Pneumonia study Flashcards
Name the 3 categories of bacterial pneumonia.
Gram +
Gram -
Anaerobic (such as that caused by aspiration of oropharyngeal secretions)
Define bacterial pneumonia.
Infection of the airspace including the lung parenchyma & area of gas exchange; often evidenced by cough, consolidation, and other changes in the lung
T or F: Pneumonia is an obstructive disease.
False; Pneumonia is a restrictive disease
Describe the pathophysiological mechanism of pneumonia and the bodies response. Name 3 main points.
1 The body amounts an immune response when it detects a micro-organism–this may manifest in a the symptom of fever
2 This results in decreased V/Q ratio: Hypoxemia, increased venous admixture, increased pulmonary shunting
3. Then decreased lung compliance due to increased lung density (consolidation)
What changes does a person infected with pneumonia experience in vital signs?
Increases in: Heart Rate Respiratory Rate Blood Pressure Temperature Cardiac Output
During inspection of a patient with pneumonia what will you see?
Chest excursion
Decreased chest expansion
Increased breathing pattern
What do you find on palpitation?
Tactile fremitus is increased
T or F: Chest pain is a normal symptom of pneumonia that often radiates down the arm.
False; Chest pain is a symptom of pneumonia but does not radiate
Why is percussion dull with pneumonia patients?
Due to alveolar filling and pleural effusion
T or F: Atelectasis and pneumonia often exist together?
True; it can be evidenced by the sounds of crackles during auscultation
T or F: Whispering pectoriloquey describes a sign of pneumonia which means that during auscultation when you listen to sound of the patient it becomes muffled and diminished due to consolidation of liquid in the alveoli.
False; In pneumonia the sound becomes louder & clearer as it goes through liquid
Describe the findings you would expect to see on an xray of a lung infected with pneumonia:
- Increased alveolar density appearing white on xray where it should not, liquid appears on the xray as white opacity where normally would be black
- Bronchograms: black branching on white border; often evidenced with a border when confined to one lobe
- Obscuring of the heart and/or its border
What is the normal plan of action to treat pneumonia when first diagnosed?
Monitoring saturation to keep above 90%
Antiobiotics to treat infection
Hydration
A pneumonia has a blood gas as follows:
pH 7.50
CO2 29
HCO3 30
PaO2 =36
SaO2 = 69%
Describe what phase is the patient exhibiting?
A. Severe pneumonia
B. Acute Ventilatory Failure superimposed with hypoxemia
C. Acute Alveolar Hypoventilation with hypoxemia
D. Acute alveolar hyperventilation superimposed with hypoxemia
D. Acute alveolar hyperventilation superimposed with hypoxemia
T or F: Pneumonia often causes a decrease in lung compliance which will result in an increase in the work of breathing.
T: A decrease in lung compliance will = an increase in the WOB; inversely related
If a patient experiences increased airway resistance they will respond by:
1. The patient will slow their RR and increase the tidal volume to respond to increased airway resistance
2. The patient will take big breaths and have a small flow rate
3. Patient will change the minute volume to respond to changes caused by airway resistance
4. The patient will maintain minute volume but change the breathing pattern
A. 1 & 2
B. 1, 2, 4
C. 1, 2, 3, 4
D. 1 & 4 only
B. 1, 2 & 4
In response to increased airway resistance a patient will respond by slowing RR and increasing tidal volume; taking big breaths and having a small flow rate
Maintaining minute volume but change the breathing pattern
When a person experiences a decrease in lung compliance how will this be exhibited?
A. Increase in RR
B. Decrease in RR & tidal volume
C. Increase in RR and decrease in tidal volume
D. Increase in RR and tidal volume
C. Increase in RR and tidal volume
This pneumonia patient had a blood gas drawn with the following results:
pH 7.24
PaCO2 55
what does this indicate?
Acute alveolar hyperventilation with hypoxemia or severe stage pneumonia
What is the formula for compliance?
RR x Vt
T or F: The first stage of pneumonia the patient exhibits a productive cough
False; Normally it is barking & non productive and then progresses to purulent, blood streaked sputum
What causes the rust color often seen in the sputum of a pneumonia patient?
Fluid moving from pulmonary capillaries into alveoli due to effects of inflammatory response; also some rbc emter
Commonly when evaluating the effects on pneumonia which way would you expect to see the oxyhemoglobin disoacciation curve to turn? Is it on steep or flat part? And how does this affect affinity?
The curve will shift to the right and stay longer on steep part; It has diminished affinity for O2; easy to unload O2 but not load; therefore hb due to increase temp not holding O2
Why is it uncommon not to see a productive cough when a person becomes infected with pneumonia?
Because it takes time for the secreation to reach the larger bronchi where it can be secreted
Name 4 manifestations that result from pneumonia?
Alveolar Consolidation
Increased alveolar capillary membrane thickness
Atelectasis
Excessive bronchial secreations