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.
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
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
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
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
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)
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
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
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
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.
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
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)
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
Auscultation = Bronchial breath sounds, crackles,pleural friction rub, Whispered pectoriloquy
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)
While examining the CXR, the presence of Right middle lobe infiltrates will obscure
the right 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
= 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