Pneumonia

Question 1

Define pneumonia

Answer 1

Pneumonia is an acute infection and inflammation of the parenchyma, most commonly caused by bacteria, viruses or fungi. It results in impaired gas exchange due to alveolar consolidation.

Question 2

In order: name the phases of pneumonia

Answer 2

1. Inflammatory response
2. Congestion
3. Red hepatisation
4. Grey hepatisation
5. Resolution

Question 3

Explain the inflammatory phase

Answer 3

Bacteria, virus or fungi enter the lungs to the alveoli, immune response is activated. Alveolar macrophages release pro-inflammatory cytokines which then recruits neutrophils and other immune mediators to infection site.

Question 4

Explain the congestion phase in pneumonia:

Answer 4

Inflammatory mediators cause vasodilation of capillaries - alveolar walls become congested , the vascular permeability of alveoli increase - and bacteria, neutrophils, RBC’s and fluids leak into the alveolar spaces.

Question 5

Explain the red hepatisation phase

Answer 5

Alveoli are filled with RBCs, fluids, neutrophils and fibrin. Inflammatory cells invade the alveolar septa.

Question 6

Explain the grey hepatisation phase

Answer 6

Due to macrophage activity - blood flow decreases to infection site and leukocytes and fibrin consolidate the infected site appearing grey of color.

Question 7

Explain the resolution phase

Answer 7

Macrophages ingest + remove neutrophils, fibrin and bacteria. Normal lung tissue is then restored. Gas exchange return to normal.

Question 8

Signs and symptoms of pneumonia

Answer 8

Change in rate, rhythm, ease of breathing
Asymmetrical chest movements
Nasal flaring
Accessory muscle use
Crackles on ascultation
Dullness on percussion
Varied colours of sputum
Chest pain

Question 9

How do you confirm a diagnosis of pneumonia?

Answer 9

Physical examination (respiratory and pain assessment), blood cultures (WBC elevation - infection), bacterial growth visisble in secretions, chest X-ray to show infiltrated lobes

Question 10

What is HAP?

Answer 10

Diagnosed with pneumonia after more than 48H post admission. It has the same pathophysiology, however is differently acquired. Patients who are on ventilators, are of advanced age, have immune suppression, high risk of aspiration and certain medical conditions are vulnerable to pneumonia. It is generally more severe than CAP as it can be associated with antibiotic resistance and potentially more severe infections.

Question 12

How to prevent HAP?

Answer 12

Proper hand hygiene, minimising invasive procedures when not necessary and using proper precautions when caring for patients at risk

Question 13

What is CAP?

Answer 13

CAP is when a person is diagnosed with pneumonia pre-admission to hospital of diagnosed before 48H post admission.

Question 14

Why encourage Pt to do deep breathing and coughing exercises?

Answer 14

Deep breathing exercises play a vital role in improving ventilation, lung expansion, reopen partially collapsed alveoli and enhance ventilation of affected areas.
Coughing exercises help mobilise mucus for effective clearance as well as clearance of inflammatory exudate from bronchial tree. Clearance of lower lobe airways, preventing further airway obstruction and consolidation.