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kyleannkelsey
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What are the complications of Pneumonia?
- Pleuritis
- Pleural fibrosis
- Empyema (infection of the pleural sac)
- Abscess
- Bronchiectasis (enlarged bronchioles)
- Sepsis
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What are the frequent comorbidities associated with pneumonia?
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What does HAP mean?
Symptoms present a minimum of 48 hours after admission
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What constitutes HCAP?
Hospitalized for 2 days in the past 90 days, attends hemodialysis, resides in a nursing home or has had chemotherapy in the last 30 days
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What constitutes VAP?
Symptoms develop w/in 48-72 hours after endotracheal intubation
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What are the risk factors for CAP?
- Splenectomy
- DM
- URI
- Young adult
- Close proximity
- Pediatics
- Elderly
- ETOH
- Seizures
- Alzheimer’s
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What are the common organisms that cause CAP (in order of occurance)?
- Streptococcus pneumonia.
- Mycoplasma pneumonia.
- Haemophilus influenzae
- Legionella pneumophilia
- Klebsiella pneumonia
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What are the common organisms that cause, HCAP, HAP and VAP (in order of occurance)?
- Streptococcus pneumoniae
- Legionella pneumo.
- Klebsiella pneumon.
- Pseudomonas aerugen.
- E. Coli
- Staph. aureus
- Staph. aureus (MRSA)
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What are the risk factors for HCAP, HAP and VAP?
- Mechainical ventilation
- Comatose
- Acid suppressive therapy
- NH
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What is the most likely organism to cause Cap in young adults?
Mycoplasma
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What is the most common organism to cause CAP in alcoholics?
Klebsiella
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To prevent CAP, all splenectomy patients should receive what prophylactic treatment?
Streptococcal vaccine
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What are the S/S specific to atypical peneumonia?
- Headache
- Low-grade fever or afebrile
- Dry, persistent cough
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What are the S/S that indicate Typical pneumonia?
- Cough with sputum production
- Fever
- Chills
- Pleuritic chest pain
- SOB
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What physical findings are associated with pneumonia?
- Distant breath sounds (Because puss filled ducts do not conduct the sound as well)
- Rhales
- Inspiratory crackles
- Dullness to percussion
- Tachypnea (Causes dry lips and exhaustion)
- Tachycardia (compensate for low O2 in blood)
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What sputum culture results indicate a pathogen?
< 10 epithelial cells and many PMNs
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What is the main biomarker of bacterial infection in pneumonia?
Procalcitonin
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What are normal concentrations of Procalcitonin?
<0.5 ng/mL
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What Procalcitonin value indicates bacterial infection and should receive antibiotics?
> Or = to 0.25 ng/mL
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How often should pro-calcitonin levels be measured?
Q2-3 Days
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When using procalcitonin levels to guide antibiotic therapy, when should you discontinue antibiotics?
When PCT levels fall below 0.25 ng/mL or by 80% of the max concentration
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What are the general supportive treatments for Pneumonia that should be given to all patietns?
- Oxygenation
- Hydration
- Analgesics/Antipyretics
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What is evaluated in a CURB 65 score?
- Confusion
- BUN
- RR
- BP
- Age> or = to 65
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What is included in the CRB65 score?
- Confusion
- RR
- BP
- Age> or = to 65
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What CURB 65 score indicates low risk and at home treatment?
0-1
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What CURB 65 score indicates short inpatient hospitalization or closely supervised as an outpatient?
2
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