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NR566 Week 2 Ch 42, 43, & 45 Complete Study Guide

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AIT Nursing (NR566)

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Thompson River University (TRU )

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nr 566 week 2 ch 42
43
nr 566 week 2 ch 42
43
and the host defen
amp 45 chapter 42 pneumonia
amp 45
chapter 42 pneumonia
etiology  pna develops when an organism invades the lung parenchyma

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NR 566 Week 2 Ch 42, 43, & 45
Chapter 42: Pneumonia

Etiology
 PNA develops when an organism invades the lung parenchyma, and the host defenses are
depressed.
 Chronically ill patients of all ages are more prone to PNA

Diagnosis
 PNA should be considered in any patient who presents with respiratory symptoms such as
cough, dyspnea, or sputum production.
 Fever or abnormal breath sounds (crackles) would strengthen the suspicion for PNA
 CxR- to confirm the dx of PNA

Classification
 Typical
o Caused by S. pneumoniae, H. influenzae, S. aureus, or gram-negative bacteria
o S/Sx:
 fever, chills
 yellow or green sputum
 pleuritic chest pain
 (+) lobar consolidation on CxR

 Atypical
o Caused by M. pneumoniae, Legionella pneumophila, viral infection
o S/Sx:
 Gradual onset of cough
 No or scant sputum
 Low-grade fever
 Myalgias
 Arthralgias
 (-) consolidation on CxR

Therapy and Goals of Treatment
 GOAL: return to the respiratory status a patient had before the illness
o Improved clinical condition in 48-72hrs after empirical abx tx
o Fever should resolve in 2-4 days
o Leukocytosis usually resolves by day 4 of tx
o NOTE: clear CxR is not an indicator of successful tx (may take time to be normal)
 Children: 6-8 weeks
 <50 yo: within 4 wks
 Older patients w/ comorbidity: on 4th week of tx

Common Bacterial Pathogens
 Streptococcus pneumonia- predominant organism (60%-75% for adults) except neonates.
 Haemophilus influenzae and Moraxella catarrhalis- common pathogens in patients with
underlying lung disease

,  Staphylococcus aureus- common co-pathogen in influenza-associated PNA
 Mycoplasma pneumoniae- pathogen difficult to detect on Gram’s stain or culture, is another
common cause of PNA

Clinical Practice Guidelines for CAP Treatment
 A practitioner will determine whether a patient needs an outpatient vs. inpatient treatment
 Criteria for hospital admission for PNA:
o RR >30
o T >101 F
o PaO2 <60 mmHg or PaCO3 >50 mmHg on RA
o Co-morbidities: DM, COPD, chronic renal failure, CHF, chronic live disease, ETOH abuse,
malnutrition (all these increase mortality of PNA)
o Age >65 yo

 Guideline in decision making for outpt vs. inpt
o Severity-of-illness scale: CURB-65 or PORT/PSI Score
 CURB-65:
 confusion, uremia, RR, low BP, age 65yo or above
 score of 2 and above = INPATIENT

o over-all clinical presentation (in the absence of guidelines)

 INITIAL EMPIRIC THERAPY:
o GROUP 1: Previously healthy outpatient with no cardiopulmonary disease, no abx in the
past months (no risk for DRSP), and no modifying factors:
 FIRST LINE: Azithromycin or clarithromycin (Erythromycin is less expensive but
can cause GI upset)
 Azithromycin 500mg on day 1, then 250mg daily on days 2 and 3
 Clarithromycin 250mg-500mg BID x 7-10 days
 Erythromycin 500mg QID x 7-10 days (250mg QID if gi upset occurs)

 SECOND LINE: doxycycline
 Treatment should not be altered for 72hrs!
 CAP- minimum 5 days treatment
 Patient should exhibit clinical response in 48-72hrs
 Patient should be afebrile for 48-72hrs.

o GROUP 2: Presence of comorbidities, immunosuppression, previous abx use for the last
3 months, other risk for DRSP infection:
 FIRST LINE: fluroquinolones (levofloxacin, moxifloxacin, gemifloxacin)
 SECOND LINE: beta lactam + macrolide
 Preferred choice: high dose of amoxicillin (1gm TID) or
amoxicillin/clavulanate (Augmentin)
 Alternatives: cefpodoxime, cefuroxime, IV ceftriaxone followed by PO
cefpodoxime
 Doxycycline- can be an alternative to macrolide

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