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Emed ACS > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

CAP is

A

Acute
not hospitalized
>14D reside in Long term care

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2
Q

HAP

A

> 48hrs after admit

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3
Q

VAP

A

> 48hrs after start mechanical ventilation

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4
Q

HCAP

A 
Pt admit >2D w/in last 90 D
RN home/LTACH
Home IV ABX therapy
Dialysis
Chronic wound care/Chemo
X-IMM
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5
Q

Pneumonia defined

A

Infection of the aveloi

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6
Q

How do people aquire pneumonia in the hospital?

A

Usually aspirated (can inhale)

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7
Q

What organisms can spread via hematogenous spread?

A

S. Aureus/S. Pneumonia

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8
Q

What factors put a person most at risk for contracting pneumonia?

A

Aspiration predisposition
impaired cilia
Bacteremia

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9
Q

Pneumonia w/ intense inflammatory response causes?

A

Exudate/WBC to fill aveoli

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10
Q

What type of cough for bacterial pneumonia?

A

Productive cough

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11
Q

Atypical organisms tend to cause?

A

less intense inflam response and milder non-productive cough

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12
Q

In order what are most common agents of pneumonia?

A
  1. Pneumococcus
  2. viruses
  3. Atypicals
    (Mycop, Chlamy, Legions)
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13
Q

Severe CAP who were completely healthy have…

A

S. Pneumoniae

Legionella

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14
Q

Which populations tend to have >1 organism?

A

RN home residents
Alcoholics
HIV low CD4

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15
Q

Viral URI before pneumonia has what S/S?

A

Coryza
Low fever,
Rhinorrhea,
Non-productive cough

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16
Q

Atypical agents ass/w what S/S?

A

HA, GI illness (Legions)

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17
Q

What agent is ass/w GI illness?

A

Legionella

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18
Q

High risk populations for Pneumococcal

A

Old, <2 years old, minorities, day care centers, X-IMM, sickle cell disease

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19
Q

Highest risk for pneumococcal pneumo

A

Old, <2 years old, minorities, day care centers, X-IMM, sickle cell DZ

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20
Q

Labs PNEUMOCOCCAL PNEUMO

A

increased WBC, INC bilirubin or LFTS, and hyponatremia

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21
Q

S. aureus pneumo ass/w

A

laryngeal cancer, X-Imm, RN home, risk for aspiration

22
Q

S. aureus pneumo attributes

A

after viral illness (influenza), insidious onset, low-grade fever, sputum production, and dyspnea

23
Q

CXR S. Aureus

A

empyema, pleural effusions, areas of infiltrate

24
Q

Leucocidin excretion by S. Aureus =

A

rapid progression and death

25
Q

S. Aureus HAP are at risk for

A

MRSA

26
Q

Klebsiella attributes

A

= sudden onset, fever, rigors, and CP

27
Q

CXR - Klebsiella

A

develop pulmonary abscesses (MC) to have lobar infiltrate

28
Q

Pseudomonas attributes

A

severe pneumo (cyanosis, confusion, signs of systemic illness)

29
Q

Pseudomonas CXR -

A

bilateral lower lobe infiltrates, occ. empyema

30
Q

H. influenzae pneumo MC in what pop

A

Elderly ( but any age can), Sickle cell, ETOH

31
Q

H. influenzae attributes

A

Either gradual progression of DZ, low-grade fever, sputum or occ. sudden onset of CP, dyspnea, sputum

32
Q

CXR H. influenzae

A

Pleural effusions and multilobar infiltrates

33
Q

Atypical bacteria

A

Legionella, Chlamydophila, and Mycoplasma

34
Q

Atypical don’t respond to what and why? B-lactam ABX but to macrolides or respiratory FQ

A

Dont respond to B-lactam ABX due Lack of cell wall

35
Q

What will Atypicals respond to concerning ABX?

A

macrolides or respiratory FQ

36
Q

Legionella attributes

A

Gi S/S - abd pain, N/V/D
Prom summer
Ass/w ARDS, multi-organ

37
Q

Legionella CXR

A

patchy infiltrate, occ. hilar LAD and pleural effusions

38
Q

Chlamydophila attributes

A

mild illness, sore throat, low-grade fever, nonproductive cough and freq may have rales or rhonchi

39
Q

Mycoplasma P. ass/w

A

retrosternal CP

40
Q

Varicella- can be serious and lead to virulent pneumo in

A

pregnant pts

41
Q

S. pneumoe is (MC), but Klebsiella and Haemophilus are important in what population?

A

Alcoholics

42
Q

MC organisms in RN homes

A

S. pneumoe, GNB, H. influenzae

43
Q

TXT of RN home residents

A

IM or PO ABX - cover GNB and MRSA

44
Q

8 independent predictors RN home pts:

A 
Tachycardia 
RR ≥30
≥38°C (100.4°F)
decreased alertness
acute confusion
crackles on auscultation
absence of wheezes
increased WBC
45
Q

MC organisms in HIV pts

A

S. pneumoe is (MC) in pts w/ HIV

P. aeruginosa is also common

46
Q

Atypical presentation in elder for pneumo

A

nonpulmonary S/s - falls, weakness, tremulousness, functional decline, abd complaints, delirium, or confusion
Likely to be afebrile on presentation

47
Q

mechanical ventilation organisms

A

GNB (esp. P. aeruginosa)

48
Q

CMV, P. jiroveci, Fungus - (esp Aspergillus species) are?

A

Oppurtnistic infections occuring w/in 6mo of transplant

49
Q

W/in 3 months of transplant what organisms are MC?

A

Mostly S. aureus and Legionella

50
Q

ICU admit criteria

A
  • marked elevated RR
  • partial pressure of arterial oxygen/fraction of inspired
  • oxygen ratio ≤250
  • multilobar infiltrates
  • confusion
  • uremia w/ a BUN >20 milligrams/dL,
  • leukopenia, thrombocytopenia, hypothermia
  • hyponatremia, lactic acidosis, and asplenia

Emed ACS (6 decks)

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