Chapter 27 Lower Respiratory Problems Flashcards
Acute bronchitis is a self-limiting inflammation of the?
bronchi in the lower respiratory tract and a common reason for seeking medical care.
- Most acute bronchial infections are caused by viruses.
- Air pollution, dust, inhalation of chemicals, smoking, chronic sinusitis, and asthma are other triggers of acute bronchitis
Acute bronchitis
- most common symptom?
- The presence of colored (e.g., green) sputum is?
- Associated symptoms may include?
- Cough, which is the most common symptom, lasts for up to 3 weeks. Clear, mucoid secretions are often present, although some patients produce purulent sputum.
- The presence of colored (e.g., green) sputum is not a reliable indicator of bacterial infection.
Associated symptoms include headache, fever, malaise, hoarseness, myalgias, dyspnea, and chest pain
Diagnosis of acute bronchitis is based on clinical assessment. Assessment may reveal?
1) normal breath sounds or crackles or wheezes, usually on expiration and with exertion.
2) Consolidation (occurs when fluid accumulates in the lungs), suggestive of pneumonia, is ABSENT with bronchitis.
3) Chest x-rays would be normal and are therefore not indicated unless pneumonia is suspected
Acute bronchitis
- The goal in acute bronchitis is to?
- Treatment is?
- Generally antibiotics are not prescribed for treating a viral infection, as they may cause?
- goal to relieve symptoms and prevent pneumonia.
- Treatment is supportive, including cough suppressants, encouraging oral fluid intake, and using a humidifier. β2-agonist (bronchodilator) inhalers are useful for patients with wheezes.
- may cause side effects and promote antibiotic resistance. However, antibiotics may be prescribed for patients with underlying chronic conditions and who have a prolonged infection associated with systemic symptoms.
Acute Bronchitis: Patients should be encouraged not to ?
- If the acute bronchitis is due to an influenza virus, treatment with?
- encouraged not to smoke, avoid secondhand smoke, and to frequently wash their hands.
- treatment with antiviral drugs, either zanamivir (Relenza) or oseltamivir (Tamiflu), can be started. These drugs should be initiated within 48 hours of the onset of symptoms
Acute bronchitis 5 main points
1) Inflammation of the bronchi
2) 90% are viral
3) Most common symptom- cough
- HA, fever, malaise, hoarseness, dyspnea, CP
3) Normal breaths sounds/ rhonchi
4) Normal CXR
Pertussis is a highly contagious infection of the respiratory tract caused by?
- The bacteria attach to the cilia of the respiratory tract and?
- The incidence of pertussis has been steadily increasing in the United States since the 1980s, with the largest increase noted in?
- It is thought that immunity resulting from childhood vaccination with DPT (diphtheria, pertussis, tetanus) may diminish over time, allowing a milder (but still contagious) infection. The Centers for Disease Control and Prevention (CDC) currently recommends that all adults age ___ years and older who have not received a dose of Tdap (tetanus, diphtheria, and pertussis) receive a?
- caused by a gram-negative bacillus, Bordetella pertussis.
- release toxins that damage the cilia, causing inflammation and swelling.
- increase noted in adults.
- age 19 years and older who have not received a dose of Tdap (tetanus, diphtheria, and pertussis) receive a one-time vaccination as soon as possible
Clinical manifestations of pertussis occur in stages.
1) The first (catarrhal) stage, occurring within?
2) The second (paroxysmal) stage, from the second to tenth week of infection, is characterized by paroxysms of cough.
3) The final (convalescent) stage lasts?
1) first 2 weeks of infection, manifests as a mild upper respiratory tract infection (URI) with a low-grade or no fever, runny nose, watery eyes, and mild, nonproductive cough
2) second (paroxysmal) stage, from the second to tenth week of infection, is characterized by paroxysms of cough.
3) lasts 2 to 3 weeks and is characterized by less severe cough and weakness
The hallmark characteristic of pertussis is?
uncontrollable, violent coughing.
- Inspiration after each cough produces “whooping” sound as patient tries to breathe in air against obstructed glottis. The “whoop” often not present in teens and adults (especially those who have been vaccinated).
- Like acute bronchitis, coughing more frequent at night.
- Vomiting may also occur with coughing.
- Unlike bronchitis, cough with pertussis may last from 6 to 10 weeks
- The primary treatment for pertussis is?
- The patient is infectious from the?
- What should NOT be used to treat pertussis?
- tantibiotics, usually macrolides (erythromycin, azithromycin [Zithromax]), to minimize symptoms and prevent spread of the disease.
- infectious from the beginning of the catarrhal stage through the third week after onset of symptoms or until 5 days after antibiotic therapy has been initiated.
- Cough suppressants and antihistamines should not be used, since they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are also not useful
Pertussis main points
1) Highly contagious
2) Gram negative bacillus
3) Uncontrolled, violent coughing
4) Low-grade or no fever
5) Runny nose, watery eyes
6) ABX to prevent spread/minimize symptoms
7) Cough suppressants, antihistamines-ineffective
8) Vaccine Dtap
- Tetanus, diphtheria, pertussis
- Pneumonia is an acute infection of the?
- Until 1936, pneumonia was the leading cause of death in the United States. The discovery of _____ and ____ was pivotal in the treatment of pneumonia.
- Since that time, remarkable progress has been made in the development of ______ to treat pneumonia.
- However, despite newer antimicrobial agents, pneumonia is still associated with significant morbidity and mortality rates. The CDC reports that pneumonia and influenza are the?
- acute infection of the lung parenchyma. Until 1936, pneumonia was the leading cause of death in the United States
- discovery of sulfa drugs and penicillin was pivotal
- development of antibiotics to treat pneumonia
- pneumonia and influenza are the eighth leading cause of death in the United States
Pneumonia 4 main points
1) Acute infection
2) Until 1936- leading cause of death
3) Still associated with high morbidity/mortality
4) Community-acquired (CAP) 6th leading cause of death for pts >65
Pneumonia Etiology
Normally, the airway distal to the larynx is protected from infection by various defense mechanisms. Mechanisms that create a mechanical barrier to microorganisms entering the tracheobronchial tree include?
- Immune defense mechanisms include secretion of?
- mechanical barrier to microorganisms include air filtration, epiglottis closure over the trachea, cough reflex, mucociliary escalator mechanism, and reflex bronchoconstrictio.
- secretion of immunoglobulins A and G and alveolar macrophages
1) Pneumonia is more likely to occur when?
2) Decreased consciousness weakens the?
3) Tracheal intubation bypasses normal?
4) What can also impair the mucociliary mechanism?
5) Chronic diseases can?
1) defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents.
2) weakens the cough and epiglottal reflexes, which may allow aspiration of oropharyngeal contents into the lungs. 3) bypasses normal filtration processes and interferes with the cough reflex and mucociliary escalator mechanism.
4) Air pollution, cigarette smoking, viral URIs, and normal changes that occur with aging
5) suppress the immune system’s ability to inhibit bacterial growth
Organisms that cause pneumonia reach the lung by three ways:
- Aspiration of normal flora from the nasopharynx or oropharynx. Many organisms that cause pneumonia are normal inhabitants of the pharynx in healthy adults.
- Inhalation of microbes present in the air. Examples include Mycoplasma pneumoniae and fungal pneumonias.
- Hematogenous spread from a primary infection elsewhere in the body. Examples are streptococci and Staphylococcus aureus from infective endocarditis
Pneumonia occurs when defense mechanisms are overwhelmed and unable to fight the virus
4 types
1) Community-acquired (CAP)
2) Medical Care-associated (MCAP) – usually 48 hrs post admission
3) Aspiration – abnormal entry from mouth or stomach into lungs – triggers inflammatory response
4) Opportunistic – altered immune system – like HIV, chemo or radiation patients
Pneumonia patho main points
1) Inflammatory response
- Attraction of neutrophils
- Release of inflammatory mediators
2) Alveoli fill w/ fluid- consolidation
3) Increased mucous production
4) Decreased gas exchange
5) Macrophages in alveoli ingest/remove debris
18 Risk Factors for Pneumonia
Risk Factors for Pneumonia
• Abdominal or thoracic surgery
• Age >65 yr
• Air pollution
• Altered consciousness: alcoholism, head injury, seizures, anesthesia, drug overdose, stroke
• Bed rest and prolonged immobility
• Chronic diseases: chronic lung and liver disease, diabetes mellitus, heart disease, cancer, chronic kidney disease
• Debilitating illness
• Exposure to bats, birds, rabbits, farm animals
• Immunosuppressive disease and/or therapy (corticosteroids, cancer chemotherapy, human immunodeficiency virus [HIV] infection, immunosuppressive therapy after organ transplant)
• Inhalation or aspiration of noxious substances
• Intestinal and gastric feedings via nasogastric or nasointestinal tubes
• IV drug use
• Malnutrition
• Recent antibiotic therapy
• Resident of a long-term care facility
• Smoking
• Tracheal intubation (endotracheal intubation, tracheostomy)
• Upper respiratory tract infection
Organisms Causing Pneumonia
Community-Acquired Pneumonia
Organisms Causing Pneumonia Community-Acquired Pneumonia • Streptococcus pneumoniae* • Mycoplasma pneumoniae • Haemophilus influenzae • Respiratory viruses • Chlamydophila pneumoniae • Chlamydophila psittaci • Coxiella burnettii • Legionella pneumophila • Oral anaerobes • Moraxella catarrhalis • Staphylococcus aureus • Pseudomonas aeruginosa • Enteric aerobic gram-negative bacteria (e.g., Klebsiella species) • Fungi • Mycobacterium tuberculosis
Organisms Causing Pneumonia
Hospital-Acquired Pneumonia
- Pseudomonas aeruginosa†
- Escherichia coli†
- Klebsiella pneumoniae†
- Acinetobacter species†
- Haemophilus influenzae
- Staphylococcus aureus
- Streptococcus pneumoniae
- Proteus species
- Enterobacter species
- Oral anaerobes
Types of Pneumonia
- potential causes of pneumonia.
- Although pneumonia can be classified many different ways (e.g., according to the causative organism), the most widely recognized and clinically effective way is to classify pneumonia as?
- Bacteria, viruses, Mycoplasma organisms, fungi,
- community-acquired or hospital-acquired pneumonia. Classifying pneumonia is important because of the differences in the likely causative organisms and the selection of appropriate antimicrobial therapy
Community-acquired pneumonia (CAP) is an acute infection of the lung occurring in patients who have?
- The decision to treat the patient at home or admit him or her to the hospital is based on several factors such as the?
- not been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms
- patient’s age, vital signs, mental status, presence of co-morbid conditions, and current physiologic condition. Clinicians can use tools such as the CURB-65 scale to supplement clinical judgment
Community-Acquired pneumonia treatment
Empiric antibiotic therapy should be started as soon as possible. It is the initiation of treatment before a definitive diagnosis or causative agent is confirmed, and should be started as soon as CAP is suspected. Empiric antibiotic administration is based on experience and knowledge of drugs known to be effective for the most likely causative agent
Hospital-acquired pneumonia (HAP), also known as ______ pneumonia, is a pneumonia in a?
- VAP pneumonia?
- Once the diagnosis of HAP or VAP is made, treatment of pneumonia is initiated based on?
- Antibiotic therapy can be?
- Both HAP and VAP are associated with?
nosocomial pneumonia
- nonintubated patient that begins 48 hours or longer after admission to hospital and was not present at the time of admission.
- Ventilator-associated pneumonia (VAP), also a type of HAP, refers to pneumonia that occurs more than 48 hours after endotracheal intubation
- based on known risk factors, early versus late onset, and probable organism.
- Antibiotic therapy can be adjusted once the results of sputum cultures identify the exact pathogen.
- longer hospital stays, increased associated costs, sicker patients, and increased risk of morbidity and mortality
1) A major problem in treating pneumonia today is the development of?
2) Primary culprits include?
3) Risk factors for development of MDR pneumonia include?
4) Antibiotic susceptibility tests can identify MDR organisms. The virulence of these organisms can severely limit the?
1) multidrug-resistant (MDR) organisms.
2) methicillin-resistant Staphylococcus aureus and gram-negative bacilli.
3) advanced age, immunosuppression, history of antibiotic use, and prolonged mechanical ventilation.
4) Available and appropriate antimicrobial therapy. MDR organisms also increase the morbidity and mortality risks associated with pneumonia
1) Aspiration pneumonia results from the abnormal entry of material from the?
2) Conditions that increase the risk of aspiration include?
3) With loss of consciousness, the?
1) mouth or stomach into the trachea and lungs
2) decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric tubes with or without tube feeding
3) gag and cough reflexes are depressed, and aspiration is more likely to occur
Aspiration pneumonia
1) The aspirated material triggers an?
2) most common form of aspiration pneumonia is a?
1) aspirated material (food, water, vomitus, or oropharyngeal secretions) triggers an inflammatory response.
2) primary bacterial infection. Typically, more than one organism is identified on sputum culture, including aerobes and anaerobes, since they both make up the flora of the oropharynx
Aspiration pneumonia:
1) Until cultures are completed and results obtained, initial antibiotic therapy is based on an assessment of?
2) For patients who aspirate in hospitals, appropriate antibiotics should include coverage for both?
3) In contrast, aspiration of acidic gastric contents causes?
1) probable causative organism, severity of illness, patient factors (e.g., malnutrition, current use of antibiotic therapy), and ability to treat common community-acquired organisms.
2) gram-negative organisms and MRSA.
3) chemical (noninfectious) pneumonitis, which may not require antibiotic therapy. However, secondary bacterial infection can occur 48 to 72 hours later
1) Necrotizing pneumonia is a rare complication of?
2) It is characterized by?
3) Although the exact pathophysiologic mechanisms involved are controversial, causative organisms include?
4) ____ ______commonly occur.
5) Signs and symptoms of necrotizing pneumonia include?
6) Treatment often includes?
1) bacterial lung infection
2) liquefaction and, in some situations, cavitation of lung tissue. This often occurs as a result of community-acquired pneumonia (CAP).
3) Staphylococcus, Klebsiella, and Streptococcus. Lung abscesses commonly occur.
4) Lung abscesses
5) immediate respiratory insufficiency and/or failure, leukopenia, and bleeding into the airways
6) Treatment often includes long-term antibiotic therapy and possible surgery
1) Opportunistic pneumonia is inflammation and infection of the lower respiratory tract in?
2) Individuals at risk for opportunistic pneumonia include those with?
3) In addition to the risk of bacterial and viral pneumonia, the immunocompromised person may develop an infection from microorganisms that?
1) immunocompromised patients.
2) altered immune responses. This can include people with severe protein-calorie malnutrition or immunodeficiencies (e.g., human immunodeficiency virus [HIV] infection) and those receiving radiation therapy, chemotherapy, and any immunosuppressive therapy, including long-term corticosteroid therapy.
3) do not normally cause disease, such as Pneumocystis jiroveci (formerly carinii) and cytomegalovirus (CMV)
Opportunistic pneumonia
1) P. jiroveci pneumonia (PJP) rarely occurs in the healthy individual but is the most common form of pneumonia in? 2) The onset is slow and subtle with symptoms of?
3) The chest x-ray usually shows?
4) In widespread disease, the lungs have?
5) PJP can be life-threatening, causing?
6) Infection can also spread to other organs, including?
7) Bacterial and viral pneumonias must first be ruled out because of the vague presentation of PJP. Although the causative agent is fungal, PJP does not respond to?
8) Treatment consists of a course of?
1) people with HIV disease.
2) fever, tachypnea, tachycardia, dyspnea, nonproductive cough, and hypoxemia.
3) diffuse bilateral infiltrates.
4) massive consolidation.
5) acute respiratory failure and death.
6) liver, bone marrow, lymph nodes, spleen, and thyroid. 7) does not respond to antifungal agents.
8) trimethoprim/sulfamethoxazole (Bactrim, Septra) either IV or orally depending on the severity of disease and the patient’s response
Opportunistic pneumonia
1) Cytomegalovirus CMV, a herpesvirus, can cause?
2) Most CMV infections are?
3) CMV is the most common life-threatening infectious complication after?
4) treatment?
1) viral pneumonia
2) asymptomatic or mild, but severe disease can occur in people with an impaired immune response
3) hematopoietic stem cell transplantation
4) Antiviral medications (e.g., ganciclovir [Cytovene], foscarnet [Foscavir], cidofovir) and high-dose immunoglobulin are used for treatment
Pneumonia Pathophysiology
Specific pathophysiologic changes related to pneumonia vary according to the offending organism, but the majority of organisms trigger an inflammatory response in the lungs.
1) Inflammation, characterized by an increase in?
2) Normal O2 transport is affected, leading to clinical manifestations of?
3) Consolidation, a feature typical of bacterial pneumonia, occurs when the?
4) Mucus production also increases, which can potentially?
5) Over time and with appropriate antibiotic therapy, what happens?
1) increase in blood flow and vascular permeability, activates neutrophils to engulf and kill the offending organisms. As a result, the inflammatory process attracts more neutrophils, edema of the airways occurs, and fluid leaks from the capillaries and tissues into alveoli.
2) hypoxia (e.g., tachypnea, dyspnea, tachycardia).
3) normally air-filled alveoli become filled with fluid and debris.
4) obstruct airflow and impair gas exchange even further. 5) macrophages lyse and process the debris, lung tissue is allowed to recover, and gas exchange returns to normal. Resolution and healing occur if there are no complications
Clinical Manifestations for pneumonia
1) The most common presenting symptoms of pneumonia are?
2) Sputum may appear?
3) Viral pneumonia may initially be seen as?
1) cough, fever, chills, dyspnea, tachypnea, and pleuritic chest pain. The cough may or may not be productive.
2) green, yellow, or even rust colored (bloody).
3) influenza, with respiratory symptoms appearing and/or worsening 12 to 36 hours after onset
Clinical manifestations for pneumonia
The older or debilitated patient may not have classic symptoms of pneumonia.
1) Confusion or stupor (possibly related to hypoxia) may be the only finding.
2) Hypothermia, rather than fever, may also be noted with the older patient.
3) Nonspecific clinical manifestations include diaphoresis, anorexia, fatigue, myalgias, and headache
Pneumonia: On physical examination, what can be heard when auscultated?
2) If consolidation is present, what is noted?
3) Patients with pleural effusion may exhibit?
1) fine or coarse crackles may be auscultated over the affected region.
2) bronchial breath sounds, egophony (a change in the sound of the voice of the patient), and increased fremitus (vibration of the chest wall produced by vocalization) may be noted.
3) dullness to percussion over the affected area
Pneumonia Complications develop more frequently in older individuals and those with underlying chronic diseases. Potential complications include the following:
• Atelectasis (collapsed, airless alveoli) of one or part of one lobe may occur. These areas may clear with effective deep breathing and coughing.
• Pleurisy (inflammation of the pleura) may occur.
• Pleural effusion (fluid in the pleural space) can occur. In most cases, the effusion is sterile and is reabsorbed in 1 to 2 weeks. Occasionally, effusions require aspiration by thoracentesis.
• Bacteremia (bacterial infection in the blood) is more likely to occur in infections with Streptococcus pneumoniae and Haemophilus influenzae.
• Pneumothorax can occur when air collects in the pleural space, causing the lungs to collapse.
• Meningitis can be caused by Streptococcus pneumoniae. The patient with pneumonia who is disoriented, confused, or drowsy may have a lumbar puncture to evaluate the possibility of meningitis.
• Acute respiratory failure is one of the leading causes of death in patients with severe pneumonia. Failure occurs when pneumonia damages the lungs’ ability to facilitate the exchange of O2 and CO2 across the alveolar-capillary membrane.
• Sepsis/septic shock can occur when bacteria within alveoli enter the bloodstream. Severe sepsis can lead to shock and multisystem organ dysfunction syndrome (MODS) (see Chapter 66).
Lung abscess is not a common complication of pneumonia. However, it may occur with pneumonia caused by S. aureus and gram-negative organisms. Empyema, the accumulation of purulent exudate in the pleural cavity, occurs in less than 5% of cases and requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage
Clinical manifestations main points for pneumonia
- Cough, fever, shaking, chills, tachypnea, pleurisy cp
- Green, yellow or rust colored sputum
- COMPLICATIONS
- Pleurisy- inflammation in pleural space
- Pleural effusion-fluid in pleural space
- Atelectasis- collapsed alveoli
- Bacteremia- blood infection
- Empyema-pus in pleural space
- Pericarditis-infection that moves to pericardium
- Meningitis
- Sepsis
- Acute respiratory failure
- Pneumothorax- collapsed lung
Pneumonia diagnostic assessment
- History and physical examination
- Chest x-ray
- Gram stain of sputum
- Sputum culture and sensitivity test
- Pulse oximetry or ABGs (if indicated)
- Complete blood count, WBC differential, and routine blood chemistries (if indicated)
- Blood cultures (if indicated)
Pneumonia Management
- Increased fluid intake (at least 3 L/day)
- Balance between activity and rest
- O2 therapy (if indicated)
Pneumonia Drug Therapy
- Appropriate antibiotic therapy
- Antipyretics
- Analgesics
Pneumonia Diagnostic Studies
1) often provide enough clinical information to make decisions about early treatment.
2) Chest x-ray often shows a typical pattern characteristic of the?
3) This may be used to obtain fluid samples from patients not responding to initial therapy
1) History, physical examination, and chest x-ray often provide enough clinical information to make decisions about early treatment.
2) Chest x-ray often shows a typical pattern characteristic of the infecting organism and is important in the diagnosis of pneumonia. X-ray may also show pleural effusions.
3) A thoracentesis and/or bronchoscopy with washings
Pneumonia diagnostic studies:
1) sputum specimen for culture and Gram stain to identify the organism are obtained when and can they be delayed?
2) When are Blood cultures done?
3) Arterial blood gases (ABGs) may be obtained to assess for?
4) Leukocytosis occurs in the majority of patients with?
1) obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained. Delays in antibiotic therapy can increase the risk of morbidity and mortality. 2) Blood cultures are done for patients who are seriously ill.
3) hypoxemia (partial pressure of O2 in arterial blood [PaO2] less than 80 mm Hg), hypercapnia (partial pressure of carbon dioxide in arterial blood [PaCO2] greater than 45 mm Hg), and acidosis (pH <7.35).
4) bacterial pneumonia; the white blood cell (WBC) count is usually greater than 15,000/µL (15 × 109/L) with the presence of bands (immature neutrophils)
Pneumonia Interprofessional Care
1) Pneumococcal vaccine is used to prevent?
2) Prompt treatment with the appropriate antibiotic is essential. Antibiotics are highly effective for both?
3) In uncomplicated cases, the patient responds to drug therapy within?
4) Indications of improvement include?
5) A repeat chest x-ray may be obtained in?
1) Streptococcus pneumoniae
2) bacterial and mycoplasma pneumonia.
3) 48 to 72 hours
4) decreased temperature, improved breathing, and reduced chest discomfort. Abnormal physical findings can last more than 7 days.
5) 6 to 8 weeks to assess for resolution
Pneumonia interprofessional Care
1) In addition to antibiotic therapy, supportive measures are individualized to the patient’s needs. These may include?
2) Although cough suppressants, mucolytics, bronchodilators, and corticosteroids are often prescribed as adjunctive therapy, the use of these drugs is controversial. However, they may be prescribed for patients with?
1) O2 therapy to treat hypoxemia, analgesics to relieve chest pain, and antipyretics (e.g., aspirin, acetaminophen) for elevated temperature.
2) underlying chronic conditions.
Pneumonia: Individualize rest and activity to each patient’s tolerance. Benefits of mobility include?
improved diaphragm movement and chest expansion, mobilization of secretions, and prevention of venous stasis.
Pneumonia: Currently, no definitive treatment exists for the majority of viral pneumonias. As identified earlier, care is generally supportive. In most circumstances, viral pneumonia is self-limiting and will often resolve in?
resolve in 3 to 4 days. Antiviral therapy may be used to treat pneumonia caused by influenza (e.g., 504oseltamivir, zanamivir) and a few other viruses (e.g., acyclovir [Zovirax] for herpes simplex virus)
Drug therapy for pneumonia:
1) For all types of pneumonia, empiric antibiotic therapy is based on whether the patient has?
2) The prevalence and resistance patterns of MDR pathogens vary among localities and institutions. Therefore the antibiotic regimen must be adapted to?
3) Multiple regimens exist, but all should initially include antibiotics that are effective against?
1) risk factors for MDR organisms.
2) local patterns of antibiotic resistance.
3) both resistant gram-negative and resistant gram-positive organisms
Pneumonia:
1) Clinical improvement usually occurs in?
2) Patients who deteriorate or fail to respond to therapy require?
1) 3 to 5 days
2) aggressive reevaluation to assess for noninfectious etiologies, complications, coexisting infectious processes, or pneumonia caused by a drug-resistant pathogen
Pneumonia drug therapy:
1) IV antibiotic therapy should be switched to oral therapy as soon as the patient is?
2) Stable patients do not need to be?
3) Total treatment time for patients with CAP should be a minimum of?
4) Longer treatment time may be needed if initial therapy was?
1) hemodynamically stable, is improving clinically, is able to ingest oral medication, and has a functioning gastrointestinal tract.
2) observed in the hospital and can be discharged to home on oral antibiotics.
3) 5 days, and the patient should be afebrile for 48 to 72 hours before stopping treatment. However, you need to emphasize the importance of completing the full course of antibiotic treatment.
4) not active against the identified pathogen or complications occur
Pneumonia Nutritional Therapy.
1) Hydration is important in the?
2) Individualize and carefully monitor fluid intake. When is IV administration of fluids and electrolytes necessary?
3) Weight loss may occur in patients with pneumonia because of?
1) supportive treatment of pneumonia to prevent dehydration and to thin and loosen secretions.
2) If the patient is an older adult, has heart failure, or has a known preexisting respiratory condition
3) increased metabolic needs and difficulty eating due to nonspecific abdominal complaints or shortness of breath. Small, frequent meals are easier for dyspneic patients to tolerate. Offer foods high in calories and nutrients
