NU 664 CAP- EX1 Mid-Term Questions and Answers (Exam Preparation) 100% A+

NU 664 CAP- EX1 Mid-Term Questions and Answers (Exam Preparation) 100% A+ CAP: - CORRECT ANSWER-- community acquired pna- 8th leading cause of death in US An acute infection of the lung parenchyma that is not acquired in a hospital, long-term care facility, or other recent contact with the health care system" • Acute infection of the lung - Lobar -(confined to a lobe) - Segmental -(a segment of the lobe) - Interstitial- (confined to interstitial tissue) - Bronchopneumonia- (confined to alveoli/bronchi) - can have mixed pna too→ lobar + segmental • Persons living in the community NOT hospitalized with the previous 2 weeks • Symptoms of an acute infection with or without infiltrate on CXR • CXR = gold standard for diagnosis • in practice people with negative CXR but +symptoms, still get treated - CORRECT ANSWER- immunizations for people 65+ or younger with comorbidities i.e. asthma, COPD, CHF - CORRECT ANSWER-pna and flu vaccines Who is at risk for CAP? - CORRECT ANSWER-Extremes of age (very young/very old) Smokers ETOH abuse GERD Chronic diseases( DM, COPD, CAD, CHF) Institutionalization TAKE A GOOD HISTORY: - CORRECT ANSWER-How/when did the symptoms develop? Any current medications?- PPIs and antipsychotics can increase risk for weakened immune system Tobacco? ETOH? Drugs? Intake and output Sick contacts? Children in daycare? Work environment HIV status/risk- screen high risk population, anyone between 13-64. should get tested for HIV ATLEAST ONCE IN THEIR LIFE! Do not need written consent anymore! PMH Any chance of aspiration? Abx use in the past 3 months!!!! * maybe one worked, one didnt Previous hx of pneumonia? Hep c screening - CORRECT ANSWER-if your exposed to hep c by drug use, intranasal drug use- screen anyone between 1945 and 1965 should have a one time Hep c screening- its secondary intervention! CAP Presentation in Adults - CORRECT ANSWER-• Cough (may or may not be productive) • Dyspnea • Fever • Hemoptysis • Pleuritic Chest Pain • Fatigue/malaise/myalgias • Post-tussive nausea/vomiting • Older Adults: change in mental status, falls, poor po intake • If pt has pleuritic CP, make sure you get an EKG to r/o cardiac causes SYMPTOMS OF CAP: - CORRECT ANSWER-Temp usually elevated O2 sat may or may not be decreased BP (may be decreased or increased) Pulse (increased) RR (increased) Cardiac Tachycardia Cyanosis Respiratory Crackles that do not clear with cough Consolidation Diminished breath sounds Consolidation on percussion! Dull sound! Egophany (eà a) Bronchophany (Louder/clearer voice sounds) Whispered petriloquy (louder/clearer) Tactile fremitus (increased) CAP: Diagnostic Tests - CORRECT ANSWER-• Chest Xray - Could be negative in early disease - Presence of infiltrate on xray is gold standard of diagnosis**** - Should definitely be performed in patient any respiratory illness with the following: • HR > 100 bpm • Temp > 100 F • RR > 20/min - Any patient with two of the following: • Decreased breath sounds • Crackles • Lack of asthma OTHER TESTS - CORRECT ANSWER-Sputum culture....if inpatient we can! Treat empirically.