Copyright © 2006 by Mosby, Inc. Slide 1 PART III Infectious Pulmonary Diseases.

Copyright © 2006 by Mosby, Inc.Slide 1

PART IIIPART III

Infectious Pulmonary DiseasesInfectious Pulmonary Diseases


Chapter 15

Figure 15-1. Cross-sectional view of alveolar consolidation in pneumonia. Figure 15-1. Cross-sectional view of alveolar consolidation in pneumonia. TI,TI, Type I cell; Type I cell;TII,TII, type II cell; type II cell; M,M, macrophage; macrophage; AC,AC, alveolar consolidation; alveolar consolidation; L,L, leukocyte; leukocyte; RBC,RBC, red blood cell. red blood cell.

Chapter 15Chapter 15PneumoniaPneumonia


Anatomic Alterations of the LungsAnatomic Alterations of the Lungs

Inflammation of the alveoliInflammation of the alveoli

Alveolar consolidationAlveolar consolidation

AtelectasisAtelectasis


EtiologyEtiology

Bacterial CausesBacterial Causes

Gram-positive organismsGram-positive organisms StreptococcusStreptococcus

StaphylococcusStaphylococcus


Figure 15-2. Figure 15-2. The The StreptococcusStreptococcus organism is a gram-positive, nonmotile coccus organism is a gram-positive, nonmotile coccus that is found singly, in pairs, and in short chains.that is found singly, in pairs, and in short chains.


Figure 15-3. Figure 15-3. The The StaphylococcusStaphylococcus organism is a gram-positive, nonmotile coccus organism is a gram-positive, nonmotile coccus that is found singly, in pairs, and in irregular clusters.that is found singly, in pairs, and in irregular clusters.


EtiologyEtiology

Gram-negative organismsGram-negative organisms

Haemophilus influenzaeHaemophilus influenzae

KlebsiellaKlebsiella

Pseudomonas aeruginosaPseudomonas aeruginosa

Moraxella catarrhalis Moraxella catarrhalis

Escherichia coliEscherichia coli

Serratia Serratia speciesspecies

Enterobacter Enterobacter speciesspecies


Figure 15-4. Figure 15-4. The bacilli are rod-shaped microorganisms and are the major The bacilli are rod-shaped microorganisms and are the major gram-negative organisms responsible for pneumonia.gram-negative organisms responsible for pneumonia.


EtiologyEtiology

Atypical organismsAtypical organisms

Mycoplasma pneumoniaeMycoplasma pneumoniae

Legionella pneumophilaLegionella pneumophila

Chlamydia psittaciChlamydia psittaci

Chlamydia pneumoniaeChlamydia pneumoniae


EtiologyEtiology

Anaerobic bacterial infectionsAnaerobic bacterial infections

Peptostreptococcus Peptostreptococcus speciesspecies

Bacteroides melaninogenicusBacteroides melaninogenicus

Fusobacterium necrophorumFusobacterium necrophorum

Bacteroides asaccharolyticusBacteroides asaccharolyticus

Porphyromonas endodontalisPorphyromonas endodontalis

Porphyromonas gingivalisPorphyromonas gingivalis


EtiologyEtiology

Viral causesViral causes

InfluenzavirusInfluenzavirus

Respiratory syncytial virusRespiratory syncytial virus

Parainfluenza virusParainfluenza virus

AdenovirusAdenovirus

Coronavirus (SARS)Coronavirus (SARS)


EtiologyEtiology

Other causesOther causes Rickettsial infectionsRickettsial infections VaricellaVaricella RubellaRubella Aspiration pneumonitisAspiration pneumonitis Lipoid pneumonitisLipoid pneumonitis Pneumocystis cariniiPneumocystis carinii CytomegalovirusCytomegalovirus TuberculosisTuberculosis Fungal infectionsFungal infections


EtiologyEtiology

Acquired pneumonia classificationAcquired pneumonia classification

Community-acquired pneumonia (CAP)Community-acquired pneumonia (CAP)

Nursing home–acquired pneumoniaNursing home–acquired pneumonia

Hospital-acquired pneumoniaHospital-acquired pneumonia

Ventilator-associated pneumoniaVentilator-associated pneumonia


Overview of the Cardiopulmonary Overview of the Cardiopulmonary Clinical Manifestations Associated Clinical Manifestations Associated

with PNEUMONIAwith PNEUMONIA

The following clinical manifestations result from the The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) pathophysiologic mechanisms caused (or activated) by by Alveolar Consolidation Alveolar Consolidation (see Figure 9-8),(see Figure 9-8), Increased Alveolar-Capillary Membrane Increased Alveolar-Capillary Membrane ThicknessThickness (see Figure 9-9), and (see Figure 9-9), and AtelectasisAtelectasis (see (see Figure 9-7)—the major anatomic alterations of the Figure 9-7)—the major anatomic alterations of the lungs associated with pneumonia (see Figure 15-1). lungs associated with pneumonia (see Figure 15-1). During the resolution stage of pneumonia, During the resolution stage of pneumonia, Excessive Bronchial SecretionsExcessive Bronchial Secretions (see Figure 9-11) (see Figure 9-11) also may play a part in the clinical presentation.also may play a part in the clinical presentation.


Figure 9-8. Alveolar consolidation clinical scenario.


Figure 9-9. Increased alveolar-capillary membrane thickness clinical scenario.


Figure 9-7. Atelectasis clinical scenario.


Figure 9-11. Excessive bronchial secretions clinical scenario.


Clinical Data Obtained at the Clinical Data Obtained at the Patient’s BedsidePatient’s Bedside

Vital signsVital signs

Increased respiratory rateIncreased respiratory rate

Increased heart rate, cardiac output, Increased heart rate, cardiac output, blood pressureblood pressure


Clinical Data Obtained at theClinical Data Obtained at the Patient’s Bedside Patient’s Bedside

Chest pain/decreased chest expansionChest pain/decreased chest expansion

CyanosisCyanosis

Cough, sputum production, and hemoptysisCough, sputum production, and hemoptysis

Chest assessment findingsChest assessment findings Increased tactile and vocal fremitusIncreased tactile and vocal fremitus Dull percussion noteDull percussion note Bronchial breath soundsBronchial breath sounds Crackles and rhonchiCrackles and rhonchi Pleural friction rub Pleural friction rub Whispered pectoriloquyWhispered pectoriloquy


Figure 2-11. Figure 2-11. A short, dull, or flat percussion note is typically produced over areas A short, dull, or flat percussion note is typically produced over areas of alveolar consolidation.of alveolar consolidation.


Figure 2-16. Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung Auscultation of bronchial breath sounds over a consolidated lung unit.unit.


Figure 2-19. Figure 2-19. Whispered voice sounds auscultated over a normal lungWhispered voice sounds auscultated over a normal lungare usually faint and unintelligible.are usually faint and unintelligible.


Clinical Data Obtained from Clinical Data Obtained from Laboratory Tests and Special Laboratory Tests and Special

ProceduresProcedures


Pulmonary Function Study: Pulmonary Function Study: Expiratory Maneuver FindingsExpiratory Maneuver Findings

FVC FEVFVC FEVTT FEF FEF25%-75%25%-75% FEF FEF200-1200200-1200

N or N or N or N or N N

PEFRPEFR MVV FEFMVV FEF50% 50% FEVFEV1%1%

N N or N N or N N or N N or

FVC FEVFVC FEVTT FEF FEF25%-75%25%-75% FEF FEF200-1200200-1200

N or N or N or N or N N

PEFRPEFR MVV FEFMVV FEF50% 50% FEVFEV1%1%

N N or N N or N N or N N or


Pulmonary Function Study Pulmonary Function Study Lung Volume and Capacity Findings Lung Volume and Capacity Findings

VT RV FRC TLC

N or

VC IC ERV RV/TLC%

N

VT RV FRC TLC

N or

VC IC ERV RV/TLC%

N


Arterial Blood GasesArterial Blood Gases

Mild to Moderate PneumoniaMild to Moderate Pneumonia

Acute alveolar hyperventilation with Acute alveolar hyperventilation with hypoxemiahypoxemia

pH PaCO2 HCO3- PaO2

(Slightly)


Time and Progression of Disease Time and Progression of Disease

100100

5050

3030

8080

00

PaCO2

1010

2020

4040

Alveolar HyperventilationAlveolar Hyperventilation

6060

7070

9090 Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

PaO2

Disease OnsetDisease OnsetP

aO2

or

PaC

O2

PaO

2 o

r P

aCO

2

Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.


Arterial Blood GasesArterial Blood Gases

Severe PneumoniaSevere Pneumonia

Acute ventilatory failure with hypoxemiaAcute ventilatory failure with hypoxemia

pH PaCO2 HCO3- PaO2

(Slightly)


Time and Progression of DiseaseTime and Progression of Disease

100100

5050

3030

80

0

PaO2

1010

2020

4040


6060

7070

9090Point at which PaO2 declines enough to stimulate peripheral oxygen receptors


PaCO 2

Acute Ventilatory Failure Acute Ventilatory FailureDisease OnsetDisease Onset

Point at which disease becomes severe and patient begins to become fatigued


Pa0

2 o

r P

aC0 2

Pa0

2 o

r P

aC0 2

Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.


Oxygenation IndicesOxygenation Indices

QS/QTDO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2

QS/QTDO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2


Time and Progression of DiseaseTime and Progression of Disease

100100

5050

3030

80

0

PaO2

1010

2020

4040


6060

7070

9090Point at which PaO2 declines enough to stimulate peripheral oxygen receptors


PaCO 2

Acute Ventilatory Failure Acute Ventilatory FailureDisease OnsetDisease Onset



Pa0

2 o

r P

aC0 2

Pa0

2 o

r P

aC0 2

Figure 4-7. PaO2 and PaCO2 trends during acute or Acute ventilatory failure.


Abnormal Laboratory Tests and Abnormal Laboratory Tests and ProceduresProcedures

Sputum examinationSputum examination

Gram-positive organismsGram-positive organisms StreptococcusStreptococcus

StaphylococcusStaphylococcus

Gram-negative organismsGram-negative organisms KlebsiellaKlebsiella

Pseudomonas aeruginosaPseudomonas aeruginosa

Haemophilus influenzaeHaemophilus influenzae

Legionella pneumophilaLegionella pneumophila


Radiologic FindingsRadiologic Findings

Chest radiographChest radiograph

Increased density Increased density

Air bronchogramsAir bronchograms

Pleural effusionsPleural effusions

CT scanCT scan

Consolidation and bronchograms Consolidation and bronchograms may be seenmay be seen


Figure 15-5. Chest X-ray film of a 20-year-old woman with severe pneumonia of the left lung.


Figure 15-6. Air bronchogram. The branching linear lucencies within the consolidation in the right lower lobe are particularly well demonstrated in this example of staphylococcal pneumonia. (From

Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)


Figure 15-7. Air bronchogram shown by CT in a patient with pneumonia. (From Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)


General Management of General Management of PneumoniaPneumonia

Respiratory care treatment protocolsRespiratory care treatment protocols

Oxygen therapy protocolOxygen therapy protocol

Bronchopulmonary hygiene therapy protocolBronchopulmonary hygiene therapy protocol


General Management of General Management of PneumoniaPneumonia

Medications and procedures commonlyMedications and procedures commonlyprescribed by the physicianprescribed by the physician

AntibioticsAntibiotics

Analgesic agentsAnalgesic agents

Ribavirin aerosolRibavirin aerosol

Aerosolized pentamidineAerosolized pentamidine

ThoracentesisThoracentesis


Classroom DiscussionClassroom DiscussionCase Study: PneumoniaCase Study: Pneumonia

Copyright © 2006 by Mosby, Inc. Slide 1 PART III Infectious Pulmonary Diseases.

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Transcript of Copyright © 2006 by Mosby, Inc. Slide 1 PART III Infectious Pulmonary Diseases.