Pneumonia and Respiratory Complications Flashcards
What is pneumonia?
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
What defence mechanisms protect the airway from infection?
Cilia, Mucus, Alveolar macrophages, Cough reflex, epiglottis
What is community-acquired pneumonia?
Pneumonia onset in the community or within the first two days of hospitalisation
What is hospital-acquired pneumonia?
Pneumonia onset more than 48 hours after admission, not incubating at the time of admission
What is ventilator-associated pneumonia?
Pneumonia onset more than 48 hours after endotracheal intubation
What is healthcare-associated pneumonia?
Pneumonia onset outside hospital after recent exposure to an acute care setting
What are the four stages of untreated pneumonia?
Congestion
Red hepatisation
Gray hepatisation
Resolution
What happens during the congestion stage of pneumonia?
Boggy lung
Fluid inside alveoli
Neutrophils inside alveoli with bacteria
Symptoms:
- Shortness of breath
- Cyanosis
- Extreme fatigue
- Tachycardia
What happens during the red hepatisation stage of pneumonia?
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
What happens during the grey hepatisation stage of pneumonia?
Consistency of liver but grey due to breakdown of red blood cells
What are the signs and symptoms of pneumonia?
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
How can pneumonia be prevented?
Taking various vaccines
- Pneumococcal vaccine
- Haemophilus influenzae vaccine
How is pneumonia diagnosed?
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
How is pneumonia managed?
Broad-spectrum antibiotic cover
Nutritional therapy
- 3L fluids daily
- 6300kj daily
Symptom management
Health promotion
- Promoting exercise
- Encouraging smoking cessation
What are the common causes of airway compromise?
Airway obstruction, Hypoxaemia, Hypoventilation
Who is at risk of airway compromise?
Patients undergoing general anaesthesia
Older population
Smokers
Those with lung disease
Obese patients
Patients undergoing thoracic, airway, or abdominal surgery
Chest trauma
What can cause airway obstruction?
Blockage of the airway by the patient’s tongue
Laryngospasm
Retained secretions
Laryngeal oedema
- Anaphylaxis
What is hypoxaemia?
What differentiates it from hypoxia?
Low oxygen in the blood
Hypoxia is low oxygen in the tissues
How is hypoxaemia tested for?
Arterial blood gases to confirm
What is the most common cause of hypoxaemia?
What is another cause of hypoxaemia?
Alveolar closure/collapse resulting in reduced gas exchange (Atelectasis)
Another cause is pulmonary oedema
What are signs and symptoms of atelectasis?
How is it manged?
Reduced breath sounds and decreased O2 saturation
Management:
- Humidified O2
- Deep breathing/coughing 1/2 hourly
- Early mobilisation
Who is at risk of developing atelectasis?
Smokers
Immobile patients
Impaired cough reflexes
What are signs and symptoms of Pulmonary oedema?
Crackles on auscultation
Difficulty breathing
Coughing blood
Pink, frothy sputum
Infiltrates on x-ray
Fluid overload
Decreased O2 saturation
Excessive sweating
Anxiety
Pallor
How is Pulmonary oedema managed?
O2 therapy
Diuretics
Fluid restriction
Positioning in upright position to aid relieve symptoms
Sometimes ventilator
What is hypoventilation a sign of?
Respiratory drive depression, possibly due to anaesthetics/opioids/sedatives
What are the signs and symptoms of hypoventilation?
How is it managed?
Decreased resp. rate or effort
Shallow respirations
Decreased O2 saturations
Increasing PaCO2 (Hypercapnia)
Management:
Reverse opioids (Narcan)
Mechanical ventilation
Monitoring vital signs
