Pneumonia

Inpatients should be switched from intravenous (IV) to oral therapy when they are hemodynamically stable, are improving clinically, are able to take medications/fluids by mouth, and have a normally functioning gastrointestinal tract.

Antibiotics for pneunomonia

Substances other than bacteria may be aspirated into the lung, such as gastric contents, exogenous chemical contents, or irritating gases. This type of aspiration or ingestion may impair the lung defenses, cause inflammatory changes, and lead to bacterial growth and a resulting pneumonia.

Aspiration pneumonia

refers to closure or collapse of alveoli and often is described in relation to x-ray findings and/or clinical signs and symptoms

Atelectasis

Pneumonia occurring in the community or ≤48 hours of hospital admission in patients who do not meet the criteria for health care-associated pneumonia (HCAP)

Community-acquired pneumonia (CAP)

-health hx -physical examination - chest x-ray -blood culture - sputum examination

Diagnosing of pneumonia is done by:

Pneumonia in older adult patients may occur as a primary diagnosis or as a complication of a chronic disease. Pulmonary infections in older people frequently are difficult to treat and result in a higher mortality rate than in younger people

Gerontologic Considerations

Because HCAP is often difficult to treat, initial antibiotic treatment must not be delayed

Health Care-Associated Pneumonia

Hospitalization for ≥2 days in an acute care facility within 90 days of infection • Residence in a nursing home or long-term care facility • Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection • Hemodialysis treatment at a hospital or clinic • Home infusion therapy or home wound care • Family member with infection due to multidrug-resistant bacteria

Health care-associated pneumonia

Pneumonia occurring in a nonhospitalized patient with extensive health care contact with one or more of the following:

Health care-associated pneumonia

HAP develops 48 hours or more after admission and does not appear to be incubating at the time of admission.

Hospital-Acquired Pneumonia

Hospitalized patients are also exposed to potential bacteria from other sources (e.g., respiratory therapy devices and equipment, transmission of pathogens by the hands of health care personnel).

Hospital-Acquired Pneumonia

Pneumonia occurring ≥48 hours after hospital admission that did not appear to be incubating at the time of admission

Hospital-acquired pneumonia

Chest x-rays may be needed to differentiate chronic heart failure, which is often seen in older adults, from pneumonia as the cause of clinical signs and symptoms.

I'm guessing that chest xray is the best way to tell CHF from pneumonia because some of the signs and symptoms are the same

Patients with compromised immune systems commonly develop pneumonia from organisms of low virulence.

Immunosupressed ppl can get sick from the a lol virus

- impaired removal of secretions - potential aspiration - endotracheal intubation -prolonged or inappropriate use of antibiotics - the use of nasogastric tubes

Intervention related factors that play a role in hospital acquired pneumonia

Normally, the upper airway prevents potentially infectious particles from reaching the sterile lower respiratory tract. Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx; patients often have an acute or chronic underlying disease that impairs host defenses.

Pathophysiology of pneumonia

Pneumonia may also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed.

Pathophysiology of pneumonia

is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.

Pneumonia

is a more general term that describes an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion

Pneumonitis

-comorbidities - supine position - aspiration - coma -malnutrition - prolonged hospitalization - hypotension - metabolic disorders

Predisposes a person to Hospital-Acquired Pneumonia

Pneumococcal vaccination reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the general older adult population

Prevention of pneumonia

General deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia, and tachypnea may signal the onset of pneumonia.

Remember this is Gerontologic Considerations

Severe complications of pneumonia include hypotension and septic shock and respiratory failure. These complications are encountered chiefly in patients who have received no specific treatment or inadequate or delayed treatment. These complications are also encountered when the infecting organism is resistant to therapy, when a comorbid disease complicates the pneumonia, or when the patient is immunocompromised

Shock and Respiratory Failure

- fever - crackles - percussion dullness - bronchial breathe sounds - egophony

Signs and symptoms in immunosuppressed patients

- Development of a cough or increased cough - sputum production - low-grade fever - malaise - pleural effusion - high fever - tachycardia

Signs and symptoms of HAP

- chills - rapildly rising fever [101° to 105°F] - pleuritic chest pain that is aggravated by deep breathing and coughing - tachypnea (25 to 45 breaths/min) - respiratory distress (e.g., shortness of breath, the use of accessory muscles in respiration) - A relative bradycardia (a pulse-temperature deficit in which the pulse is slower than that expected for a given temperature) may suggest viral infection, mycoplasma infection, or infection with a Legionella organism. -upper respiratory tract infection (nasal congestion, sore throat) - headache, -low-grade fever -pleuritic pain -myalgia - rash - pharyngitis -mucoid or mucopurulent sputum is expectorated - cheeks are flushed and the lips and nail beds demonstrate central cyanosis (a late sign of poor oxygenation [hypoxemia]) -The patient may exhibit orthopnea (shortness of breath when reclining or in the supine position),preferring to be propped up or sitting in bed leaning forward (orthopneic position) in an effort to achieve adequate gas exchange without coughing or breathing deeply. - Appetite is poor, and the patient is diaphoretic and tires easily. -Sputum is often purulent - Rusty, blood-tinged sputum may be expectorated with streptococcal (pneumococcal), staphylococcal, and Klebsiella pneumonia

Signs and symptoms of pneumonia

Mycoplasma pneumonia is caused by M. pneumoniae. Mycoplasma pneumonia is spread by infected respiratory droplets through person-to-person contact

The inflammatory infiltrate is primarily interstitial rather than alveolar. It spreads throughout the entire respiratory tract, including the bronchioles, and has the characteristics of a bronchopneumonia.

: A type of HAP that develops ≥48 hours after endotracheal tube intubation

Ventilator-associated pneumonia (VAP):

is used to describe pneumonia that is distributed in a patchy fashion

bronchopneumonia

originated in one or more localized areas within the bronchi

bronchopneumonia

occurs when thick, purulent fluid accumulates within the pleural space, often with fibrin development and a loculated (walled-off) area where the infection is located

empyema

If a substantial portion of one or more lobes is involved, the disease is referred to as

lobar pneumonia

A parapneumonic effusion is any pleural effusion associated with bacterial pneumonia, lung abscess, or bronchiectasis. After the pleural effusion is detected on a chest x-ray, a thoracentesis may be performed to remove the fluid, which is sent to the laboratory for analysis. There are three stages of parapneumonic pleural effusions based on pathogenesis: uncomplicated, complicated, and thoracic empyema. An empyema occurs when thick, purulent fluid accumulates within the pleural space, often with fibrin development and a loculated (walled-off) area where the infection is located (see later discussion). A chest tube may be inserted to treat pleural infection by establishing proper drainage of the empyema. Sterilization of the empyema cavity requires 4 to 6 weeks of antibiotics, and sometimes surgical management is required.

pleural effusion