Exam 4: pneumonia Flashcards
define pneumonia
acute infection of the lung parenchyma
do people still die of pneumonia
yes
8th leading cause of death
s/s of older adults that may indicate they are developing pneumonia
confusion stupor hypothermia diaphoresis anorexia fatigue myalgia headache
true or false
pneumonia typically develops from the weakening of the body’s normal defense mechanisms
true
what are the body’s normal body defenses
air filtration epiglottis closure over the trachea cough reflex mucociliary escalator mechanism reflex bronchoconstriction
what is aspiration
an abnormal substance or object entering trachea and lungs
what should you avoid giving a person who is at high risk of aspiration?
why?
straws
thin liquids
increased possibility of aspiration
liquids shoot down throat faster
3 ways pneumonia causing organisms can reach the lungs?
inhalation
aspiration
hematogenous spread from a primary infection elsewhere in the body
risk factors for pneumonia
abdominal or thoracic surgery age over 65 air pollution altered consciousness: alcoholism, head injury, seizures, anesthesia, drug overdose, stroke bed rest and prolonged immobility chronic disease: chronic lung and liver disease, diabetes mellitus, heart disease, cancer, chronic kidney disease exposure to bats, birds, rabbits, farm animals immunosuppressive disease inhalation or aspiration of noxious substances IV drug use malnutrition recent antibiotic therapy resident of a long term care facility smoking tracheal intubation upper respiratory tract infection
what organism is the most common cause of CAP
streptococcus pneumoniae
what organism is the most common cause of HAP
pseudomonas aeruginosa
e coli
klebsiella pneumoniae
acinetobacter species
what is the CURB65
used as supplement to clinical judgement to determine the severity of pneumonia and if patients need to be hospitalized Confusion bUn > 20 Respiratory rate > or = 30 per min Blood pressure systolic < 90 or diastolic < or = 60 age > or = 65 each is worth 1 point score of.. - 0: treat at home - 1-2: consider hospital admission - 3 +: hospital admission - 4-5: consider admission to intensive care unit
what is empiric antibiotic therapy
when should this be started
the initiation of treatment before a definitive diagnosis or causative agent is confirmed
as soon as CAP is suspected
what is HAP aka?
what other type of pneumonia is a HAP?
nosocomial pneumonia
VAP
what is MDR?
what organisms does this usually include?
what test can identify these?
risk factors for development of MDR?
multidrug resistant organisms
staph aureus and gram negative bacilli
antibiotic susceptibility tests
advanced age, immunosuppression, history of antibiotic use, and prolonged mechanical ventilation
what is a rare complication of bacterial lung infection?
how it is characterized?
what type of pneumonia is it a result of?
s/s?
treatment?
- necrotizing pneumonia
- liquefaction and in some situations cavitation of lung tissue
- result of CAP
- immediate respiratory insufficiency and/or failure, leukopenia, and bleeding into the airways
- long term antibiotic therapy and possible surgery
who is at risk for opportunistic pneumonia?
individuals with :
severe protein calorie malnutrition
immunodeficiencies
those receiving chemotherapy, radiation therapy, and immunosuppressive therapy
what is the most common form of pneumonia in people with HIV? onset? symptoms? what does the x-ray show? is this life threatening? treatment?
- P. jiroveci pneumonia
- slow and subtle onset
- fever, tachypnea, tachycardia, dyspnea, nonproductive cough, and hypoxemia
- x-ray usually shows diffuse bilateral infiltrates
- is life-threatening
- trimethoprim/sulfamethoxazole (Bactrim, Septra) either IV or orally depending on severity of disease and the patient’s response
what is cytomegalovirus (CMV)? what does this cause? symptoms? when is this a life threatening complications? treatment?
- herpesvirus
- can cause viral pneumonia
- most are asymptomatic or mild, but severe disease can occur in people with an impaired immune response
- most common life threatening complication after hematopoietic stem cell transplantation
- treated with antiviral medications (ganciclovir (Cytovene), foscarnet (Foscavir), cidofovir (Vistide)) and high dose immunoglobulin
most common presenting symptoms of pneumonia?
cough (may or may not be productive with sputum green, yellow, or even bloody) fever chills dyspnea tachypnea pleuritic chest pain fine or coarse crackles
how may viral pneumonia initially be seen?
when does it change?
viral pneumonia may initially be seen as influenza, with respiratory symptoms appearing and/or worsening 12-36 hours after onset
