Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPT 3 Lectures > Module 2.4.2 (Management of Pneumonia) > Flashcards

Module 2.4.2 (Management of Pneumonia) Flashcards

1
Q

What are the risk factors for pneumonia?

A
  • Age >65 „
  • Children < 2 „
  • Chronic disease „

>heart failure and seizure disorders „

  • Alcoholism „
  • Asthma, COPD „
  • Cigarette smoking „
  • Dysphagia due to stroke, dementia, Parkinson’s disease „
  • Institutionalisation (RACF) „
  • Immunosuppression „
  • > HIV/AIDS, organ transplant, chemotherapy, long term steroids, PPI „ Indigenous background
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to prevent pneumonia?

A
  • Annual influenza vaccination „
  • Pneumococcal vaccination (>65 years of age every 5 years)„
  • Smoking cessation „
  • Treatment of comorbidities „
  • Medication review (e.g. proton pump inhibitors, benzodiazepines and other sedatives) „
  • Good oral hygiene and early mobilisation during the hospital stay (for HAP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some signs and symptoms of pneumonia? What is significant about sputum production?

A
  • Fever (often > 380C) „
  • Dyspnoea „
  • Rigors or night sweats „
  • New onset cough „
  • Chest discomfort /pain „
  • Pleuritic chest pain „
  • Elevated Respiratory Rate
  • Sputum production

> Colour may suggest a particular pathogen:

  • S. pneumoniae: rust coloured sputum
  • Klebsiella species: red currant jelly sputum
  • Pseudomonas: green sputum

> Elderly persons may present with less specific symptoms such as reduced mobility, falls and mental confusion, incontinence (new onset), alteration in sleep-wake cycles, loss of appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some other investigations used in pneumonia?

A
  • Chest X-ray „
  • Pulse oximetry „
  • Respiratory Rate „
  • Full blood count (FBC) – elevated WCC „
  • BP „
  • Urine testing „
  • Sputum Gram stain and cultures „
  • Nucleic acid amplification testing (NAAT) „
  • Blood culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is used to diagnose pneumonia?

A

A chest X-ray is crucial to making a diagnosis of pneumonia

  • Alveoli are filled with a mixture of inflammatory exudate, bacteria and white cells
  • It appears on a chest X- ray as an opaque area in the normally clear lung fields
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The following ways are used to classified pneumonia, provide further detail to the types of pneumonia

A) By pathogen

B) By place of acquisition –> focus of lecture

C) By means of acquisition

D) By chest X-Ray appearance

E) By Severity

A

A)

  • Typical/Atypical
  • Bacterial/Viral/Fungal

B)

  • Community-acquired pneumonia (CAP)
  • Hospital-acquired pneumonia (HAP / nosocomial infection)
  • Nursing home-acquired (NHAP)

C)

  • Aspiration pneumonia

D)

  • Lobar pneumonia
  • Bronchopneumonia

E)

  • Mild/moderate/severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is community-acquired pneumonia (CAP)? Which patients are excluded?

A

Pneumonia in individuals who are not hospitalised, or have been hospitalised for <48 hours not including patients who are:

  • Immunocompromised „
  • Has chronic suppurative lung diseases „
  • Residents of aged care facilities (high level care)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the common and uncommon pathogens assoicated with CAP

A

Common Pathogen

  • Streptococcus pneumoniae (50%)
  • Atypical Pathogens (20%)
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Legionella pneumophilia
  • Respiratory viruses (10%)
  • Haemophilus influenzae (5%)

Uncommon Pathogen

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Burkholderia pseudomallei
  • Acinobacter baumannii (in tropical region)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Once CAP confirmed, what are considerations that guide management?

A
  • How severe is the disease? (CORB, SMARTCOP score – mild, moderate vs severe)
  • Where should the person be treated? (inpatient vs outpatient)
  • Which antibiotics to use? – microbiology investigation, local treatment guideline, patient allergy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are red flags for hospital admission in adults with CAP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are red flags for intensive care support in adults with community-acquired pneumonia?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Compare empirical treatment to directed treatment

A

empirical treatment

  • Empirical use of antibiotics „
  • Treat an established infection when the causative organism has not been identified „
  • Guided by clinical presentation „
  • Used when there is likely to be a clear benefit

directed treatment

  • Directed use of antibiotics treats an established infection taking into account antimicrobial susceptibility
  • Use the most effective, least toxic and narrowest spectrum drug available in accordance with clinical guidelines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to manage mild CAP? What to do if no improvement within 48 hours?

A
  • Amoxycillin (Amoxicillin)
  • OR Doxycycline*

*Reserved for atypical pathogens e.g. mycoplasma pneumoniae –> possess no cell wall, beta-lactam AB not effective against it thats why doxycycline is used

*C/I in pregnancy; Clarithromycin 500mg orally 12 hrly for 5-7 days can be used instead of doxycycline

If no improvement within 48 hours

  • Amoxycillin (amoxicillin) + doxycycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to manage moderate CAP in all regions (except tropical regions)

>Collect blood and sputum samples for culture BEFORE starting antibiotics

A
  • Benzylpenicillin (IV)

+

  • Doxycycline (replace with clarithromycin 500 mg orally, 12 hourly if doxycycline not appropriate) –> (ORAL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient with a moderate-severity CAP improves within 2 to 3 days –> what to do?

A
  • Treat for 5 days (intravenous + oral).
  • Treat for 7 days (intravenous + oral) if clinical response is slow

IV: benzylpenicillin

ORAL: doxycycline or clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What to do for moderate CAP as the patient’s condition improves?

A

Consider switching to oral therapy as per mild CAP

  • Amoxicillin orally
  • Doxycycline orally
  • If doxycycline poorly tolerated –> clarithromycin orally
17
Q

How to manage severe CAP in all regions (except for tropical regions)

> Collect blood and sputum samples for culture BEFORE starting antibiotics

A
  • Ceftriaxone IV

OR

  • Cefotaxime IV

+ (in all cases)

  • Azithromycin IV

> Modify therapy based on the result of susceptibility testing

> Switch to oral therapy as per moderate CAP once patient has improved significantly

18
Q

What is hospital-acquired pneumonia?
> nosocomial infection

A
  • Develop in a patient who has been hospitalised for longer than 48 hours
  • Mostly occur by ‘micro-aspiration’ of bacteria that colonise the oropharynx or upper gastrointestinal tract
19
Q

What are some risk factors for HAP?

A
  • Endotracheal intubation
  • Multiple organ failure
  • Decreased mental status
  • Reduction in gastric acidity
  • Thoraco-abdominal surgery
  • Recent broad-spectrum antibiotic exposure
  • Chronic lung disease
  • Age
  • Duration of hospitalisation (5 days or more)
20
Q

What is the risk for a intubated patient?

A

Presence of endotracheal tube provides a direct pathway into the lower normally sterile respiratory tract

21
Q

What are the common and uncommon pathogens associated with HAP?

A

Common Pathogens

  • Streptococcus pneumoniae
  • Aerobic Gram-negative bacilli
  • MRSA, multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter species (recent exposure to broad spectrum antibiotic tx)

Uncommon Pathogens

  • Legionella (see Legionella pneumonia)
  • Respiratory viruses (including influenza, parainfluenza, respiratory syncytial virus and adenovirus)
  • Candida species
22
Q

What does the empirical treatment of HAP depend on? Provide THREE different reasons.

A
  1. Disease severity (Features of patients with high-severity HAP)
  • septic shock „
  • respiratory failure, particularly if requiring mechanical ventilation „
  • rapid progression of infiltrates on chest X-ray.
  1. Risk of acquiring multidrug-resistant (MDR) organisms
  2. Antibiotic susceptibility patterns – refer to local treatment guideline
23
Q

For the management of HAP, when is there a high risk of multidrug-resistant infection (MDR)?

A
  • Staying in high risk ward (Intensive care unit, high dependency unit, area with a high rate of MDR infection) „
  • Recent treatment with antibiotics „
  • Recurrent or prolonged hospitalisation „
  • Resident of a high level care nursing home „
  • Immunocompromised
24
Q

How manage mild to moderate HAP disease?

> Collect blood and sputum for cultures before starting antibiotic therapy

A
  • Amoxycillin + Clavulanate –> oral or enteral

OR

  • Cefuroxime (in immediate nonsevere or delayed nonsevere penicillin hypersensitivity) –> oral or enteral
25
Q

How manage severe HAP disease?

> Collect blood and sputum for cultures before starting antibiotic therapy

A
  • Piperacillin + tazobactam IV
  • Cefepime (in immediate nonsevere or delayed nonsevere penicillin hypersensitivity) IV

> Switch to oral therapy as per mild to moderate severity HAP once the patient has improved significantly

26
Q

What is aspiration pneumonia? What may contribute towards it?

A

Aspiration pneumonia is a bacterial infection that occurs in the days following ‘macroaspiration’ of organisms from the oropharynx

  • Food „
  • Saliva „
  • Liquids „
  • Vomit
27
Q

What are some risk factors for aspiration pneumonia? Provide THREE answers.

A
  • Conditions associated with altered or reduced consciousness
  • Any condition that reduces gag reflex, coughing, ciliary movement and immune mechanism

> Alcoholism „

> Seizures „

> Drug overdose „

> Stroke „

> Head Trauma

  • People with poor dentition, severe periodontal disease - aspiration of anaerobes
28
Q

How to manage pneumonia? What is the difference between pneumonia and pneumonitis?

A
  • Asses need for antibiotic (aspiration pneumonia vs aspiration pneumonitis)
  • Treat as per CAP in patients from the community or who have been in hospital for <48 hours
  • Treat as per HAP in patients who have been in hospital for > 48 hours

aspiration pneumonia: symptom onset delayed, tachycardia, fever, hypoxaemia

aspiration pneumonitis: acute chemical injury to the lung, symptom onset rapid within hours of aspiration. Symptoms improve quickly within 24-48 hours.

29
Q

For Aspiration pneumonia

If no improvement within 48 hours:

> Reassess diagnosis ƒ

>If anaerobe is likely, then consider the following therapy

A) What drugs to use if not responding to tx of CAP or HAP

B) What drugs to use if not responding to tx of CAP or HAP and cannot tolerate oral therapy

A

A)

  • Amoxicillin oral

+

  • Metronidazole oral

B)

  • Benzylpenicillin IV

+

  • Metronidazole IV
  • alternative: amoxicillin+clavulanateIV
30
Q

What is some other supportive management for Pneumonia? For moderate to severe pneumonia?

A
  • Paracetamol for antipyretic action

Moderate to severe pneumonia

  • Oxygen therapy „
  • Supportive nursing care and monitoring
31
Q

Monitoring for outcomes, efficacy and toxicity is ahcieved through the following headings, briefly explain further

A) Resolution of symptoms

B) Complications

C) Resolution of signs

D) Adverse effect of antibiotic tx

A

A)

  • Fever, cough, sputum, SOB, chills

B)

  • Tx failure „
  • Sepsis „
  • End-organ failure

C)

  • Decrease WCC „
  • Decrease in CRP and ESR (markers of inflammation)
  • Clearing of X-ray changes

D)

  • Monitor for adverse effects of antibiotic treatment
32
Q

Summary of Pneumonia

A
  • Pneumonia can be categorised by place or means of acquisition „
  • Streptococcus pneumoniae is the most common cause of CAP „
  • HAP is defined as pneumonia where onset occurs in patient who are hospitalised for > 48 hours „
  • Aspiration pneumonia is due to aspiration of organisms from the oropharynx „
  • Empirical treatment is often given before culture results are available – obtain blood and sputum for culture before empirical tx „
  • Treatment of pneumonia is mostly with antibiotics and choice of therapy depends on the severity of the disease, pathogens involved and institution guidelines based on local sensitivity pattern as well as patient comorbidities and allergy

IPT 3 Lectures (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions