Lower Respiratory Problems

• Aging
• Air Pollution
• Altered level of consciousness (alcoholism, head injury, seizures, anesthesia, drug overdose, stroke)
• Altered oropharyngeal flora secondary to antibiotics
• Bedrest and prolonged immobility
• Chronic diseases (lung disease, diabetes, heart disease, cancer, and end-stage renal disease)
• HIV

• Aspiration of normal flora from the nasopharynx or oropharynx
• Inhalation of microbes present in the air (mycoplasma pneumonia and fungal)
• Hematogenous spread from a primary infection elsewhere in the body (Staph aureus)

Lower resp. tract infection with onset in the community or within 2 days of hospitalization

• Temp >100.4^oF
• Pulse >100
• Resp Rate >24
• Systolic BP <90
• O2 Saturation <90
• Inability to maintain oral intake

• Pneumonia occuring 48 hours or longer after hospital admission and not incubating at time of hospitalization
• Usually bacterial and rarely viral or fungal related

Occurs 48-72 hours after endotracheal intubation

• Abnormal entry of secretions or substances in the lower airway most often from the mouth or stomach
• Generally manifests in 48-72 hours after aspiration episode

• Decreased LOC
• Diminished gag reflex
• Feeding tubes

Associated with altered immune function including protein-calorie malnutrition, immune disease, those who have received transplants and taking immunosupressive drugs, radiation and chemotherapy drugs and corticosteroids for prolonged periods

Pneumocystis jiroveci (PCP)

Diffuse bilateral alveolar pattern of infiltration and in wide spread disease show massive consolidation

• Fever
• Tachypnea
• Tachycardia
• Dyspnea
• Nonproductive cough
• Hypoxemia

Bactrim

Streptococcus pnuemoniae

• Congestion
• Red Hepatization
• Gray Hepatization
• Resolution

Bacteria invade the alveoli causing outpouring of fluid which interferes with lungs function

massive dilation of the capillaries fill the alveoli with organisms, neutrophils, RBCs, and fibrin

blood flow decreases and leukocytes and fibrin consolidate the affected lung

exudate is lysed and processed into macrophages; normal lung tissue is restored

• Sudden onset of fever, chills, SOB, cough of a productive and purulent nature, pleuritic chest pain
• Physical exam: signs of pulmonary consolidation such as dullness to percussion, increases fremitus, bronchial breath sounds, and crackles

• Lobar or segmental consolidation suggests bacterial
• Diffuse pulmonary infiltrates suggests viral
• Cavitary shadows suggest presence of a necrotizing infection with lung destruction commonly caused by S. aureus or M. tuberculosis effusions

Leukocytes greater than 15,000 and bands

• Infectious disease caused by Mycobacterium tuberculosis
• Usually infects the lungs but can also affect multiple organs

• Homeless
• Residents of inner-city neighborhoods
• Foreign-born persons
• Older Adults
• Those in Institutions
• IV drug users
• Those living in poverty
• Poor access to health care

• Initial: fatigue, malaise, anorexia, unexplained wieght loss, low-grade fevers and night sweats
• Cough that becomes frequent with white, frothy sputum
• Late: Dyspnea and hemoptysis

• INH (Isoniazid)- bacteriocidal against rapidly dividing cells
• Refampin (Rifadin)- bacteriocidal against rapidly dividing and semidormant bacteria (turns urine orange)
• Pyrazinamide (PZA)- bacteriocidal against dormant or semidormant organisms
• Ethambutol- bacteriostatic for tubercle bacillus

Isoniazid once daily for 6-9 months