Pneumonia (Exam 1b)

Question 1

Pneumonia

Answer 1

Any type of infection of the lower respiratory system

Question 2

Pneumonia can be

Answer 2

Viral, fungal, protozoa, or parasitic (Many etiology)

Question 3

Pneumonia causes

Answer 3

Inflammation of the lung tissues, the alveolar air spaces become filler with purulent, inflammatory cells and fibrin

Question 4

Pneumonia is transmitted via

Answer 4

inhaled infectious droplets

Question 5

Risk factors for PNA

Answer 5

Age extremes

Compromised immunity

Underlying Lung Disease

Alcoholism

Altered LOC

Impaired swallowing = Aspiration

Nursing home resident

Hospitalization

Influenza (most common cause)

Question 6

CAP vs HAP

Answer 6

Community acquired pneumonia

Hospital acquired pneumonia

Question 7

Which PNA is most common reason for hosptilaizations

Answer 7

CAP

Question 8

HAP=

Answer 8

PNA developed within 48 hours after admission

HAP has worse out omes than CAP

Typically associated with ICU

Question 9

CAP is easier to treat

Answer 9

HAP can be more resistant to antibiotics and virulant

Question 10

VAP

Answer 10

Ventilator associated pneumonia

Question 11

HCAP

Answer 11

Healthcare associated PNA

Question 12

PNA pathogenesis

Answer 12

Aspiration of oropharyngeal secretions MOST COMMON route

Inhalation of droplet containing bacteria or other pathogens

Inflammatory reaction is stimulated within the lungs –> vasodilation occurs, infection begins to spread into the respiratory tract and alveoli

Goblet cells are stimulated and mucus is secreted –> mucus accumulates between the alveoli and capillaries

Alveoli attempt to open and close against the purulent exudate but cannot so gas exchange becomes less than optimal, making it difficult to breathe

Question 13

PNA: Patho

Answer 13

Failure of mucociliary defense mechansim allows exudative fluid and inflammatory cells to invade the alveoli

NOTE: Smoking is one of the biggest risk factors because impair ciliary

Question 14

PNA: Clinical Manifestations

Answer 14

-Usually preceded by an URI

-Proceeds to fever, chills, productive or dry cough, malaise, pleural pain, sometimes dyspnea and hemoptysis

Cough (productive with sputum) (Bacterial PNA is productive / Purulent and usually gram negative HAP) (Sputum may be green, rusty or red currant jelly)

Cough Viral (Non productive scanty cough) (CAP)

Question 15

Respiratory Distress

Answer 15

Maintain O2 only be increasing WOB

Question 15

Severe PNA: S/S

Answer 15

Tachypnea, signs of respiratory distress/failure

Question 16

Respiratory Failure

Answer 16

Cannot compensate for inadequate O2 despite extra respiratory effort and rate

Circulatory and respiratory sysytem collapse

Question 17

Difference between Respiratory Distress-Failure-Arrest

Answer 17

Know the slide

Question 18

Clinical Diagnosis

Answer 18

Pulmonary consolidations –> dullness to percussion, inspiratory crackles, increased tactile fremitus, egophony

Question 19

Clinical Diagnosis: Diagnostic Test

Answer 19

Chest x-ray –> infiltrates

CBC - Helps determine if cause is bacterial (increase WBC)

Question 20

Different Types of PNA

Answer 20

Bacterial
Viral
Atypical
Fungal

Question 21

Bacterial PNA

Answer 21

Typically HAP

Question 22

Bacterial PNA: Gram +

Answer 22

Staphylococcus aureus:

-Usually enters through the bloodstream via IV routes travels to lungs
-Most common cause of gram + HAP = MRSA

Streptococcus pneumoniae:

-Most frequent organism associated with CAP
-Pneumococcal PNA
-Sputum usually brown or rusty tinge

Question 23

What is the most common cause of gram + HAP

Answer 23

MRSA

Question 24

CAP bacterial PNA will be

Answer 24

Streptococcus PNA

Question 25

Bacterial PNA: Gram -

Answer 25

-Tend to make you more sick and are more difficult to treat

-pseudomonas auruginosa, Acinetobacter, Klebsiella pneumoniae

Typically from Central line or IV drug use

Question 26

Aspiration PNA

Answer 26

Aspirated material from GI tract causes PNA –> stimulates inflammatory reaction

Severity of inflammatory response depends on pH of aspirate (More acidic = More inflammatory)

Question 27

Who is at risk for Aspiration PNA

Answer 27

Anyone with altered LOC

NG tubes, decreased LOC, decreased gag reflex, decreased gastric emptying

Question 28

Key thing with Aspiration PNA

Answer 28

Can be subtle or abrupt

Silent aspiration

Dysphagia evaluation crucial

Question 29

Viral PNA

Answer 29

INfluenza (CAP)
-major risk factor
-other viruses

Virus alters the pulmonary immune defense and makes the lungs vulnerable to an ADDITIONAL bacterial infection (secondary pneumonia)

Question 30

Atypical PNA: Pneumocystis carini

Answer 30

-Related to immune suppression (HIV - Transplant)

-Yeast like fungus

Question 31

Atypical PNA: Mycoplasma PNA

Answer 31

-Walking PNA

-Mild PNA, patient may complain of persistent cough, H/A, E/A

-Bacterial like organism, properties of both bacterial and virus

Question 32

Atypical PNA: Legionella

Answer 32

Gram negative organism

(Very serious) (Report to Health Department)

Spread via water systems –> air conditioners, mists sprayed on produce, hot tubs

Question 33

Atypical PNA: Aspergillus

Answer 33

Fungal PNA

Release from walls of OLD buildings, reconstruction, stored graine, dead leaves, compost

Affects lung tissues

Question 34

PNA Treatment:

Answer 34

Bacterial = Antibiotics

Viral = Supportive care

OTHER: Ensure ventilation and oxygenation, hydrates, hygiene, nebulizer treatments

Question 35

2 PNA vaccines

Answer 35

1. PCV13- Prevents pneumococcal pneumonia caused by 13 strains of strep PNA
2. PPSV23- Prevents against an additional 23 types of PNA bacteria