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SNF Pneumonia. 4/10/12. Facts. 6/1000 get Pneumonia each year 8 th cause of death, 60,000 If hospitalized then, 23% death rate ,and 28% mortality within one year. Risk factors for Pneumonia. Reduced level of consciousness Smoker Age greater than 65 Malnutrition Previous pneumonia

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Snf pneumonia

SNF Pneumonia

4/10/12


Facts
Facts

  • 6/1000 get Pneumonia each year

  • 8th cause of death, 60,000

  • If hospitalized then, 23% death rate ,and 28% mortality within one year


Risk factors for pneumonia
Risk factors for Pneumonia

  • Reduced level of consciousness

  • Smoker

  • Age greater than 65

  • Malnutrition

  • Previous pneumonia

  • Viral Syndrome, Influenza

  • Underlying lung cancer

  • COPD

  • CHF

  • Drugs, PPIs, H2 blockers, antipsychotic


BUGS

  • Mainly 4-5 organisms

  • Strep pneumonia, 18%

  • Influenza, viral, 15%

  • Mycoplasma, 15%

  • Legionella,2-9%

  • Chlamydophilia, 5-10%


Other bugs
Other BUGS

  • Gram Negatives

    • Klebsiella

    • Pseudomonas

    • Moraxella

    • Staph. Aureus

    • Fungi, and many others


How to diagnose
How to Diagnose

  • Chest X-ray

  • Physical Exam, rales and rhonchi is specific lobe in lung

  • Temp

  • Oxygen Saturation reduced

  • Respiratory Rate increased


Factor to consider for possible transfer to hospital
Factor to consider for possible transfer to Hospital

  • Age greater than 70

  • RR greater than 30

  • O2 sat less than 92%

  • Temp greater than 35 Centigrade

  • BP Systolic less than 90

  • (PSI, if positive on all 5 then 27% rate of mortality)


Risk calculators
Risk Calculators

  • Confusion

  • Urea (elevated BUN)

  • RR greater than 30

  • Age greater than 65

  • Low BP

  • Each factor is one point, if more than 3 points, may consider hospitalization


Canadian pneumonia study in snfs
Canadian Pneumonia Study in SNFs

  • DX criteria, cough, new infiltrate, and temp greater than 38

  • Criteria to be in the SNF

    • Eat and drink

    • Pulse less than 100

    • Respiratory rate less than 30

    • BP greater than 90 systolic

    • O2 sat greater than 92


Results of study
Results of Study

  • Reduced rate of admission from 22 to 10

  • No change in mortality

  • Cost Savings $1016 per patient


Antibiotic choices
Antibiotic Choices

  • In SNF

  • Rocephin and zpak for low risk patients

  • See attached sheet


Pneumonia treatment complicated
Pneumonia Treatment Complicated

  • Hx of COPD and CHF

  • Immuno-compromized

  • Treatment options

  • Flouroquinolones

  • Ceftazadine


When to send to the hospital
When to send to the hospital?

  • Not responding to treatment in SNF ( however if patient in NO Code, supportive therapy can be managed in the SNF)

  • Persistent Fever

  • Respiratory Rate greater than 30/min



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