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not my original words,from instructor notes, from Egan's Fundamental's of Respiratory Care 10th edition, Clinical Manifestation and Assessment of Respiratory Disease

Lobar pneumonia

involves an entire lobe of the lung

Double Pneumonia

aka Bilateral Pneumonia, Involves both lungs

Walking Pneumonia

A mild case of Pneumonia

C.A.P. /Community Acquired Pneumonia

Pneumonia Contracted in an outpatient Setting

H.A.P./ Hospital Acquired Pneumonia

Develops after 48 hours of admission,excludes C.A.P.
,is THE 2ND MOST COMMON NOSOCOMIAL INFECTION IN THE U.S.

HCAP/ HealthCare-Associated Pneumonia aka Nursing Home Acquired Pneumonia

often caused by MRSA

According to Egan's Hospital Acquired Pneumonia is defined as

a lower respiratory tract infection that develops in hospitalized patients more than 48 hours after admission and excludes community acquired infections that are incubating at the time of admission

BACTERIAL PNEUMONIA

Often occurs after an Upper Respiratory Infection such as a cold or flu

Early Signs of Bacterial Pneumonia are

Shaking chills, Shaking, high fever, sweating, chest pain, increased RR and productive cough

Bacterial Pneumonia is divided into 3 categories of causative organisms

Gram Positive, Gram Negative and Anaerobic organisms

Ventilator Acquired Pneumonia/ V.A.P.

a lower Respiratory tract infection that develops more than 48-72 hours after endotracheal intubation

What is the most common cause of Bacterial Pneumonia?

Streptococcal pneumonia a gram positive organism, is responsible for more than 80% of all bacterial pneumonia, transmitted by aerosol from a cough or sneeze,with most strains being sensitive to penicillin and its derivatives

How many Causes are there of Pneumonia

Etiology: There are over 30 causes of Pneumonia

There are two gram positive bacterial causes of Pneumonia other than Streptococous pneumoniae which are

Staphylococcus aureus which is typically responsible for most "Staph" infections and Staphylococcus epidermidis ( and or Staphylococcus aureus) which is part of Normal Skin Flora

Staphylococcal pneumonia typically follows what type of infection?

A viral infection,

What patient population is Staphylococcal Pneumonia found in ?

Staphylococcal pneumonia is most often found in Children and Immunosuppressed Adults and can be transmitted directly by aerosol through a cough or sneeze or indirectly by contaminated objects.

Hospital acquired pneumonia is often caused by what organism?

Staphylococci and is increasingly becoming antibiotic resistant

MRSA stands for

Multiple Drug- Resistant S. aureus

What is the most common cause of epiglottitis in small children and /or a secondary pneumonia after a viral infection?

Haemophilus influenza (Gram Negative Organism)

Haemophilus influenzae is transmitted by

aerosol or contact with contaminated objects

There are 7 Gram Negative organisms responsible for bacterial pneumonia, what are they?

Haemophilus influenza, Klebsiella pneumonia, Pseudomonas aeruginosa, Moraxella caterrhalis, Escherichia coli, Serratia species and Entrobactter species

Pseudomonas aeruginosa is a gram-Negative organism that frequently cultured from the respiratory tract of the chronically ill and is

green and sweet smelling

Moraxella catarrhalis is a natural inhabitant of the human pharynx and it is the 3rd most common cause of:

exacerbation of chronic bronchitis

Escherichia coli is a natural inhabitant of the intestinal tract and sometimes causes

nosocomial pneumonias

There are four atypical organisms responsible for bacterial pneumonia, they are :

Mycoplasma pneumonia, Legionella pneumonphila, Chlamydia psittacosis andChlamydia pneumonia

Mycoplasma pneumonia , an atypical organism commonly causing a mild bacterial pneumonia seen in what patient population and what time of year

Mycoplasma pneumonia is seen in people younger than 40 during late summer and early fall

Legionella pneumophila , an atypical organism found in soil and water , is most commonly the cause of a bacterial pneumonia in what patient population?

Legionella pneumophila is most commonly seen in middle aged males that smoke ( responds to erythromycin)

Legionella pneumophila is an atypical organism found in soil and water which is transmitted when

it becomes airborne in small places where people gather such as airplanes, but has not been proven to be communicated from person to person

Approximately half of all pneumonias are caused by

viruses

Viral pneumonias tend to start with what type of symptoms?

flulike signs and symptoms such as a dry /nonproductive cough, headache fever, muscle pain and fatigue.

As Viral Pneumonia progresses, the patient may have signs and symptoms that move from flulike symptoms to

shortness of breath, cough producing a small amount of clear or white sputum

Viral pneumonia carries a risk of developing

a secondary bacterial pneumonia

Causes of viral pneumonia are

Influenza Virus, Respiratory Synctial Virus , Parainfluenza Virus, Adenoviruses, Severe Acute Respiratory Syndrom ( SARS )

Influenza Virus commonly occurs in the winter months and is transmitted by

person to person through aerosol droplets, usually causing a upper respiratory infection that can develop into a lower respiratory infection

Respiratory Syncytial Virus ( RSV) is commonly seen in what patient population?

RSV is commonly seen in children less than 6 months of age and in the elderly, and is transmitted by aerosol from person to person or through contaminated objects

Parainfluenza Virus is typically the cause of

croup in children who can gain relief from symptoms by being put in a car with air conditioning. Cool dry air .

Severe Acute Respiratory Syndrome (SARS) first appeared in China in 2002 and is believed to be caused by

a newly recognized viral strain called coronavirus

Other causes of pneumonia are :

Rickettsial Infections, Varicella ( Chicken Pox) and Rubella ( measles )

Aspiration pneumonitis can cause pneumonia through

aspiration of gastric contents with a pH of 2.5 or less causing oropharyngeal secretions and gastric fluids colonized by anaerobic pathogen to introduced to the lower respiratory tract.

Aspiration pneumonia can progress into

ARDS

There are 3 types of Aspiration Pneumonia, which are

Toxic injury to the lung due to gastric acid, obstruction by ways of foreign bodies or fluids and infection

What is the initial hypoxemia associated with Aspiration Pneumonitis

the aspiration of gastric content

Low pH (1-1.5)of gastric contents in Aspiration Pneumonitis causes irreversible damage to the

parenchyma

The advantage to a higher pH in aspiration contents is

the damage in a pH of (>5.9) is reversible

What can food aspiration cause?

obliterative bronchiolitis with granuloma formation ( with the presence of dense collagen in the walls or lumen of the small airways)

Aspiration is typically caused by

dysplagia

Other causes of Pneumonia are

Lipoid Pneumonitis, Pneumocystis Carinii Pneumonia, Cytomegalovirus, Fungal Infections, Tuberculosis, Anaerobic organisms

Anatomic Alterations associated with Pneumonia are

Alveolar consolidation, increased Alveolar-capillary Membrane Thickness, Atelectasis, Excessive Bronchial Secretions( during resolution stage)

Vital Signs associated with Pneumonia are

Increased RR (due to stimulaton of peripheral chemoreceptors, decreased lung compliance,stimulation
of J receptors, Pain, Anxiety,fever )
Increased HR, Cardiac Output and Blood Pressure
Chest Pain, decreased chest expansion
Cough, Initially dry and hacking , more productive as secretion move toward larger bronchi,
Hemoptysis due to RBC

Chest Assessment will show

palpation= increased tactile fremitus
Percussion= dull
Auscultation = Bronchial breath sounds, crackles,pleural friction rub, Whispered pectoriloquy

PFT shows primarily what kind of process?

Show predominantly restrictive disease process

ABG in a mild to moderate pneumonia will reveal

Acute Alveolar hyperventilation with hypoxemia ( uncompensated respiratory alkalosis)

ABG results in a severe pneumonia will reveal

Acute Ventilatory Failure with hypoxemia (uncompensated respiratory acidosis)

CXR can show

increased density, air bronchograms and Pleural effusions

A CT can show

Alveolar consolidation and air bronchograms

While examining the CXR, the presence of Right middle lobe infiltrates will obscure

the right heart border

While examining the CXR, the presence of lower lob infiltrates will obscure

the right diaphragm

While examining the CXR, the presence of lingular infiltrates will obscure

the left heart border

While examining the CXR, the presence of left lower lobe infiltrates will obscure

the left diaphragm

Air Bronchograms on the CXR appear as

an outline of air-containing bronchi beyond the normal point of visibility and develop as a result of an infiltration or consolidation that surround the bronchi, producing a contrasting air column on the radiograph

Respiratory Care Management of Pneumonia includes

Oxygen, Bronchial Hygiene Therapy, and Hyperinflation

Medical management of Pneumonia includes

Antibiotics , Analgesics, Ribavirin if RSV infection is involved, Aerosolized Pentamidine if PCP present

Management of a Pleural Effusion includes

Thoracentesis ; Fluid analysis

Thoracentesis

= perforation of chest wall with needle for the aspiration of fluid from a pleural effusion for diagnostic or therap putic purposes or for the removal of a specimen for biopsy

Fluid analysis from a pleural effusion includes

Color, odor, RBC count, Protein, Glucose, LDH, Amylase, pH, Wright, Gram's and AFB stains, Aerobic, anaerobic TB and fungal cultures, Cytology

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