Pulmonary Infections

Question 1

What are the usual causes of pulmonary infections?

Answer 1

• bacterial

- viral

Question 2

What are some unusual causes of pulmonary infections?

Answer 2

• fungal

- mycoplamsal

Question 3

When do pulmonary infections generally occur?

Answer 3

Generally occur when host defense mechanisms are impaired

Question 4

What are some causes for the host defense mechanisms to be impaired?

Answer 4

• Impaired cough reflex
• Injury to mucociliary apparatus
• Immunodeficiency
• Pulmonary vascular congestion and edema
• Accumulation of secretions

Question 5

occurs when bacteria enter bronchioles and alveoli and proliferate

Answer 5

bacterial pneumonia

Question 6

What does bacterial pneumonia result in and where?

Answer 6

Results in purulent exudate collecting in alveoli, or in bronchioles and surrounding tissue

Question 7

Is bacterial pneumonia bilateral or unilateral?

Answer 7

unilateral

Question 8

Is bacterial pneumonia unilobar or bilobar?

Answer 8

unilobar

Question 9

What is the most common cause of acute bacterial pneumonia?

Answer 9

streptococcus pneumoniae

Question 10

What may bacterial pneumonia follow?

Answer 10

may follow a viral respiratory infection

Question 11

What is something you should consider with someone who has bacterial pneumonia?

Answer 11

consider immunosuppression

Question 12

What are the 2 patterns of bacterial pneumonia?

Answer 12

• bronchopneumonia

- lobar pneumonia

Question 13

Infection within the walls of the bronchioles, may be associated with infection into alveoli

Answer 13

bronchopneumonia

Question 14

What pattern of bacterial pneumonia has patchy consolidation and is unilateral or bilateral?

Answer 14

bronchopneumonia

Question 15

Suppurative fluid fills alveoli

Answer 15

lobar pneumonia

Question 16

What pattern of bacterial pneumonia results in consolidation of a large portion or all of a lob and is usually unilateral?

Answer 16

lobar pneumonia

Question 17

What are some complications of bacterial pneumonia?

Answer 17

• abscess formation
• empyema
• organization of the exudate (becomes solid)
• bacteremia / sepsis

Question 18

What are symptoms of bacterial pneumonia? (9)

Answer 18

• Typically develop quickly
• High fever and chills
• Productive cough with yellow or brown sputum
• Pleuritic chest pain
• Shortness of breath
• Altered mental status (especially in elderly)
• Loss of appetite
• Easy fatigue
• Fatigue

Question 19

Viral proliferation within respiratory epithelial cells results in inflammation of tissues, transudate/exudate formation

Answer 19

viral pneumonia

Question 20

With viral pneumonia, is there generally evidence of consolidation or not?

Answer 20

generally no evidence of consolidation

Question 21

Is viral pneumonia usually bilateral or unilateral?

Answer 21

often bilateral

Question 22

What are some organisms that cause viral pneumonia?

Answer 22

• Influenza virus A and B – children and elderly
• Respiratory syncytial viruses
• Adenovirus
• Parainfluenza

Question 23

What is something you should consider with someone who has viral pneumonia?

Answer 23

consider immunosuppression

Question 24

What are symptoms of viral pneumonia?

Answer 24

• Cough (usually nonproductive)
• Fever and chills, excessive sweating and clammy skin
• Shortness of breath
• Altered mental status (especially elderly)
• Headache
• Loss of appetite
• Easy fatigue
• Pleuritic chest pain

Question 25

How to you evaluate pneumonia?

Answer 25

- history and PE - CXR, CT - endoscopic bronchoscopy - CBC - sputum assessment - Legionella and pneumococcus urinary antigen tests - PCR

Question 26

What will a CBC for viral pneumonia show?

Answer 26

lymphocytes and monocytes are elevated

Question 27

focal infection within a tissue, generally filled with pus

Answer 27

abscess

Question 28

4 stages of abscess formation

Answer 28

1. infection 2. localization/acute inflammation 3. enlargement 4. rupture

Question 29

What happens during the infection stage of abscess formation?

Answer 29

-Microbes enter tissue and become established

Question 30

What are the sources of infection?

Answer 30

Sources include: - direct implantation - hematogenous spread - lymphatic spread

Question 31

What happens during the localization/acute inflammation stage of abscess formation?

Answer 31

- Microbial growth initiates inflammation, attracts neutrophils into area, focuses area of infection - Tissue remodeling results in formation of a collagen-rich capsule around the area of inflammation

Question 32

What happens during the enlargement stage of abscess formation?

Answer 32

- As more neutrophils accumulate the abscess enlarges | - Tissue remodeling and capsule formation continues

Question 33

What happens during the rupture stage of abscess formation?

Answer 33

The purpose of abscess formation is to eventually cause the purulent fluid to be extruded from the body by rupturing out of the tissue

Question 34

Microbes contained in the ______ may be released into blood or _____ to cause _______ at another site.

Answer 34

Microbes contained in the abscess may be released into blood or lymph to cause infection at another site.

Question 35

What are the causes of pulmonary abscesses?

Answer 35

- aspiration - primary bacterial infection - septic embolism - neoplasia

Question 36

What is the most common cause of pulmonary abscesses?

Answer 36

aspiration

Question 37

What are signs and symptoms of pulmonary abscess?

Answer 37

-SOB -hemoptysis -fever -pleuritic chest pain -cough with sputum production night sweats anorexia -weight loss

Question 38

What is the evaluation for an pulmonary abscess?

Answer 38

- history and PE - CXR, CT - CBC

Question 39

An infection within the pleural space and fluid resulting in accumulation of purulent pleural fluid

Answer 39

empyema

Question 40

What is an empyema often caused by?

Answer 40

extension of a pulmonary infection

Question 41

What are the stages of an empyema?

Answer 41

- exudative stage - fibrinopurulent stage - organizational stage

Question 42

What happens in the exudative stage of an empyema?

Answer 42

pleural fluid accumulates in the pleural space secondary to inflammation

Question 43

What happens in the fibrinopurulent stage of an empyema?

Answer 43

- bacterial invasion and growth with deposition of fibrin on visceral and parietal pleural membranes - formation of fibrinous loculations, adhesions

Question 44

What happens in the organizational stage of an empyema?

Answer 44

if the infection progresses, the empyema fluid solidifies into a thick, non-elastic pleural “peel” that inhibit lung expansion, causing a condition known as trapped lung

Question 45

Which stage has a high mortality if it is reached?

Answer 45

organizational stage

Question 46

What are signs and syptoms of empyema?

Answer 46

- SOB - fever - pleuritic chest pain - other associated symptoms of pneumonia