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SNF Pneumonia

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

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  1. SNF Pneumonia 4/10/12

  2. 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

  3. 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

  4. BUGS • Mainly 4-5 organisms • Strep pneumonia, 18% • Influenza, viral, 15% • Mycoplasma, 15% • Legionella,2-9% • Chlamydophilia, 5-10%

  5. Other BUGS • Gram Negatives • Klebsiella • Pseudomonas • Moraxella • Staph. Aureus • Fungi, and many others

  6. How to Diagnose • Chest X-ray • Physical Exam, rales and rhonchi is specific lobe in lung • Temp • Oxygen Saturation reduced • Respiratory Rate increased

  7. 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)

  8. 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

  9. 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

  10. Results of Study • Reduced rate of admission from 22 to 10 • No change in mortality • Cost Savings $1016 per patient

  11. Antibiotic Choices • In SNF • Rocephin and zpak for low risk patients • See attached sheet

  12. Pneumonia Treatment Complicated • Hx of COPD and CHF • Immuno-compromized • Treatment options • Flouroquinolones • Ceftazadine

  13. 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

  14. Questions

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