Page 80 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 65

Copious purulent sputum
Shortness of breath and dyspnea

Hemoptysis
Adventitious breath sounds: crackles (rales), gurgles (rhonchi), wheezes and
friction rubs

Interpreting Test Results
There is no agreement or specific criteria for the diagnosis of pneumonia, but
most resources include the following:
Positive sputum cultures
Elevated white blood cell counts
Localized chest x-ray infiltrates
Arterial blood gases may indicate respiratory acidosis if sputum obstructs
oxygen and carbon dioxide exchange

NURSING ALERT

Although sputum cultures are routinely done on patients with suspected pneumonia, Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

50% of the time a causative agent is NOT identified. Therefore, a negative sputum
does not necessarily indicate that the patient does not have pneumonia.

Treatment
HAP is a major focus in hospitals and especially critical care areas. In order to
decrease occurrences, the Institute of Healthcare Improvement has recom-
mended “bundles of care” to help improve patient outcomes. Currently there
are four bundles of care in the ventilator bundle. These include
1. Positioning – keep the bed elevated at least 30 degrees, turn and reposition
prn.
2. Lifting sedation – allow the patient to come out of paralyzing medications
to assess the need for MV.
3. Prevention of gastric ulcers.
4. Prevention of deep vein thrombosis.
Prevention and treatment of HAP also includes:

Oxygen and mechanical ventilation (if ARF occurs)
Frequent and judicious use of hand washing and universal precautions
Antibiotics