Exam (elaborations)
NU 664 CAP- EX1 – QUESTIONS & ANSWERS
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- NU 664 CAP-
NU 664 CAP- EX1 – QUESTIONS & ANSWERS
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NU 664 CAP- EX1 – QUESTIONS &ANSWERS
CAP: - -- 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 - -
-immunizations for people 65+ or younger with comorbidities i.e. asthma,
COPD, CHF - -pna and flu vaccines
-Who is at risk for CAP? - -Extremes of age (very young/very old)
Smokers
ETOH abuse
GERD
Chronic diseases( DM, COPD, CAD, CHF)
Institutionalization
-TAKE A GOOD HISTORY: - -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 - -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 - -• 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: - -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 - -• 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 - -Sputum culture....if inpatient we can! Treat empirically.
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