Pneumonia Pathophysiology 2012 (1)

Pathogenesis of infection factors diminishing cough

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Pathogenesis of Infection Factors diminishing cough reflex and increasing aspiration risk (mechanical): Impairment of pulmonary defenses Alcohol intoxication Narcotics Seizure Stroke Altered consciousness CNS altering drugs General anesthesia Supine position during enteral feeding
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Pathogenesis of Infection Factors affecting alveolar macrophage activity and immune function: Impairment of pulmonary defenses Alcohol ingestion Advancing age Diabetes mellitus Sickle cell disease Malnutrition Malignancy HIV/AIDS Immune suppressive drugs Hypogammaglobulinemia Viral infection (influenza) *Can predispose patient to 2º bacterial pneumonia *30% of deaths due to H1N1 had bacterial co-infection in a recent study
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Key Steps in the Evaluation and Management of Pneumonia 1. Consider clinical presentation 1. Evaluate diagnostic tests and lab values 3. Determine the organisms most likely to be causing the infection 4. Choose appropriate antibiotic therapy 5. Provide appropriate monitoring of therapeutic interventions
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Key Steps for Evaluating Pneumonia Consider Clinical Presentation Symptoms: Fever, chills, pleuritic chest pain, productive cough, purulent sputum Less common: headache, nausea, vomiting, diarrhea, myalgia Signs: Tachypnea, tachycardia Positive focal lung exam Diminished breath sounds or restricted airflow
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Key Steps for Evaluating Pneumonia Temperature Fever: ≥100.4º F (98.6º) or ≥38º C (37º) Heart rate Tachycardia: > 100 beats/min (60-100) Respiratory rate Tachypnea: > 20 breaths/min (12-18) Blood pressure Hypotension may indicate systemic infection Oxygen saturation A measure of oxygenation of the blood (>92%) Diagnostic Testing and Laboratory Data
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Key Steps for Evaluating Pneumonia Chest x-ray Infiltration A small, usually local collection of fluid, with or without WBCs and inflammatory cells Pleural effusion Collection of fluid in the pleural space surrounding the lungs Consolidation A larger, focal collection of fluid and WBCs within the lung Cavitary lesions Formation of cavities in the lung as a result of pneumonia – more common with tuberculosis Diagnostic Testing and Laboratory Data
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Key Steps for Evaluating Pneumonia Microbiologic evaluation Sputum Gram’s stain and culture
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