Saturday, January 20, 2007

Pneumonia (community-acquired)

In response to Jules:


Yup, it does get more and more difficult doesn't it?, especially when you get to MS. I am also in my 3rd year, although I'm already a regular because I'm done with all my minor subjects.

About your questions, I can only offer a summary. I haven't yet encountered this case in my clinical duty.

The common causes of community-acquired pneumonia are the following bacteria: streptococcus pneumonia, haemophilus influenzae, legionella pneumonia and histoplasmosis capsulatom.

It can also be caused by viral or fungal infection, aspiration of food, fluids or gastric substances, or irritation by noxious/ chemical substances.

So the pathophysiology looks something like this:

Inhalation of the microorganisms/ noxious substances --> inflammation of the tissues in the lungs --> exudates formation --> increased proliferation of bacteria --> insistent sputum production --> impaired gas exchange --> etc (signs and symptoms)

Common clinical manifestations: wheezing, dyspnea, cough, rales, rhonchi, chest pains.

Meds: Antibiotics (For example, Amphothericin B - IV route; antidote for the side effects of that drug: benadryl, steroids)

Disgnostics: Chest X-ray, sputum exam with gram stain (the definitive test), culture and sensitivity test and blood culture.

Nursing management:

To facilitate adequate ventilation:

a. Increase fluid intake to at least 3 L/day;
b. Chest physiotherapy;
c. Chest splinting;
d. Suctioning when necessary (not more than 9 secs at a time);
e. O2 when needed;
f. Incentive spirometry
g. Administration of antibiotics (penicillin for pneumococcus, ampicillin for haemophilic influenzae)

I don't know about the prognosis and the discharge planning, though.

Hope that helps.

Good luck to you!

BTW, my references are the MS books by Black, Ignatavicius and Udan.

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