Pneumonia

Question 1

Definition

Answer 1

Acute infection of the alveoli due to bacteria, virus or fungi.
Can be the primary presenting problem or secondary to the other disease e.g. influenza
Therefore it has 2 types

Question 2

2 Types of Pneumonia

Answer 2

Community Acquired Pneumonia (CAP)

Hospital Acquired Pneumonia (HAP) - classified if px is hospitalised for more than 2 day in the last 90 days

Question 3

Further categorisation of Pneumonia

Answer 3

1. Typical - acute onset with fever, chills and a productive cough
2. Atypical - dry cough, fever, sore throat and headache.

Question 4

Categorisation of pneumonia depending on the site

Answer 4

1. Lobar pneumonia - it involves all of a single lobe of the lungs and become consolidated (opposite to spongy texture) and more prone to occur in younger adults.
2. Bronchopneumonia - affects the alveoli close to the larger bronchioles of the bronchial tree. Most prevalent in infants, young children and aged adults.

Both type is often caused by bacterial infection namely Streptococcus pneumoniae.

Question 5

Aetiology

Answer 5

Bacterial - streptococcus pneumoniae
Viral: influenza
Fungal: pneumocystis

Question 6

Risk factors (determinants)

Answer 6

Tobacco smoke exposure , chronic lung disease
Lack of immunization , Chronic health condition
Poor nutrition , Age 75
Poor housing
Over-crowding
Reduced access to primary healthcare

Question 7

Epidemiology - incidence and prevalence

Answer 7

7th leading cause of death in USA
Leading cause of death in children- killing 1.1millon each year.
Age 75
4
3 time more prevalent in Maori than non-Maori

Question 8

Control

Answer 8

Immunization
Good nutrition
eliminate exposure to cig
better housing
limit exposure to illness
improved access to primary care

Question 9

Pathophy

Answer 9

Infectious organism enters the respiratory tract
Macrophage (WBC) response to it with production of fibrin-rich exudate.
Exudate fills the alveoli and block the gas exchange
Further inflammatory response - neutrophils damages lung tissue causing pulmonary oedema and fibrosis.
This can lead to pleural effusion.
Reduced Gas exchange –> Dcr in O2 –> Incr in WOB –> Incr Co2 –> Incr RR + HR

Question 10

Progression

Answer 10

uncomplicated one is usually improved within one or 2 days with antibiotics. Antibiotics must be continued for full course of 7 days.

Question 11

Clinical Feature

Answer 11

Children - usually a 1-2day history of
Fever, Incr Dyspnea, Incr WOB, Stridor or Wheeze
Pleuratic chest pain, Cough
Tachycardia, Tachypnea (Incr RR)

Pneumonia in adults - 1-2 days history of
Cough, Fever >37.8C
Tachypnea, Tachycardia, dyspnea, Sputum production, Confusion

Question 12

Stridor

Answer 12

High pitched breath sound resulting from tubulent air flow in the larlynx or lower in the bronchial tree

Question 13

Diagnosis - physical examination

Answer 13

Incr HR, RR, Temperature
Low oxygen Saturation
Coarse crackles

Question 14

Diagnosis - investigation

Answer 14

Xray, Blood tests, Sputum culture, ABGs

Question 15

Interdisciplinary management

Answer 15

Adults
1. Antibiotics - Amoxicillin 500mg-1g 3times daily for 7days
2. regular pain relief
3. oxygen therapy
4. physiotherapy - optimise V/Q match, secretion clearance, mobilization.
Child
early Vaccination.

Question 16

Prognosis

Answer 16

Prognosis varies depending on type of pathogen, age.
CAP has very low mortality rate
HAP higher mortality rate due to degree of pathogen and px’s underlying condition.

Question 17

Outcome Measures

Answer 17

Length of stay
Re-admission rate
Mortality rate