pneumonia

Question 1

pneumonia

Answer 1

any infection of LRS: viral, fungal, protozoa, parasitic
cause inflam, alveoli filled with purulent, inflam cells, and fibrin = no gas exchange
transmit via droplets inhaled (precautions)
morbidity and morality: increase in winter and males

Question 2

pneumonia: rf

Answer 2

age extremes, compromised immunity (organ transplant, HIV, steroid, etc), underlying lung disease (COPD, pulm htn), alcholism, (asp risk), altered LOC (asp risk), aspiration (impaired swallow), nursing home (immobile), hospital (trach), flu

Question 3

pneumonia: types

Answer 3

CAP = community
HAP = hospital, 48hr after admin, worse outcomes bc more virulent, ICU care
VAP = ventialor, endotracheal, VAP bundle to prevent
HCAP = hc associated, long term care, constant contact

Question 4

pneumonia: patho

Answer 4

failure of cough, mucociliary clearance (ineffective in smokers), immune system
asp of oropharyngeal secretions -> inhale droplets with pathogens
inflam rxn in lungs -> vasodilation, infection spread to tract and alveoli
goblet cells stim and mucus excreted -> accumulate in alveoli and capilarries
alveoli attempt to open and close but cant -> no gas exchange, increased WOB

Question 5

pneumonia: cm

Answer 5

URI precede
fever, chills, productive/nonP (etiology dep), malaise, pleural pain with breathing, dysp, hemptysis
bacterial: productive, HAP = gram -, green, red currant, rusty
viral: scant, nonP, CAP
severe: tachypnea, s of resp distress/failure

Question 6

pneumonia: diagnose

Answer 6

s/s and PA: cough, fever, chill, wet breath sounds (ronchi), exercise intol, pleuritic pain
pulm consolidations -> dull with percussion, insp crackles, increased tactile fremitus egophony (palpable fibration)
tests: cxr = infiltrates, cbc = bacterial = increased wbc and leukocytosis, + sputum for c+s

Question 7

resp distress

Answer 7

tachypnea, nasal flare/pursed lips, stridor/wheeze, ams/agitation, tachy, delayed cap refill, pale
maintain oxygenation only by increasing WOB

Question 8

resp failure

Answer 8

RR > 60
retractions, grunting, mottling, head bobbing, severe air hunger, brady, hypoT
cannot compensate for inad oxygenation despite extra resp effort and rate
circulatory and resp system collapse

Question 9

resp arrest

Answer 9

bradypnea, inefficient respirations, cyanosis/gray, no air movement

Question 10

pneumonia: etiology - bacterial

Answer 10

gram +: staph aureus - HAP = central line, enter via bloodstream (IV), travel to lung, usually MRSA; staph pneumoniae = CAP, pneumococcal, sputum brown and rusty
gram -: sicker and harder to treat

Question 11

pneumonia: etiology - asp

Answer 11

severity of inflam response depends on pH (lower = more response, why we give PPI)
rf: NG, decreased LOC, decreased gag reflex, decreased gastric emptying
subtle or abrupt: silent, dysphagia eval!

Question 12

pneumonia: etiology - viral

Answer 12

flu (CAP)
alter pulm immune defense and make lungs vulnerable to additionally infection - secondary pna so can become bacterial
cm: fever, chills, DOE, cough
tm: supportive -> no abx (unless secondary)

Question 13

pneumonia: etiology: atypical

Answer 13

pneumocysts carinii pneumonia: related to immune suppression, yeast like fungus
mycoplasma: walking pna, mild pna, pt may have persistent cough, HA, earache, bacterial like, properties of bacterial and virus
legionella: gram -, spread via water -> ac, mists sprayed on produce, hot tubs, report! deadly!
aspergillus: fungal pna, released from walls of old buildings, reconstruction, stored grain, dead leaves, compose, affects lung tissues

Question 14

pneumonia: tm

Answer 14

abx = bacterial
viral = support
vent/oxygenation, hydrate, pulm hygiene, neb
prevent -> vaccines! (elderly and immunocompromised), PCV 13 -> pneumococcal (strep), PPSV23 -> bacteria