Pneumonia

Question 1

What is pneumonia?

Answer 1

Is an inflammatory condition of the lung leading to abnormal alveolar filling with consolidation and exudation.

Question 2

What are the 4 stages of pneumonia?

Answer 2

Congestion - first 24 hours
Red hepatizaion 2-3 days
Gray hepatization 4-6 days
Resolution >6 days

Question 3

What are the causes of pneumonia?

Answer 3

Bacteria eg. Streptococcus pneumonia, hemophillus influenza type b, fungi, virus eg respiratory syncytial, parasites, chemical

Question 4

What are the signs and sermons of pneumonia?

Answer 4

Fever, malaise, muscle ache, coughing, tactile fremitus on palpation, dyspnoea, loss of appetite rapid heart rate.

Question 5

What are some potential further complications form pneumonia

Answer 5

Lung abscess - pockets of pus within the lung
Pleural effusions - inflammation causes infusion
Empyema- pus in between the pleural cavity
Septic shock

Question 6

What to check for if there’s a patient with pneumonia?

Answer 6

High temp 
Increase beart rate
Crackles
Decreased breath sounds of bronchus breath sounds 
Absence of asthma

Question 7

What physiotherapy treatment can be used to help treat patients?

Answer 7

Care is needed as it may increase oxygen consumption and demand or cause bronchospasm.
Positioning, breathing exercising and adjuncts etc.

Question 8

What is bronchiectasis?

Answer 8

Bronchiectasis is the permanent abnormal dilation in more of more of the lungs bronchi. Extra mucus is secreted and pools in the areas of the airways that are dilated making the person more prone to infection.

Question 9

What is the patho genesis of bronchiectasis?

Answer 9

1. Impaired mucociliary clearance leads to accumulation of secretions
2. Accumulation of secretions leads to infection by bacteria
3. Infection by bacteria leads to increased mucus production, impaired ciliary performance and increased inflammation response. Excessive inflammatory response causes tissue damage which cause the bronci to dilate further and the mucociliary clearance to become more impaired - vicious circle

Question 10

What are the clinical features of bronchiectasis?

Answer 10

75% dyspnoea
50% chest pain
All patients have cough and chronic sputum production

Question 11

What is the diagnosis of bronchiectasis?

Answer 11

Chest x ray
Blood and sputum microbiology
Pulmonary function tests

Question 12

What are the different types of bronchiectasis?

Answer 12

Saccular- large bronchi
Cylindrical- involves the medium sized bronchi
Varicose- constrictions and dilutions deform the bronchi
The above may be localised or widespread

Question 13

What are the symptoms of acute exacerbation of bronchiectasis?

Answer 13

Changes in sputum production - red brown colour
Increased dyspnoea
Increased cough
Temperature
Increased wheezing
Malaise, fatigue, lethargy or decreased exercise tolerance
Reduces pulmonary function

Question 14

Here is a summary of bronchiectasis

Answer 14

Chronic disease requiring long term follow up. It is unlikely that many of the underlying causes of bronchiectasis will be eradicated in the future.There is emphasis placed on the need to improve our understanding of the condition and effectiveness of treatment

Question 15

What would you expect to observe in a patient with pneumonia?

Answer 15

Fever- sweaty skin, due to increase temperature, may be ruddy or cyanosed, may be able to tell by body position and quality of voice, sob may be able to tell when looking at chest position and their pattern of breathing, a faster breathing pattern would be expected in pneumonia, pursed lip breathing and use of accessory muscles, coughing is productive or unproductive.

Question 16

What would you typically palpate in someone with pneumonia?

Answer 16

Chest expansion in pneumonia is decreases, tactile fremitus is felt in pneumonia, body temperature may be increased due to fever, chest pain symptom of pneumonia, skin also relates to fever

Question 17

What tools would you use to assess someone with pneumonia?

Answer 17

Chest x-ray and auscultation

Question 18

Why is there reduced ventilation of the lungs in pneumonia?

Answer 18

The alveoli are filled with exudate impairing delivery of air to alveoli and lengthening diffusion pathway.

Question 19

How does gravity trigger a change in ventilation and perfusion?

Answer 19

Pleural pressure is increased at the base of the lungs, the alveoli here are more compliant and they have a better ability to become ventilated.
Hydrostatic pressure decreases at the apex of the lung resulting in decreased flow and perfusion of the lung

Question 20

How does positioning influence ventilation perfusion matching?

Answer 20

Ventilation is the volume of gas inhaled and exhaled from the lungs in a given time, perfusion is the total volume of blood reaching the capillaries in a given time period, the ideal va ratio is 1for efficient pulmonary function, however ratio depends on the part of the lung concerned, there are different ratios for different areas, areas of the lung below the heart have increased perfusion relative to ventilation due to gravity reducing V/Q ratio