Pneumonia

Question 1

what is pneumonia

Answer 1

acute infection of the lower respiratory tract due to infectious agents, therefore causing consolidation of the affected tissue

Question 2

what are 3 anatomic alterations of the lung in pneumonia

Answer 2

• Inflammation of the alveoli
• Alveolar consolidation
• Atelectasis (e.g., aspiration pneumonia)

Question 3

What is CAP?

Answer 3

community acquired pneumonia

Question 4

what is the characteristic of CAP?

Answer 4

infection occurs in a previous healthy individual or somebody with COPD

• a syndrome in which acute infection of the lungs develops in persons who have not : 1) been hospitalized recently and have not 2) had regular exposure to the health care system

Question 5

what is HAP?

Answer 5

hospital acquired pneumonia

Question 6

what is the characteristic of HAP?

Answer 6

• develops 2 or more days after admission to hospital for some other reason
• occurs 24 hours or more after admission, which was not incubating at the time of admission
• pneumonia is a 2nd infection in patient with other disease

Question 7

what is CAP caused by

Answer 7

streptococcus pneumonia

Question 8

what is VAP

Answer 8

ventilator associated pneumonia that arises more than 48-72 hours after ETT intubation

Question 9

what is HCAP?

Answer 9

• health care associated pneumonia
• patient that was hospitalized within 90 days of infection
• -> reside in nursing home LTC facility; received IV antibiotics, chemotherapy or wound care within 30 days of the current infection

Question 10

what is the etiology of pneumonia

Answer 10

1. host upper and lower respiratory tracts are overwhelmed by micro-organisms
2. lead to a production an inflammatory response that affects gas exchange

Question 11

what is the mechanism that lead to pneumonia

Answer 11

1. Aspiration of “upper airway” secretions
2. Inhalation of droplets
3. Dissemination of pathogens by blood

Question 12

what are the risk factors of pneumonia

Answer 12

• ineffective cough
• elderly
• immunocompromised
• intubation

Question 13

what are the 2 bacteria causes of pneumonia

Answer 13

1. Gram-positive organisms(round)
   - Streptococcus
   - Staphylococcus
2. Gram-negative organisms(rod)
   - Hemophilus influenzae
   - Klebsiella pneumonia

Question 14

what are some atypical cause of pneumonia

Answer 14

Chlamydia
Legionella
Mycoplasma

Question 15

What is Pneumocystis carinii pneumonia (PCP)?

Answer 15

a lung infection that can affect people with weakened immune systems, such as those infected with HIV

Question 16

What is PCP caused by

Answer 16

fungus

Question 17

what is the treatment of PCP

Answer 17

Trimethoprim-Sulfamethoxazole orally

Pentamidine

Question 18

What is the pathophysiology of pneumococcus pneumonia

Answer 18

1. aspiration of stretptococcus
2. adherence of alveolar macrophage
3. inflammation response
   - ->attraction of neutrophil
   - ->release of inflammatory mediators
   - ->accumulation of RBC and bacteria
4. red heparization
   - red blood cells, neutrophils, and fibrin in the pulmonary alveolus/ alveol
   - lead to consolidation of lung parenchyma
5. grey heparization
   - deposition of fibrin on pleural surfaces
   - phagocytosis in alveoli
6. resolution of infection
   - ->macrophages in alveoli
   - ->removed by lymphatics

Question 19

what cause aspiration pneumonitis or lead to it

Answer 19

• gastic aspiration due to GERD (Gastroesophageal reflux disease)
• food
• asthma/osa (huge effor to breath–>aspirate acid)
• may lead to ARDS within 24hrs

Question 20

what is the treatment of aspiration pneumonitis

Answer 20

bronchio-alveolar lavage (BAL)

Question 21

What are the type of pneumonia based on lung location

Answer 21

1. Broncho-pneumonia
   - ->Patchy pattern limited to segmental bronchi
2. Lobar Pneumonia
   - ->Widespread or diffuse alveolar inflammation & consolidation
3. Interstitial Pneumonia
   - ->Usually diffuse & typically associated with viruses or infections with mycoplasma

Question 22

characteristic of Bronchopneumonia

Answer 22

• a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
• involves both lungs (bilateral) and non-homogenous patchy infiltrates surrounding one or more bronchi

Question 23

what is the characteristic of lobar pneuomna

Answer 23

• not limited to – segmental boundaries, but can spread throughout entire lobe
• a widespread or diffuse alveolar inflammation and consolidation.
• the end result of a severe or long-term bronchopneumonia in which the infection has spread from one lung segment

Question 24

what is the characteristic of Interstitial Pneumonia

Answer 24

inflammatory process within interstitial walls (connective tissue) rather than alveolar spaces

patchy densities often bilateral and diffuse in distribution

associated with infections with Mycoplasma pneumonia or viruses

Question 25

What is the change in vitals signs in patient with pneumonia

Answer 25

SNS effect - increase RR, HR, CO, BP - decrease Spo2 - increase temperature

Question 26

What are the findings in physical assessment

Answer 26

- Chest pain (pleuritis or i.c. muscle)/decreased chest expansion - Cyanosis - Cough (dry early), sputum production, and hemoptysis Chest assessment findings - Increased tactile and vocal fremitus - Dull percussion note - Bronchial breath sounds - Crackles and rhonchi - Pleural friction rub - increase Whispered pectoriloquy

Question 27

What is a typical ABG of mild to moderate pneumonia

Answer 27

Acute alveolar hyperventilation with hypoxemia - increase ph - decrease Paco2 - decrease Hco3 (slightly) - decrease Pao2

Question 28

What is a typical ABG of severe pneumonia

Answer 28

Acute ventilatory failure with hypoxemia ph:decrease Paco2: increase Hco3: decrease slightly Pao2: decrease

Question 29

what are some chest radiological findings in pneumonia

Answer 29

- Increased density - Air bronchograms - Pleural effusions

Question 30

how about CT scan

Answer 30

Consolidation and bronchograms

Question 31

what are the symptoms of pneumonia

Answer 31

* Cough * Fever * Sputum production * Pleuritic chest pain

Question 32

what are the signs of pnuemonia

Answer 32

* Chest x-ray infiltrates * Physical exam: * Crackles * Pulse oximetry * Tachypnea * Tachycardia * Diminished breath sounds

Question 33

how to prevent VAP?

Answer 33

via VCB

Question 34

What are the 4 components of VCB

Answer 34

* Elevation of the head of the bed * Daily sedation hold * Gastric ulcer prophylaxis * DVT prophylaxis

Question 35

What is the management of pneumonia

Answer 35

bronchscopy--> to obtain the secretion Use higher peep for mechanically ventilated patient

Question 36

what is the complication of pneumonia

Answer 36

- VAP - reduce lung volume - sepsis - organ failure

Question 37

What are RT roles in pnuemonia

Answer 37

- Collection of sputum samples - Assist with bronchoscopy, monitoring, auscultation, medication delivery - Oxygen, ventilation & ABG’s - Counsel patients in sputum clearance techniques such as PEP & autogenic drainage - Model optimal infection control practices and prevent nosocomial by handwashing