NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
Pneumonia
•Infection of one or both lungs.
•Parenchyma, alveolar spaces, and/or interstitial tissue.
Pneumonia is categorized based on site of acquisition.
• Community Acquired Pneumonia (CAP)- acute infection of the pulmonary
parenchyma outside of a health care setting.
• Nosocomial pneumonia- acute infection of the pulmonary parenchyma
acquired in the hospital and encompasses both hospitals acquired pneumonia
(HAP) and ventilator-associated pneumonia (VAP)
•Adults with CAP:
•Viruses including influenza
•Bacteria are most common cause
•Typical vs atypical organisms
•The most common causes of CAP in outpatients:
● S. pneumoniae,
● M. pneumoniae
● H. influenzae
● S. aureus
● Legionella
● respiratory viruses
Typical
•Streptococcus pneumoniae (which accounts for 60% to 70% of all bacterial CAP
cases), Hemophilus influenzae, S. aureus, Moraxella catarrhalis, anaerobes, and
aerobic gram-negative bacteria
Atypical
•Legionella, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia
psittaci, and respiratory viruses.
Risk Factors
● OLDER AGE: >/ 65 YEARS OLD IS APPROX. 2000 PER 100,000 IN THE U.S.
● CHRONIC DISEASES (DIABETES, RENAL DISEASE, COPD, CAD, CHF)
● VIRAL RESPIRATORY TRACT INFECTION
● SMOKING AND ALCOHOL OVERUSE
Classic presentation
•Cough (with or without sputum)
•Dyspnea
•Pleuritic chest pain
•Physical Exam:
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
● Tachypnea
● Increased WOB
● adventitious breath sounds
○ Rales/crackles and rhonchi.
● Tactile fremitus, egophony, and dullness to percussion
● Fever>100.4 F
Differential Diagnosis
Noninfectious illnesses that mimic CAP:
•CHF
•PE
•Pulmonary hemorrhage
•Atelectasis aspiration or chemical pneumonitis
•Lung cancer
Respiratory illnesses that mimic CAP:
•Acute exacerbation of COPD
•Influenza
•Acute bronchitis
•Asthma exacerbation
PNEUMONIA:
Diagnosis:
Patient Hx:
● Age
● Smoking status
● Malnourishment
● underlying lung disease
● medical problems
● recent travels etc.
Physical Examination:
● Chest auscultation
● dullness to percussion
● Egophony
● tachycardia, tachypnea
● pleural rubs,
● asymmetric breath sounds and increased fremitus etc.
● Headache and sore throat (atypical pneumonia).
Presenting Signs & Symptoms:
● Cough with or without sputum
● High fever, malaise
● pleuritic chest pain
● rales or bronchial breath sounds
● dyspnea and hemoptysis.
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
Diagnostic Tests:
Chest X -Ray:
● Most reliable test for confirming diagnosis of pneumonia.
● Recommended by IDSA/ATS for all patients to establish diagnosis
and rule out complications.
● Check for inflammation in the lungs.
● Pneumonia is confirmed when new infiltrates are found on chest radiography.
Sputum Testing:
● Sample of sputum (spit) or phlegm (slimy substance from deep in your
lungs) that is produced from a deep cough may be send to the lab for
testing.
● Help in identifying the bacteria causing the pneumonia.
● Will assist with treatment plan. IDSA/ATS do not recommend sputum
testing for outpatients diagnosed with CAP.
Labs
•CBC and differentials • Complement Fixations • ABGs • Viral culture • Blood Chemistries
Bac VS Viral PNE
Further Tests and Labs.
● Patients with CAP should be investigated for specific pathogens that would
significantly alter standard (empirical) management decisions, when the
presence of such pathogens is suspected based on clinical and epidemiologic
clues
● Urine Testing
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
● Blood Oxygen Measurement/Pulse oximetry. (should be assessed in all
patients with possible CAP)
● Pleural fluid culture
● CT Scan.
● Bronchoscopy
Non-Pharmacologic Therapy
•Hydration with increased fluids
•Reduce activity during acute phase
•Patient education about disease, treatment, emergency action
Pharmacologic Therapy Adult Outpatient Treatment: updated guidelines: Outpatient,
previously healthy, no recent antibiotic:
● Amoxicillin 1 g po TID x 5 days OR (do not use with PCN allergy)
● Doxycycline hyclate 100 mg po BID x 5 days OR Macrolide: Azithromycin
(Zithromax) 500 mg po once, then 250 mg po QD x 4 days
Outpatient, co-morbidities (COPD, diabetes, renal, HF, or malignancy, EtOH,
immunosuppression, asplenia)
● Amoxicillin clavulanate (Augmentin) 875 mg po BID
● Cefpodoxime 200 mg po BID
● Cefuroxime 500 mg po BID, PLUS: Azithromycin (Zithromax) 500 mg po
once, then 250 mg po daily x 4 days
● Doxycycline hyclate 100 mg po BID x 5 days
If cephalosporin/Penicillin allergy:
● respiratory fluoroquinolone
○ Levofloxacin 750 mg po daily x 5 days
○ Moxifloxacin 400 mg po daily x 5 days
Pneumonia
•Infection of one or both lungs.
•Parenchyma, alveolar spaces, and/or interstitial tissue.
Pneumonia is categorized based on site of acquisition.
• Community Acquired Pneumonia (CAP)- acute infection of the pulmonary
parenchyma outside of a health care setting.
• Nosocomial pneumonia- acute infection of the pulmonary parenchyma
acquired in the hospital and encompasses both hospitals acquired pneumonia
(HAP) and ventilator-associated pneumonia (VAP)
•Adults with CAP:
•Viruses including influenza
•Bacteria are most common cause
•Typical vs atypical organisms
•The most common causes of CAP in outpatients:
● S. pneumoniae,
● M. pneumoniae
● H. influenzae
● S. aureus
● Legionella
● respiratory viruses
Typical
•Streptococcus pneumoniae (which accounts for 60% to 70% of all bacterial CAP
cases), Hemophilus influenzae, S. aureus, Moraxella catarrhalis, anaerobes, and
aerobic gram-negative bacteria
Atypical
•Legionella, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia
psittaci, and respiratory viruses.
Risk Factors
● OLDER AGE: >/ 65 YEARS OLD IS APPROX. 2000 PER 100,000 IN THE U.S.
● CHRONIC DISEASES (DIABETES, RENAL DISEASE, COPD, CAD, CHF)
● VIRAL RESPIRATORY TRACT INFECTION
● SMOKING AND ALCOHOL OVERUSE
Classic presentation
•Cough (with or without sputum)
•Dyspnea
•Pleuritic chest pain
•Physical Exam:
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
● Tachypnea
● Increased WOB
● adventitious breath sounds
○ Rales/crackles and rhonchi.
● Tactile fremitus, egophony, and dullness to percussion
● Fever>100.4 F
Differential Diagnosis
Noninfectious illnesses that mimic CAP:
•CHF
•PE
•Pulmonary hemorrhage
•Atelectasis aspiration or chemical pneumonitis
•Lung cancer
Respiratory illnesses that mimic CAP:
•Acute exacerbation of COPD
•Influenza
•Acute bronchitis
•Asthma exacerbation
PNEUMONIA:
Diagnosis:
Patient Hx:
● Age
● Smoking status
● Malnourishment
● underlying lung disease
● medical problems
● recent travels etc.
Physical Examination:
● Chest auscultation
● dullness to percussion
● Egophony
● tachycardia, tachypnea
● pleural rubs,
● asymmetric breath sounds and increased fremitus etc.
● Headache and sore throat (atypical pneumonia).
Presenting Signs & Symptoms:
● Cough with or without sputum
● High fever, malaise
● pleuritic chest pain
● rales or bronchial breath sounds
● dyspnea and hemoptysis.
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
Diagnostic Tests:
Chest X -Ray:
● Most reliable test for confirming diagnosis of pneumonia.
● Recommended by IDSA/ATS for all patients to establish diagnosis
and rule out complications.
● Check for inflammation in the lungs.
● Pneumonia is confirmed when new infiltrates are found on chest radiography.
Sputum Testing:
● Sample of sputum (spit) or phlegm (slimy substance from deep in your
lungs) that is produced from a deep cough may be send to the lab for
testing.
● Help in identifying the bacteria causing the pneumonia.
● Will assist with treatment plan. IDSA/ATS do not recommend sputum
testing for outpatients diagnosed with CAP.
Labs
•CBC and differentials • Complement Fixations • ABGs • Viral culture • Blood Chemistries
Bac VS Viral PNE
Further Tests and Labs.
● Patients with CAP should be investigated for specific pathogens that would
significantly alter standard (empirical) management decisions, when the
presence of such pathogens is suspected based on clinical and epidemiologic
clues
● Urine Testing
, NURS 611 Master Resp 2 - Comprehensive Notes on Pneumonia and Asthma Management
● Blood Oxygen Measurement/Pulse oximetry. (should be assessed in all
patients with possible CAP)
● Pleural fluid culture
● CT Scan.
● Bronchoscopy
Non-Pharmacologic Therapy
•Hydration with increased fluids
•Reduce activity during acute phase
•Patient education about disease, treatment, emergency action
Pharmacologic Therapy Adult Outpatient Treatment: updated guidelines: Outpatient,
previously healthy, no recent antibiotic:
● Amoxicillin 1 g po TID x 5 days OR (do not use with PCN allergy)
● Doxycycline hyclate 100 mg po BID x 5 days OR Macrolide: Azithromycin
(Zithromax) 500 mg po once, then 250 mg po QD x 4 days
Outpatient, co-morbidities (COPD, diabetes, renal, HF, or malignancy, EtOH,
immunosuppression, asplenia)
● Amoxicillin clavulanate (Augmentin) 875 mg po BID
● Cefpodoxime 200 mg po BID
● Cefuroxime 500 mg po BID, PLUS: Azithromycin (Zithromax) 500 mg po
once, then 250 mg po daily x 4 days
● Doxycycline hyclate 100 mg po BID x 5 days
If cephalosporin/Penicillin allergy:
● respiratory fluoroquinolone
○ Levofloxacin 750 mg po daily x 5 days
○ Moxifloxacin 400 mg po daily x 5 days
