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STUDENT NAME:

Patient Initials:
Age:
Room#:
Diagnosis: Aspiration Pneumonia
DEFINITION / ETIOLOGY / PRE-DISPOSING FACTORS

DATE:

Aspiration pneumonia, occurring as either CAP or MCAP, results from the abnormal entry of material
from the mouth or stomach into the trachea and lungs. Conditions that increase the risk of aspiration
include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake),
difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of
consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Other
high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-reducing
medications. (Lewis, 2014, p. 524)
References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

PATHOPHYSIOLOGY
The aspirated material (food, water, vomitus, or oropharyngeal secretions) triggers an inflammatory
response. The most common form of aspiration pneumonia is a primary bacterial infection. Typically,
more than one organism is identified on sputum culture, including both aerobes and anaerobes, since
they comprise the flora of the oropharynx. Until the cultures are completed, the choice of antibiotic
therapy is based on an assessment of the severity of illness, where the infection was acquired
(community versus medical care), and the probable causative organism. In contrast, aspiration of acidic
gastric contents causes chemical (noninfectious) pneumonitis, which may not require antibiotic therapy.
However, secondary bacterial infection can occur 48 to 72 hours later.
(Lewis, 2014, p. 524)
References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

DIAGNOSTIC TESTS
History and physical examination, Chest x-ray, Gram stain of sputum, Sputum culture and sensitivity
test, Pulse oximeter or ABGs (if indicated), Complete blood count, WBC differential, and routine blood
chemistries (if indicated), Blood cultures (if indicated) (Lewis, 2014, p. 525)
References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

CLINICAL MANIFESTATIONS (Place an * next to areas specific to patient.)


The most common presenting symptoms of pneumonia are cough*, fever*, shaking chills, dyspnea*,
tachypnea, and pleuritic chest pain. The cough may or may not be productive. Sputum may appear
green, yellow, or even rust colored (bloody). Viral pneumonia may initially be seen as influenza, with
respiratory symptoms appearing and/or worsening 12 to 36 hours after onset. The older or debilitated
patient may not have classic symptoms of pneumonia. Confusion or stupor (possibly related to hypoxia)
may be the only finding. Hypothermia, rather than fever, may also be noted with the older patient.
Nonspecific clinical manifestations include diaphoresis, anorexia, fatigue*, myalgias, headache, and
abdominal pain.
On physical examination, rhonchi and crackles* may be aus-cultated over the affected region. If

consolidation is present, bronchial breath sounds, egophony, and increased fremitus (vibration of the
chest wall produced by vocalization) may be noted. Patients with pleural effusion may exhibit dullness
to percussion over the affected area. (Lewis, 2014, pp. 524-525)
References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

COMPLIATIONS THAT MAY DEVELOP (Identify patient complications with an *.)


*Pleurisy (inflammation of the pleura) is relatively common.
Pleural effusion (fluid in the pleural space) can occur. In most cases, the effusion is sterile and is
reabsorbed in 1 to 2 weeks. Occasionally, effusions require aspiration by thoracentesis.
*Atelectasis (collapsed, airless alveoli) of one or part of one lobe may occur. These areas usually clear
with effective coughing and deep breathing.
Bacteremia (bacterial infection in the blood) is more likely to occur in infections with Streptococcus
pneumoniae and Haemophilus influenzae.
Lung abscess is not a common complication of pneumonia. However, it may occur with pneumonia
caused by S. aureus and gram-negative organisms.
Empyema, the accumulation of purulent exudate in the pleural cavity, occurs in less than 5% of cases
and requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage.
Pericarditis results from spread of the infecting organism from infected pleura or via a hematogenous
route to the pericardium.
Meningitis can be caused by S. pneumoniae. The patient with pneumonia who is disoriented, confused,
or drowsy may have a lumbar puncture to evaluate the possibility of meningitis.
Sepsis can occur when bacteria within alveoli enter the bloodstream. Severe sepsis can lead to shock
and multisystem organ dysfunction syndrome (MODS)
Acute respiratory failure is one of the leading causes of death in patients with severe pneumonia.
Failure occurs when pneumonia damages the lungs' ability to exchange oxygen for carbon dioxide.
Pneumothorax can occur when air collects in the pleura space, causing the lungs to collapse
(Lewis, 2014, p. 525)
References: References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of
Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783

MEDICAL TREATMENT (Identify patient treatments with an *.)


Once the pneumonia is classified, the health care provider bases empiric therapy on the likely infecting
organism (see Table 28-2). Table 28-6 presents the drug therapy for bacterial CAP. For HAP, VAP, and
HCAP, empiric antibiotic therapy is based on whether the patient has risk factors for MDR organisms.
The prevalence and resistance patterns of MDR pathogens vary among localities and institutions.
Therefore the antibiotic regimen needs to be adapted to the local patterns of antibiotic resistance.
Appropriate initial antibiotic therapy for HAP, VAP, and HCAP may also vary markedly. Multiple

regimens exist, but all should include antibiotics that are effective against both resistant gram-negative
and gram-positive organisms. Clinical improvement usually occurs in 3 to 5 days. Patients who
deteriorate or fail to respond to therapy require aggressive evaluation to assess for noninfectious
etiologies, complications, coexisting infectious processes, or pneumonia caused by a drug-resistant
pathogen. *IV antibiotic therapy should be switched to oral therapy as soon as the patient is
hemodynamically stable, is improving clinically, is able to ingest oral medication, and has a normally
functioning gastrointestinal (GI) tract. Patients on oral therapy do not need to be observed in the
hospital and can be discharged to home. Total treatment time for patients with CAP should be a
minimum of 5 days, and the patient should be afebrile for 48 to 72 hours before stopping treatment.
Longer treatment time may be needed if initial therapy was not active against the identified pathogen
or complications occur.
(Lewis, 2014, p. 526)

References: References: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of
Clinical Problems, 9th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323086783