...Hospital Acquired Infections (HAI) are a concerning complication during hospital stays. In 2011, it was estimated that out of 722,000 calculated HAI’s, 157,500 were caused by Pneumonia (CDC.gov, 2015). Ventilator Associated Pneumonia (VAP), a sub-category of Pneumonia, is a worldwide, challenging complication in the Intensive Care Unit (ICU) setting of many hospitals. VAP often leads to not only increased mortality rates, but also an increase in comorbidity, and healthcare costs in the affected population. It has been estimated that VAP As of 2013, Ventilator Associated Pneumonia has been renamed under the umbrella term Ventilator Associated Events (VAE), making it difficult to find statistics that specifically represent VAP incidences and...
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...insufficiency. But this can profoundly impair the defensive mechanisms which keep the lower respiratory tract sterile, increasing the risk of bacterial colonization and ventilator-associated pneumonia. Although endotracheal suctioning is a standard of care in all mechanically ventilated patients, clear guidelines regarding the technique and timing of suctioning are lacking. The applicable American Association for Respiratory Care (AARC) guideline suggests that endotracheal suctioning should be performed at some minimum frequency or when clinically indicated. Since endotracheal suctioning can cause hypoxemia, mechanical trauma, bronchospasm, and hemodynamic instability, an accurate assessment of the need for suctioning might decrease the frequency of suctioning complications. TBA Care is a novel device designed to generate a signal when secretions are present in the respiratory tract of an intubated patient, indicating the need for endotracheal suctioning. This is the first prospective randomized trial to compare different indications for endotracheal suctioning. This study compares the efficacy of TBA Care in detecting the presence of secretions in the airways to standard indications, and tested the hypothesis that different suctioning indications could impact the incidence of ventilator-associated pneumonia and extubation rate (Lucchini et al., 2011). This is a quantitative research study with prospective randomized trial with 72 general intensive care unit patients randomized at intubation...
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...Background: Pneumonia is a disease, in which the lungs become inflamed and congested, reducing oxygen exchange and leading to uncomfortable cough and shortness of breathing. It affects individuals of all ages but occurs most frequently in children and the elderly. Pneumonia in children is the most common cause of death around the world. Historically, in developed countries, deaths from pneumonia have been reduced by improvements in living conditions, air quality, and nutrition. In the developing countries, many deaths from pneumonia illness are also preventable by immunization and effective treatments. Material and Methods: This study was conducted in sulaimani pediatric hospital from the period January 2014 to December 2015, a retrospective...
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...1.0Introduction 1.1Background to the Problem Streptococcus Pneumoniae is the causative agent of lung disease Pneumonia. Pneumonia was described as early as two thousand five hundred years ago by the Hippocrates. DR. Williams Osler, whom has studied pneumonia throughout his career, described pneumonia as the “captain of the men of death” owing to its great effect on humanity (Pneumonia,2006).The term pneumonia refers to any infection of the lung. Pneumococcal pneumonia is the term that is used to describe pneumonia that is caused by Streptococcus pneumoniae. Pneumococcal pneumonia not only affects the lungs but other parts of the body such as upper respiratory tract, middle ear, or the nervous system causing pneumococcal meningitis. Pneumococcal meningitis has a high fatality rate when compared to the other infections caused by Streptococcus pneumoniae. The means of transmission of Streptococcus pneumoniae is via respiratory droplet from the mouth or nose of an infected person or a carrier. Penicillin became available in the 1940’s which changed radically the treatment of pneumococcal pneumonia which was based on watchful waiting. Despite this major development pneumonia still posed a major clinical problem today because of the resistance the organism developed against anti -microbial agents.Penicillin resistance is caused by a mosaic mutation of penicillin binding Protein (PBP) genes due to interspecies recombination of homologous genes. It is also recognized that a penicillin...
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...fever of 38.9 degrees Celsius, a blood pressure of 75/40 mm Hg, blood glucose level of 3.7, diaphoretic and a three day history of diarrhea, nausea and generalized weakness. The admitting diagnosis for this 82 year old male was Pneumonia. Pneumonia is an acute inflammation of the lower respiratory tract due to an infectious agent that impairs gas exchange due to alveolar edema and congestion (Thiem, Heppner, & Pientka, 2011). There are many factors that predispose individuals to pneumonia; however, in the case of this patient the predisposing factors are age and the presence of chronic diseases. The patient’s complete history and demographics can be found in Appendix A. The classic clinical manifestations of pneumonia consist of a temperature above 38 degrees Celsius, diaphoresis, cough, and shortness of breath, chest pain, tachycardia, purulent sputum, fatigue, nausea, vomiting, and diarrhea (Thiem, Heppner, & Pientka, 2011). Physical examination will show signs of percussion dullness over the affected area, diminished breath sounds, and crackles. The patient will also often present as hypotensive with a systolic pressure of less than 90 mm Hg (Thiem, Heppner, & Pientka, 2011; Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2010). Analysis Patient X was transferred to...
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...The doctor that was caring for Tre' kept me informed of the details of Tre's case. Dr. Jones came up with possible solutions for this bacteria that caused this infection or virus in his lungs which was prednisone and antibiotics. The doctors thought this solution would help Tre’ get better. This solution was effective to treat the infection. However, it did not treat the disease. There were other steps that Tre had to take to try to help treat the disease. Exercising his lungs with breathing treatments and taking medicine would slow down the virus. A lung biopsy was the alternative solution to see what the cause was. Finding this alternative solution was crucial since time was of an essence to avoid Tre’ from getting pneumonia again. Doctor Jones had a series of tests for his chest done for Tre’. An HRCT, which is a high-resolution chest computed tomography, which is...
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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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...would protect Cari’s lungs from infectious pathogens and particulate matter? -Some structures that may be found are macrophages. These macrophages would protect her lungs from infectious pathogens and particulate matter. They are also known to remove dust particles and other types of debris from the alveolar spaces. D. How would the resistance of Cari’s airways be affected by excess mucus and fluid in her lung? -Well first of all Cari already has excess mucus and fluid buildup in her lungs, so this would cause an airways obstruction and pressure on the lung. She would not be able to take in enough oxygen. E. How would Cari’s lung compliance (the effort required to expand the lungs) be altered as her alveoli fill with fluid due to pneumonia? - As far as Cari’s lung compliance, it would be hard for the lungs to expand due to all the fluid buildup. The fluid makes the alveoli sticky and unable to open or expand. F. How would fluid in Cari’s lungs affect her lung capacity? -Her lung capacity would go down due to the fact that the air space is already taken up by the excess...
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...chronic of the pleura , the double sheet serous that lines the inside of the chest cavity and surrounds the lungs . Often expression of insults viral or bacterial , pleurisy is normally perceived as a strong chest pain , exacerbated by a deep breath and coughing . Pleurisy is synonymous with "pleural chest pain", just to highlight the spasm caused by the rubbing of two inflamed membrane every time the lungs expand to breathe. Cause More often the cause of pleurisy resides in viral infection ( adenovirus and influenza viruses ) or bacterial ( tuberculosis and pneumonia ). However, infections are not the only factors involved in ' etiology of pleurisy. Other causes that contribute...
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...Airway/Breathing (Oxygenation) Pneumonia/Chronic Obstructive Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was widowed...
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...Ventilator Associated Pneumonia and Guidelines VAP: Definition • Pneumonia in patients receiving invasive mechanical ventilation for at least 48 hours • Early VAP: < 4 days in the ICU • Late VAP: > 4 days in the ICU VAP: Incidence US National Nosocomial Infection Surveillance Type of ICU Mean VAP Rate (Cases/1000 vent days) Trauma 15.1 Neurosurgical Surgical Burn Cardiothoracic 12.9 9.9 9.6 7.9 Data from January 2002 – June 2003 Reported as VAP rates/1000 vent days VAP: Burden of Illness • Incidence 10-20% of patients receiving mechanical ventilation > 48 hours • Increased ICU Mortality (2-4 times) • Increased ICU LOS (5-7 days) • Increased hospital costs (>$10,000 US in additional costs) Safdar et al, Crit Care Med, 2005; 33: 2184 VAP: Healthcare Cost Burden of Illness Canada (per year) (10.6 cases/1000 Vent days) Excess Vent days Excess Deaths1 16,000 days (55 ICU beds) 216 Excess Cost2 $46,000,000 1Based on attributable mortality of 5.8% cost cost methodology 2Ontario Clinical Criteria for Suspicion of VAP • New or persistent infiltrate on CXR without another cause • Plus any 2 of the following: • • • • Purulent endotracheal secretions Increasing oxygen requirements Core temperature > 38.0o C WBC < 3.5 or > 11.0 Adapted from N Engl J Med 2006;355:2619-30. Host Risk Factors for VAP • Underlying pulmonary disease (e.g. COPD) • • • • • Sepsis ARDS ...
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...this assignment is to address this problem in nursing practice, and discuss evidence on practices that will address this issue. The problem Hospital associated infections (HAIs) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (central line associated bloodstream infections, catheter associated urinary tract infections, surgical site infections, ventilator associated pneumonia, etc.) (World Health Organization, 2002). HAI’s have become one of the leading caused of hospital related deaths in the United States. However, these infections have been proven to be highly preventable. Many initiatives have been launched in order to reduce the incidence of HAIs. At the facility in which I work, several projects and protocols have implemented in a attempt to reduce the patients’ as well as the staffs’ risk of acquiring an infection. Foam hand sanitizer dispensers have been installed inside and outside of each patient’s...
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...Community Teaching Experience I chose to do my teaching project at a community festival, Edgewater Founders Day 2015, honoring their founding. I was fortunate enough to have made friends with a couple of individuals that were of indescribable assistance. First was the group that allowed me to present my platform at their booth during the founder’s day celebration,The Golden Girls for Glory (Faith Based Social Club). A group of ladies that, by virtue of age, are considered older adults. They belong to varying church congregations of various faiths but come together regularly for community based activities and sponsor many events. Secondly, one of the Golden Girl’s husbands runs a printing shop and donated his time and much of the printed material, not the least of which were the banners for the canopy on the booth at the venue for the festival. The organizers of the event provided the tote bags, canopy and chairs. A local restaurant supplier married to another Golden Girl donated disposable shot glasses upon which stickers were applied. The Golden Girls Event Coordinator is the best friend of my roommate and was struggling to find a theme for their booth this year, and I just happened to be present during her conversation about her dilemma. When I asked if she would consider allowing me to do my presentation as their theme we were all ecstatic. My chosen topic was entitled “HAVE A SHOT>>>ITS GOOD FOR WHAT AILS YOU” An educational presentation for the promotion of health...
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...bacteria live in the intestines, for both people and animals. Symptoms of E. coli infection include diarrhea, abdominal pain and vomiting (Bennett, Jarvis & Brachman, 2007). E. coli emanates from taking contaminated food and water. E. coli may lead to death or permanent health problems if appropriate measures are taken on time. Nosocomial diseases can be termed as an infection that a person gets while being attend to in a health institution. The goal for this task is to explore the nosocomial infections, intervention strategies and recommendations on how to control and manage the various types of nosocomial infections. Analysis of Good Health Hospital records Records of Good Health Hospital show that a number of nosocomial diseases have been reported. Among the commonest nosocomial infections at Good Health Hospital includes, surgical site infection, pneumonia infection, and unitary tract infection among others. It is crustal for medical professionals and other people involved in providing health care to understand the different types of nosocomial infections and how to prevent them. The period between 2009 and 2011 recorded about 10,000 cases of skin and...
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...Noninvasive ventilation (NIV) is defined as the delivery of ventilation support with techniques that do not require invasive endotracheal airway. NIV achieves comparative physiological benefits to conventional mechanical ventilation by reducing work of breathing and improving gas exchange. The intervention is recognised as an effective treatment for respiratory failure in COPD exacerbations and cardiogenic pulmonary oedema, respiratory support for immunocompromised patients, and to facilitate the weaning of stable intubated patients. Avoiding admittance to critical care units is clinically important as intubation is associated with respiratory muscle weakness, upper airway trauma, ventilator-associated pneumonia, and sinusitis1. Most commonly used in critical care, improvements in training and greater awareness has led to NIV use in other acute settings2 and the community3....
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