Pneumonia is Also the Most Common Fatal Infection Acquired by Already Hospitalized Patients

7/30/2019 Pneumonia is Also the Most Common Fatal Infection Acquired by Already Hospitalized Patients

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Pneumonia is also the most common fatal infection acquired by already

hospitalized patients. In developing countries, like the Philippines, pneumonia ties with

diarrhea as the most common cause of death. Pneumonia remains in the list of the

leading causes of morbidity and mortality in the Philippines. The incidence of

pneumonia in developing countries in children less than 5 years old is almost 30% with a

high mortality rate. Approximately 10-20% of all children


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C. Bacterial Pneumonia

-more commonly caused by Streptococcal Pneumoniae

There are many causes of pneumonia, including bacteria, viruses, mycoplasmas,

fungal agents and protozoa. Pneumonia may also result from aspiration of food, fluids,

vomitus or from inhalation of toxic or caustic chemicals, smoke, dusts or gases.

Pneumonia may complicate immobility and chronic illnesses. It often follows influenza.

Major risk factors for pneumonia include: advanced age, very young age, history

of smoking, upper respiratory infection, tracheal intubation, prolonged immobility, non-

functional immune system, malnutrition, dehydration and chronic disease states, such

as diabetes, heart disease, chronic lung disease, renal disease and cancer. Additional

risk factors are exposure to air pollution, altered consciousness from alcoholism, drug

overdose, general anesthesia or a seizure disorder; inhalation of noxious substances;

aspiration of food, liquid or foreign or gastric material; or residence in institutional setting

where transmission of disease is more likely.

Predisposing / Precipitating factors

Predisposing factors:

>age especially infants

due to their immature or underdeveloped immune system

>immunocompromised individuals

easily susceptible to such disease upon exposure to microorganisms

>common colds

these conditions when unresolved could lead to Pneumonia

Precipitating factors:

>aspiration of foods or fluids

provides a medium for growth of microorganisms.


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Anatomy & Physiology of the Respiratory System

The respiratory system is situated in

the thorax, and is responsible for gaseous

exchange between the circulatory system

and the outside world. Air is taken in via the

upper airways (the nasal cavity, pharynx

and larynx) through the lower airways

(trachea, primary bronchi and bronchialtree) and into the small bronchioles and

alveoli within the lung tissue.

Move the pointer over the coloured regions

of the diagram; the names will appear at

the bottom of the screen)

The lungs are divided into lobes; The left lung is composed of the upper lobe, the

lower lobe and the lingula (a small remnant next to the apex of the heart), the right

lung is composed of the upper, the middle and the lower lobes.


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Appearance on X ray

Normal AP CXR Normal lateral CXR

AP CXR showing left lower lobe

pneumonia associated with a

small left sided pleural effusion

AP CXR showing right

lower lobe pneumonia

A lateral CXR showing

right lower lobe pneumonia

AP CXR showing

pneumonia of the lingula of

the left lung

Right upper lobe pneumonia as

marked by the circle.

Prevention

There are several ways to prevent infectious pneumonia. Appropriately treating underlying illnesses

(such asAIDS) can decrease a person's risk of pneumonia.Smoking cessationis important not only

because it helps to limit lung damage, but also because cigarette smoke interferes with many of the

body's natural defenses against pneumonia.
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Researchshows that there are several ways to prevent pneumonia in newborninfants. Testing

pregnant women forGroup B StreptococcusandChlamydia trachomatis, and then

givingantibiotictreatment if needed, reduces pneumonia in infants. Suctioning the mouth and throat

of infants withmeconium-stainedamniotic fluiddecreases the rate ofaspiration pneumonia.

Vaccinationis important for preventing pneumonia in both children and adults. Vaccinations

againstHaemophilus influenzaeandStreptococcus pneumoniaein the first year of life have greatly

reduced the role these bacteria play in causing pneumonia in children. Vaccinating children

against Streptococcus pneumoniaehas also led to a decreased incidence of these infections in

adults because many adults acquire infections from children. Hib vaccine is now widely used around

the globe. The childhood pneumococcal vaccine is still as of 2009 predominantly used in high-

income countries, though this is changing. In 2009, Rwanda became the first low-income country to

introduce pneumococcal conjugate vaccine into their national immunization program.[18]

Avaccine against Streptococcus pneumoniaeis also available for adults. In the U.S., it is currently

recommended for all healthy individuals older than 65 and any adults withemphysema,congestive

heart failure,diabetes mellitus,cirrhosisof theliver,alcoholism,cerebrospinal fluidleaks, or those

who do not have aspleen. A repeat vaccination may also be required after five or ten years.[19]

Influenza vaccinesshould be given yearly to the same individuals who receive vaccination

againstStreptococcus pneumoniae. In addition, health care workers, nursing home residents, and

pregnant women should receive the vaccine.[20]

When an influenza outbreak is occurring,

medications such asamantadine,rimantadine,zanamivir, andoseltamivircan help prevent

influenza.[21][22]

Treating Pneumonia

Typically, oral antibiotics, rest and fluids are sufficient for treatment of pneumonia. However,

there is concern that expanded and sustained use of antibiotics to treat children with pneumonia

could lead to increased antibiotic resistance, which would make the management of cases more

difficult in the future.

High levels of antibiotic resistance to first-line treatments, notably cotrimoxazole, have been

reported in many parts of the world. A study in Pakistan investigated the relationship between

high levels of S. pneumoniaeand Hib resistance to cotrimoxazole and the clinical efficacy of

using this drug to treat children with pneumonia.1 However, this study found that despite high
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levels of cotrimoxazole resistance, treatment failure rates were low among children with

pneumonia.

It is important that scaling up treatment for pneumonia go hand-in-hand with rigorous training

and oversight of health facility personnel and community health workers to ensure proper

diagnosis and treatment of pneumonia in communities.

Nursing interventions and responsibilities in caring for the patient with pneumonia include

administering oxygen and medications as prescribed and monitoring for thier effects. Monitoring

vital signs including oxygen level, monitoring lung sounds, watching for edema and patients

feeling of shortness of breath. It may also include doing chest physiotherapy, educating on the

use of incentive spirometry and flutter valve. If the patient is immobile it is imperative that the

patient be turned every two hours and encouraged to cough and deep breathe. If the patient has

a tracheostomy proper trach care and suctioning after hyperoxygenating is also a responsibility.

Asthmais a commonchronicinflammatorydiseaseof theairwayscharacterized by variable and

recurring symptoms, airflow obstruction, andbronchospasm.[1]

Symptoms includewheezing,cough,

chest tightness, andshortness of breath.[2]

Medicines such as inhaled short-actingbeta-2 agonistsmay be used to treat acute attacks.[3]

Attacks

can also be prevented by avoiding triggering factors such as allergens[4]

or rapid temperature

changes[5]and through drug treatment such as inhaled corticosteroids.[6]Leukotriene antagonistsare
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less effective than corticosteroids, but have fewer side effects.[7]

Themonoclonal

antibodyomalizumabis sometimes effective.[8]

It affects 7% of the population of the United States,[9]

6.5% of British people and a total of 300 million

worldwide.[10]

[citation needed]

Asthma causes 4,000 deaths per year in theUnited States[11]

and 250,000

deaths per year worldwide.[12]Prognosis is good with treatment.

Although asthma is achronicobstructivecondition, it is not considered as a part ofchronic

obstructive pulmonary diseaseas this term refers specifically to combinations

ofbronchiectasis,chronic bronchitis, andemphysema. Unlike these diseases, the airway

obstruction in asthma is usually reversible; however, if left untreated, asthma can result in

chronic inflammation of the lungs and irreversible obstruction.[citation needed]In contrast

toemphysema, asthma affects the bronchi, not thealveoli.[13]Public attention in

thedeveloped worldhas increased recently because of its rapidly increasingprevalence,

affecting up to one quarter ofurbanchildren.Classification

Clinical classification of severity[15]

SeveritySymptom

frequency

Nighttime

symptoms

%FEV1

of predicted

FEV1

Variability

Intermittent 1 per week 6080% >30%

Severe persistent Daily Frequent 30%

Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in 1

second (FEV1), andpeak expiratory flow rate.[15]

Asthma may also be classified as atopic (extrinsic)

or non-atopic (intrinsic), based on whether symptoms are precipitated by allergens (atopic) or not

(non-atopic).[16]

[edit]Brittle asthma

Main article:Brittle asthma
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Brittle asthma is a term used to describe two types of asthma, distinguishable by recurrent, severe

attacks.[17]

Type 1 brittle asthma refers to disease with wide peak flow variability, despite intense

medication. Type 2 brittle asthma describes background well-controlled asthma, with sudden severe

exacerbations.[17]

[edit]Signs and symptoms

Because of the spectrum of severity among asthma patients, some people with asthma only rarely

experience symptoms, usually in response to triggers, where as other more severe cases may have

marked airflow obstruction at all times.[18]

Common symptoms of asthma include wheezing,

shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the early

morning, or in response to exercise or cold air.[19]

[edit]Asthma attack

Severity of acute asthma exacerbations

[17]

Near-fatal asthma HighPaCO2and/or requiring mechanical ventilation

Life threatening asthma

Any one of the following in a person with severe asthma:-

Clinical signs Measurements

Alteredconscious level Peak flow< 33%

Exhaustion Oxygen saturation< 92%

Arrhythmia PaO2< 8 kPa

Lowblood pressure "Normal" PaCO2

Cyanosis

Silent chest

Poor respiratory effort

Acute severe asthma Any one of:-
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Peak flow 33-50%

Respiratory rate 25 breaths per minute

Heart rate 110 beats per minute

Unable to complete sentences in one breath

Moderate asthma exacerbation

Worsening symptoms

Peak flow > 50% best or predicted

No features of acute severe asthma

An acute exacerbation of asthma is commonly referred to as an asthma attack. The cardinal

symptoms of an attack are shortness of breath (dyspnea),wheezing, and chest

tightness.[20]Although the former is often regarded as the primary symptom of asthma,[21]some

people present primarily withcoughing, and in the late stages of an attack, air motion may be so

impaired that no wheezing is heard.[17]

When present the cough may sometimes produce

clearsputum. The onset may be sudden, with a sense of constriction in the chest, as breathing

becomes difficult and wheezing occurs (primarily upon expiration, but sometimes in

bothrespiratoryphases). It is important to note inspiratorystridorwithoutexpiratorywheezehowever, as an upper airway obstruction may manifest with symptoms similar to

an acute exacerbation of asthma, with stridor instead of wheezing, and will remain unresponsive to

bronchodilators.[21]

Signsof an asthmatic episode include wheezing, prolonged expiration, a rapid heart rate

(tachycardia), andrhonchouslung sounds (audible through astethoscope). During a serious asthma

attack, the accessorymusclesof respiration (sternocleidomastoid and scalene muscles of the neck)

may be used, shown as in-drawing oftissuesbetween the ribs and above thesternumandclavicles,

and there may be the presence of aparadoxical pulse(a pulse that is weaker during inhalation and

stronger during exhalation), and over-inflation of the chest.[citation needed]

During very severe attacks, an asthma sufferer canturn bluefrom lack of oxygen and can

experiencechest painor even loss ofconsciousness. Just before loss of consciousness, there is a

chance that the patient will feel numbness in the limbs and palms may start to sweat. The person's

feet may become cold. Severe asthma attacks which are not responsive to standard treatments,
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calledstatus asthmaticus, are life-threatening and may lead to respiratory arrest and death.[citation

needed]

Though symptoms may be very severe during an acute exacerbation, between attacks a patient may

show few or even no signs of the disease.[22]

Prevention

Fluticasone propionatemetered dose inhaler commonly used to prevent asthma attacks.

Prevention of the development of asthma is different from prevention of asthma episodes.

Aggressive treatment of mild allergy withimmunotherapyhas been shown to reduce the likelihood of

asthma development. In controlling symptoms, the first step is establishing a plan of action to

prevent episodes of asthma by avoiding triggers and allergens, regularly testing for lung function,

and using preventive medications.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
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Current treatment protocols recommend controller medications such as an inhaledcorticosteroid,

which helps to suppressinflammationand reduces the swelling of the lining of the airways, in

anyone who has frequent (greater than twice a week) need of relievers or who has severe

symptoms. If symptoms persist, additional controller drugs are added until almost all asthma

symptoms are prevented. With the proper use of control drugs, patients with asthma can avoid the

complications that result from overuse of rescue medications.

Patients with asthma sometimes stop taking their controller medication when they feel fine and have

no problems breathing. This often results in further attacks after a time, and no long-term

improvement.

The only preventive agent known is allergen immunotherapy. Controller medications include the

following:

Inhaledglucocorticoidssuch asbeclomethasoneare the most widely used prevention

medications and normally come asinhalers. Side effects, while they may occur are generally not

seen with the inhaled steroids when used in conventional doses for control of asthma due to the

smaller dose which is targeted to the lungs, unlike the higher doses of oral or injected

preparations. Deposition of steroids in the mouth may result inoral thrush. Deposition near the

vocal cords can causehoarse voice. These may be minimised by rinsing the mouth with water

after inhaler use, as well as by using aspacer. Spacers also generally increase the amount of

drug that reaches the lungs.

Leukotrienemodifiers such asmontelukastprovide both anti-spasm and anti-inflammatory

effects. They are less effective than inhaled corticosteroids, but do not have any steroid related

side-effects and the benefit is additive with inhaled steroid.

Mast cellstabilizers such as (cromoglicate(cromolyn), andnedocromil). These medications are

believed to prevent the initiation of the allergy reaction, by stabilizing the mast cell. They are not

effective once the reaction has already begun, and typically must be used 4 times a day for

maximal effect. But they do truly prevent asthma symptoms and are nearly free of side-effects.

Antimuscarinics/anticholinergics (ipratropium,oxitropium, andtiotropium). These agents both

relieve spasm and reduce formation of mucous. They are more effective in patients with

empysema or 'smokers lung.' They are rarely effective in asthma and are not true asthma

controller medications.

Methylxanthines (theophyllineandaminophylline). These agents are bronchodilators with

minimal anti-inflammatory effect. At one time they were the only effective asthma medications

available. They are sometimes considered if sufficient control cannot be achieved with inhaled

glucocorticoid, leukotriene modifier, and long-acting -agonist combinations.
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Antihistaminesare often used to treat the nasal allergies which can accompany asthma. Older

agents are too drying and can result in thick mucous so should be avoided. Newer

antihistamines which do not have this effect can safely be used by patients with asthma.[verification

needed]

Allergy Desensitization, also known asallergy immunotherapy, may be recommended in some

cases where allergy is the suspected cause or trigger of asthma. Allergy shots are dangerous in

severe asthma and in uncontrolled asthma. However if allergy immunotherapy is started early in

the disease there is a good chance that a remission of asthma can be induced (aka "asthma

cure"). Typically the need for medication is reduced by about half with injection allergy

immunotherapy, when done correctly. If a patient is only allergic to one or two items, oral allergy

immunotherapy can be used. This is safe, much easier in young children, and is about half as

effective. Unfortunately if a patient is allergic to more than 2 or 3 items then oral therapy cannot

be given in a dose which is proven safe and effective.

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing

(constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or

at least partially reversible with treatments.

Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or

irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened

sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial

hyperreactivity in all individuals. However, it is clear that asthmatics andallergicindividuals (without apparent

asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In

sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such

as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms

while others may have severe BHR and chronic symptoms.

Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental

triggers. This naturally influences the type and dose of medication prescribed, which may vary from one

individual to another.
http://en.wikipedia.org/wiki/Histamine_antagonisthttp://en.wikipedia.org/wiki/Histamine_antagonisthttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Allergy_immunotherapyhttp://en.wikipedia.org/wiki/Allergy_immunotherapyhttp://en.wikipedia.org/wiki/Allergy_immunotherapyhttp://www.medicinenet.com/script/main/art.asp?articlekey=6748http://www.medicinenet.com/script/main/art.asp?articlekey=6748http://www.medicinenet.com/script/main/art.asp?articlekey=6748http://www.medicinenet.com/script/main/art.asp?articlekey=6748http://en.wikipedia.org/wiki/Allergy_immunotherapyhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Histamine_antagonist


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According tohealth and nutrition, the oriental and Chinese herbs have the capability to strengthen the immune

system directly to make itfunctionproperly for the prevention of asthma like problems. The only drawback of

herbs is that they taste awful; therefore, to make your children gulp these herbal drinks easily is to mix them

with theirfavorite juices to make them taste better.

A certified health and nutrition expert having the experienceof childrenstreatmentscan judge your childsrequirements and recommend an herbal medicine to cure congestion and develop the immune system.

Massaging certain herbs on specific areasof your childs body during asthmatic periods can aid to give relief

from cough, irritation and wheezing.

Lung 1 releases blocked energy in the lungs: positioned on each side of the chest in the malleable area just

below the lateral head of the collarbone. Ding chuan is a particular spot to ease asthma; positioned on the

backside, just underneath and lateral to the most prominent vertebra in the base of neck.
http://www.newsgates.com/http://www.newsgates.com/http://www.newsgates.com/http://www.newsgates.com/

Pneumonia is Also the Most Common Fatal Infection Acquired by Already Hospitalized Patients

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