Pneumonia

Question 1

Acute infection of lung parenchyma

Answer 1

Pneumonia

Question 2

Risk factors for pneumonia

Answer 2

1. Abdominal/chest surgery, >65 years old, air pollution, altered consciousness, bed rest/prolonged mobility, debilitating illness, IV drug use, malnutrition

Question 3

Classifications of pneumonia

Answer 3

i. Community-acquired (CAP) or

ii. Hospital-acquired (HAP)

Question 4

Acute infection in patients who have not been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms

Answer 4

community-acquired pneumonia (CAP)

Question 5

CAP assessment “CURB-65”

Answer 5

1. C: confusion, U: BUN >20mg/dL, R: Respiratory rate >30 bpm, B: Systolic BP <90 mmhg, DBP: <60 mmhg
2. > 65 years olf
3. LDH: >230
4. Albumin <3.5 g/dL
5. Platelet count: <100

Question 6

Occurs 48 hours or longer after hospitalization and not present at time of admission

Answer 6

HAP

Question 7

Types on pneumonia

Answer 7

Viral (most common)
Bacterial 
Mycoplasma
aspiration
opportunistic

Question 8

Abnormal entry of oral or gastric material into lower airway

Answer 8

Aspiration pneumonia

Question 9

Risk factors of aspiration pneumonia

Answer 9

1. Decreased level of consciousness
2. Depressed cough or gag reflex
3. Difficulty swallowing
4. Insertion of nasogastric tubes with or without tube feeding

Question 10

Most common symptoms

Answer 10

i. Cough: productive or nonproductive
ii. Green, yellow, or rust-colored sputum
iii. Fever, chills
iv. Dyspnea, tachypnea
v. Pleuritic chest pain

Question 11

Risk factors for Multi-drug resistant (MDR) pathogens (major problem in treatment)

Answer 11

i. Advanced age
ii. Immunosuppression
iii. History of antibiotic use
iv. Prolonged mechanical ventilation

Question 12

Diagnostic studies for pneumonia

Answer 12

1. chest xray
2. Thoracentesis & bronchoscopy
3. Pulse ox
4. ABGs
5. Sputum grain stain
6. Blood cultures
7. CBC

Question 13

Pneumococcal vaccines response occurs within 48-72 hrs..what does these meds do?

Answer 13

i. Decreased temperature
ii. Improved breathing
iii. Decreased Chest discomfort

Question 14

Viral pneumonia

Answer 14

no definitive treatment

Question 15

Initial empiric therapy:

Answer 15

gram-negative & gram-positive organisms
Should see improvement in 3-5 days
Antibiotics: IV proceed to oral when stable
afebrile 48-72 hrs

Question 16

Nutritional therapy

Answer 16

prevent dehydration

small, frequent, high calorie meals

Question 17

Respiratory objective data

Answer 17

tachypnea, asymmetric chest movements, use of accessory muscles, nasal flaring, decreased excursion, crackles, friction rub, dullness on percussion, increased tactile fremitus, sputum amount and color

Question 18

Diagnostic studies show

Answer 18

i. Increased WBCs
ii. Abnormal ABGs
iii. Positive sputum
iv. Abnormal chest x-ray

Question 19

Prevent aspiration pneumonia

Answer 19

i. Elevate head-of-bed 30 degrees and have sit up for all meals
ii. Assist with eating, drinking, taking meds as needed
iii. Assess for gag reflex
iv. Monitor reflux and gastric residuals (NG tube)
v. Early mobilization
vi. Cough and deep breathe, incentive spirometry
vii. Twice-daily oral hygiene