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PM2C: Therapeutics and Patient Care: Summer > Respiratory: Pneumonia > Flashcards

Respiratory: Pneumonia Flashcards

1
Q

What is pneumonia? And how is it characterised?

A
  1. Inflammation of the lung parenchyma of infective origin (lower respiratory tract)
  2. Characterised by consolidation (radiographic x ray shadowing)
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2
Q

What is the pathophysiology of pneumonia alveoli compared to a normal one?

A

Infected: (lower lobe of left lung)

  • Inflammation of alveolar wall
  • Fluid and pus filled air space containing bacteria/blood cells

Normal: (upper left lung)

  • Bronchiole (tiny air ways)
  • Healthy Alveoli (airspaces)
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3
Q

What is primary pneumonia? What pathogens cause it?

A
  1. Patient without risk factors (infection occurs as bacteria like growing in mucus)
  2. Pathogens: bacteria (gram postitive) and viruses
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4
Q

What is secondary pneumonia? What pathogens cause it?

A
  1. Patient has risk factors that predispose for pneumonia
  2. Risk factors: COPD, HIV (compromised immune system), aspiration of gastric acid
  3. Pathogens: Herpes virus, fungi and anaerobial bacteria
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5
Q

What different sections can pneumonia localise itself in the lung?

A
  1. Bronchioles
  2. Lobar: lower long
  3. Interstitial: between alveoli
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6
Q

What are the three clinical ways pneumonia is classified?

A
  1. Community acquired pneumonia:
    - Infection occurs during normal life from nursing homes etc
  2. Hospital acquired pneumonia:
    - Infection acquired within hospital 48 hours or more after admission
  3. Aspiration pneumonia:
    - Caused by inhalation of stomach content
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7
Q

Who are mainly at risk from community acquired pneumonia?

A
  1. Infants 2 years and younger or patients 65 and older (weak immune system)
  2. Living and working in nursing home or in contact with children
  3. Smoking (passive included)
  4. Pre-existing pathological conditions (COPD, stroke). Less movement leads to build up of mucus.
  5. Influenza
  6. Hospitalisation in previous 5 years
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8
Q

What is the main cause of pneumonia?

A

Streptococcus Pneumoniae

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9
Q

What are the typical symptoms of community acquired pneumonia?

A
  1. Temperature is higher than 38 degrees
  2. Cough
  3. Purlent/ blood stained/ rusty coloured sputum
  4. Malaise

Sometimes:
1. Pleural pain

  1. Night sweats
  2. Dyspnea (laboured breathing)
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10
Q

What are the four stages of pneumonia?

A
  1. Consolidation (shadow in x ray picture)
  2. Red hepatization
  3. Grey hepatization
  4. Resolution
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11
Q

How do you diagnose pneumonia?

A
  1. Acute illness in 21 days or more
  2. Cough
  3. Least one symptom of respiratory tract infection:
    - Fever
    - Sputum production
    - Breathlessness
    - Wheeze
    - Chest discomfort or pain
    - acute bronchitis or COPD exacerbation
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12
Q

How do you assess the severity of a patient to see where they are in terms of developing pneumonia?

A
  1. Severity Assessment test that scores for mortality in primary care
  2. 0= low risk
  3. 1-2 = intermediate risk
  4. 3-4 High risk
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13
Q

What questions can be asked to see if a patient is confused or not?

A
  1. Age
  2. Date Birth
  3. Time (nearest hour)
  4. year
  5. Hospital name
  6. Recognition of two people (nurse and doctor)
  7. Address
  8. Date of significant event
  9. Name of monarch
  10. Count backwards

8 or less points = mid confusion

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14
Q

How do you confirm the diagnosis of community acquired pneumonia?

A
  1. Chest X ray
  2. Oxygen saturations
  3. Severity test score
  4. C reactive protein at hospitalisation
  5. Microbiology test: blood and sputum test
  6. Full blood count and liver function tests
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15
Q

What do each of the letters mean in CURB65 for the severity index and mortality assessment?

A

C: confusion

U: Urea more or equal to 7mmol/l

R: Respiratory rate more or equal to 30/min

B: Blood pressure more than or equal to 90mmHg/60mmHg

65: Age 65 or more?

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16
Q

What does a 0 to 1 CURB65 value, severity and treatment site mean?

A
  1. Low risk of death

2. No hospitalisation required for clinical reasons

17
Q

What does a 2 CURB65 value severity and treatment site mean?

A
  1. Moderate severity
  2. Increased risk of death
  3. Hospitalisation and assessment should be considered
18
Q

What does a 3 to 5 CURB65 value of severity and treatment site mean?

A
  1. High severity
  2. High risk of death
  3. Urgent hospital and admission required
19
Q

How do you treat pneumonia? Give examples of some antibiotics used?

A
  1. Empiric treatment with antibiotics
  2. Examples:
    - Betalactams: Amoxicillin
    - Macrolides: Erythromycin
    - Tetracyclins: Doxycyclin
    - Cephalosporins
20
Q

How do you treat patients with low severity community associated pneumonia?

A
  1. 5 day course of single antibiotic
  2. Amoxicillin: first line of treatment
    Macrolide: second line of treatment
    Tetracyclin: second line of treatment
  3. Improvement in 3 days
    if not: seek more medical advice and extend treatment for 2/5 days
21
Q

How do you treat patients with moderate and high severity community associated pneumonia?

A
  1. 7 to 10 day course of dual antibiotic therapy
  2. Moderate: Amoxicillin and Macrolide
  3. High: beta lactams, beta lactamase and macrolide:
    Amoxiclav, cefotaixime and clarithyromycin
  4. Improvement in 1 week, symptoms should steadily improve
22
Q

How do you monitor the efficacy of therapy and discharge the patient?

A
  1. Improvement of clinical presentation seen in 48 to 72 hours

Discharge:
2. Temperature: 37.5 degrees

  1. Heart rate: 100 beats/min
  2. Systolic blood pressure: 90mmHg or more
  3. Oxygen saturation: 90% or more
  4. Normal mental status
  5. Eat without assistance
  6. Need at least 2 of the above criteria
23
Q

What’s the indication for therapeutic failure?

A
  1. Increase of lung infiltration

2. Looking at wrong possible dose, wrong diagnosis

24
Q

When should you use parenteral and oral treatment for pneumonia?

A
  1. Parenteral treatment: severe pneumonina and impaired conciousness
  2. Oral therapy: not as severe
25
Q

What are the other pharmacological and non pharmacological treatments for pneumonia?

A
  1. NSAIDS to relieve pain
  2. Fever reducing agents
  3. Cough suppressant
  4. Salbutamol
  5. Fluids
  6. Oxygen therapy
26
Q

What are the risk factors of hospital acquired pneumonia, diagnosis and causes?

A
  1. Risk factors:
    - Stroke
    - Chronic Lung Disease
    - Mechanical ventilation
    - Recent surgery
    - Previous antibiotic treatment
  2. Diagnosis: Chest X ray
  3. Causes: bacteria and virus
27
Q

Describe the aetiology (causes of a disease) of hospital acquired pneumonia

A

Aerobic gram negative bacilli

28
Q

Describe the treatment options available for hospital acquired pneumonia? And the advantages and disadvantages?

A
  1. Empiric antibiotic therapy: as soon as possible within 4 hours.
    - 5 to 10 day course of therapy
  2. Pros:
    Mortality lower if treatment is effective
  3. Cons:
    - Unnecessary use of extended spectrum anti-biotics
    - Anti-biotic treatment may have to be changed
29
Q

How do you prevent hospital acquired pneumonia?

A
  1. Hand hygiene
  2. Personal protective equipment
  3. Sterilisation or disinfection of equipment and maintenance of instruments
  4. Patient procedures
  5. Anti-microbials
    - Selective decontamination of digestive tract tropical
    - Parenteral agents with activity against gram negative bacilli
  6. Modalitites:
    - Chest physiotherapy
30
Q

How is aspiration pneumonia caused and the factors that may enhance it? (ventilator associated)

A
  1. Caused by aspiration of gastric contents
    - Pneumonitis
    - Infection by bacteria in oropharyngeal secretions
  2. Predisposing factors:
    - Decreased consciousness
    - Hepatic failure
    - Protracted vomiting
    - Neuromuscular disorders e.g. multiple sclerosis, parkinsons
    - Alcohol and drug abuse
31
Q

Explain the important infection pathway in hospital associated pneumonia?

A
  1. Lung tissue necrosis
  2. Secondary infection
  3. Gram positive and Gram negative pathogens
  4. Pneumonia

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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