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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
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
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