pneumonia

Question 1

what is pneumonia

Answer 1

is an inflammatory condition of the lung leading to abnormal alveoli filling with consolidation and exudation
usually caused by organisms, becomes non air filled, limiting diffusion

Question 2

epidemiology

Answer 2

largest infectious cause of death in children worldwide, killed 920K children aged 5 in 2015- usually in higher areas of poverty

Question 3

number of deaths from pneumonia 2012

Answer 3

28952- 12,239 male, 16,713 females

Question 4

pathology pneumonia

Answer 4

infection or chemical or aspirations irritant. during pulmonary infection, acute inflammation results in the migration of neutrophils out of capillaries and into airspaces (alveoli) these cells phagocytose and release antimicrobial enzymes and inhibitors- more inflammation and oedema

Question 5

4 stages of pneumonia- congestion

Answer 5

first 24 hours- characterised by vascular engorgment, intra-alveolar fluid, and numerous bacteria, the lung is heavy, boggy and red

Question 6

4 stages of pneumonia- red hepatization

Answer 6

2-3 days- in this stage, massive exudation develops with RBC, leukocytes and fibrin filling the alveolar spaces, the affected area appears red, firm and airless with a liver like consistency

Question 7

4 stages of pneumonia- grey hepitisation

Answer 7

4-6- this stage is characterised by progressive disintegration of RBC and the persistence of fibril exudate

Question 8

4 stages of pneumonia- resolution

Answer 8

> 6 days- the consolidated exudate within the alveolar spaces undergoes progressive digestion to produce debris that is lateral reabsorbed, ingested by macrophages or coughed up

Question 9

causes

Answer 9

bacteria, fungi, virus, parasites, chemical, aspiration- 0f vomit, or food, inhalation- smoke, burns

Question 10

classification of pneumonia

Answer 10

community acquired pneumonia (CAP), health care associated pneumonia (HCAP)- when patients are being nursed in some form of environment (not hospital), hospital acquired pneumonia (HAP)- acquired 48 hours of admission who weren’t showing symptoms before, ventilator associated pneumonia (VAP)- people who are ventilated between 48-72 hours

Question 11

pneumonia classified depending on

Answer 11

classified dependent on causative organisms, or by the pathology or anatomy (where it is). more commonly caused how it is court, the environment is first appeared

Question 12

signs and symptoms- common

Answer 12

fevers, malaise, muscle ache/fatigue, coughing- productive or non- productive, tactile remits on palpation, dyspnea, pleuritic or chest pain, loss of appetite, rapid heartbeat

Question 13

signs and symptoms- less common

Answer 13

coughing up blood, fatigue, nausea/ vommiting, diarrhoea, wheezing, confusion

Question 14

complications

Answer 14

lung abscess- pockets of puss in lungs, pleural effusion, emphysema- infection/ pus in between pleural cavity, septic shock

Question 15

medical diagnosis

Answer 15

temperature- >37.8, HR>100 BPM, crackles, decreased breath sounds or bronchial breath sounds, absence of asthma

Question 16

clinical prediction rule

Answer 16

5 findings- 84-91% probability, 4 findings- 58-85%, 3 findings- 35-51%, 2 findings- 14-24%, 1 findings- 5-9%, 0 findings- 2-3%

Question 17

other diagnostic tests

Answer 17

CXR- consolidation or collapse- repeating them with different angles, CT scan, blood tests- shows form of infections, sputum culture- if productive cough, pleural fluid culture, bronchoscopy

Question 18

general management

Answer 18

antibiotics/ anti fungal medication- treat source, oxygen support, hydration- IV fluids- helps with resolution phase, rest, analgesics, cough suppressant medication, fever- reducing medication, prevention through vaccination programme

Question 19

physio management

Answer 19

care needed as it may increase oxygen consumption and demand, or cause bronchospasm, treat the clinical signs and symptoms, non-productive- positioning V/Q, mobilising or no intervention
productive- sputum clearance techniques including positioning, breathing exercises, adjuncts