pneumonia part 3 Flashcards
What is the most common opportunistic infection in person with HIV infection?
PJP (fungal) opportunistic
What are the S and S of PJP?
- onset is slow and subtle
- fever, tachypnea, tachycardia, dyspnea, nonproductive cough, hypoxemia
- chest X ray shows diffues bilateral infiltrates
- lungs have massive consolidation in widespread disease
- causes acute respiratory failure and death
- infection can spead to other organs
- bacterial and viral must be ruled out because of vague presentation
Does PJP respond to antifungal agents?
no even through it the causative agent is fungal
Although specific pathophysiologic changes related to pneumonia vary according to the organism, what do the maority of organisms trigger?
an inflammatory response in the lungs
Pathophysiology of pneumonia?
- inflammation, increased blood flow
- activates neutrophils to engullf and kill offending organsisms
- edema in airways, fluid leaks into alveoli
- Normal oxygen transport is affected leading to hypoxia
- consolidation: air filled alveoli become filled with fluid and debris, mucous production increases, potentially obstructs airflow and gas exchange further
- recovery: antibiotic therapy, macrophages lyse, lung tissue recovers, and gas exchange returns to normal
What are the most common presenting symptoms of pneumonia?
cough fever shaking chills dyspnea tachypnea pleuritic chest pain -cough may or may not be productive -sputum may be green, yellow, or rust colored (bloody)
What may viral pneumonia initially present as?
influenza with respiratory symptoms appearing and/or worsening 12 to 36 hours after onset
The older or debilitated patient may not have classic symptoms of pneumonia. What might the symptoms be?
confusion or stupor (possibly related to hypoxia)
hypothermia rather than fever
What are some nonspecific clinical manifestations?
diaphoresis, anorexia, fatigue, myalgias, and headache
On physical examination fine or coarse crackles may be present and patients with pleural effusion may exhibit dullness to percussion over affected area. If consolidation is present what breath sounds may be heard?
bronchial breath sounds:
-egophony: a change in the sound of the voice of the patient and increased fremitus: vibration of the chest wall produced by vocalization.
Why might the diagnosis of pneumonia be missed in a geri patient?
the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult patients
Explain the onset of pneumonia in a geri patient?
general deterioration weakness abdominal symptoms anorexia confusion tachycardia tachypnea hypothermia
What is the supportive treatment for a geri patient?
hydration O2 deep breathing coughing frequent position changes
What is the prevention for a geri patient?
pneumococcal and influenza vaccine
MDR pathogens are a major problem in treatment. What are the risk factors for MDR?
advanced age
immunosupression
history of antibiotic use
prolonged mechanical ventilation