Pneumonia

Question 1

Pathogens for Community-Acquired Atypical Pneumonia

Answer 1

• Mycoplasma pneumonia
• Chlamydia spp.—C. pneumonia, C. psittaci, C. trachomatis, and C. burnetii (Q fever)
• Viruses: respiratory syncytial virus, parainfluenza virus (children); influenza A and B (adults); adenovirus (military recruits), human metapneumoviru

Question 2

Pathogens for Community-Acquired Pneumonia

Answer 2

• Streptococcus pneumonia
• Staphylococcus aureus (also hospital-acquired pneumonia)
• Haemophilus influenza
• Legionella pneumophila
• Enterobacteriaceae (Klebsiella pneumonia)
• Pseudomonas aeruginosa (also hospital-acquired pneumonia)

Question 3

Pathogens for Hospital-Acquired (Nosocomial) Pneumonia

Answer 3

• Gram-negative bacilli belonging to Enterobacteriaceae (Klebsiella spp., Serratia marcescens, Escherichia coli) and Pseudomonas spp., and Staphylococcus aureus (usually methicillin-resistant)
• Ventilator-acquired pneumonia (P. aeruginosa, Klebsiella, and S. aureus)

Question 4

Risk factors

Answer 4

• Age over 65 years
• Aspiration of oropharyngeal secretions
• Viral respiratory infections
• Chronic illness and debilitation (e.g., diabetes mellitus, uremia)
• Chronic respiratory disease (COPD, asthma, cystic fibrosis)
• Cancer (especially lung cancer)
• Prolonged bed rest
• Tracheostomy or endotracheal tube
• Abdominal or thoracic surgery
• Rib fractures
• Immunosuppressive therapy
• AIDS

Question 5

Bronchopneumonia

Answer 5

Patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
Bronchopneumonia usually involves both lungs and is seen more often in the lower lobes of the lung

Question 6

Lobar pneumonia

Answer 6

A widespread or diffuse alveolar inflammation and consolidation.

Lobar pneumonia is typically the end result of a severe or long-term bronchopneumonia in which the infection has spread from one lung segment to another until the entire lung lobe is involve

Question 7

Interstitial pneumonia

Answer 7

A diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space.

In contrast to alveolar pneumonia caused by bacteria, the polymorphonuclear leukocytes do not migrate into the alveoli—they remain in the alveolar interstitial spaces

Question 8

Chest Assessment Findings

Answer 8

• Increased tactile and vocal fremitus
• Dull percussion note
• Bronchial breath sounds
• Crackles
• Pleural friction rub (if process extends to pleural surface)
• Whispered pectoriloquy

Question 9

ABG

Answer 9

mild to moderate:
Acute Alveolar Hyperventilation with Hypoxemia
(Acute Respiratory Alkalosis)

severe:
Acute Ventilatory Failure with Hypoxemia
(Acute Respiratory Acidosis)

Question 10

Chest Radiograph

Answer 10

• Increased density (from consolidation and atelectasis)
• Air bronchograms
• Pleural effusions

Question 11

General Management of Pneumonia

Answer 11

Oxygen Therapy Protocol
Lung Expansion Therapy Protocol
Thoracentesis