1. Nursing Assistant Monthly Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults

2. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults What is pneumonia?  Pneumonia is an infection and/or inflammation of the deep tissues of the lung  It can be caused by –Bacteria, viruses, fungi, exposure to toxic chemicals –Aspiration pneumonia is usually due to oral bacteria entering the lungs

3. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults How does pneumonia affect the body? Pneumonia interferes with exchange of gases:  Taking in oxygen  Removal of carbon dioxide from the body

4. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults Types of pneumonia One way to categorize pneumonia is by the setting where it occurs:  Community-acquired pneumonia: usually but not always milder disease  Hospital-acquired pneumonia: often, more resistant organisms  Nursing home-acquired pneumonia: may involve resistant organisms, especially if recently hospitalized

5. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults Signs and symptoms of pneumonia in older adults  Often the first sign is a change in cognitive status or behavior  Cough  Weakness, fatigue  Shortness of breath  Achy chest  Fever, chills (this may not occur in older adults)

6. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults Preventing aspiration pneumonia Aspiration pneumonia is the most common type in nursing home settings  Help to prevent it by: –Encouraging residents to move, ambulate, and change position –Turning bedbound residents frequently – at least every 2 hours helps to expand all areas of the lung –Providing enough fluids, according to care plan –Good oral care

7. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults Why is oral care important?  Oral care reduces the number of bacteria in the mouth  That is why residents without teeth still need oral care! –Always wear a fresh pair of disposable gloves –Use a soft bristled brush –Explain what you are doing –If a resident resists oral care, report this to the nurse –Observe and report the presence of white patches or anything unusual

8. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults Aspiration pneumonia & mealtime  Positioning –Have residents sit upright in a chair (wheelchair is not best) –If bedbound, sit the person as upright as possible  Watch for and report signs of swallow difficulty –Facial expressions, grimacing, frowning when swallowing –Coughing, choking  Some residents are “silent aspirators” –They may not seem to choke, but are silently aspirating secretions

9. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. July 2012 Pneumonia in older adults “Take-home” points You are the “eyes and ears” of the nurses!  Aspiration is not always easy to detect  Pay close attention to residents’ swallowing ability during meals  Understand the health benefits of oral care  Provide adequate fluids  Physical activity helps prevent pneumonia by moving secretions  Report any change in cognitive status, level of alertness, or behavior to the nurse