Dehydration & Pneumonia

Question 1

What can lead to dehydration and then hypovolaemic shock?

Answer 1

• Reduced fluid intake: cant drink or wont drink
• Increased extra-vascular loss GIT: vomiting, diarrhoea, gastritis
• Increased extra-vascular loss Renal: polyuria from hyperglycaemia or ADH insufficiency
• Other factors: diuretic use, excessive sweating, burns, ascites

Question 2

What signs and symptoms would you expect with mild, moderate and severe dehydration?

Answer 2

• Mild: lethargy, nausea, dizziness, postural hypotension, thirst, headache (hangover symptoms)
• Moderate: apathy, muscle cramps, cotton mouth, sunken eyes, poor skin turgor, postural hypotension, tachyc, oilguria, increased RR
• Severe: weakness, confusion, coma, peripheral vasoconstriction, SBP <90, oligura => anuria

Question 3

What are some compensatory mechanisms our body activates for dehydration?

Answer 3

• Baroreceptor reflex: increased sympathetic drive to heart, vasomotor tone, adrenaline release
• Chemoreceptors: increase RR (decreased tissue perfusion = increased anaerobic metabolism)
• ADH, thirst response, RAAS

Question 4

How would you treat a dehydrated patient with hypovolaemic shock?

Answer 4

• Fluid replacement: by mouth if possible, IV saline bolus
• Posture: supine, feet up
• Manage precipitating factors: temperature, vomiting
• Close monitoring

Question 5

How is pneumonia caused and classified?

Answer 5

-Caused by infection of the lung parenchyma
Classified by:
-organism microbes (bacterial, fungal, viral)
-Location - lobular or bronchopneumonia
-Location of acquisition: community and hospital acquired or ventilator-associated

Question 6

How do pathological mechanisms of pneumonia cause hypoxia, fever and bronchial breathing?

Answer 6

• Hypoxia: V/Q mismatch, many alveoli have more perfusion than ventilation so blood leaving alveolar caps is not well oxygenated
• Fever: causes inflammation and SIRS
• Bronchial breathing: fluid filled alveoli change sound transmission resulting in sound heard (rales, wheezing, bronchial breathing)

Question 7

What are the signs and symptoms of pneumonia?

Answer 7

• Respiratory: dyspnoea, low Sp02, bronchial breathing sounds, cough with or sputum, rales, wheezing, dullness to percussion
• CV: tachy, hypotensive, pleuritic chest pain
• Other: fever or hypothermia, malaise, GI symptoms, septic shock

Question 8

What treatment would you initiate to a person with suspected pneumonia?

Answer 8

• Oxygen: to reduce V/Q and hypoxia
• IV fluids: support circulation, reduce hypotension
• Transport: need antibiotics from hospital so wont recover from staying at home