LRI Flashcards
(41 cards)
Three types of Bronchitis are
Acute
Chronic
Bronchiolitis
Types of Pneumonia
Aspiration
HCAP
HAP-VAP
CAP
What is pneumonia
Pneumonia is an infection of the lungs that leads to consolidation of the normally air filled alveoli. It can be an infection in one or both of the lungs and can be caused by bacteria, viruses, fungus, or chemical irritants. It causes air sacs to be filled with pus or fluid.
CAP
Community acquired pneumonia is the most common type of pneumonia. It is defined as a pneumonia that developed in the outpatient setting in patients who have not been in any healthcare facilities. This includes wound care or dialysis clinics.
HAP and VAP
Hospital acquired pneumonia occurs in a patient who is been admitted and develops pneumonia 48 hours or more after admission.
VAP-A type of hospital acquired pneumonia that is common is ventilator associated pneumonia. This is for patients who are endotracheal intubated and develop pneumonia 48 to 72 hours after intubation.
HCAP
pneumonia occurring in any hospitalized patient for at least two days within 90 days of the onset of the infection. This includes patients who reside in a nursing home or long-term care facility, and any patients who have recently received IV antibiotic therapy, wound care, or chemotherapy within the last 30 days or patients who attend a hemodialysis clinic regularly.
Other classifications of PNA
Other ways to classify pneumonia is based on causation. Different causes of pneumonia can include aspiration pneumonia, chemical pneumonia, eosinophilic pneumonia, bronchiolitis obliterans organizing pneumonia, necrotizing pneumonia, severe acute respiratory syndrome, or opportunistic pneumonias.
Classification of PNA in location
Pneumonias can also be classified based on the area of the lung where they occur. Lobar pneumonias affect only a single lobe. Multi-lobar pneumonias affect multiple lobes. Bronchial pneumonia affects the bronchi or bronchioles, and interstitial pneumonia affects the areas between the alveoli.
Patho of PNA
Pneumonia occurs when organisms gain access to the lower respiratory tract that is usually sterile by being inhaled, entering from the blood stream from an extra pulmonary site of infection, or through aspiration. Viral lung infections can suppress a bacterial clearing in the lungs, thus increasing the risk for a secondary bacterial pneumonia. A majority of pneumonias are community acquired in otherwise healthy adults.
CAP: Primary pathogens
Streptococcus pneumonia. It contributes to approximate 75% of the cases seen. This pathogen colonizes the nasopharyngeal flora in up to 50% of healthy adults.
Other common causes are mycoplasma pneumonia and H influenza
Haemophilus influenza is seen in a higher rate in patients with COPD and is usually a colonizer in patients with cystic fibrosis.
Staph aureus pneumonia is more likely to be seen in elderly patients, particularly those who reside in a long-term care facility.
Viruses cause about ___ percent of PNA. These pathogens are ____, ____,___,___.
10-15 percent
include influenza, parainfluenza, RSV, and adenovirus.
Causative agent for HAP
causative agents for hospital associated pneumonia are gram-negative aerobic bacilli or Staphylococcus aureus.
Causative agent for VAP
ventilator associated pneumonia is more likely to be resistant enteric gram-negative bacilli, Pseudomonas aeruginosa, or Acinetobacter species.
Causative agent(S) for aspiration PNA
Anaerobic bacteria are the more likely cause of an aspiration pneumonia.
PNA in pediatrics
In the pediatric population you’re more likely to see pneumonia caused by a virus, particularly RSV, parainfluenza, or adenovirus.
Risk factors for PNA
Risk factors include children younger than two or adults greater than 65, having a chronic lung disease, or being an immune compromised host. Having a neuromuscular weakness that causes an inability to cough is also a risk factor. Other risk factors include increased alcohol or tobacco abuse, malnutrition, frequent exposure to certain irritants, advanced cardiac disease, or mechanical ventilation.
Clinical presentation of PNA
Your patient will likely complain of fever, chills, dyspnea, a productive cough, hemostasis, pleuritic chest pain, and confusion and lethargy is usually seen in the elderly. On physical exam you might find tachypnea and tachycardia, dullness to percussion or diminished breath sounds over the affected area, chest wall retractions, or inspiratory crackles on auscultation.
PNA diagnostics
Diagnosis is made based on clinical presentation, history, and chest x-ray. In order to diagnose pneumonia, you must see and infiltrate on radiographic findings. Other diagnostic test might include a CBC but it is not necessary for diagnosis they can help further confirm. You might see leukocytosis or bands. Renal function in order to appropriately dose of medication or oxygen levels via pulse oximetry or ABG might also be done.
Elevated lymphocytes in viral
predominance of neutrophils for bacterial
PNA diagnostics, cont
Some other diagnostic tests. Sputum cultures are not routinely done particularly the outpatient setting. The sensitivity and specificity can vary. They are useful when resistant microorganisms are suspected. Bronchoscopy might be done to help improve ability to diagnose or again for resistant microorganisms. Serology such as an IgM and IgG can sometimes be helpful in determining the presence of an atypical organisms such as a mycoplasma. Urine antigens can sometimes be useful for things like strep and Legionella. PCR’s are more frequently done to detect DNA of respiratory pathogens. Blood cultures need to be drawn and all hospitalize patients diagnosed with pneumonia. This is a JACHO guideline.
CAP: abx treatment 1st line
empirically treated for the most common pathogen, strep pneumonia.
1st line is a macrolide-mycin or Doxy
CAP, treatment for suspected H. influenzae
azythromycin
CAP- PCN resistance or recent abx use, use an
FQ
an alternative agent is beta lactic plus macrolide
CAP- PCN resistance or recent abx use, use an
FQ
an alternative agent is beta lactic plus macrolide
S pneumonia is resistant to
Ciprofloxacin
