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Pulmonary Infection.docx

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NURS 203
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Pulmonary Infection Pneumonia 2 kinds – Typical and Atypical Typical – wake feeling normal, then suddenly develop a fever, productive cough Atypical – slow, insidious onset (feel bad over few days) Community vs. Nosocomial (hospital acquired) If you get pneumonia in the community and it’s typical, it is Strep pneumoniae. If you get pneumonia in the community and it is atypical, it’s mycoplasma pneumoniae. Organisms in the hospital (nosocomial) = E coli, Pseudomonas, Staph aureus (will not get strep pneumoniae in the hospital). Productive cough in Typical pneumonia Reason for productive cough in typical pneumonia: have exudate (pus) and signs of consolidation in the lung – Slide: yellow areas with microabcesses which are consolidation in the lung. Ie lobar pneumonia = see consolidation in lung, within alveoli, causing consolidation. Therefore, with typical, see consolidation and pus in the lung. Physical dx’tic tools of lung consolidation: decreased percussion, increased TVF (when the person talks, feel vibrations in chest – if have consolidation in ie the upper left lobe, will have increased TVF b/c it is a consolidation, compared to the other side – so, increased TVF indicates consolidation), having an “E to A” (egophony) sign (pt says E and you hear A), whispered pectoriloquy (pt whispers “1, 2, 3” and I will hear it very loud with the stethoscope). Therefore, decreased percussion, increased TVF, egophony, and pectoriloquy = consolidation. What if there is a pleural effusion overlying the lung? Only thing you would have isdecreased percussion (this separates pleural effusion from pneumonia). Atypical pneumonias They do not have a high temp and do not have productive cough b/c they are interstitial pneumonias. They have inflammation of the interstitium – there is no exudate in the alveoli – which is why you are not coughing up a lot, and therefore do not have signs of consolidation. So, will not have increase TVF, “E to A”, with an atypical. Atypical pneumonia has an insidious onset, relatively nonproductive cough, no signs of consolidation. MCC typical pneumonia = strep pneumoniae (know the pic) – gram “+” diplococcus (aka diplococcus) – Rx = PCN G MCC atypical pneumonia = mycoplasma pneumoniae; 2 MCC = Chlamydia pneumoniae; which are all interstitial pneumonias. Bronchopneumonia: MC due to strep pneumonia, and community acquired. Lobar pneumonia. Slide: lobar consolidation on chest x-ray – strep. Pneumonia. a) Viral pneumonias 1) Rhinovirus = MCC common cold; they are acid labile – meaning that it won’t lead to gastroenteritis in the stomach b/c is destroyed by the acid in the stomach. Never will have a vaccine b/c 100 serotype. 2) RSV – MCC bronchiolitis – whenever you inflame small airways, its leads to wheezing. This is a small airway dz and bronchiolitis is MC due to RSV and pneumonia. So, pneumonia and bronchiolitis is MC due to RSV in children. 3) Influenza – drift and shift – have hemagglutinins, which help attach the virus to the mucosa. Have neuraminidase bore a hole through the mucosa. Antigenic drift = minor change/mut’n in either hemagglutinins or neuraminidase; do not need a new vaccine; antigenic shift= major change/mut’n in either hemagglutinins or neuraminidase need a vaccine. The vaccine is against A Ag. b) Bacterial pneumonias 1) Chlamydia psittacosis – from birds (ie parrots, turkeys). 2) Chlamydia trachomatis – a little kid was born and a week later he was wheezing (big time), pneumonia, increased AP diameter, tympanic percussion sounds, no fever, eyes are crusty (both sides), weird cough – staccato condh (short coughs). He got it from his mom’s infected cervix. (MCC conjunctivitis in 2 week = Chlamydia trachomatis). (MC overall of conjunctivitis is inflammation of erythromycin drops). c) Hospital-acquired gram-negative pneumonias 1) Pseudomonas – water loving bacteria, therefore see in pt in ICU when on a RESPIRATOR. pt water unit with green productive cough with. 2) Klebsiella – famous in the alcoholic; however, alcoholic can also get strep pneumonia. So, how will you know strep vs. Klebsiella? Alcoholic with high spiking fevers, productive cough of MUCOID appearing sputum – the capsule of Klebsiella is very thick. Lives in the upper lobes and can cavitate, therefore can confuse with TB. 3) Legionella – atypical cough, nonproductive cough, very sick can kill you, from water coolers (water loving bacteria), seen in mists in groceries or at restaurants. Example: classic atypical pneumonia, then pt had hyponatremia – this is Legionella. Legionella just doesn’t affect the lungs, also affects the other organs such as liver dz, interstial nephritis and knocks off the juxtaglomerlur cells, and kills the renin levels, low aldosterone and therefore lose salt in the urine, leads to hyponatremia (low renin levels with low aldosterone). Rx = erythromycin Fungal Infections The two systemic fung
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