Pneumonia Flashcards
Definition of Pneumonia
> Inflammatory condition of the lung (part or whole)
Abnormal alveolar filling with consolidation + exudate
(affecting diffusion of air - ‘diffusion disorder’)
Prevalence of pneumonia
> Largest infectious cause of death in children worldwide (mostly poverty stricken areas)
Mainly in very young or very old (immunocompromised)
affects females worse as they ignore the symptoms
Pathology of pneumonia
> cause = infection or chemical/aspiration irritant
migration of neutrophils from capillaries to alveoli
phagocytosis of neutrophils - release antimicrobial enzymes and inhibitors
causes further inflammation + oedema
4 stages of pneumonia
> Congestion (inflammatory phase) - 0-24hrs
- vascular engorgement
- intra-alveolar fluid
- numerous bacteria
- lung appears heavy, boggy + red
> Red Hepatization - 2-3 days
- massive exudation develops (red blood cells, leukocytes and fibrin fill alveolar space)
- affected area appears red, firm and airless (liver-like appearance)
> Grey Hepatization - 4-6 days
- Progressive disintegration of red blood cells
- persistence of fibrin exudate
> Resolution - 6+ days
- Consolidated exudate is progressively digested
- debris
= reabsorbed
= ingested by macrophages
= coughed up
*Physios become more involved as faster we get exudate out the less infection risk there is
Causes of pneumonia
> Bacteria > fungi > virus > parasites > chemicals > aspiration > inhalation (causes burns)
Classification of pneumonia
> Based on where it originated > Community acquired pneumonia = CAP - within community setting > Health Care associated pneumonia = HCAP - health care but not on a ward setting > Hospital Acquired Pneumonia = HAP - within 48hrs of admission - can't already have CAP - higher death rate > Ventilator Associated Pneumonia = VAP - intubated/ventilated for 48-72 hrs
*CAP + HAP = most common but 1/3 of cases - cause can’t be identified so we use where it originated to classify and guide treatment (knowing the organism will obviously aid this)
> Signs/Symptoms
> Common
- Fever
- Malaise
- Muscle ache/fatigue
- Coughing (both productive + non-productive)
- Tactile fremitus (on palpation)
- Dyspnoea (Shortness of breath)
- Pleuritic chest pain
- Loss of appetite
- rapid heart rate
> Less Common
- Coughing up blood
- fatigue
- nausea
- diarrhoea
- wheezing
- confusion (lack of O2)
Diagnosis
> Clinical Prediction
- Temp > 37.8
- HR > 100bpm
- Crackles
- changed breath sounds (increased/decreased)
- absence of asthma (alters hr + breath sounds)
> CXR
- 5 abnormalities = 84-91% probability
- 0 abnormalities = 2-3% probability
+ Other CXR angles
+ CT scan
+ blood test
+ sputum culture (only if cough = productive)
+ pleural fluid culture or bronchoscopy (more invasive)
Complications of pneumonia
> Lung abscess (pockets of pus form)
Pleural effusion (inflammation causes irritation)
Empyema - infection/pus between the pleural cavity
Septic Shock - overwhelmed by pneumonia
General management of pneumonia
> Antibiotics/antifungal meds
o2 support
hydration via IV fluids (aids moving sputum)
Analgesics
Rest (conserve energy)
Cough suppressant meds (reduce irritation but we also don’t want to impede sputum clearance)
Vaccines for prevention
Physiotherapy for pneumonia
> Treat symptoms > non - productive cough - positioning - V/Q matching - mobilising *may not need intervention > Productive - sputum clearing techniques (positioning, breathing exercises + adjuncts)
