CAP/HAP Flashcards
What is the CURB-65 score?
clinical prediction rule for predicting mortality in community-acquired pneumonia
What is involved in the CURB-65 score?
C- confusion
U- urea >7mmol/L
R- RR >30/min
B- BP systolic: <90mmHg, diastolic <60mmHg
Age >65 years
According to the CURB score what is the severity and recommended tx for a score of 0
severity: low
tx: outpt
According to the CURB score what is the severity and recommended tx for a score of 1
Severity: low
Tx: outpt
According to the CURB score what is the severity and recommended tx for a score of 2
Severity: moderate
Tx: Hospital
According to the CURB score what is the severity and recommended tx for a score of 3-5
Severity: high
Tx: hosptial (ITU admission)
What is the most common bacterial cause for PNA?
Streptococcal Pneumoniae
What are other common causes for CAP?
H. influenzae
M. catarrhalis
What are causes of atypical PNA?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella
RSV
What are examples of HAP agents?
Pseudomonas aeruginosa
Staph aureus
Klebsiella pnuemonia
E. coli
What are some s/s of PNA
Fever
Productive cough
SOB
What Dx tests may you order in the w/u of PNA?
O2 sat
CBC: increased WBC
CXR: Infiltrations
sputum cx
Typical PNA has a ___ onset while atyplical PNA has a ____ onset
Abrupt
insidious
What are the two vaccine options for PNA prevention?
Who should get these vaccines?
Polyvalent 23
+65 y.o.
2+ and high risk
Prevnar 13
children 0-5 y.o.
65+ or high risk
What are important hx questions to ask a pt with possible PNA
Productive cough
Sick contacts
Recent hospitalizations
Co-morbid illnesses.
What are PE signs you are looking for to dx PNA?
Fever lymphadenopathy Tachypnea Tachycardia adventitious breath sounds consolidation
How is egophony performed?
have pt say the letter “E”, while you’re listening through the stethoscope to a suspected area of involvement.
If you are listening for an “E”, and it comes through like “A”, then egophony is present.
How is bronchophony performed
Have the pt verbalize “99”.
if bronchophony is present, the sound is very distinct, very clear and very loud.
How is Whisper Pectoriloquy performed?
Same as bronchophony, but now the patient whispers “99”.
in areas of the lung that are filled with fluid it comes through very distinctly. it is a more sensitive indicator than bronchophony
What is the tx for CAP in an otherwise healthy pt?
Macrolide (clarithromycin, azithromycin)
Doxycycline (not 1st line)
What is the tx for in-pt CAP or for out-pt tx in a pt with comorbidities
Respiratory Fluoroquinolone (levofloxacin) or B-lactam (Amoxicillin) + Macrolide
How do you tx a pen allergic pt with PNA?
Respiratory Fluoroquinolone or Aminoglycoside (Gentamicin, Tobramycin)
How do you tx HAP?
levofloxacin + vancomycin OR Linezolid + penicillin if MSSA suspected
How long should a pt admitted to the hosptial for PNA be given IV abx.
When can you d/c a pt with PNA?
take of IV abx when vitals stabilize
D/c once pt has been hemodynamically stable and afebrile 48-72 hrs
