Pneumonia. Flashcards
Symptoms and signs of….
Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors
acute lung infection
PT presents with theses issues what do you suspect
-Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors.
-Bronchial breath sounds or rales are frequent auscultatory findings.
-Parenchymal infiltrate on chest radiograph.
-Occurs outside of the hospital or less than 48 hours after admission in a patient who is not hospitalized or residing in a long-term care facility.
Pneumonia - Community acquired, bacterial, and viral
Development of lower respiratory tract infections occurs from…..
1) Aspiration of secretions containing bacteria.
2) Inhalation of infected aerosols.
These are called what?
1) Cough reflex
2) Mucociliary clearance system
3) Immune responses
Pulmonary defense mechanisms
Pneumonia
Occurs ____ of the hospital or less than ___ hours after admission in a patient who is not hospitalized or residing in a long-term care facility
outside
48 hours
Prospective studies have failed to identify the cause of community- acquired pneumonia in ____% of cases
40-60%
The most common bacterial pathogen identified in most studies of community acquired pneumonia is
Streptococcus pneumonia
Streptococcus pneumonia Accounts for approximately what fraction of pneumonia infections?
two- thirds
PE Findings for what?
1) Fever or hypothermia
2) Tachypnea
3) Tachycardia
4) Mild arterial oxygen desaturation.
5) Many patients will often appear acutely ill.
6) Chest examination is often remarkable for altered breath sounds and rales.
7) Dullness to percussion may be present if a par pneumonic pleural effusion is
present.
Pneumonia
What would you suspect from these issues..
a) Constitutional symptoms such as fever, weight loss, and malaise.
b) Cough with expectoration of foul- smelling purulent sputum .
c) Absence of productive cough does not rule out such an infection.
d) Dentition is often poor.
e) Patients are rarely edentulous; if so, an obstructing bronchial lesion is usually present.
anaerobic pleuropulmonary infection
Essentials of diagnosis for what?
(a) History of/or predisposition to aspiration.
(b) Indolent symptoms, including fever, weight loss, malaise.
(c) Poor dentition.
(d) Foul-smelling purulent sputum (in many patients).
Aspiration Pneumonia and Lung Abscess
True/False
Aspiration of small amounts of oropharyngeal secretions occurs during sleep in normal individuals commonly causes disease
False
Rarely causes disease
Most aspiration patients with ______ pneumonia, lung abscess, and empyema are found to be infected with multiple species of anaerobic bacteria
necrotizing
Clearing of pulmonary infiltrates in patients with community- acquired pneumonia can take __ weeks or longer.
6
What type of imaging may confirm the diagnosis and detect associated lung diseases. It can also be used to help assess severity and response to therapy over time.
Chest Radiography
What are some DDx for pneumonia
(a) Cardiac
(b) Pulmonary
(c) Trauma
(d) GI
(e) Musculoskeletal
(f) Psych
What would you use to treat pneumonia?
-Antipyretics,
-cough suppressants as needed.
-Maintain hydration and oral intake
-Empiric antibiotic options for patients with community-acquired pneumonia who do not require hospitalization
What are the Empiric antibiotic options for tx pneumonia?
Macrolides
->Azithromycin, 500 mg orally as a first dose and then 250 mg once a day for 4 days, or 500 mg daily for 3 days.
Tetracyclines
-Doxycycline 100mg BID for 7 days.
Fluoroquinolones
-Levofloxacin 500 mg orally once a day for 7 days
-Moxifloxacin 400 mg orally once a day for 7 days.
What antibiotic is used for suspected aspiration
pneumonia?
Amoxicillin-potassium clavulanate 875/125 mg BID or 500/125 mg TID x 7 days
True/False
Uncomplicated pneumonia can usually be treated on an outpatient basis with antibiotics and supportive care.
True
When would you admit a pneumonia pt?
1) Failure of outpatient therapy, including inability to maintain oral intake and medications.
2) Exacerbations of underlying disease that would benefit from hospitalization.
3) Complications of pneumonia arise
(such as hypoxemia, pleural effusion, sepsis,
and encephalopathy)
These issues are from what?
1) Empyema
2) Endocarditis
3) Pericarditis
4) Cavitation
5) Necrotizing pneumonia
6) Skin rashes
7) Bacteremia
8) Sepsis
9) Respiratory failure
10) ARDS
11) Death
Complications for pneumonia
