Lower Respiratory Problems

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  1. 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
  2. 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)
  3. Community Acquired Pneumonia
    Lower resp. tract infection with onset in the community or within 2 days of hospitalization
  4. 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
  5. 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
  6. Ventilator associated pneumonia (VAP)
    Occurs 48-72 hours after endotracheal intubation
  7. 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
  8. Major risk factors of Aspiration Pneumonia
    • Decreased LOC
    • Diminished gag reflex
    • Feeding tubes
  9. 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
  10. Most common acquired opportunistic pnuemonia
    Pneumocystis jiroveci (PCP)
  11. Chest X-Ray results in PCP
    Diffuse bilateral alveolar pattern of infiltration and in wide spread disease show massive consolidation
  12. Clinical manifestations of PCP
    • Fever
    • Tachypnea
    • Tachycardia
    • Dyspnea
    • Nonproductive cough
    • Hypoxemia
  13. Primary treatment of PCP
  14. Pneumococcal Pneumonia is the most causative of bacterial pnuemonia and is caused by _____.
    Streptococcus pnuemoniae
  15. Four characteristic stages of pnumonia
    • Congestion
    • Red Hepatization
    • Gray Hepatization
    • Resolution
  16. Congestion
    Bacteria invade the alveoli causing outpouring of fluid which interferes with lungs function
  17. Red hepatization
    massive dilation of the capillaries fill the alveoli with organisms, neutrophils, RBCs, and fibrin
  18. Gray Hepatization
    blood flow decreases and leukocytes and fibrin consolidate the affected lung
  19. Resolution
    exudate is lysed and processed into macrophages; normal lung tissue is restored
  20. 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
  21. 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
  22. CBC of pt with bacterial pneumonia generally show:
    Leukocytes greater than 15,000 and bands
  23. Tuberculosis
    • Infectious disease caused by Mycobacterium tuberculosis
    • Usually infects the lungs but can also affect multiple organs
  24. 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
  25. 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
  26. 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
  27. Latent TB Infection Treatment
    Isoniazid once daily for 6-9 months
Card Set
Lower Respiratory Problems
Test 2
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