're coming into contact every day on a daily basis through you know filtering out through your nose but certain conditions can increase your ability of developing pneumonia and decrease your ability of your body's ability to UM fight off these germs so what happens say you get a bacterial body can't fight it off what happened is that this a viola sex or so type a viola psyche and it gets inflamed and when it gets inflamed what happens is that things start to pull in there so it starts to become full of fluid this one's nice and um spread out it opens and closes this one has become bogged down with fluid then your body has since that there's inflammation going on so it seems its army of white blood cells to come and fight that infection that's there so it starts to fill with red white blood cells and then you have your red blood cells that are normally they're already getting stuck there and they start forming along with that bacteria so that's just way too much for the alveoli sac to implant to inflate and deflate so what happens is that you don't have the ability of those cells to rid itself of carbon dioxide so you're going to have the buildup of carbon dioxide then you can't get that fresh oxygen to the system so guess what you're going to have hypoxemia low oxygen in the blood because that oxygen can't get through that capillary wall to be transported so you're going to get conditions called rest or acidosis which we'll go over a little bit more here in a second but I wanted to cover that with you so you can see that now there are certain things that will increase a patient's chances of developing pneumonia so let's look at those risk factors okay a prior infect Shen's such as influenza a cold a lot of times patients will get that and they will develop pneumonia because there's they've got this infection that's decreased their ability to filter out these germs and bacteria so they develop this along with whatever they have else going on also if they have a weak immune system infants and elderly are definitely at risk for developing pneumonia an HIV or if they're taking medications and that are autoimmune to suppress the immune system they're at risk for developing this because their body's not working like it should because it's suppressed another thing is if they're in mobile they're in bed they've had a stroke that has made them where they're not allowed where they can't move or they've had some type of change in neuro status like dementia and these patients are really a lot at risk for aspiration where and they may aspirate their stomach contents or food they eat into the lungs which increases pneumonia or they have a lung problem underlying issue like COPD or pneumonia as a nurse taking care of patients and had a lot of patients come in with pneumonia especially during the wintertime fall time and they have COPD and they got pneumonia or they'll post up from surgery a lot of times we talked about this in the incentive spirometer in CLECs review video we want to teach our patients before surgery how to use that incentive spirometer after surgery because these patients usually are in pain especially if they've had abdominal surgery chest surgery they don't want to call debrief take deep breaths so their risk for developing this plus their system has just went through a major surgery and has stress out their bodies so the ramune system isn't working as strong as it should now let's talk about respiratory acidosis I talked a little bit about this at the beginning now let's look at a little bit more in depth specifically those ABG values now if you're not familiar with respiratory acidosis I had a whole Inc Lex lecture on that a cart should be popping up so you can access that comes with the quiz and everything so you can watch that familiarize yourself with this condition but what happened in pneumonia as we learn those sacks are not being able to inflate and deflate so the alveoli aren't being able because they're so inflamed they're so congested they're not allowing those cells to release the carbon dioxide into the respiratory system so you can exhale it so what's going to happen is that your body is going to be keeping carbon dioxide and we don't like that because it's a waste product and we want rid of it in turn the fresh oxygen that we just have taken in through inhalation isn't going to get through that capillary wall to go to the heart so it can be transported through the system so you're going to have low oxygen in the blood and the patient's going to be experiencing hypoxia so your arterial blood gases your ABG's are going to reflect this so we're going to have high carbon dioxide and low oxygen in the blood so typical AVG's RPO po2 is going to probably be about less than 90 millimeters of mercury our blood pH because carbon dioxide when we keep too much of that it's a waste it's an acid and our blood is going to become acetic so our blood pH is going to drop it's going to run less than 7.35 and our pco2 which is our carbon dioxide measurement is going to be high because we are retaining carbon dioxide so greater than 45 now your body tries to balance itself out so the lungs and the kidneys in these acid baths acid-base imbalance try to help each other out so what will happen because you also look at your bicarb and to compensate the kidneys will try to keep or conserve the hco3 which is your bicarb to increase that Bloods pH because it's so low right now it's acidic and a normal blood pH is 7.35 to 7.45 so you may see a bicarb if it's trying to help compensate and be greater than 26 now let's look at the causes we talked about how bacteria can cause it viruses and guy so let's talk a little bit more about those and then we'll talk about the types of pneumonia okay so bacterium most pneumonia infections are bacteria it's the most common especially in your community acquired types of pneumonia I'm streptococcus pneumoniae is the most common type of bacteria that infects a person to cause them to have bacterial of pneumonia another type of pneumonia is caused by an atypical bacterium and it causes what's called as walking pneumonia we've all heard it and it's caused by that type of bacteria my coat mycoplasma pneumoniae and walking pneumonia how it's different the symptoms tend to be a little bit more milder then straight-up pneumonia and hence why they call it walking because it doesn't seem to be a severe to confound them to bed require hospitalization and that is what that but that bacteria is what causes that then you have the viruses some viruses that can cause pneumonia like influenza or RSV which is a lot in your pediatric patients and then fungi like I said this is the least common it tends to affect people who have weakened immune system and they get it from just normal outside like plants or animals that healthy people who have strong immune systems can fight off normally but because they're awake immune system normally something that a person wouldn't get they just get it okay now let's talk about the types okay there's two types that I would be familiar with with their definition okay you have community-acquired and this is the most occurring and this is where the person has got that germs bacteria water they've got outside of the healthcare set setting hence why they call it community they were acquired at somewhere in the community another type is hospital-acquired and a lot of patients who are on mechanical ventilation aren't risk for this the person has contracted this pneumonia germs somewhere within the hospital setting now this tends to be your worst type of pneumonia because the bacteria tends to be really strong and tends to be resistant to antibiotics and the criteria for putting this as hospital-acquired I would remember this is if the patient has developed it 48 hours to 72 hours after admission it would be classified as hospital-acquired pneumonia so how is pneumonia diagnosed a lot of times it will be picked up whenever your auscultate een with the stethoscope the doctor may be listening and they may hear coarse crackles rhonchi which is a type of wheezy or bronchial breath sounds which are normal breath sounds if hurt in the tracheal area but they're not normal if you hear them over the peripheral one field because it can represent lung consolidation and I have a whole video series on with audio clips where you can listen to normal breath sounds and abnormal breath sounds and a card should be popping up so you can access that and the patient along with these sounds may have these other signs and symptoms but this will usually lead to the doctor ordering a chest x-ray which is a great way to diagnose pneumonia because they will be able to look at the lung field see where it's at and show infiltrates if they have any and a sputum culture a lot of times these patients have very productive coughs or coughing at all different color types stuff and you can send that sputum off and they can culture it to identify the type of bacteria or fungus that is causing the problem and which is great because whenever they pick medication therapy if it's a bacteria they can pick if it's a grand positive or gram-negative what type of antibiotic they should use which we'll be covering in part two okay so what are the signs and symptoms of pneumonia to help you remember this remember the pneumonic pneumonia we're talking about pneumonia so just remember each letter in each letter will correspond with the sign and symptom so here are the typical signs and symptoms of pneumonia P productive cough or pleuritic pain this type of pain is chest pain that the patient experiences whenever they're coughing or breathing it feels like chest pain in for neuro changes this is especially common in elderly patients they probably won't even have a fever but you'll notice that they're all of a sudden confused they have an increased respiratory rate and they're just really tired so that's how they can present with that eve for elevated labs such as as you've seen with the carbon dioxide the pco2 and increase white blood cells because your body is trying to fight infection so those will be increased you for unusual breast healed again you may hear these coarse crackles rhonchi or those bronchial breath sounds within the peripheral lung fields M for mild to high fever the bacteria if this is a bacterial cause of pneumonia these patients can run really high temperatures sometimes greater than 104 degrees Fahrenheit Oh for oxygen saturation will be to decrease a lot of times it will be less than 90% and they will need supplementary oxygen in for nausea and vomiting these people absolutely just feel horrible they don't feel like eating they feel sick to their stomach I for increased heart rate and respiratory rate they'll beat a kapeniak and tachycardic because of the infection going on in the body and the hypoxemia because the heart the lungs is trying to increase that respiratory rate to blow off that carbon dioxide they have and get some more oxygen in but it's not working because it's all inflamed those Abiola sacs and then a the last part of it they'll be aching all over they'll feel horrible and they'll have activity intolerance with shortness of breath just simply moving from the bed to the chair will make them very winded okay so that is part one of pneumonia be sure to check out part two and don't forget to take that quiz in clicks review quiz on pneumonia and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

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Keywords: pneumonia, pneumonia lung sounds, pneumonia symptoms, pneumonia cough, pneumonia treatment, pneumonia pathophysiology, pneumonia nursing, pneumonia pathology, pneumonia presentation, pneumonia signs and symptoms, pneumonia simple nursing, respiratory disorders, respiratory disorders nursing, respiratory disorders nclex, respiratory disorders pathophysiology, respiratory disorders lecture, lower respiratory disorders

Id: q9dKz8UwEcY

Length: 17min 17sec (1037 seconds)

Published: Wed Oct 26 2016