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pneumonia Flashcards

1
Q

what does the URT consist of?

A

nasal passages, pharynx, larynx

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2
Q

what are the common causes of URTI?

A

Usually from the virus groups:-– Rhinovirus,

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3
Q

what conditions affect the URT?

A
  • Common cold
  • Laryngitis
  • Pharyngitis
  • Laryngotracheobronchitis (Croup)
  • Epiglottitis
  • Sinusitis
  • Tonsillitis
  • Ear - Otitis externa, media, interna
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4
Q

what is sinusitis?

A
  • Inflammation of the paranasal sinuses
  • Symptoms - Nasal discharge/blockage, facial pain, headache, anosmia
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5
Q

when would sinusitis need hospital referal?

A

– Orbital involvement
– Intracranial involvement

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6
Q

how do you manage sinusitis that does not need referal?

A
  • Provide information regarding condition
  • Advise on self management of symptoms
  • Advise on over the counter symptom relief including: – Paracetamol, ibuprofen, decongestants.
  • Advise a clinical review if the condition worsens or becomes prolonged.
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7
Q

who needs to be referred for sinusitis?

A
  • Otherwise well but symptoms lasting longer than 10 days or more with little or no improvement.
    OR
  • Very young, elderly and frail, immunocompromised,
    complicating co-morbidities (e.g. significant heart, lung, kidney disease), persisting fever, chest pain,
    neurological changes.
  • Severe symptoms.
  • Caution in those with diabetes and asthma
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8
Q

what is the antibiotic interventions that should be given for sinusitis?

A

first choice phenoxymethylpenicillin- less chance of leading to resistance as it has a narrow spectrum of activity than amoxicillin

Co-amoxiclav reserved for more severe cases, this is active against active against beta-lactamase-producing bacteria

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9
Q

what should you give for sinusitis if there is a penicillin allergy?

A

doxycycline
clarithromycin
erythromycin (in pregnancy)

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10
Q

how does acute oitis media present?

A
  • Presenting with earache.
  • Common in children.
  • Bacterial or viral cause.
  • Often following ‘common cold’ symptoms.
  • Referral often needed for examination with an
    otoscope
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11
Q

for patients who do not require admission for AOM what advice should be given?

A

Reassure, antibiotics are not often needed.
– Without antibiotic treatment, symptoms will improve within 24 hours in 60% of children and 80% will recover within 3 days (but it can be up to a week).
– Long term complications are rare.
* Advise on self management of symptoms
– OTC symptom relief with paracetamol or an NSAID,
with appropriate age and weight advice.
+ safety net

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12
Q

how should you manage AOM with antibiotics?

A
  • If an antibiotic is required:
  • First line, amoxicillin for 5-7 days - see age based dosing advice.
  • Second line (worsening symptoms despite 2 to 3 days of standard antibacterial treatment): co-amoxiclav.
  • For people who are allergic to penicillin, a 5-7 day course of erythromycin or clarithromycin.
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13
Q

define pneumonia

A
  • Infection in the lungs
  • Tissue inflammation
  • Alveoli filled with pus
  • Clinical symptoms of respiratory infection
  • Confirmed with new shadowing on chest X-ray
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14
Q

what can cause pneumonia?

A
  • Commonly - Inhalation or aspiration
  • Bacterial, viral or fungal microorganisms
  • Failure of defence mechanisms
  • Subsequent infection
  • Inflammation of the lung parenchyma :- characterised by consolidation of the affected part, the alveolar air spaces being filled with exudate, inflammatory cells, and fibrin
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15
Q

what are the different classifications of pneumonia?

A
  • Community acquired pneumonia (CAP)
  • Hospital acquired pneumonia (HAP)
  • Healthcare associated pneumonia (HCAP)
  • Aspiration pneumonia
  • Ventilator associated pneumonia
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16
Q

how do you diagnose pneumonia?

A
  • COUGH - Symptoms similar to other LRTI
  • Need examination or chest x-ray to distinguish
17
Q

who are at risk of developing pneuomia?

A
  • Smokers
  • Chronic lung disease
  • Immunocompromised
  • Elderly / frail
  • Diabetes
18
Q

what are red flag symptoms for pneuomonia?

A
  • Dyspnoea - difficulty in breathing or wheezing
  • No improvement in condition after two or three weeks
  • Persistent cough for longer than three weeks
  • Recurrent cough
  • Dry night-time cough in children
  • Haemoptysis
  • Chest pain
  • Unexplained weight loss
  • General malaise, systemically unwell, sweats or fever
  • Painful or swollen, inflamed calf
19
Q

what is the most common cause of CAP?

A

Streptococcus pneumoniae

20
Q

who does Haemophilus influenzae most affect?

A

Typically affects patients with COPD and other chronic chest conditions.
* Sensitive to most antibiotics used commonly. Resistance developing

21
Q

what is special about Mycoplasma pneumonia?

A
  • Mollicute lacks a cell wall.
  • No cell wall with peptidoglycan
    means resistance to beta-lactam
    antibiotics.
22
Q

who does Mycoplasma pneumonia affect ?

A
  • Affects young people
23
Q

how do you assess the severity of pneumonia?

A
  • Peripheral Oxygen
    Saturation levels
  • Blood pressure
  • Respiratory rate
  • Urea and electrolytes
  • C-reactive protein
  • Full blood count
  • Liver function tests
  • Sputum culture and
    sensitivity
  • May need blood cultures.
  • The CURB-65 score
24
Q

when should you treat pneumonia?

A
  • consider home-based care for patients with a
    CURB65 score of 0
  • consider hospital assessment for all other patients, particularly those with a CURB65 score of 2 or more
25
Q

what should you not routinely offer to patients with low severity cap ?

A

microbial tests

26
Q

what should you do for patients with moderate- high sverity CAP?

A
  • take blood and sputum cultures and
  • consider pneumococcal and legionella urinary
    antigen tests.
27
Q

when would you use urinary antigen tests?

A
  • NICE suggests for moderate or high severity CAP
    – pneumococcal and legionella urinary antigen tests
28
Q

how do you manage CAP with antibiotics? low severity

A
  • Low-severity community-acquired pneumonia (CURB - 0)
  • 5 days treatment
  • Amoxicillin 500mg TDS
  • Penicillin Allergic
  • Macrolide - clarithromycin 500 mg twice a day for 5 days
  • Tetracycline - doxycycline 200 mg on the first day
    then 100 mg once a day for 4 days (total course of 5 days)
  • Inform patient - no improvement at day 3 or deterioration -seek further advice
  • Prescriber may then extend the course or change therapy.
29
Q

how do you manage moderate-high severity CAP?

A
  • Moderate and high severity community-acquired pneumonia
  • 7-10 days treatment
  • Moderate severity- dual therapy with amoxicillin and a macrolide
  • Severe - beta-lactamase stable beta-lactam and a macrolide.
  • IV administration may be required
30
Q

if a patient is admitted to hospital with CAP what should be done?

A
  • Process to include rapid definitive diagnosis
  • Chest x-ray
  • Blood tests (CRP, WCC, FBC etc.)
  • Early administration of antibiotics
  • Within 4 hours of admission.
31
Q

what monitoring should you do in hospital for CAP?

A

As a minimum (in hospital) measure a baseline
C-reactive protein concentration in patients with community-acquired pneumonia on admission to hospital, and repeat the test if clinical progress is uncertain after 48 to 72 hours.

32
Q

what do you have to consider when switching from IV to oral?

A
  • Resolution of fever > 24hrs
  • Pulse rate <100bpm
  • Resolution of tachyapnoea
  • Well hydrated and taking oral fluids
  • Absence of hypoxia
  • Improving WCC
  • Non-bacteraemic infection
  • No evidence of legionella, staphylococcal or gram negative
    enteric bacilli infection.
  • No concerns over G/I absorption.
33
Q

what other treatment are there for pneuomnia?

A
  • Oxygen
  • Bronchodilators
  • Steroids (depends on underlying conditions)
  • Asses risk of venous thromboembolism - prophylaxis.
  • Pain management
  • Hypotension - fluid depletion/requirements
  • Nutritional needs.
34
Q

when is a patient with pneuomnia safe to discharge from hospital?

A
  • They are not ready yet if in the past 24 hours they have
    had 2 or more of the following findings:
    – temperature higher than 37.5°C
    – respiratory rate 24 breaths per minute or more
    – heart rate over 100 beats per minute
    – systolic blood pressure 90 mmHg or less
    – oxygen saturation under 90% on room air
    – abnormal mental status
    – inability to eat without assistance.
35
Q

How should you council a patient on their long term recovery from pneuomnia?

A
  • 1 week: fever should have resolved
  • 4 weeks: chest pain and sputum production should have substantially reduced
  • 6 weeks: cough and breathlessness should have substantially reduced
  • 3 months: most symptoms should have resolved but fatigue may still be present
  • 6 months: most people will feel back to normal.

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