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Patho 1 (PATH 254) > Mod 6 Pneumonia > Flashcards

Mod 6 Pneumonia Flashcards

1
Q

what is Pneumonia is commonly characterized as?

A

An infection within the lung parenchyma caused by bacteria, viruses, or fungi (micro bacteria being the most common)

  • causes inflammatory response that impairs normal alveolar function (gas exchange)
  • pus/fluid buildup in the lungs further impairs gas exchange
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2
Q

Why does pneumonia affect immunocompetent patients differently in comparison to immunospressed?

A

Immunocompetent are more suspectible to pathogens leading to:

  • Inflammation of the alveoli
  • alveolar consolidation

Severe immunosuppression makes pts more prone to

  • Atelectasis (particularly in aspiration pneumonia)
  • A combo of weak ciliary clerance, thick secretions, and blunted immune response
  • Secretions/pathegns accumlate more
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3
Q

List 3 classifications of pneumonia

A
  • Communities acquired pneumonia [CAP]
  • Nosocomial pneumonia
  • pneumonia in the immunocompromised host
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4
Q

Which pneumonia phenotype is community acquired?

A

CAP

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5
Q

which pneumonia phenotype is acquired in the hospital?

A

nosocomial pneumonia

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6
Q

which phenotype of pneumonia can be acquired in all settings?

A

pneumonia in a immunocompromised host

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7
Q

What demographic group/range is most affected by community acquired pneumonia?

A

Most common in children > 5, becomes progressively more common from age 40 peaking in the elderly.

common w/those w/diseases

  • COPD
  • Chronic heart disease
  • Chronic renal disease
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8
Q

What are 2 types of immune dysfunction predisposed (liable) to pneumonia?

A

Both are types of adaptive immunity that use WBCs to protect the body from pathogens

  1. Humoral immune dysfunction (fast)
  2. Cell-mediated immune function (longer)
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9
Q

Main trait of humoral immune dysfunction?

A

Immunoglobulin deficiencies; basically a lack of antibodies so a crappy immune response

  • B cells normally produce antibodies that bind to antigens to get rid of extracellular pathogens: should normally be a fast response
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10
Q

Cell-mediated immune function can be characterized by?

A

Events that compromise the immune response
Cancer chemotherapy, organ transplantation, bone marrow transplantation

  • Cell mediated immunity uses T cells to destroy cells and stimualtes others to get rid of pathogens
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11
Q

What are some clinical manifestations of CAP?

A

Abrupt onset of symptoms like:

  • cough
  • dyspnea
  • pleuritic chest pain
  • general symptoms w/infection

and

Abnormalities on physical examination

  • i.e hypotension, abnormal breath sounds, or tachycardia etc. etc.
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12
Q

What are general symptoms associated w/infection?

broad question don’t worry too much about this one

A
  • Shivers
  • Malaise (discomfort)
  • Myalgia or Arthralgia (muscle vs joint pain/stifness)
  • Headache
  • Palpitations
  • Diarrhea
  • Neurological symptoms such as confusion
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13
Q

What are the most severe illness/pathogens that causes pneumonia?

A
  • Streptococcus pneumoniae
  • Legionella
  • Staphylococcal pneumonia
  • gram-negative infections
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14
Q

What phenotype of pneumonia is the most common?

hint its bacterial

A

Streptococcus pneumonia; the most common cause of severe illness and death

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15
Q

What is the most common viral cause of CAP?

A

Influenza

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16
Q

When is Staphylococcal infection most likely to occur?

A

Following influenza virus infection and IV drug users

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17
Q

Where would Legionella outbreaks typically happen/occur?

A

Typically due to water aerosol sources; like showers.

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18
Q

mycoplasma pneumonia causes mild illness in which age demographic?

A

Most common between ages 5-17, mild cases under 5

  • Causes resp tract infections via resp droplets via coughing and sneezing
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19
Q

What is humoral immune deficiency associated with?

A

Bacterial infection

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20
Q

What are cell mediated immune defects typically associated with/caused by in pneumonia?

A

viral and fungal infections

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21
Q

How would you assess CAP?

i.e Parameters and criteria?

edit refer to slide 15

A
  • Severity Assessment; Identifies pts w/risk of mortality w/increasing intensified monitoring and therapy
  • CxR
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22
Q

How should organ dysfunction be evaluated for community acquired pneumonia [CAP]?

A

[AMA/Infectious Diseases Society of America minor criteria]

  • Confusion
  • Uremia (declining renal function)
  • RR ≥ 30bpm
  • Hypotension
  • PaO2/FiO2 ≤250
  • Multilobar infiltrates
  • Leukopenia (insufficient leukocytes/low wbc)
  • Thrombocytopenia
  • Hypothermia
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23
Q

Are CxR’s useful for assessing pneumonia?

A

Yes; They’re essential to confirm new lung shadowing

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24
Q

What are characteristics on a CxR that would suggest community acquired pneumonia?

A

Shadowing conforms to lobar pattern

  • associated with air bronchograms
  • may occupy less than a whole lobe and be patchy, multulobar, and bilateral
  • may include pleural effusion, less commonly a pneumothorax as well
  • lower lobes are not typically affected
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25
Q

Community acquired pneumonia [CAP] management inside the hospital setting?

A

Correction of gas exchange and fluid balance

  • Oxygen therapy
  • Diuretics
  • Fluid management

Appropriate antibiotics

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26
Q

Community acquired pneumonia [CAP] management outside the hospital setting?

A
  • Rest
  • Fluids
  • Oral antibiotics
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27
Q

Community acquired pneumonia [CAP] oxygen therapy goas?

A

SpO2 > 92%
- high flow nasal cannula

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28
Q

Community acquired pneumonia [CAP] management:

  • If there is unacceptable rise of PaCO2, what are your next steps?
A

Mechanical ventilation should be considered

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29
Q

Why is intubation preferred over NIV when pneumonia is suspected?

follow up w/mike to confirm

A

More precise control of the Pts breathing and airway management.

  • Easier suctioning of the airway, especially when there is an accumulation of secretions or mucus in the airways.
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30
Q

What is a typical range for duration of antibiotics?

A

5-7 days in uncomplicated cases.

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31
Q

what is the time frame of greatest risk for worsening organ function because of Community acquired pneumonia [CAP]

A

Risk of Organ failure can occur within the first 72 hour

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32
Q

How often should a pt w/Community acquired pneumonia [CAP] be re-evaulated?

A

QD

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33
Q

Ask someone about these values: slide 21

A
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34
Q

What is the most preventable risk for pneumonia?

A

Smoking

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35
Q

Community acquired pneumonia [CAP] prevention

  • which demographic group is indicated for influenza and pneumococcal vaccination
A

The elderly and those w/chronic illness

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36
Q

Hospital acquired pneumonia [HAP] is defined as?

A

Pneumonia that occurs > 45hrs after admission that was not incubating at the time of admission.

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37
Q

Ventilator acquired pneumonia [VAP] is defined as

A

pneumonia that arises 48-72hrs after intubation

38
Q

What 2 classifications of pneumonia can be acquired in this same place/time?

A

HAP and VAP

39
Q

General risk factors of Hospital acquired pneumonia [HAP]

A

Age (extremes)
- Pts < 35 = less prone than elderly

Type of hospital
- Teaching hospitals > rural bc of pt complexity

Type of ward
- Most common in ICU

40
Q

What are the main sources of Hospital acquired pneumonia [HAP]?

A
  • Healthcare devices
  • Environment
  • Transfer of microorganisms between pt and staff.
  • oropharyngeal and gastric colonization w/subsequent aspiration of their contents into the lungs in pts w/impaired immune system
41
Q

What are risk factors for the development of Hospital Acquired pneumonia [HAP]?

A

Host Related

  • nutritional status
  • Immunosuppressive treatments
  • unplanned extubation
  • deep breathing and cough exercises
42
Q

what are environment related risks for health care acquired pneumonia [HAP]

A

Attention to infection control measures

43
Q

What are some risk factors associated with devices/treatment when considering hospital acquired pneumonia [HAP]?

A

Use of sedatives and paralytics (should min use)

  • gastric overdistension
  • intubation/re-intubation
  • soiled vent. circuits
  • continuous aspiration of subglottic secretions
44
Q

what are the main causes of gram-negative bacterial pathogens as risk factors of hospital acquired pneumonia [HAP]?

don’t waste time on this one if strapped on time

A

Streptococcus, Staphylococcus aureus and MRSA account for 35-39% of all cases

other common pathogens:
Klebsiella, Acinetobacter, Pseudomonas aeruginosa, and E.

45
Q

What are treatment therapies for hospital acquired pneumonia [HAP]?

A
  1. admin antibiotics
  2. Resp. related treatment
    - keep SpO2 > 92% on high flow nasal cannula
    - If not enough, intubate -> mech. ventilation
46
Q

ventilator acquired pneumonia [VAP] prevention/precautions/treatments?

A
  • gloves + gown for ETT manipulation
  • elevation of [HOB] between 30 - 45 degrees
  • provide oral care [Chlorhexidine]
  • minimize vent circuit changes if possible
  • Ensure cuff pressure
47
Q

Why is cuff pressure important to keep vent. circuits below the level of the mouth?

A

Prevents condensate draining into the ETT

48
Q

Why is it important to ensure cuff pressure?

A

prevent micro aspirations

49
Q

Generally, what is aspiration pneumonia?

A

pneumonia associated w/aspiration of food and gastric contents.
- anaerobic bacterial infection

50
Q

why could aspiration pneumonias be missed?

A

inflammatory reaction requiring 12-24 hrs to peak

51
Q

What are aspiration pneumonia pts at risk of?

A

Developing ARDS

52
Q

What are 3 phenotypes of aspiration pneumonia?

A
  1. Toxic injury to lungs (chemical pneumoitis)
  2. Obstruction (by fluids/foreign bodies)
  3. Infection
53
Q

Aspiration of food is (district from stomach acid) can lead to the formation of what?

A
  • Obliterative bronchiolitis [popcorn lung]
  • Granuloma formation

generally, inflammation?
- confirm later

54
Q

How does pneumonia w/Immunocompromised hosts differ from CAP or HAP?

A

Immune status vs. Acquisition

55
Q

pneumonia Immunocompromised hosts is defined as relevant risk for

A

opportunistic pathogens
- fungi
- viruses
- mycobacteria
- parasites

insert slide 33

56
Q

Pneumocystis Jirovecii Pneumonia can present with how many possible symptoms?

A

At least one of the following:

  • Fever
  • Cough
  • Dyspnea on exertion
  • Oral candidiasis is typically present
57
Q

Pneumocystis. Jirovecii Pneumonia can occur in pts w/ what helper T cell count?

A

< 200 CD4 helper T cells per microliter

58
Q

what is the following CxR?

(slide 37)

A

Pneumocystis Jirovecii pneumonia

59
Q

How does pneumocystis jirovecii pneumonia typically present on a CxR?

A

Discloses bilateral infiltrates in a perihilar distribution.

Looks like typical pneumonia

60
Q

How is pneumocystis jirovecii pneumonia typically diagnosed?

A
  1. Bronchoalveolar Lavage
  2. Sputum sample if not intubated or ventilated
61
Q

Treatment plans for pneumocystis jirovecii pneumonia?

A
  1. Pentamidine (anti-infective agent)
  2. Septra (combo antibiotic) sometimes paired w/steroids in pts with acute resp. failure.\
62
Q

Pneumocystis jirovecii pneumonia typically coexists with what complication?

A

Cytomegalovirus

63
Q

What is a key management step for pneumonia

A

Severity assessment

64
Q

Is pneumonia restrictive or obstructive

A

Restrictive

65
Q

Define Nosocomial pneumonia

A

Hospital acquired pneumonia- from immunocompetent individuals
S. aureus, Pseudomonas, other enteric gram-negative rods

Arises >48 hours after hospital admission

66
Q

Define Community Acquired Pneumonia (CAP)

A

any pneumonia that results from contagious infection outside of a hospital or clinic

Usually from an Immunocompetent individual

67
Q

Define Community Acquired Pneumonia (CAP)

A

any pneumonia that results from contagious infection outside of a hospital or clinic

Usually from an Immunocompetent individual

68
Q

Comorbidities of Community Acquired Pneumonia [CAP]

A

COPD
bronchiectasis
Chronic heart disease
Chronic renal diseas

69
Q

What are the two types of immune dysfunction processes?

A
  1. Humoral immune dysfunction
  2. Cell-mediated immune dysfunction
70
Q

Humoral immune dysfunction

A

Immunoglobulin deficiencies (IgE , IgG.)
- Antibodies

Associated with bacterial infection

71
Q

Cell-mediated immune dysfunction

A

T cells decrease because of immunosuppressants

  • From chemotherapy, organ transplantation, bone marrow transplant.
  • Associated with viral and fungal infections (opportunistic infections)
72
Q

Causes of Cell-mediated immune dysfunction

A
  • T cells decrease because of immunosuppressants
  • Form chemotherapy, organ transplantation, bone marrow transplant.

Associated with viral and fungal infections (opportunistic infections)

73
Q

Pathogens associated with CAP

A

Streptococcus pneumoniae (Most common)

  • Most important cause of severe illness and death
    Legionella
  • Staphylococcal Pneumoniae
  • Gram-negative infections
74
Q

GOLD standard for CAP diagnosis

A

Chest X-ray

74
Q

GOLD standard for CAP diagnosis

A

Chest X-ray

75
Q

Where is fluid buildup normally seen on the CXR for Community acquired pneumonia [CAP]?

A

In the lower lobes (West zone III)
fluid will go to the gravity dependent areas

76
Q

What things do we judge for the:
Severity assessment for CAP

A

Confusion
Uremia
RR > 30bpm
Hypotension
P/F <250
Multilobular infiltrates
Leukopenia
Thrombocytopenia
Hypothermia

77
Q

How often to you reevaluate the stability of the patient w/pneumonia?

A

at least once per day

do all vitals, LOC, ability to eat..etc

78
Q

Main CAP prevention?

A

smoking cessation

79
Q

Pathogen that is main causative of HAP?
[2]

A
  • Gran-negative bacterial pathogens (pseudomonas aeruginosa)
  • Staphylococcus aureus (MRSA)
80
Q

Most important tx of HAP

A

prompt administration of appropriate antibiotics
get that C+S sputum sample ASAP!

81
Q

Treatment of VAP

A
  • Hand hygiene
    - HOB elevation 30-45 degrees
    assessment fo readiness fo extubate
    Oral care
  • circuit changes with circuit is dirty
  • ETT maintenance (cuff pressure)
  • daily sedative interruptions
81
Q

Treatment of VAP

A
  • Hand hygiene
    - HOB elevation 30-45 degrees
    assessment fo readiness fo extubate
    Oral care
  • circuit changes with circuit is dirty
  • ETT maintenance (cuff pressure)
  • daily sedative interruptions
82
Q

Describe typical traits and causal agents of Aspiration pneumonia

A
  • can occur when a foreign substance, such as vomit, is inhaled into the lungs

-takes 12-24 hours to peak

  • patients with this are at an increased risk of ARDS
83
Q

3 distinctive forms to aspiration pneumonia

A
  • Toxic injury to the lung (chemical- damage done by the acid itself)
  • Obstruction
  • Infection

Bonus:
Aspiration of food can lead to calcified granulomas (high density spots)

84
Q

Most common infection of pneumonia in the immunocompromised host

A

Pneumocystis Jirovecii

84
Q

Most common infection of pneumonia in the immunocompromised host

A

Pneumocystis Jirovecii

85
Q

Which Diagnostic would best indicate pneumonia in the immunocompromised

A

History
Physical examination
CXR

  • Blood work and sputum sample
  • Bronchoscopy for those with bilateral infiltrates
86
Q

What is the HAP mortality rate?

A

30-70%

87
Q

Common pathogens for HAP include?

A

Gram-negative bacteria:
- **Pseudomonas aeruginosa
- E. Coli
- Streptoccous pneumoniae

88
Q

Is bacterial or viral pneumonia more severe?

A

Bacterial is usually more severe than viral, viral often resolves on its own

89
Q

What’s the difference between viral and bacterial pneumonia?

A

All pneumonia is inflammation caused by an infection in the lungs. Bacterial tends to be more common due its location of acquirement (hospital).

  • Bacterial pneumonia needs antibiotics to be treated, viral presents with flu symptoms which resolve on their own

Patho 1 (PATH 254) (18 decks)

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