Pneumonia Flashcards
(12 cards)
Pneumonia definition
Inflammatory condition of lung leading to abnormal alveolar filling with consolidation and exudation
Pneumonia epidemiology
Affects youngest and oldest populations
Largest infectious cause of death in children globally
Females>males
Linked with poor healthcare, poverty, malnutrition
Pneumonia pathology
Infection, chemical or aspiration irritant
Causes overwhelming inflammatory response in alveoli:
1. Acute inflammation causes neutrophils (and serous fluid) to migrate out of capillaries (vasodilated) into alveolar airspace’s
2. Neutrophils phagocytose and release anti-microbial enzymes + inhibitors to fight infection
3. Serous fluid, puss, proteins accumulate causing more inflammation and oedema consolidation decreases gas exchange
4 stages of pneumonia
Congestion
- first 24hrs
- Vascular engorgement, intra-alveoli fluid + numerous bacteria, lung heavy, boggy and red
Red repatization
- 2-3days
- massive exudation, RBC, leukocytes + fibrin fill alveolar spaces , affected area red, firm + airless with a liver like consistency
Grey hepatization
- 4-6 days
- progressive disintegration of RBC and persistence of fibrin exudate
Resolution
- > 6 days
Consolidated exudate in alveolar spaces undergoes progressive digestion producing debris. Debris later absorbed, ingested by macrophages of coughed up
Causes of pneumonia
- Bacteria - streptococcus pneumonia, Hib pneumonia, MRSA, legionella
- fungi - inhaled
- Virus
- Parasites
- chemical eg. Cl gas, fertiliser dust
- Aspiration eg. Food/vomit
- Inhalation eg. Smoke, burns
Classification of pneumonia
Anatomical classification
- lobar pneumonia
- Bronchopneumonia
Setting
- community acquired pneumonia (CAP)
- health care associated pneumonia (HCAP)
- hospital acquired pneumonia (HAP) - within 48hrs hospital admission
- Ventilator associated pneumonia (VAP)
Causes of CAP/HAP pneumonia
Many cases have unknown cause - pneumonia defined by setting and risk as it’s difficult to classify. setting predicts treatment
Many bacterial causes
CAP - Strep C pneumonia , Virus
HAP - MRSA
Signs and symptoms of pneumonia
- common
Fever
Malaise
Muscle ache/fatgue
Coughing - productive/non-productuive
Tactile Freitas on palpation
Dyspnoea
Pleuritic or chest pain
Loss of appetite
Rapid heartbeat - less common
Coughing up blood
Fatigue
Nausea/vomitting
Diarrhoea
Wheezing
Confusion
Complications of pneumonia
Lung abscess - cavity fills with puss
Pleural effusions -build up of pleural fluid
Emphysema - infection/pus in between pleural cavity
Septic shock - whole body response to infection, vasodilation, less o2 of vital organs
How to diagnose pneumonia
Findings:
Temp > 37.8 degrees
HR > 100 bpm
Crackles
Decreased breath sounds/bronchial breath sounds (consolidation)
Absence of asthma (causes similar sounds, more wheezing)
Clinical prediction rule
X-ray change + finding = probability patient has pneumonia
5 findings = 84-91%
4 findings = 58-85%
3 findings = 35-51%
2 findings = 14-24%
1 finding = 5-9%
0 findings = 2-3%
Other diagnostic tests:
Chest X-ray
CT scan
Blood test
Sputum culture
Pleural fluid culture - invasive, pleural tap in cavity
Bronchoscopy - invasive, camera in bronchi to observe consolidation
Management/treatment of pneumonia
Depends on setting
Antiobiotics/anti-fungal meds
O2 support
Hydration -IV fluids - water sputum more easily cleared, dehydrated due to less appetite and higher temp also
Rest - fight infection, don’t increase o2 demand unnecessarily, but some activities help clear sputum
Analgesics - chest pain and aches
Cough suppressant meds
Fever reducing meds
Vaccination programmes
Physiotherapy treatment for pneumonia
Caution - consolidation causes poor oxygen of lung, physio may increase o2 demand/casue bronchospasm, therefore monitor o2 during treatment for safety, but exercise good for sputum clearance to increase oxygenation
Treat signs/symptoms
Non-productive pneumonia:
Stage 1-3 consolidated (liver consistency)
Dry cough as consolidation not broken down
O2 support, positioning V/Q, mobilising, or no intervention
Productive pneumonia:
Resolution (stage 4) cough more productive
Sputum clearance techniques (positioning, breathing exercise, manu,pal techniques) - alveoli air-filled
