Pneumonia prophylaxis

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Spirometer for breathing training

Measures of pneumonia prophylaxis used in nursing and medicine in preventing a lung infection (pneumonia) in patients at risk.

It is a term used in German-speaking nursing and care for the elderly, which can be seen in a concept to prevent consequential damage and complications in people in need of care in the context of prophylaxis .

There is no such term in English-speaking countries.

In the case of preventive intervention, the knowledge about the impairment of breathing is based on experience and tradition and less on concrete evidence of effectiveness.

indication

Various situations carry an increased risk of developing pneumonia:

With shallow breathing and reduced ventilation of the lungs, secretion is not coughed up sufficiently. This is the case, for example, with being bedridden due to illness or restricted mobility and with pain-related restriction of breathing, as can occur postoperatively or after chest injury . This leads to the formation of poorly ventilated areas or areas in the lungs that are cut off from breathing ( atelectasis ) and, as a result, pneumonia.

Old age and weak immune system, e.g. B. by HIV infection, chemotherapy or diseases of the bone marrow, promote pneumonia as well as pre-existing diseases, especially of the lungs.

Likewise, the patient with limited consciousness, also through centrally depressant medication, is at greater risk. Hospital patients who are endotracheally intubated (and therefore usually have to be ventilated ) are at increased risk of developing pneumonia.

activities

Pneumonia prophylaxis measures are primarily aimed at deepening breathing and liquefying and removing viscous secretions from the airways.

The earliest possible mobilization after operations, suitable positioning of the patient as well as vibration massage and physiotherapy come into question . Breathing exercises, e.g. B. with flutter or spirometer (see Fig.), The patient can also perform alone according to the instructions. Pain that hinders breathing can be fought with painkillers , the liquefaction of thick mucus can be assisted with secretolytics . Adequate fluid intake also contributes to this. With the breath-stimulating liniment (ASE) breathing to deepen the patient and his body awareness to promote this. The effect of ASE as prophylaxis for pneumonia has not yet been adequately proven. In the long term, improving the general and nutritional condition is important. General hygiene measures, such as hand disinfection and the wearing of protective clothing, especially mouth and nose protection , must be observed.

In the case of patients with impaired consciousness , particular attention is paid to aspiration prophylaxis; the airways must be kept free by suction if necessary .

The bronchial toilet plays an important role in intubated or tracheostomized patients .

The prevention of pneumonia caused by ventilation (VAP - Ventilator Associated Pneumonia ), pneumonia acquired in the hospital in the intensive care unit , falls into the specialized area of intensive care and medicine. It includes a wide variety of areas such as suction technology, hand hygiene and employee training.

See also

Breathing scale

literature

  • P. Fickus: Pneumonia prophylaxis. In: Annette Lauber, Petra Schmalstieg, Christine Lackner: Prevention and Rehabilitation. 2nd Edition. Thieme, Stuttgart 2007, ISBN 978-3-13-128612-3 , p. 221 f. ( PDF, 266 kB )

Individual evidence

  1. Horst Konrad: Pneumonia prophylaxis in hospital patients. Analysis of data from the nursing classification ENP in electronic patient records. Edition Nursing Science, Volume 2. RECOM Verlag, Bad Emstal 2009, ISBN 978-3-89752-113-1 .
  2. Hans Walter Striebel: The operative intensive care medicine: Safety in clinical practice. Schattauer Verlag, Stuttgart 2007, ISBN 978-3-7945-2480-8 , pp. 307-313. (books.google.de)
  3. M. Zimmer: Surgery, Orthopedics, Urology. Urban & Fischer Verlag, 2006, ISBN 3-930192-77-2 , p. 25. (books.google.de)
  4. Christoph Becker, Susanne Schevior-Popp: Examen Pflege. Written examination day 2. Thieme-Verlag, Stuttgart 2007, ISBN 978-3-13-141511-0 , p. 203. (books.google.de)
  5. Nicole Menche: Revision Course Care Today. Elsevier, Urban & Fischer Verlag, Munich 2006, ISBN 3-437-27840-1 , p. 66. (books.google.de)
  6. ^ Fulda Information Service for Applied Health Sciences and Clinical Practice. Breath-stimulating rub-in for pneumonia prophylaxis. on: findax.de
  7. ^ Robert Koch Institute : Prevention of nosocomial ventilation-associated pneumonia. In: Federal Health Gazette. 56, 2013, pp. 1578-1590. doi: 10.1007 / s00103-013-1846-7