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1

What is the most common opportunistic infection in person with HIV infection?

PJP (fungal) opportunistic

2

What are the S and S of PJP?

-onset is slow and subtle
-fever, tachypnea, tachycardia, dyspnea, nonproductive cough, hypoxemia
-chest X ray shows diffues bilateral infiltrates
-lungs have massive consolidation in widespread disease
-causes acute respiratory failure and death
-infection can spead to other organs
-bacterial and viral must be ruled out because of vague presentation

3

Does PJP respond to antifungal agents?

no even through it the causative agent is fungal

4

Although specific pathophysiologic changes related to pneumonia vary according to the organism, what do the maority of organisms trigger?

an inflammatory response in the lungs

5

Pathophysiology of pneumonia?

-inflammation, increased blood flow
-activates neutrophils to engullf and kill offending organsisms
-edema in airways, fluid leaks into alveoli
-Normal oxygen transport is affected leading to hypoxia
-consolidation: air filled alveoli become filled with fluid and debris, mucous production increases, potentially obstructs airflow and gas exchange further
-recovery: antibiotic therapy, macrophages lyse, lung tissue recovers, and gas exchange returns to normal

6

What are the most common presenting symptoms of pneumonia?

cough
fever
shaking
chills
dyspnea
tachypnea
pleuritic chest pain
-cough may or may not be productive
-sputum may be green, yellow, or rust colored (bloody)

7

What may viral pneumonia initially present as?

influenza with respiratory symptoms appearing and/or worsening 12 to 36 hours after onset

8

The older or debilitated patient may not have classic symptoms of pneumonia. What might the symptoms be?

confusion or stupor (possibly related to hypoxia)
hypothermia rather than fever

9

What are some nonspecific clinical manifestations?

diaphoresis, anorexia, fatigue, myalgias, and headache

10

On physical examination fine or coarse crackles may be present and patients with pleural effusion may exhibit dullness to percussion over affected area. If consolidation is present what breath sounds may be heard?

bronchial breath sounds:
-egophony: a change in the sound of the voice of the patient and increased fremitus: vibration of the chest wall produced by vocalization.

11

Why might the diagnosis of pneumonia be missed in a geri patient?

the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult patients

12

Explain the onset of pneumonia in a geri patient?

general deterioration
weakness
abdominal symptoms
anorexia
confusion
tachycardia
tachypnea
hypothermia

13

What is the supportive treatment for a geri patient?

hydration
O2
deep breathing
coughing
frequent position changes

14

What is the prevention for a geri patient?

pneumococcal and influenza vaccine

15

MDR pathogens are a major problem in treatment. What are the risk factors for MDR?

advanced age
immunosupression
history of antibiotic use
prolonged mechanical ventilation

16

Pneumonia complications develop in the older individual and those with underlying chronic diseases more frequently. What are potential complications?

-ateleactasis: collapsed airless alveoli (may clear with deep breathing)
-pleurisy: inflammation of pleura
-pleural effusion: fluid in pleura space (usually absorbed in 1-2 weeks)
-bacteremia: bacterial infection in blood
-pleumothorax: occurs when air collects in pleura space causing lung to collapse
-acute respiratory failure: oxygen and carbon dioxide exchange is inhibited
-sepsis: bacteria in alveoli enter bloodstream
-lung abscess: with S.aureus and gram negative organisms
-emphysema: accumulation of purulent exudate in pleural cavity

17

What is one of the leading causes of death in patients with severe pneumonia?

acute respiratory failure

18

What are the diagnostic tests for pneumonia?

-history, physical, chest X ray (pattern of infecting organism)
-Sputum analysis: culture and sensitivity (diagnose bacterial infection, select antibiotic, and evaluate treatment), gram stain (identify if organims was obtained), cytology (indication of malignant condition)
-CBC with differential: leukocytosis in majority of patients with bacterial pneumonia. WBC count is usually greater than 15,000 uL
-pulse ox
-ABGs: assess for hypoxemia, hypercapnia, and acidosis
-blood cultures: done for seriously ill patients
-thoracentesis and/or bronchoscopy with washings may be used to obtain fluid samples form patients not responding to initial therapy.

19

Who is recommended for the pneumococcal vaccine (protects against 13 types of pneumococcal bacteria)?

65 plus and 19 and older with weak immune system (HIV, organ transplant, leukemia, lymphoma, severe kidney disease.

20

Why is prompt treatment with the appropriate antibiotic essential?

-antibiotics are highly effective for both bacterial and mycoplasma pneumonia

21

What is the supportive treatment for pneumonia?

-oxygen for hypoxemia
-increase fluid intake 3L/day
-analgesics for chest pain
-antipyretics for fever
-indivualized rest and activity
-viral pneumonias: no definitive treatment
-antivirals for influenza pneumonia and herpes

22

Cough suppressants, mucolytics, bronchodilators, and corticosteriods are controversial. Why might they be prescribed?

for patients with underlying chronic conditions

23

What are the benefits of mobility?

improved diaphragm movement
chest expansion
mobilization of secretions
prevention of venous stasis