Pneumonia and Respiratory Complications

Question 1

What is pneumonia?

Answer 1

Pneumonia is an acute infection and inflammation of the lower respiratory tract which leads to fluid build up in the alveoli and impaired gas exchange

Question 2

What defence mechanisms protect the airway from infection?

Answer 2

Cilia, Mucus, Alveolar macrophages, Cough reflex, epiglottis

Question 3

What is community-acquired pneumonia?

Answer 3

Pneumonia onset in the community or within the first two days of hospitalisation

Question 4

What is hospital-acquired pneumonia?

Answer 4

Pneumonia onset more than 48 hours after admission, not incubating at the time of admission

Question 5

What is ventilator-associated pneumonia?

Answer 5

Pneumonia onset more than 48 hours after endotracheal intubation

Question 6

What is healthcare-associated pneumonia?

Answer 6

Pneumonia onset outside hospital after recent exposure to an acute care setting

Question 7

What are the four stages of untreated pneumonia?

Answer 7

Congestion
Red hepatisation
Gray hepatisation
Resolution

Question 8

What happens during the congestion stage of pneumonia?

Answer 8

Boggy lung
Fluid inside alveoli
Neutrophils inside alveoli with bacteria

Symptoms:
- Shortness of breath
- Cyanosis
- Extreme fatigue
- Tachycardia

Question 9

What happens during the red hepatisation stage of pneumonia?

Answer 9

Consistency of the lung becomes like the liver.
Red blood cells accumulate in the lungs with the vasodilation
Lungs filling with pus and debris and making the lungs harder

Question 10

What happens during the grey hepatisation stage of pneumonia?

Answer 10

Consistency of liver but grey due to breakdown of red blood cells

Question 11

What are the signs and symptoms of pneumonia?

Answer 11

Lungs:
- Cough with sputum, phlegm (yellow/brown) and/or blood
- Shortness of breath
- Pleuritic chest pain
- Increased respiratory effort

Cardiovascular:
- High heart rate
- Low blood pressure

Nervous system:
- Headaches
- Anorexia
- Mood swings
- Confusion

Systemic:
- High fever
- Chills

Muscular
- Fatigue
- Aches

Other
- Nausea and Vomiting
- Joint pain

Question 12

How can pneumonia be prevented?

Answer 12

Taking various vaccines
- Pneumococcal vaccine
- Haemophilus influenzae vaccine

Question 13

How is pneumonia diagnosed?

Answer 13

History and physical exam
- Crackles, Wheezing during auscultation
- Dull sound during percussion
Chest X-ray
Sputum microscope, culture & sensitivity
Full blood count
Blood cultures
Possibly bronchoscopy +/- washings/brushings

Question 14

How is pneumonia managed?

Answer 14

Broad-spectrum antibiotic cover
Nutritional therapy
- 3L fluids daily
- 6300kj daily
Symptom management
Health promotion
- Promoting exercise
- Encouraging smoking cessation

Question 15

What are the common causes of airway compromise?

Answer 15

Airway obstruction, Hypoxaemia, Hypoventilation

Question 16

Who is at risk of airway compromise?

Answer 16

Patients undergoing general anaesthesia
Older population
Smokers
Those with lung disease
Obese patients
Patients undergoing thoracic, airway, or abdominal surgery
Chest trauma

Question 17

What can cause airway obstruction?

Answer 17

Blockage of the airway by the patient’s tongue
Laryngospasm
Retained secretions
Laryngeal oedema
- Anaphylaxis

Question 18

What is hypoxaemia?

What differentiates it from hypoxia?

Answer 18

Low oxygen in the blood

Hypoxia is low oxygen in the tissues

Question 19

How is hypoxaemia tested for?

Answer 19

Arterial blood gases to confirm

Question 20

What is the most common cause of hypoxaemia?

What is another cause of hypoxaemia?

Answer 20

Alveolar closure/collapse resulting in reduced gas exchange (Atelectasis)

Another cause is pulmonary oedema

Question 21

What are signs and symptoms of atelectasis?

How is it manged?

Answer 21

Reduced breath sounds and decreased O2 saturation

Management:
- Humidified O2
- Deep breathing/coughing 1/2 hourly
- Early mobilisation

Question 22

Who is at risk of developing atelectasis?

Answer 22

Smokers
Immobile patients
Impaired cough reflexes

Question 23

What are signs and symptoms of Pulmonary oedema?

Answer 23

Crackles on auscultation
Difficulty breathing
Coughing blood
Pink, frothy sputum
Infiltrates on x-ray
Fluid overload
Decreased O2 saturation
Excessive sweating
Anxiety
Pallor

Question 24

How is Pulmonary oedema managed?

Answer 24

O2 therapy
Diuretics
Fluid restriction
Positioning in upright position to aid relieve symptoms
Sometimes ventilator

Question 25

What is hypoventilation a sign of?

Answer 25

Respiratory drive depression, possibly due to anaesthetics/opioids/sedatives

Question 26

What are the signs and symptoms of hypoventilation?

How is it managed?

Answer 26

Decreased resp. rate or effort
Shallow respirations
Decreased O2 saturations
Increasing PaCO2 (Hypercapnia)

Management:
Reverse opioids (Narcan)
Mechanical ventilation
Monitoring vital signs