Chapter 15 Pneumonia

1. Chapter 15Pneumonia

2. Figure 15-1. Cross-sectional view of alveolar consolidation in pneumonia.

3. Anatomic Alterations of the Lungs • Inflammation of the alveoli • Alveolar consolidation • Atelectasis (e.g., aspiration pneumonia)

4. Lobar pneumonia: Involvement of the entire lung lobe Double pneumonia: Involvement of both lungs Walking pneumonia: Mild case of pneumonia. Patient remains ambulatory Etiology

5. Box 15-1 Causes of Pneumonia and Classifications Bacterial Causes • Gram-positive organisms • Streptococcus • Staphylococcus

6. Figure 15-2. The Streptococcus organism is a gram-positive, nonmotile coccus that occurs singly, in pairs, and in short chains.

7. Figure 15-3. The Staphylococcus organism is a gram-positive, nonmotile coccus that is found singly, in pairs, and in irregular clusters.

8. Box 15-1 Causes of Pneumonia and Classifications (Cont’d) Gram-negative organisms Haemophilus influenzae Klebsiella Pseudomonas aeruginosa Moraxella catarrhalis Escherichia coli Serratia species Enterobacter species

9. Figure 15-4. The bacilli are rod-shaped microorganisms and are the major gram-negative organisms responsible for pneumonia.

10. Atypical organisms Mycoplasma pneumoniae Legionella pneumophila Chlamydia psittaci Chlamydia pneumoniae Box 15-1 Causes of Pneumonia and Classifications (Cont’d)

11. Anaerobic bacterial infections Peptostreptococcus species Bacteroides melaninogenicus Fusobacterium necrophorum Bacteroides asaccharolyticus Porphyromonas endodontalis Porphyromonas gingivalis Box 15-1 Causes of Pneumonia and Classifications (Cont’d)

12. Viral causes Influenzavirus Respiratory syncytial virus Parainfluenza virus Adenovirus Coronavirus (SARS) Box 15-1 Causes of Pneumonia and Classifications (Cont’d)

13. Other causes Rickettsial infections Varicella Rubella Aspiration pneumonitis Lipoid pneumonitis Pneumocystis carinii Cytomegalovirus Tuberculosis Fungal infections Avian Influenza A Box 15-1 Causes of Pneumonia and Classifications (Cont’d)

14. Acquired pneumonia classification Community-acquired pneumonia (CAP) Nursing home–acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Box 15-1 Causes of Pneumonia and Classifications (Cont’d)

15. Etiology Acquired pneumonia classification • Community-acquired pneumonia (CAP) • Nursing home–acquired pneumonia • Hospital-acquired pneumonia • Ventilator-associated pneumonia

16. Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumonia The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Alveolar Consolidation Increased Alveolar-Capillary Membrane Thickness Atelectasis Excessive Bronchial Secretions During the resolution stage of pneumonia

21. Clinical Data Obtained at the Patient’s Bedside

25. Clinical Data Obtained from Laboratory Tests and Special Procedures

29. PaO2 and PaCO2 trends during acute alveolar hyperventilation.

31. PaO2 and PaCO2 trends during acute or chronic ventilatory failure.

35. Figure 15-5. Chest X-ray film of a 20-year-old woman with severe pneumonia of the left lung and patchy pneumonia in the right middle and lower lobes.

36. Figure 15-6. Air bronchogram. The branching linear lucencies within the consolidation in the right lower lobe are particularly well demonstrated in this example of staphylococcal pneumonia.

38. Figure 15-7. Air bronchogram shown by CT in a patient with pneumonia.

39. General Management of Pneumonia The treatment of pneumonia is based on: • The specific etiology of the pneumonia, and • The severity of symptoms demonstrated by the patient.

40. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them

41. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

42. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

43. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

44. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

45. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

46. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

47. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

48. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

49. Table 15-1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d)

50. Respiratory Care Treatment Protocols • Oxygen Therapy Protocol • Bronchopulmonary Hygiene Therapy Protocol • Lung Expansion Therapy Protocol