Communicable Disease- Pneumonia Flashcards
Inflammation of lung tissues
Pneumonia
Factors Predisposing to Pneumonia
15
1. Aging
2. Air pollution
3. Altered consciousness, alcoholism, head injury seizures
4. Altered oropharyngeal flora secondary to antibiotics
5. Bed rest and prolonged immobility
6. Chronic diseases: chronic lung disease, diabetes mellitus, heart disease, cancer, end - stage renal disease.
7. Debilitating disease
8. Human Immunodeficiency virus (HIV) infection.
9. Immunosuppressive drugs (corticosteroids,
cancer
chemotherapy, immunosuppressive therapy after organ transplant).
10. Inhalation or aspiration of noxious substances
11. Intestinal and gastric feedings via nasogastric or naso-intestinal tubes
12. Malnutrition
13. Smoking
14. Tracheal intubation (endotracheal intubation, tracheostomy)
15. Upper respiratory tract infection
Acquisition of Organisms that cause pneumonia
AIH
Aspiration from the nasopharynx or oropharynx.
- many organisms that cause pneumonia are normal inhabitants of pharynx in healthy adults
Inhalation of microbes present in air
-eg. Mycoplasma pneumoniae and fungal pneumonias
Hematogeneous spread from a primary infection elsewhere in body
- stapyloccocus aureus
Types of Pneumonia
- Community Acquired Pneumonia
- Hospital Acquired Pneumonia
Ventilator Acquired Pneumonia
Health Care Associated Pneumonia - Fungal Pneumonia
- Aspiration Pneumonia
- Opportunistic Pneumonia
- Pneumococcal Pneumonia
a lower respiratory tract infection of lung tissues with the onset in the community or during the first 2 days of hospitalization.
Community Acquired Pneumonia (CAP)
A pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization
Hospital Acquired Pneumonia (HAP)
Pneumonia that occurs more than 48 to 72 hours after endotracheal intubation.
Ventilator Associated Pneumonia (VAP)
includes patient with a new onset pneumonia who:
a. Was hospitalized in an acute care hospital for 2 more days within 90 days of the infection.
b. Reside in a long - term care facility.
c. Received recent intravenous antibiotic
therapy, chemotherapy or wound care within the past 30 days of the current infection.
d. Attended a hospital or hemodialysis clinic.
Health Care Associated Pneumonia (HCAP)
Caused by fungi
- Histoplasma capsulatum
- Coccidioides immitis
- Candida albicans
Fungal Pneumonia
Refers to the sequelae caused by abnormal entry of secretions or substances into the lower airway.
It usually follows aspiration of material from the mouth or stomach into the trachea and subsequently into the lungs.
Aspiration Pneumonia
The patient who has aspiration pneumonia usually has a history of?
Loss of Consciousness
Why do patient who has history of loss of consciousness is at risk for Aspiration Pneumonia?
During loss of consciousness the gag and cough reflexes are depressed so aspiration is more likely to occur.
Triggering mechanism causing the aspiration pneumonia
Aspirated material such as (food, water, vomitus, or toxic fluids (e.g., gastric juices)
Patients with altered immune responses are at risk to respiratory infections.
Opportunistic Pneumonia
These are patients who are at risk for Opportunistic Pneumonia
a. Those who have severe protein - calorie malnutrition.
b. Those who have immune deficiencies.
c. Those who have received transplants and have been “ treated with immunosuppressive drugs.
d. Patients who are being treated with radiation therapy, chemotherapy drugs, and prolonged corticosteroid therapy.
Causative agents that cause Opportunistic Pneumonia
BVP PFC
• Bacteria (gram-negative)
• Virus
• Pneumocystis jiroveci (formerly carinin)
• Fungus
• Cytomegalovirus (CMV)
most common acquired immunodeficiency syndrome (AIDS) - defining opportunistic infection.
Pneumocystis Jiroveci Pneumonia
cause of viral pneumonia in the immunecompromised patients, particularly in
transplant recipients
Cytomogelavirus (CMV)
It is the most common cause of bacterial pneumonia
Pneumococcal Pneumonia
It is a bacteria usually found in nose and throat in Pneumoccocal Pneumonia
Streptoccocus Pneumoniae also called Pneumococcus
Pathophysiology of Pneumoccocal Pneumonia
- Congestion
- Red Hepatization
- Gray Hepatization
- Resolution
PNEUMOCOCCAL PNEUMONIA
What happens during Congestion?
After pneumococcus organisms invade alveoli, there is outpouring of fluid into alveoli.
microorganisms multiply in serous fluid and infection is spread
pneumococci damage the host by their overwhelming growth and by interfering with lung function.
PNEUMOCOCCAL PNEUMONIA
What happens during Red Hepatization?
There is massive dilation of the capillaries
The alveoli are filled with organisms, neutrophils, red blood cells and fibrin.
The lungs appear red and granular, similar to the (liver, thus hepatization.)
PNEUMOCOCCAL PNEUMONIA
What happens during Gray Hepatization?
Blood flow decreases and leukocytes and fibrin consolidate in the affected part of lung
PNEUMOCCOAL PNEUMONIA
What happens during Resolution?
Complete resolutiom and healing occur if there are no complications
The exudate becomes lysed and is processed by the macrophages
The normal lung tissue is restored and the patient’s gas exchange ability returns to normal
Clinical Manifestations of Pneumoccoal Pneumonia
9 FSC SPP CSP
Fever
Shaking
Chills
Shortness of Breath
Productive Couge (Rusty Colored Sputum)
Pleuritic Chest Pain
Confusion, Stupor
Pulmonary Consolidated
dullness on percussion of the chest, increased fremitus, bronchial breath sound and crackles
Pulmonary Consolidation
Pathophysiology of Pneumonia
Bacterial, Viral, Fungal, Mycoplasma, Aspiration, Chemial Irritants → Inflammation of lung tissue → Hypertrophy of Mucous Membrane →Increased Capillary Permeability → Inflammation of Pleurae → Hypoventilation → Protective Mechanism
Patient may manifests if there is Hypertrophy of Mucous Membrane
IWD CRR
Increased sputum production
Wheezing
Dyspnea
Cough
Rales
Rhonci
Patient may manifests if there Increased Capillary Permeability
ICH
Increased fuid in ISC (interstitial compartment)
Consolidation
Hypoxemia
Patient may manifests if there Inflammation of the Pleurae
CP DDD
Chest pain
Pleural effusion
Dullness
Diminished breath sounds
Decreased vocal fremitus
Patient may manifests if there is Hypoventilation
DR
Decreased chest expansion
Respiratory Acidosis
Patient may manifests during Protective Mechanism
IIF
Increased WBC (leukocytosis)
Increased RR
Fever
Complications of Pneumonia
9 PPA BLE PME
Pleurisy
Pleural Effusion
Atelectasis
Bacteremia
Lung Abscess
Empyema
Pericarditis
Meningitis
Endocarditis
inflammation of the pleurae
Pleurisy
Transudate fluid in the pleural space.
Pleural Effusion
airless, collapsed alveoli.
These areas usually clear with effective coughing and deep breathing.
Atelectasis
bacterial infection in the blood
Bacteremia
It is caused by pneumonia due to steptococcus aureus and gram - negative pneumonia.
Lung abscess
accumulation of purulent exudate in the pleural cavity.
This requires antibiotic therapy and drainage of the exudate by a chest tube or open surgical drainage.
Empyema
Results from the spread of the infecting organism from an infected pleura or via hematogenous route to the pericardium.
Pericarditis
It can be caused by streptococcus pneumonia.
Meningitis
The patient with pneumonia who is disoriented, confused, or somnolent should have this procedure to evaluate the possibility of meningitis.
Lumbar Puncture
It can develop when the organism attack the endocardium and the valves of the heart
Endocarditis
Interprofessional collaborative management for patients with pneumonia
Promote rest
Provide adequte fluids
Incentive spirometry
O2 Therapy
Semi- fowler’s position
Bronchial hygiene measures
Oral hygiene
Humidifier
Splint chest when coughing
Monitor sputum, chest XRay, Temperature
Pharmacotherapy: Antibiotics
Influenza and Pneumoccoal Vaccine prior discharged as prescribed
Recommended position for Pneumonia
SEMI- FOWLERS
to promote lung expansion
Pharmacological treatment with Asthma
Antibiotics
but
Blood culture should be done before starting antibiotics
Vaccine given annually for patients with Pneumonia
Influenza Vaccine
Vaccine given every 5 years with Pneumonia
Pneumonia vaccine or
Pneumococcal vaccine
Do these vaccines can be given at the same time?
Yes, these vaccines can be given at the same time but in different arms.
How many weeks during Pleural Effusion may be reabsorbed?
1-2 weeks
If it has pass weeks, what should be done in Pleural Effusion?
if not, thoracentesis (aspiration of the fluid) is done.
