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Factors predisposing to pneumonia
- 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
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3 methods that the organisms causing pneumonia reach the lungs
- 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)
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Community Acquired Pneumonia
Lower resp. tract infection with onset in the community or within 2 days of hospitalization
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Hospital discharge recommended for pt with pneumonia when 24 hours prior to discharge the pt has no more than one of the following:
- Temp >100.4oF
- Pulse >100
- Resp Rate >24
- Systolic BP <90
- O2 Saturation <90
- Inability to maintain oral intake
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Hospital Acquired Ventilator Associate and Health Care Associated Pneumonia (HAP)
- Pneumonia occuring 48 hours or longer after hospital admission and not incubating at time of hospitalization
- Usually bacterial and rarely viral or fungal related
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Ventilator associated pneumonia (VAP)
Occurs 48-72 hours after endotracheal intubation
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Aspiration Pneumonia
- 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
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Major risk factors of Aspiration Pneumonia
- Decreased LOC
- Diminished gag reflex
- Feeding tubes
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Opportunistic Pneumonia
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
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Most common acquired opportunistic pnuemonia
Pneumocystis jiroveci (PCP)
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Chest X-Ray results in PCP
Diffuse bilateral alveolar pattern of infiltration and in wide spread disease show massive consolidation
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Clinical manifestations of PCP
- Fever
- Tachypnea
- Tachycardia
- Dyspnea
- Nonproductive cough
- Hypoxemia
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Primary treatment of PCP
Bactrim
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Pneumococcal Pneumonia is the most causative of bacterial pnuemonia and is caused by _____.
Streptococcus pnuemoniae
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Four characteristic stages of pnumonia
- Congestion
- Red Hepatization
- Gray Hepatization
- Resolution
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Congestion
Bacteria invade the alveoli causing outpouring of fluid which interferes with lungs function
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Red hepatization
massive dilation of the capillaries fill the alveoli with organisms, neutrophils, RBCs, and fibrin
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Gray Hepatization
blood flow decreases and leukocytes and fibrin consolidate the affected lung
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Resolution
exudate is lysed and processed into macrophages; normal lung tissue is restored
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Manifestations of Pneumococcal Pneumonia
- 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
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Chest X-Ray
- 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
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CBC of pt with bacterial pneumonia generally show:
Leukocytes greater than 15,000 and bands
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Tuberculosis
- Infectious disease caused by Mycobacterium tuberculosis
- Usually infects the lungs but can also affect multiple organs
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Persons at risk for TB
- 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
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Symptoms of TB
- 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
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Treatment for TB (initial 6 months)
- 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
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Latent TB Infection Treatment
Isoniazid once daily for 6-9 months
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