Pneumonia (Exam 1b) Flashcards
Pneumonia
Any type of infection of the lower respiratory system
Pneumonia can be
Viral, fungal, protozoa, or parasitic (Many etiology)
Pneumonia causes
Inflammation of the lung tissues, the alveolar air spaces become filler with purulent, inflammatory cells and fibrin
Pneumonia is transmitted via
inhaled infectious droplets
Risk factors for PNA
Age extremes
Compromised immunity
Underlying Lung Disease
Alcoholism
Altered LOC
Impaired swallowing = Aspiration
Nursing home resident
Hospitalization
Influenza (most common cause)
CAP vs HAP
Community acquired pneumonia
Hospital acquired pneumonia
Which PNA is most common reason for hosptilaizations
CAP
HAP=
PNA developed within 48 hours after admission
HAP has worse out omes than CAP
Typically associated with ICU
CAP is easier to treat
HAP can be more resistant to antibiotics and virulant
VAP
Ventilator associated pneumonia
HCAP
Healthcare associated PNA
PNA pathogenesis
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
PNA: Patho
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
PNA: Clinical Manifestations
-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)
Respiratory Distress
Maintain O2 only be increasing WOB
Severe PNA: S/S
Tachypnea, signs of respiratory distress/failure
Respiratory Failure
Cannot compensate for inadequate O2 despite extra respiratory effort and rate
Circulatory and respiratory sysytem collapse
Difference between Respiratory Distress-Failure-Arrest
Know the slide
Clinical Diagnosis
Pulmonary consolidations –> dullness to percussion, inspiratory crackles, increased tactile fremitus, egophony
Clinical Diagnosis: Diagnostic Test
Chest x-ray –> infiltrates
CBC - Helps determine if cause is bacterial (increase WBC)
Different Types of PNA
Bacterial
Viral
Atypical
Fungal
Bacterial PNA
Typically HAP
Bacterial PNA: Gram +
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
What is the most common cause of gram + HAP
MRSA
CAP bacterial PNA will be
Streptococcus PNA
Bacterial PNA: Gram -
-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
Aspiration PNA
Aspirated material from GI tract causes PNA –> stimulates inflammatory reaction
Severity of inflammatory response depends on pH of aspirate (More acidic = More inflammatory)
Who is at risk for Aspiration PNA
Anyone with altered LOC
NG tubes, decreased LOC, decreased gag reflex, decreased gastric emptying
Key thing with Aspiration PNA
Can be subtle or abrupt
Silent aspiration
Dysphagia evaluation crucial
Viral PNA
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)
Atypical PNA: Pneumocystis carini
-Related to immune suppression (HIV - Transplant)
-Yeast like fungus
Atypical PNA: Mycoplasma PNA
-Walking PNA
-Mild PNA, patient may complain of persistent cough, H/A, E/A
-Bacterial like organism, properties of both bacterial and virus
Atypical PNA: Legionella
Gram negative organism
(Very serious) (Report to Health Department)
Spread via water systems –> air conditioners, mists sprayed on produce, hot tubs
Atypical PNA: Aspergillus
Fungal PNA
Release from walls of OLD buildings, reconstruction, stored graine, dead leaves, compost
Affects lung tissues
PNA Treatment:
Bacterial = Antibiotics
Viral = Supportive care
OTHER: Ensure ventilation and oxygenation, hydrates, hygiene, nebulizer treatments
2 PNA vaccines
- PCV13- Prevents pneumococcal pneumonia caused by 13 strains of strep PNA
- PPSV23- Prevents against an additional 23 types of PNA bacteria
