Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
23 Cards in this Set
- Front
- Back
|
Components of Lower Respiratory Tract
|
-Trachea
-Bronchus -Bronchioles -Alveoli |
|
|
Three modes of pathogen entry
|
1)Aspiration of oropharyngeal flora
2)Inhaled as aerosolized particles 3)Enter the lung via blood stream |
|
|
Pneumonia likely develop due to
|
-Exposure to an overwhelming innoculum
-Exposure to a highly virulent organism -Compromised pulmonary defenses |
|
|
The role of pulmonary defenses - mechanical
|
-Mucociliary clearance
*Larger particles >10 um -Cough Reflexes *2-10 um |
|
|
The role of pulmonary defenses - Immune mediated
|
-Local immunity
*antibacterial peptides, complement and immunoglobulin -Alveolar macrophages *Defense against smaller particles |
|
|
Factors diminishing transport of debris from lower airways
|
-Smoking
-COPD -Asthma -Cystic Fibrosis -Advancing age -Toxic inhalations |
|
|
Factors diminishing cough reflex and increasing aspiration risk
|
-Alcohol intoxication
-Narcotics -Seizure -Stroke -Altered consciousness -CNS alteringdrugs -General anesthesia -Supine position during enteral feeding |
|
|
Factors affecting alveolar macrophage activity and immune functions
|
-Advancing age
-DM -Sickle cell disease -HIV/AIDS -Immune suppressive drugs -Hypogammaglobulinemia |
|
|
Symptoms
|
-Fever
-Chills -pleuritic chest pain -productive cough -purulent sputum |
|
|
Signs
|
-Tachypnea
-Tachycardia -Positive focul lung exam |
|
|
Diagnostic testing and laboratory data
|
-Fever > 100.4 or 38
-Tachycardia > 100 beats/min -Tachypnea >20 breaths/min -Hypotension -Oxygen saturation >92% |
|
|
Chest X-Ray
|
#1 to diagnose
-Infiltration - small, local collection of fluid -Pleural effusion -Consolidation -Cavitary lesions |
|
|
Microbiologic evaluation
|
-Sputum gram stain & culture
-Blood culture |
|
|
Community Acquired Pneumonia
|
-Pts not currently hospitalized
-Do not have a recent history of healthcare exposures |
|
|
Common CAP pathogens
|
-Streptococcus pneumoniae
-Haemophilus influenzae -Moraxella catarrhalils |
|
|
Streptococcus pneumonia
|
-Gram positive cocci
Pairs and chains Protective capsule -Infections Upper/lower resp. Meningitis -Increased resistance to penicillin |
|
|
Additional diagnostic testsfor CAP
|
-Bacterial urinary antigen assays
Detects the presence of bacterial Ags -Advantages Rapid results Remain + after antibiotics are started Adds to diagnostic data -Disadvantages Unable to provide antibiotic sensitivity data Legionella serogroup 1 only |
|
|
Hospital acquired pneumonia (HAP)
|
-After 48 hours after admission
Early onset is <5 days after admission Late onset is >=5 days from admission |
|
|
Ventilator associated pneumonia (VAP)
|
Pneumonia >= 48-72 hours following endotracheal intubation
|
|
|
Common HAP and VAP pathogens
|
-Staphylococcus aureus
-Pseudomonas aeruginosa |
|
|
Pseudomonoas aeruginosa
|
-Gram negative bacilli
Non lactose fermenting -Infections HAP and VAP UTI, bacteremia Post-neurosurgical meningitis Foliculitis (Hot tub) -Often multi-drug resistant |
|
|
healthcare associated pneumonia (HCAP)
|
Must have 1 or more of the following criteria
-Previous hospitalization -Residence in nursing home -Received antibiotics -Received chemotherapy -Received wound care -Attends a hemodialysis clinic Patients may be at risk for HAPs or drug resistant pathogens |
|
|
Determining Potential Microbiologic Causes by day
|
CAP in first 2 days
HAP - Early day 3-4, Late 5 or up Hospitalization before day 1 |
