pneumonia Flashcards
what is pneumonia?
inflammation of alveoli or interstitium of lung cause my microorganism (bacteria, viral, fungal)
how is pneumonia classified and what are the 4 types we went over?
by source of infection major groups: - CAP: community acquired -HAP: hospital acquired minor groups: -HIV associated (immunocompromised) -Flu associated MRSA pneumonia
how long must you have been at the hospital for it to be classified as HAP?
48 hrs after admission
3 risk factors for CAP
extremes of age, alcoholism, other medical conditions (i.e. DM)
3 types of CAP
bacterial (worse symptoms, 85% of cases) viral (milder symptoms) fungal (only in immunocompromised people)
3 typical bacterial organisms that cause CAP
Strep Pneumo, H flu, M catarrhalis
which bacterial organisms for CAP are penicillin sensitive and penicillin resistant
Strep pneumo- sensitive
H flu- somewhat resistant- txt w/ Beta Lactamase inhib
M cattarrhalis- resistant
3 atypical bacterial organisms that cause CAP
legionella, mycoplasma, C pnemoniae
-usually less acute symptoms w/ less productive cough
rare bacterial pathogens that cause CAP and what are they assosciated with?
klebsiella (w/ alcoholism)
staph aureus (w/ flu)
* recent reports of recent fatal CA-MRSA pneumonia
inoculation of pneumonia
microaspiration
clinical presentation of pneumoniae, how are these different if its viral?
symptoms come on rapidly, early onset cough (if productive it is purulent), pleurisy (localized chest pain w/ breathing), maybe SOB and dec. pulse ox
*viral: same symptoms but more mild
respiratory rate w/ pneumonia
commonly increased
PE for pneumonae
- bronchial breath sounds in periphery (consolidation, fluid filled causes transmitted sounds to travel)
- dull to percussion (effusion)
- crackles (pus in alveoli)
Dx for simple pneumonia (no hospital admission)
chest x ray (gold standard) : shows interstitial infiltrates (pus in lung tissue) or consolidation (pus in airways- alveoli)
txt for pneumoniae: abx?
tripack > Zpack
azithromycin: 1 pill/day for 3 days
if Dx with CAP and considering hospitalization, what two further tests will you run?
deep cough sputum culture before giving abx and gram stain
additional tests for CAP and hospitalizing… to evaluate severity..
pulse ox (if not as sick), ABG (if very sick) procalcitonin to evaluate severity (elevated w/ sepsis)
6 signs that pt should be admitted with CAP
neutropenia, multilobar infection, 50+yo and other med. problems, altered mental status, low BP
if CAP and hospitalized, what drugs (in general) are you giving?
IV Abx, multi-drug therapy
4 requirements to give oral abx and discharge
able to take PO, WBC decreasing, afebrile, improving cough and SOB
when txt considered failed?
if not better in 72 hours: this might mean you gave the wrong drug, the bug was resistant or there are other complications (i.e. empyema)
what is empyema?
collection of pus in pleural cavity (abx cant reach these) (might need thoracentesis and drainage)
symptoms get better before _____ gets better
chest xray (for longterm followup)
klebsiella pneumoniae has what as a risk factor?
alcoholism
