Pneumonia Flashcards
what is pneumonia
acute infection of the lower respiratory tract due to infectious agents, therefore causing consolidation of the affected tissue
what are 3 anatomic alterations of the lung in pneumonia
- Inflammation of the alveoli
- Alveolar consolidation
- Atelectasis (e.g., aspiration pneumonia)
What is CAP?
community acquired pneumonia
what is the characteristic of CAP?
infection occurs in a previous healthy individual or somebody with COPD
- a syndrome in which acute infection of the lungs develops in persons who have not : 1) been hospitalized recently and have not 2) had regular exposure to the health care system
what is HAP?
hospital acquired pneumonia
what is the characteristic of HAP?
- develops 2 or more days after admission to hospital for some other reason
- occurs 24 hours or more after admission, which was not incubating at the time of admission
- pneumonia is a 2nd infection in patient with other disease
what is CAP caused by
streptococcus pneumonia
what is VAP
ventilator associated pneumonia that arises more than 48-72 hours after ETT intubation
what is HCAP?
- health care associated pneumonia
- patient that was hospitalized within 90 days of infection
- -> reside in nursing home LTC facility; received IV antibiotics, chemotherapy or wound care within 30 days of the current infection
what is the etiology of pneumonia
- host upper and lower respiratory tracts are overwhelmed by micro-organisms
- lead to a production an inflammatory response that affects gas exchange
what is the mechanism that lead to pneumonia
- Aspiration of “upper airway” secretions
- Inhalation of droplets
- Dissemination of pathogens by blood
what are the risk factors of pneumonia
- ineffective cough
- elderly
- immunocompromised
- intubation
what are the 2 bacteria causes of pneumonia
- Gram-positive organisms(round)
- Streptococcus
- Staphylococcus - Gram-negative organisms(rod)
- Hemophilus influenzae
- Klebsiella pneumonia
what are some atypical cause of pneumonia
Chlamydia
Legionella
Mycoplasma
What is Pneumocystis carinii pneumonia (PCP)?
a lung infection that can affect people with weakened immune systems, such as those infected with HIV
What is PCP caused by
fungus
what is the treatment of PCP
Trimethoprim-Sulfamethoxazole orally
Pentamidine
What is the pathophysiology of pneumococcus pneumonia
- aspiration of stretptococcus
- adherence of alveolar macrophage
- inflammation response
- ->attraction of neutrophil
- ->release of inflammatory mediators
- ->accumulation of RBC and bacteria - red heparization
- red blood cells, neutrophils, and fibrin in the pulmonary alveolus/ alveol
- lead to consolidation of lung parenchyma - grey heparization
- deposition of fibrin on pleural surfaces
- phagocytosis in alveoli - resolution of infection
- ->macrophages in alveoli
- ->removed by lymphatics
what cause aspiration pneumonitis or lead to it
- gastic aspiration due to GERD (Gastroesophageal reflux disease)
- food
- asthma/osa (huge effor to breath–>aspirate acid)
- may lead to ARDS within 24hrs
what is the treatment of aspiration pneumonitis
bronchio-alveolar lavage (BAL)
What are the type of pneumonia based on lung location
- Broncho-pneumonia
- ->Patchy pattern limited to segmental bronchi - Lobar Pneumonia
- ->Widespread or diffuse alveolar inflammation & consolidation - Interstitial Pneumonia
- ->Usually diffuse & typically associated with viruses or infections with mycoplasma
characteristic of Bronchopneumonia
- a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
- involves both lungs (bilateral) and non-homogenous patchy infiltrates surrounding one or more bronchi
what is the characteristic of lobar pneuomna
- not limited to – segmental boundaries, but can spread throughout entire lobe
- a widespread or diffuse alveolar inflammation and consolidation.
- the end result of a severe or long-term bronchopneumonia in which the infection has spread from one lung segment
what is the characteristic of Interstitial Pneumonia
inflammatory process within interstitial walls (connective tissue) rather than alveolar spaces
patchy densities often bilateral and diffuse in distribution
associated with infections with Mycoplasma pneumonia or viruses
What is the change in vitals signs in patient with pneumonia
SNS effect
- increase RR, HR, CO, BP
- decrease Spo2
- increase temperature
What are the findings in physical assessment
- Chest pain (pleuritis or i.c. muscle)/decreased chest expansion
- Cyanosis
- Cough (dry early), sputum production, and hemoptysis
Chest assessment findings
- Increased tactile and vocal fremitus
- Dull percussion note
- Bronchial breath sounds
- Crackles and rhonchi
- Pleural friction rub
- increase Whispered pectoriloquy
What is a typical ABG of mild to moderate pneumonia
Acute alveolar hyperventilation with hypoxemia
- increase ph
- decrease Paco2
- decrease Hco3 (slightly)
- decrease Pao2
What is a typical ABG of severe pneumonia
Acute ventilatory failure with hypoxemia
ph:decrease
Paco2: increase
Hco3: decrease slightly
Pao2: decrease
what are some chest radiological findings in pneumonia
- Increased density
- Air bronchograms
- Pleural effusions
how about CT scan
Consolidation and bronchograms
what are the symptoms of pneumonia
- Cough
- Fever
- Sputum production
- Pleuritic chest pain
what are the signs of pnuemonia
- Chest x-ray infiltrates
- Physical exam:
- Crackles
- Pulse oximetry
- Tachypnea
- Tachycardia
- Diminished breath sounds
how to prevent VAP?
via VCB
What are the 4 components of VCB
- Elevation of the head of the bed
- Daily sedation hold
- Gastric ulcer prophylaxis
- DVT prophylaxis
What is the management of pneumonia
bronchscopy–> to obtain the secretion
Use higher peep for mechanically ventilated patient
what is the complication of pneumonia
- VAP
- reduce lung volume
- sepsis
- organ failure
What are RT roles in pnuemonia
- Collection of sputum samples
- Assist with bronchoscopy, monitoring, auscultation, medication delivery
- Oxygen, ventilation & ABG’s
- Counsel patients in sputum clearance techniques such as PEP & autogenic drainage
- Model optimal infection control practices and prevent nosocomial by handwashing
