Patho 2- Pneumonia Flashcards
Pneumonia definition
Inflammatory condition of lung leading to abnormal alveolar filling with consolidation and exudation
Pathology of pneumonia
Infection, chemical or aspiration irritant
During pulmonary infection, acute inflammation results in migration of neutrophils out of capillaries and into air-paces (alveoli).
These cells phagocytose and release antimicrobial enzymes and inhibitors
More inflammation and oedema
Stages of pneumonia
Congestion (24hours)- vascular enlargement, intra alveolar fliid and bacteria, lungs are heavy, boggy and red. Red hepatization (2/3 days)- massive exudation with RBC, Leukocytes and fibrin filling alveolar spaces, affected areas red, firm and airless with liver like consistency. Grey hepatization (4-6 days)- progressive disintegration of RBC and persistence of fibrin exudate Resolution (>6 days) consolidated exudate within alveolar spaces undergo progressive digestion to provide debris thats later reabsorbed, ingested by macrophages or coughed up
Causes of pneumonia
Bacteria Fungi Virus Parasites Chemical Aspiration Inhalation
Classification of pneumonia
Community acquired (CAP) Health care (HCAP) Hospital acquired (HAP) Ventilator assisted (VAP)
Classification and causes of pneumonia
CAP strep C, pneumonia/staphylococcus aureus 25% Virus 10% Mycoplasma 6% H influenza 5% Leguionella 3% Unknown 37%
Hap Mrsa 15% Pseudomonas aeruginosa 14% Mssa 9% Klebsielia pneumonia 3% Other gram negative rods 9% Unknown 37%
Common symptoms
Fever Malaise Muscle ache/fatigue Coughing Tactile fremitus on palpation Dyspnoea Pleuritic/chest pain Loss of appetite Rapid heartbeat
Less common symptoms
Coughing up blood Fatigue Nausea/vomiting Diarrhoea Wheezing Confusion
Medical diagnosis of pneumonia
Temp >37.8 HR >100bpm Crackles Decreased breath sounds or bronchial breath sounds Absence of asthma
Clinical prediction rate
5 findings- 84-91% 4- 58-85% 3-35-51% 2-14-24% 1-5-9% 0-2-3%
Other diagnostic tests
CXR CT scan Blood test Sputum culture Pleural fluid culture Bronchoscopy
General management
Antibiotics/fungal meds O2 support Hydration- IV fluids Rest Analgesics Cough suppressant meds Fever reducing meds Prevention via vaccination
Physio treatment
Care- increased O2 consumption and demand due to bronchial spasm
Treat signs and symptoms
Non productive- positioning, V/Q, mobs or no intervention
Productive- sputum clearance techniques- positioning, breathing exercises, adjuncts
