Respiratory Diseases - Pneumonia Flashcards
Give a clinical definition of Pneumonia
- Lung inflammation
- Caused by bacteria or viral infection
- Air sacs fill with pus and may become solid (filled with micro-organisms, fluid and inflammatory cells)
- Infection of lung tissues (opposed to bronchitis => infection of bronchi)
- alveoli air is replaced with microorganisms, fluid and inflammatory cells
How is pneumonia transmitted?
- airborne microbes from an infected individual are inhaled or more commonly self infected by bacteria already present in the nose
- can be classified as:
- community acquired (developed outside hospital)
- hospital acquired pneumonia (develops more than 48 hours after hospital admission)
- aspirational pneumonia (result of aspiration after inhaling a foreign material e.g. food)
- can be: bacteria, viral or fungal (fungal difficult to treat due to depth in lungs + damp)
Why is Pneumonia significant to scoliosis?
- Scoliosis will compromise bronchi and lungs (de-kink) potentially leading to an increased risk of pneumonia as microbes can travel further down into alveoli
What are the Clinical Signs and Symptoms of Pneumonia?
- cough-dry or produce thick yellow, green, brown or blood-stained mucus
- difficulty breathing
- rapid or shallow breathing, may feel breathless even when resting
- rapid heartbeat
- high temp
- generally unwell - sweating & shivering
- loss of appetite
- chest pain that gets worse with breathing or coughing
- haemoptysis (coughing up blood)
- headaches
- fatigue
- feeling sick or being sick
- wheezing
- joint and muscle pain
- feeling confused & disorientated particularly in elderly people
What are the severe symptoms of pneumonia?
- haemoptysis
- feeling confused & disorientated particularly in elderly people
- significant difficulty breathing
- chest pain that is worsening
What are the complications of Pneumonia?
- babies, infants, elderly, smokers
- people with other conditions e.g. asthma, cystic fibrosis, heart, kidney or liver conditions
- weakened immune system e.g. flu, alcoholic, HIV, AIDS, chemotherapy, meds for transplant
- pleurisy (inflammation of the pleural sounding the lungs) - thin linings between lungs and rib cage (pleura) become inflamed => respiratory failure
- lung abscess - rare complication, mostly seen in people with pre-existing illness or Hx of severe alcohol misuse (tend to vomit, expiate vomit back into lungs - lying down drunk - immune system is down)
- blood poisoning (septicaemia) - rare but serious
What are the risk factors for Pneumonia?
- babies, infants
- elderly people
- smokers
- other health conditions e.g. asthma, cystic fibrosis, heart, kidney or liver conditions
- weakened immune system e.g. flu, alcohol dependency, HIV, AIDS, chemotherapy, taking meds after an organ transplant
How would you explore your suspicions of Pneumonia?
- case history
- occupation
- how is the patent generally (checking for wheeze, cough, smoking)
- previous episodes of pneumonia
- hospital admission
- cough - production or otherwise
- duration of cough
- breathlessness
- change in respiratory rate
- chest pain, worse on breathing or coughing
- raised temperature
What would you observe in a patient with pneumonia?
- cough, productive or otherwise
- duration of cough = 2/3 weeks
- breathlessness, change in respiratory rate
- chest pain, worse on breathing or coughing
- raised temperature
- pallor
- sweating
- generally looking unwell
- onion breath
What physical examinations would you perform on a patient with pneumonia?
- take the PT temperature
- auscultate their lungs (cracking over alveoli)
- percuss their lungs (stony dullness over alveoli)
- cardiovascular as lots of cross over between heart and lungs
Tests/examinations available for pneumonia?
- refer!
- chest x-ray
- blood tests if symptoms haven’t responded w/i 48 hours
- antibiotics, NSAIDs, aspirin
Case History:
Donna is a 42 yo flight attendant who has specialised in long haul flight for the last 12 years. She’s of average heigh and weight. She was diagnosed with an idiopathic scoliosis at 14 yo when she went to see her GP because she was suffering with HA. She was regularly monitored by an orthopaedic consultant for several years but because the scoliosis seemed stable she had no active treatment.
Donna has recently felt unwell, with shortness of breath, rapid breathing and feeling sweaty. She had a similar experience 2 years ago, but didn’t see the doctor for treatment.
What is her diagnosis and justify your answer
Diagnosis: Pneumonia
- Higher risk due to scoliosis; unravels bronchioles allowing microorganisms to get deeper into the lungs
- Has happened twice in 2 years, more likely to have aspirational pneumonia
- Works on long-haul flights where the cabin is pressurised and air is recirculating
- Contact with multiple people
What is the epidemiology of pneumonia?
- major cause of death among all age groups
- 4th leading cause of death in world (2016)
- children, older adults, alcoholics, substance abusers particularly at risk
Describe the location of the lungs:
- 2 lungs: right and left lungs
- apex of lungs are 2.5cm above the clavicle
- 3 lobes on right
- 2 lobes on left
- Anteriorly: midsternal line = finish at rib 6
- Anteriorly: Axillary line = finish at rib 10
- Anterolaterally = finish at rib 6
- Posterolaterally = finish at rib 9
- Posteriorly: Vertebral line = finish at rib 9
- Posteriorly: Scapula line = finish at rib 9
What medications are commonly prescribed to treat pneumonia?
- antibiotics
- NSAIDS (anti-inflammatory 3-5 days to be effective and need to be taken regularly)
- Aspirin
