Aspiration Pneumonia : Aspiration Pneumonia Aspiration is the inhalation of oropharyngeal secretion and/ or stomach contents into the lungs. It may produce an acute form of pneumonia. Pathophysiology and etiology : Pathophysiology and etiology Patient at risk and factors associated with risk:
Loss of protective airway reflexes (swallowing & cough) caused by:
a. altered state of consciousness.
b. alcohol or drug overdose.
c. during resuscitation procedures. Pathophysiology and etiology : Pathophysiology and etiology d. seriously ill or debilitated patients.
e. abnormalities of gag and swallowing reflexes. Pathophysiology and etiology : Pathophysiology and etiology f. NG tube feeding.
g. obstetric patients from GA, lithotomy position, decreased emptying of the stomach from enlarged uterus, labor contractions. Pathophysiology and etiology : Pathophysiology and etiology h. G I conditions – hiatus hernia, intestinal obstruction and abdominal distention. Pathophysiology and etiology : Pathophysiology and etiology 2. Effects of aspiration depend on volume and character of aspirated material
Particulate matter – mechanical blockage of airways and secondary infection.
Anaerobic bacterial aspiration – from oropharyngeal secretions. Pathophysiology and etiology : Pathophysiology and etiology c. gastric juice – destructive to alveoli and capillaries results in outpouring of protein rich fluids into the interstitial & intra alveolar spaces ( impairs exchange of oxygen and CO2, producing hypoxemia, respiratory insufficiency and respiratory failure. Clinical manifestations : Clinical manifestations Tachycardia, fever.
dyspnea, cough, tachypnea.
Crackles, rhonchi, wheezing.
Pink, frothy sputum. Diagnostic evaluation : Diagnostic evaluation Chest X – Ray may be normal initially; with time shows consolidation. Management : Management Clearing the obstructed airway.
a. if foreign body is visible it may
be removed manually.
b. place the patient in tilted
head – down on right side
(right side more commonly
affected if patient has aspirated
solid particles) Management : Management c. Suction trachea/ ET tube – to
remove particulate matter.
2. Laryngoscopy / bronchoscopy if patient has been asphyxiated by solid material.
3. Fluid volume replacement for correction of hypotension. Management : Management 4. Antimicrobial therapy if there is evidence of superimposed bacterial infection.
5. Correction of acidosis.
6. Oxygen therapy & assisted ventilation if adequate ABG values cannot be maintained. Complications : Complications Lung abscess; empyema.
Necrotizing Pneumonia. Nursing assessment : Nursing assessment Assess for airway obstruction.
Assess for risk factors for aspiration.
Assess for development fever and foul smelling sputum. Nursing diagnosis : Nursing diagnosis Impaired gas exchange related to decreased ventilation secondary to inflammation and infection involving distal airspaces.
Ineffective airway clearance related to excessive tracheobronchial secretions.
Acute pain related to inflammatory process & dyspnea.
Risk for injury secondary to complications. Additional nursing interventions : Additional nursing interventions Monitor the patient constantly.
Elevate head of bed for debilitated patients and for those receiving tube feedings.
Place patient with impaired reflexes on a lateral position. Additional nursing interventions : Additional nursing interventions 4. Make sure NG tube is patent.
5. Give tube feeding slowly, with patient sitting up in bed, check position of tube in stomach before feeding. check seal of cuff of tracheostomy or ET tube before feeding.
6. Keep patient in fasting state before anesthesia (at least 8 hours). Slide 18: 7. Feed patients with impaired swallowing slowly, and make sure that no food is retained in mouth after feeding.
Nursing alert morbidity & mortality rate of aspiration pneumonia remain high even with optimal treatment. Prevention is the key to the problem.