Term
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Definition
| an infection of the alveoli, distal airways and the interstitium of the lungs |
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Term
| how can microorganisms enter the lungs? |
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Definition
| direct extension from the mediastinum or subphrenic space (unusual), hematogenous seeding from extrapulmonary sources, inhalation of these microorganisms into the lower airways or aspiration of organisms from the oropharyngeal contents (most common) |
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Term
| host defenses to counteract microbial invasion into the lungs |
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Definition
| mechanical and structural (nose filtering, coughing, gag reflex, branching of airways, mucociliary clearance), normal flora competes for space, cellular (macrophaces- tissue white blood cells involved with cleaning up cellular debris in organisms, epithelial cells and neutrophils), humoral and molecular (immunoglobuling, IgG, IgA, cytokenes, colony-stimulating factors) |
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Term
| two big groups of pneumonia |
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Definition
| community-acquired pneumonia and health care-associated pneumonia (hospital-acquired and ventilator-associated) |
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Term
| number one organism for community-acquired pneumonia |
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Definition
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Term
| community-acquired pneumonia microorganisms |
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Definition
| Strep pneumoniae, Mycoplasma, Haemophilus influenza, Chlamydia, viruses |
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Term
| hospital-acquired pneumonia |
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Definition
non-icu- brough in, mycoplasma, chlamydia, haemophilus, also Legionnaire's
icu- Staph aureus, Legionnaire's |
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Term
| pt risk factors and organisms for pneumonia |
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Definition
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Term
| risk factors for community acquired pneumonia |
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Definition
| alcoholics, patients with asthma, immunosuppression, HIV/AIDS, leukemia, lymphoma patients, chronic steroid users, post-chemo therapy, anyone institutionalized, nursing homes, long-term care settings, prisons, hospitals, jails, age over 70, history of dementia, seizure disorder, biggest one is smoking |
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Term
| clinical manifestations of pneumonia |
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Definition
| mild to full-blown leading to sepsis or fatal symptoms, typically fever, tachycardia, chills, sweats, if shaking like more unusual like TB, productive/nonproductive cough, shortness of breath, pleuritic chest pain, nonspecific things, fatigue, headache, muscle aches, pains |
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Term
| physical exam findings for pneumonia |
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Definition
| inc RR, using accessory muscles for respirations, signs of consolidation, dullness to percussion, increase to tactile fremitus, crackles, bronchial breath sounds on auscultation, rales, may have an infusion as well (decreased tactile fremitus and flat percussion) |
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Term
| things that mimic community-acquired pneumonia |
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Definition
| pts w pulmonary edema, pulmonary infarcts, pulmonary embolism |
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Term
| criteria we look for to diagnose pneumonia |
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Definition
| cough, tachycardia HR>100, elevated RR or tachypnea, RR>20., fever, temp >37.8, at least one abnormal chest finding on exam (dec breath sounds, rhonchi, crackles, wheezing), key thing is new x-ray infiltrate with no clear alternative diagnosis such as history of lung cancer or history of pulmonary edema |
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Term
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Definition
| bacterial causes for our pneumonia |
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Term
| bilateral interstitial infiltrates, fluffiness throughout indicates |
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Definition
| Mycoplasma pneumonia, viral pneumonias, or PCP (pneumocystis) pneumonia in HIV/AIDS patients |
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Term
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Definition
| fungal or lung cnacer or metastatic disease of the lungs from a cancer somewhere else |
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Term
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Definition
| Histoplasmosis or tuberculosis |
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Term
| diagnostic tests for pneumonia |
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Definition
| gram stain and sputum culture. look for >25 neutrophils and less than 10 SECs per LPF, sputum culture sensitivity and specificity is less than 50%, greatest benefit is to alert us to unusual organisms |
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Term
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Definition
| stable vital signs, RR under 30, pulse<125, BP adequate, temp under 40, if comorbid condition it's stable |
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Term
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Definition
| vital signs inc, RR inc, pulse inc, temp over 40, x-ray findings may show multilobes involved, progression has spread within the last 24 hours, may be an abscess formation, may hav pleural effusion on chest x-ray, suspected aspiration, extra pulmonary findings, unstable comorbid condition |
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Term
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Definition
| all categories under moderate plus impending or frank respiratory failure, signs of hypoxia, low PaO2s, inc PaCO2, trouble ventilating, starting to retain CO2, or start to drop systolic or diastolic BP, urine output drops, altered mental status |
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Term
| if low risk CAP how do you treat |
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Definition
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Term
| if high risk CAP how do you treat |
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Definition
| )signs of shock, hypoperfusion, hyptension, AMS, dec urine output) put in ICU |
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Term
| if a pos lab or physical exam finding but no sign of possible impending shock how do you treat |
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Definition
| mod risk CAP, hospitalize but put on general floor |
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Term
| antibiotic to use for low risk CAP |
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Definition
| macrolide, oral (clarithromycin or azithromycin, niacin or doxycycline) |
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Term
| low risk CAP but had a comorbid or antibiotics in last 3 months what antibiotic to use? |
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Definition
| respiratory fluoroquinolone like levofloxacin or beta-lactam like amoxicillin or one of the cephalosporins |
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Term
| antibiotic for mod risk CAP |
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Definition
| fluoroquinolones, levofloxacin IVor combination of using a IV beta-lactam like ceftriaxone/Rocephin plus a macrolide (azithromycin or clarithromycin) |
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Term
| antibiotic for high risk CAP |
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Definition
| beta-lactam plus azithromycin or a fluoroquinolone in ICU |
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Term
| if you're worried about pseudomonas w CAP what additional coverage should you use |
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Definition
| an antipsudomonal beta-lactam, piperacillin combination with tazobactam, 3rd gen cephalosporin- ceftazidime, fluoroquinolones- ciprofloxacin and levofloxacin, may also want to add an aminoglycoside- tobramycin or gentamicin or combo one one antipsudomonal beta-lactam plus an aminoglycoside plus an antipseudomonal fluoroquinolone |
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Term
| antibiotics to add if worried about MRSA w CAP |
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Definition
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Term
| treatment besides antibiotics for CAP |
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Definition
| IV fluids, oxygen therapy if hypoxic (keep O2 sats above 96%), may need to ventilate them |
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Term
| if pneumonia fails to improve within 1st 48-72 hrs think what? |
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Definition
| non-infectious? caner? pulmonary embolism? resistant pathogen? wrong drug? unusual pathogen?respiratory failure, shock, multiorgan system failure, bleeding disorders, exacerbating comorbid diseases |
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Term
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Definition
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Term
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Definition
| infections can spread to brain, heart, other parts of lung and body, can wall off infection and develop lung abscess then pleural effusion |
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Term
| how do we know if pts w pneumonia are getting better? |
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Definition
| fever decline wi 48-72 hrs (normalize wi 5 days), respiratory rate back to nromal, appetite improved, able to maintain own fluid status? , crackles on luing exam could take a few days to go away, white count should drop after 3-4 days, CRP will go down pretty rapidly within a day or two, can take chest x-ray up to 3 months to clear |
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Term
| mortalities based on risk group |
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Definition
| low risk 5% mortality, high risk 36% |
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Term
| health care-associated pneumonia definition |
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Definition
| occurs in pts what have been hospitalized for 2 or more days within 90 days of present infecxtion |
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Term
| ventilator-associated pneumonias |
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Definition
| pneumonias that arise more than 48 to 72 hours after endotracheal intubation |
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Term
| hospital acquired pneumonia |
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Definition
| pneumonia that occurs 48 hours or more after admission |
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Term
| other organisms for hospital acquired pneumonias |
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Definition
| MRSA, Enterobacteriaceas, E. colis, Klebsiella, Proteus, Enterobacter, Pseudomonas |
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Term
| how do pts acquire hospital acquired pnuemonia? pathophys? |
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Definition
| colonization of the upper airway with these organisms found in the hospital and then they aspirate, may have been sleeping lying flat, tend to have compromised host defenses in the hospital |
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Term
| clinical manifestations for hospiral or healthcare associated pneumonia |
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Definition
| same as CAP but also worsening oxygenation (O2 sats go donw) and increased minute ventilation (starting to breathe a little bit faster) |
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Term
| antibiotic treatment for HAP |
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Definition
| if no risk factors for MDR pathogens, ceftriaxone IV (rocephin) or one of the fluoroquinolones (moxifloxacin, ciprofloxacin, levofloxacin) or ampicillin or ampicillon/sulbactam. if risk factors for MDR, add anti-pseudomonas coverage, a beta-lactam, ceftazidime, aminoglycoside for more gram neg coverage (Gentamicin, tobramycin) or ciprofloxacin or levofloxacin (not moxi) or vancomycin, not unusual to be on 3 drugs |
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Term
| patients may fail to improve w HAP due to |
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Definition
| multi drug resistant pathogen, reintoduction of microbes or new, super infection, extra pulmonary infections, drug toxicity |
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Term
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Definition
| death, necrotizing pneumonia (eating away at lung tissues) |
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Term
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Definition
| 50-70%, goes up with the presence of other underlying disorders |
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Term
| when to switch to oral antibiotics in HAP |
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Definition
| less cough and reduction in respiratory distress, RR back to normal, pt's been afebrile for at least 24 hrs, etiology was not a high-risk pathogen, no unstable co-morbid condition, no obvious reason for continued hospitalization |
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Term
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Definition
| better nutrition, reduction of smoking and smoke pollution, sitting up, immunizations (everyone over 6months who doesn't have a contraindication should get a flu shot) |
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Term
| flu shot for certain populations |
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Definition
| history of hives after exposure to eggs should receive the age-appropriate influenza vaccine, history of egg alergy w angioedema or respiatory distress or needed epinephrine may receive the age-appropriate agents as well but need to monitor them in an office after. pregnant women should receive the inactivated influenza vaccine |
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Term
| pneumococcal vaccine recommendations |
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Definition
| immunocompetent >65 PCV13 and PCV23 1 year later. adults if 2 or more doses of 23 are indicated the interval should be at least 5 years and no additional PCV23 if rec'd at 65 or older. if pt can't tell you, start series over again |
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Term
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Definition
| all children younger than 5 in US, usually given to babies starting at 2 month, can immunize older kids and adults if worred about certain medical conditions/have dec immune system function |
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