PNEUMONIA is an inflammation of the lung parenchyma. MICROORGANISMS THAT CAUSES LUNG PARENCHYMA INFLAMMATION: a. bacteria b. mycobacteria c. fungi d. virus CLASSIFICATION: COMMUNITY ACQUIRED PNEUMONIA most common infectious disease that occurs either in the community setting or within the first 48 hours after hospitalization. S. Pneumoniae – most common bacterial that is common in people younger than 60 years old without comorbidity and those 60 years old with comorbidity. gram positive that resides in URT and cause disseminated invasive infections. HEALTH CARE- ASSOCIATED PNEUMONIA MDROs – causative pathogens HOSPITAL-ACQUIRED PNEUMONIA develops 48 hours or more after hospitalization and does not appear to be incubating at the time of admission. Factors that predispose patients to HAP: 1. Comorbid conditions (severe acute or chronic) 2. Supine positioning 3. Aspiration 4. Coma 5. Malnutrition 6. Prolonged hospitalization 7. Hypotension 8. Metabolic disorders VENTILATOR-ASSOCIATED PNEUMONIA PNEUMONIA IN THE IMMUNOCOMPROMISED HOST Causes: 1. Use of corticosteroids/immunosuppressive agents 2. Chemotherapy 3. Nutritional depletion 4. Use of broad spectrum antimicrobial agents 5. AIDS 6. Genetic immune disorders 7. Long-term advanced life support technology (Mechanical ventilation) ASPIRATION PNEUMONIA Pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway. PATHOPHYSIOLOGY a. Aspiration of flora (oropharynx) b. Blood-borne organism enter the pulmonary circulation and trapped in the pulmonary capillary bed. RISK FACTORS: 1. Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (CA, COPD) 2. Immunocompromised patient 3. Smoking 4. Prolonged immobility 5. Depressed cough reflex 6. NPO status, placement of NGT 7. Supine positioning 8. Antibiotic therapy 9. Alcohol intoxication 10. General anesthesia, sedative 11. Advanced age 12. Transmissions of organisms from health providers CLINICAL MANIFESTATIONS (PNEUMOCOCCAL): 1. Sudden onset of chills and rapidly rising of fever (38.5-40.5 C) 2. Pleuritic chest pain aggravated by deep breathing and coughing 3. Tachypnea 4. Respiratory distress ( shortness of breath and use of accessory muscles) 5. Orthopnea (shortness of breath when reclining or in the supine position) 6. Appetite is poor 7. Diaphoretic and tires easily 8. Rusty, blood-tinged sputum – streptococcal pneumonia ASSESSMENT AND DIAGNOSTIC FINDINGS: 1. History of a recent respiratory tract infection. 2. Physical Examination 3. Chest x-ray 4. Blood culture 5. Sputum examination PREVENTION: 1. Pneumococcal vaccination MEDICAL MANAGEMENT: 1. Antibiotics – for bacterial pneumonia 2. Adequate rest 3. Hydration 4. Supplemental oxygenation Note: Antibiotics – ineffective in viral URT.
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