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Pneumonia

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