Pneumonia

Question 1

definition of pneumonia

Answer 1

ANY type or infection of the LOWER respiratory system

Question 2

pneumonia disease process

Answer 2

inflammation of lung tissues = alveolar air spaces become filled with purulent, inflammatory cells and fibrin

Question 3

how does transmission occur with pneumonia?

Answer 3

inhalation of infectious droplets

Question 4

risk factors for PNA

Answer 4

–age extremes
–compromised immunity
–underlying lung disease
–alcoholism
–altered LOC
–impaired swallowing
–nursing home resident
–hospitalization
–influenza

Question 5

what puts people at risk for aspiration PNA?

Answer 5

–alcoholism
–altered LOC
–impaired swallowing

Question 6

HAP

Answer 6

hospital acquired pneumonia
–develops within 48 hours of admission
–worse outcomes than CAP
–ICU care

Question 7

VAP

Answer 7

–endotracheal intubation

Question 8

most common route of getting PNA

Answer 8

aspiration of oropharyngeal secretions

Question 9

patho of PNA

Answer 9

inflammatory rxn in lungs –> vasodilation –> infection spreads to resp. tract and alveoli –> goblet cells stimulated and mucus excreted –> mucus accumulates between alveoli and capillaries –> alveoli cannot open and close effectively d/t purulent exudate –> gas exchange suffers

Question 10

what fails in PNA?

Answer 10

failure of mucociliary defense mechanism allows exudative fluid and inflammatory cells to invade alveoli

Question 11

who has an ineffective mucociliary clearance mechanism?

Answer 11

smokers

Question 12

symptoms of PNA

Answer 12

–usually preceded by URI
–fever
–chills
–productive OR dry cough
–malaise
–pleural pain
–dyspnea
–hemoptysis

Question 13

cough differences in PNA

Answer 13

bacterial = productive/purulent (gram negative in HAP)
viral = nonproductive/scanty (cause of CAP)

Question 14

sputum in bacterial PNA

Answer 14

green, rusty colored, look like red currant jelly

Question 15

symptoms of severe PNA

Answer 15

–tachypnea
–signs of respiratory distress/failure

Question 16

signs of respiratory distress

Answer 16

–tachypnea
–nasal flaring/pursed lips
–stridor/wheezing
–AMS/agitation
–tachycardia
–delayed cap refill
–pale

Question 17

signs of respiratory failure

Answer 17

–RR > 60
–retractions
–grunting
–mottling
–head bobbing
–severe air hunger
–bradycardia
–hypotension

Question 18

diagnosis of PNA

Answer 18

–pulmonary consolidations
–infiltrates on CXR
–CBC
–+ sputum for C&S

Question 19

components of pulmonary consolidations

Answer 19

–dullness to percussion
–inspiratory crackles
–increased tactile fremitus (vibration with speech)
–egophony (prolonged “ahh” in lungs when people say “ee”)

Question 20

bacterial PNA

Answer 20

gram +
–staph aureus (through bloodstream via IV to lungs)
–strep pneumoniae (usually with CAP, sputum brown or rusty)

gram -
–sicker and more difficult to treat
–central line infection

Question 21

aspiration PNA

Answer 21

aspirated material from GI tract stimulates inflammatory response within alveoli

Question 22

viral PNA

Answer 22

–flu = major risk factor
–virus alters pulmonary immune defense and makes lungs vulnerable to additional bacteria infection

Question 23

s/s of viral PNA

Answer 23

–fever
–chills
–DOE
–cough

Question 24

treatment of viral PNA

Answer 24

supportive care

Question 25

pneumocystis carini pneumonia

Answer 25

–related to immune suppression
–yeast-like fungus

Question 26

mycoplasma

Answer 26

–“walking pneumonia”
–mild PNA, persistent cough, HA, earache
–bacterial “like” organism, properties of bacteria and virus

Question 27

Legionella

Answer 27

–gram negative
–spread via water system –> A/C, mists sprayed on produce, hot tubs
–must report to health dept

Question 28

aspergillus

Answer 28

–fungal PNA
–released from walls of old buildings, reconstruction, stored grain, dead leaves, compost
–affects lung tissue

Question 29

PNA treatment

Answer 29

–bacterial = antibiotics
–viral = supportive
–ensure oxygenation
–adequate hydration
–good pulm. hygiene
–neb treatments

Question 30

PCV13 vaccine

Answer 30

prevents pneumococcal pneumonia caused by 13 strains of strep PNA
–recommended for children

Question 31

PPSV23 vaccine

Answer 31

prevents against additional 23 types of PNA bacteria
–secondary dose for adults if received PCV15 for first dose