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25 Cards in this Set
- Front
- Back
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t/f
many bacterial organisms are responsible for pneumonia in ambulatory pt's, in most cases the target organism is easily isolated. |
false; in most cases a specific bacterium is not found.
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t/f
there is increased morbidity in bacterial pneumonia and increased mortality among older pt's and pt's with underlying pumonary diseases |
true
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what are the common pt presentations with bacterial pneumonia?
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productive cough occ. with hemoptysis
pleuritic chest pain sob tachypnea fever |
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how may symptoms vary among children or elderly patients with bacterial pneumonia?
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they may present without a cough and with vague, poorly defined sx's such as fever, nausea, or abdominal pain.
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what lung sounds are commonly found over areas of consolidation?
-rhonchi -rales -wheezing |
rales
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what other physical test may you find positive with pneumonia?
-wheezing -egophony |
egophony
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how is the diagnosis of pneumonia confirmed?
-cbc -cxr -abg |
cxr
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what views of a cxr should be done to diagnose pneumonia?
-A/P and lat -P/A and lat -anterior and lateral -posterior and lateral |
P/A and lateral views will help localize the area of infiltrate
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What can be helpful in the in directing the selection of antibiotics?
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sputum culture and sensitivity
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what test should be run on patient's with pre-existing pulmonary disease?
-pulmonary function test -cbc/cmp -abg's or pulse ox |
abg's or pulse ox
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for pt's who appear ill what lab values should you be considering?
-wbc/blood culture -abg/pulse ox -cmp/ua |
wbc/blood culture
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what type of patient populations should you definiately consider for inpatient tx of pneumonia? (what other co-morbidities).
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underlying pulmonary disease
cirrhosis significant hypoxia or hypotension tachypnea >30 |
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what is the difference between the complaints and presentation of a middle age adult and older adult?
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the elderly often c/o nonspecific complaints such as anorexa, confusion, or falling.
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What changes in an elder adult should force you to r/o pneumonia?
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acute mental status changes....sorry shitty question i know. getting tired.
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what is the most common type of pneumonia (what bug)?
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strep pneumonia
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what should initial antibiotic selection be based on?
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gram stain results
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if a gram stain is not possible, how should you make your abx selection?
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chosen to cover the most common community-acquired agents.
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what class of abx is most commonly chosen as 1st line due to its broad spectrum coverage?
-floroquinolones -macrolides -cephalosporins |
macrolides-azithromycin most commonly
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what is usually the 2nd line choice in abx therapy in the tx of CAP?
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floroquinolones
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what is the most common respiratory bug seen in pt's with chronic pulmonary disease?
-s. pneumonia -h. influenza -s. aureaus |
h. influenza-drug of choice to cover this as well as the typicals is 2nd gen. cephalosporin or clarithromycin or a FQ.
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a pt with a chronic pulm disease also with other risk factors such as institutionalization, alcoholism may require what class of abx for their pneumonia?
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2nd or 3rd gen. cephalosporin such as cefuroxime (zinacef) an additional abx such as a macrolide to cover legionella should also be considered
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what are risk factors for infection with DRSP?
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recent hospitalization
recent use of beta-lactam abs (last 3 months) severe underlying illness |
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initial therapy for a pt with drsp should be a....?
-FQ -macrolide -penicillinase resistant |
FQ such as levofloxacin or ofloxacin or in the critically ill-vancomycin
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if a pt does not clear or respond to initial therapy with abx, what diagnostic test should you do next?
-repeat culture and sensitivity -repeat cxr -ct scan |
ct scan to evaluate for an obstructing tumor. and a f/u cxr is indicated in 4-6 weeks of the older populations
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what type of preventative medicine should you be encouraging your pts to obtain to prevent pneumonia?
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yearly influenza vaccine, pneumonia vaccine q5 years. smoking cessasation.
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