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