Pneumonia Flashcards
What is pneumonia?
Inflammatory condition of the lung leading to abnormal alveolar filling with consolidation and exudation
Pathology -
Infection or chemical or aspiration irritant - all cause overwhelming inflammatory response
During pulmonary infection, acute inflammation results in the migration of neutrophils out of capillaries and into airspace’s (alveoli), these cells phagocytose and release antimicrobial enzymes and inhibitors to try to fight infection
This leads to more inflammation and oedema
4 stages of pneumonia
1) congestion -
First 24 hours
Characterised by vascular engorgement, intra-alveolar fluid and numerous bacteria.
The lung is heavy, boggy and red
4 stages pneumonia
2) redhepatization -
2-3 days
Massive exudation develops, with RBCs, leukocytes and fibrin filling the alveolar spaces. Affected area appears red, firm and airless, with a liver like consistency
4 stages pneumonia
3) gray hepatization -
4-6 days
Stage is characterised by progressive disintegration of RBC’s and the persistence of a fibrin exudate
4 stages pneumonia
4) resolution -
> 6 days
The consolidation exudate within the alveolar spaces undergoes progressive digestion to produce debris that is later re absorbed, ingested by macrophages or coughed up
Causes of pneumonia -
Bacteria eg. Streptococcus pneumonia, haemophilia influenza type b
Fungi - normally inhaled from environment
Viruses eg respiratory syncytial
Parasites
Chemical - eg chlorine gas
Aspiration - vomit/food going into lungs
Inhalation - smoke/burns
Two types of anatomical classification of pneumonia -
Lobar pneumonia
Bronchopneumonia
Setting classifications of pneumonia -
Community acquired pneumonia* - acquired away from hospital setting (CAP)
Health care associated pneumonia - came into hospital for check up for eg. And developed pneumonia within 90 days of this (HCAP)
Hospital acquired pneumonia* - within 48 hours of admission (HAP)
Ventilator associated pneumonia - 48-72 hours after someone has been put on ventilator (VAP)
**the ones to pay attention to for this
Classification and causes
CAP -
Strep C
Pneumonia/staphylococcus aureus 25%
Virus 10%
Influenza 5%
Unknown cause 37%
Classification and causes
HAP -
Higher mortality rate and is normally bacterial
MRSA 15%
MSSA 9%
Other gram negative rods 9%
Unknown cause 37%
What does pneumonia classification tell us?
That pneumonia cannot be defined by the infective organism, only by the setting and risk
Knowing which type will help influence treatment as setting predicts treatment
Common symptoms -
Fever
Malaise
Muscle ache/fatigue
Coughing (productive/non productive)
Tactile termitus on palpation
Dyspnoea
Pleurtic or chest pain
Loss of appetite
Rapid heart beat
Less common symptoms -
Coughing up blood
Fatigue
Nausea/vomitting
Diarrhoea
Wheezing
Confusion
Complications of pneumonia -
Lung abscess
Pleural effusions (fluid around lungs increase)
Empyema (infections/pus in between the pleural cavity)
Septic shock
Medical diagnosis -
Temp > 37.8 degrees
Heart rate > 100bpm
Crackles and decreased breath sounds/bronchial breath sounds during auscultation
These all have to be in absence of asthma
What is the clinical prediction rule?
5 findings - 84-91% probability
4 findings - 58-85% probability
3 findings - 35-51% probability
2 findings - 14-24% probability
1 finding - 5-9% probability
0 - 2-3% probability
Diagnostic tests that can be used to identify pneumonia -
Chest x ray (CXR)
CT scan
Blood test
Sputum culture
Pleural fluid culture
Bronchoscopy
* last two are more invasive, therefore not as commonly done.
General management of pneumonia -
Antibiotics/anti-fungal medication
Oxygen support - because of decreased gaseous exchange
Hydration - IV fluids - helps reduce thick sputum
Rest
Analgesics - for chest pain and aches
Cough suppressant medication
Fever reducing medication
Prevention through vaccination programmes
Physio treatment for pneumonia -
Care needed as it may increase xylem consumption and demand, or cause bronchopsasm
Treat clinical signs and symptoms
Non-productive (stage 1-3) -quite consolidated, likely to have dry cough… positioning V/Q (ventilation profusion matching), mobilisation, or no intervention, physios may not be needed at this stage.
Productive - stage 4, wet cough,therefore can help clear - sputum clearance techniques including positioning,breathing exercises, adjuncts etc…
