Pneumonia aspect for nurses
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Pneumonia aspect for nurses

Pneumonia aspect for nurses

..


Pneumonia aspect for nurses

  • 1 < 5

  • 8-10%


Pneumonia aspect for nurses

  • pneumonia

      • Terminal, respiratory bronchiole

      • Alveoli

      • Interstitium

  • Community acquired pneumonia

    • .. 4-14

  • Typical

  • Atypical

    • Gradual onset


Pneumonia aspect for nurses

  • : , ,

    • Direct contact with respiratory droplet

    • Physical transfer of respiratory secretion

    • Aspiration of upper airway flora

    • Hematogenous


Pneumonia aspect for nurses

  • 25-75% bacteria virus

impair defense mechanism


Pneumonia aspect for nurses

ciliated epithelium

Mononuclear cell submucosa

debris

PMN

debrismucous

atelectasis

air trapping

normal flora nasopharynx


Pneumonia aspect for nurses

S.aureus, K. pneumoniae

necrosis of intra alveolar septa

destruction

abscess


Pneumonia aspect for nurses


Pneumonia aspect for nurses


Protective defense mechanism

Protective defense mechanism

  • nose, nasopharynx : filtration by nasal hair, sneezing

  • epipharynx : coughing

  • vocal cord : expiration

  • larynx : coughing( cough reflex)


Pneumonia aspect for nurses

mucous blanket

1 mm/min in peripheral airways

2 cm/min in the trachea

pharynx

swallowed

mucociliary system


Pneumonia aspect for nurses

alveolar macrophage

macrophage

phagocytose FB

mucociliary escalator

leave the lung by lymphatics or blood


Pneumonia aspect for nurses

bacteria

IgA in the mucous

kill by macrophage


Host defense disorders leading to pneumonia

Host defense disorders leading to pneumonia


Host defense disorders leading to pneumonia1

Host defense disorders leading to pneumonia


Pneumonia aspect for nurses

..3

(1)

Cystic fibrosis


Pneumonia aspect for nurses

infection

bronchospasm

retained secretion

chronic lung disease

increased work of breathing

diaphragm fatigue

hypoxemia

hypercapnia


Pneumonia aspect for nurses

    • :


Pneumonia aspect for nurses

  • (1)

    • <2 >60 2-12 >50

    • 1-5 >40 5-16 >28

  • (dyspnea)

    • crackles


Pneumonia aspect for nurses

    • Vocal fremitus

    • Breath sound

    • Bronchial breath sound (consolidation)

    • Fine crackles(), rhonchi

  • pleura

    • Refer pain: ( meningism)


Pneumonia aspect for nurses

  • Consolidation

      • chest expansion

      • tactile vocal

        fremitus

      • Localized dullness

      • air entry - localized crackles

      • Bronchial breath sound - Pleural rub


Pneumonia aspect for nurses

  • Hypoxemia

    • hyperventilation

    • :

    • : ,

    • ,

    • pulmonary hypertension

  • Hypercapnia


Pneumonia aspect for nurses

      • Pulse oximetry

    • Poor peripheral perfusion, mottling, shock


Pneumonia aspect for nurses

flaring of alae nasi

suprasternal notch retraction


Pneumonia aspect for nurses

subcostal retraction


Pneumonia aspect for nurses

intercostal retraction


Pneumonia aspect for nurses

coryza

, wheezing


Cxr alveolar consolidation

CXR: alveolar( consolidation)

Infected mucous

acinus

Alveolar wall injury

hematogenous

Edema fluid leak

Rapid spread from pore of Kohn

bronchiole

Terminal airspace

  • Spare: bronchial wall

    • Interstitial

Adjacent lobules


Cxr alveolar consolidation1

CXR: alveolar( consolidation)

Homogenous opacity fluffy margin except fissure


Cxr interstitial viral

CXR: interstitial(viral)


Pneumonia aspect for nurses

Bronchovascular bundle

Interlobular septa

Increase bronchovascular marking


Pneumonia aspect for nurses

interstitial+ hyperaeration

Virus, aspiration


Pneumonia aspect for nurses

  • Bacterial: Alveolar infiltration: consolidation

    • Lobar, segmental

    • Air bronchogram

    • Diffuse bilateral bronchopneumonia


Pneumonia aspect for nurses

  • Virus, Mycoplasma: Interstitial infiltration

    • Bronchovascular marking

    • Peribronchial cuffing

    • Hyperaeration

    • Linear, nodule, honeycomb

    • Patchy consolidation from atelectasis

    • Bronchopneumonia ()


Pneumonia aspect for nurses

consolidation

interstitial


Pneumonia aspect for nurses

    • Pneumatocele: S. aureus

    • Reticulonodular : M.pneumonia

    • Round pneumonia:

    • :


Pneumonia aspect for nurses

    • 3-25

    • S.aureus

      • 33: primary 89: disseminated

    • .. 2-5

  • bronchoalveolar lavage

    • normal flora: TB


Pneumonia aspect for nurses

  • ESR, CRP:

  • antidiuretic hormone

    • 10

      • >25 PMN/high power field

      • <10 squamous cell

    • Hypertonic saline


Pneumonia aspect for nurses

  • ET tube aspiration

    • 1

      • Flora upper airway

      • Inflammatory response ET tube

    • Capsular polysaccharide antigen

    • nasopharynx effusion

    • Nasopharynx: PCR

    • Culture

    • Serology:IgG, IgM

  • M.pneumoniae: cold agglutinin,IgM,IgG, PCR


Pneumonia aspect for nurses

lymphocyte

bilateral diffuse interstitial


Pneumonia aspect for nurses

  • pleural effusion

  • empyema


S pneumoniae

S.pneumoniae

  • Pleural effusion 20, empyema

  • CXR

    • Lobar

    • Bulging if fissure (inflammatory exudate )

      • Klebsiella pneumoniae


H influenzae

H. influenzae

  • Unilateral consolidation bilateral

  • Pneumatocele

  • Pleural effusion: 26-76%

  • type b


S aureus

S.aureus

  • 4.3+/- 2.5 , 32%:

  • Primary:

    • Unilateral lobar

  • Secondary:

    • Diffuse bilateral

  • Effusion:15% - 75%-

  • Pneumatocele 45-68%

  • Empyema ,Pneumothorax


S aureus1

S.aureus

  • 1986-1995

    • 27 primary

    • 92.6% < 2 (1-14)

    • Lobar consolidation 96.3% Multiple lobe 40.7%

    • 11.1%

    • 24.6% 14.8% 33.3%

    • WBC

      • 20,344 +/- 10,266 cell/mm3

      • < 15,000: 33.3%

      • PMN< 50% : 22.2%


Aspiration pneumonia

Aspiration pneumonia

  • : ,

  • Wheezing: edema,mucous

    • Anaerobe

  • CXR

    • 2 ..

    • Lower lobe, diffuse bilateral

    • Perihilar: recurrent microaspiration


Pneumonia aspect for nurses

posterior

Superior segment

Basilar segment


Pneumonia aspect for nurses

Nasopharyngeal aspiration


Pneumonia aspect for nurses

TE fistula


Pneumonia aspect for nurses

  • RSV

    • URI

    • Wheezing, rales

    • bronchiolitis

  • Influenza

    • 2-3

    • :

  • Adenovirus

    • bronchiolitis obliteran


Chlamydia trachomatis

Chlamydia trachomatis

  • genitalia

  • Conjuntivitis 10

  • 3-6; staccato cough

  • Wheezing

  • CXR: perihilar infiltration

  • eosinophilia> 300 cell/mm3


M pneumoniae

M. pneumoniae

  • Wheezing

  • CXR:

    • interstitial,

    • One lower lobe 50% bilateral 10-40%

    • 34%

    • Effusion<10%


Immunodefiency

Immunodefiency


Immunodeficiency

Immunodeficiency


Pneumonia aspect for nurses


Antibody

:antibody

  • Recurrent+ severe URI/LRI

  • Encapsulated bacteria

    • X-linked agammaglobulinemia

      • 9-18antibody

      • IgG

    • Common variable immunodeficiency(CVID)

      • 10-30

      • IgA CD4/CD8 ratio


Antibody1

:antibody

  • IgGsubclass deficiency

    • IgG2 deficiency total IgG

    • IgG4 ,IgA deficiency

    • Atopic disease: asthma, allergic rhinitis


Pneumonia aspect for nurses

:T cell

  • SCID:severe combined immunodeficiency

    • X-linked, AR()

    • 4-6

    • Lymphopenia

    • CD3 T cell

    • Immunoglobulin


Pneumonia aspect for nurses

  • Monitoring: HR, SpO2

  • hypoxemia

  • ??


Pneumonia aspect for nurses

..

  • < 6 : diaphramatic fatigue

  • hypoxemia

  • : empyema


Pneumonia aspect for nurses

  • Collateral channels of ventilation

Paediatr Respir Rev 2004;5 Suppl A:S77-9.


Wheezing

: wheezing

Paediatr Respir Rev 2004;5 Suppl A:S77-9.


Pneumonia aspect for nurses

-horizontal insertion of diaphram

- fatigue-resistant muscles

Paediatr Respir Rev 2004;5 Suppl A:S77-9.


Pneumonia aspect for nurses

cannula


Pneumonia aspect for nurses

Oxygen hood


Pneumonia aspect for nurses

Endtidal CO2


Positioning

positioning

  • Unilateral lung lesion (children and adult)

    • Lie down on an unaffected side (normal lung)

      • Better ventilation on the dependent lung matching with more perfusion also on the dependent lung (less ventilation- perfusion mismatch)

      • Secretion drainage by gravitation

      • Easy to do chest PT

      • Always monitoring

Prasad SA, Hussey J. Chest physiotherapy techniques and adjuncts to chest physiotherapy. In: Prasad SA, Hussey J, Campling J, editors. Pediatric respiratory care: a guide for physiotherapists and health professionals. London: Hapman & Hall; 1995. p. 67-97.


Pneumonia aspect for nurses

  • PaO2 < 60 mmHg FiO2 > = 0.6

  • PaCO2 > 50 60 mmHg CO2 ,PH < 7.3

  • (negative inspiratory pressure < -20 cmH2O vital capacity < 12-15 ./.)

  • protective airway reflex , gag reflex

  • shock


Pneumonia aspect for nurses

  • hyperventitation


Pneumonia aspect for nurses


Pneumonia aspect for nurses

Erythromycin(10-14)

Clarithromycin (10-14)

Azithromycin 10MKD then 5MKD(4)

Cloxacillin or cefazolin, Clindamycin (allergic)

Vancomycin( resistant)


Pneumonia aspect for nurses

PenicillinG

3rd cephalosporin(DRSP)

Clindamycin

PenicillinG, clindamycin

Erythromycin,ClarithromycinAzithromycin


Pneumonia aspect for nurses

:Penicillin, clindamycin, amoxcicillin-clavulanate

: Nosocomial- aminoglycoside, 3rd cephalosporin


Pneumonia aspect for nurses

    • : 5-7-10

    • : 10-14 3

    • S. aureus, , gr.A streptococcus: 2-3-4

    • S. aureus: 10-14

    • S.pneumoniae

      • 24-48

      • Empyema: 7

    • gr.A streptococcus :


Pneumonia aspect for nurses

  • H. influenzae/S.pneumiae/ S. aureus

    • 2nd, 3rd cephalosporin +cloxacillin

    • ampicillin with clavulanate+cloxacillin

  • S.pneumiae/M. pneumoniae

    • 2nd, 3rd cephalosporin+erythromycin


Pneumonia aspect for nurses

Chest physiotherapy


Incentive spirometry

Incentive spirometry


Positive end expiratory pressure

Positive end expiratory pressure


Ezpap

EzPAP


Pneumonia aspect for nurses

  • Hib vaccine

    • 2-4-6

  • Pneumococal vaccine

    • Conjugate: 2-4-6-15


Pneumonia aspect for nurses

2

> 6

< 9 : 21 1

surface glycoprotein(hemagglutinin+ neuraminidase)

Antigenic variation


Pneumonia aspect for nurses


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