What are three 3 physical assessment findings that are noted with the development of pneumonia?
CASE NO. 1 Show
CHIEF COMPLAINT: Cough and fever for four days HISTORY: Mr. Alcot is a 68 year old man who developed a harsh, productive cough four days prior to being seen by a physician. The sputum is thick and yellow with streaks of blood. He developed a fever, shaking, chills and malaise along with the cough. One day ago he developed pain in his right chest that intensifies with inspiration. The patient lost 15 lbs. over the past few months but claims he did not lose his appetite. "I just thought I had the flu." Past history reveals that he had a chronic smoker's cough for "10 or 15 years" which he describes as being mild, non-productive and occurring most often in the early morning. He smoked 2 packs of cigarettes per day for the past 50 years. The patient is a retired truck driver who has been treated for mild hypertension, bronchitis, appendicitis (as a young adult), hemorrhoids and a fractured femur and splenic injury. (motorcycle accident). PHYSICAL EXAMINATION: The patient is an elderly man who appears tired haggard and underweight. His complexion is sallow. He coughs continuously. Sitting in a chair, he leans to his right side, holding his right chest with his left arm. Vital signs are as follows: blood pressure 152/90, apical heart rate 112/minute and regular, respiratory rate 24/minute and somewhat labored, temperature 102.6�F. Examination of the neck reveals a large, non-tender hard lymph node in the right supraclavicular fossa. Both lungs are resonant by percussion with one exception: the right mid-anterior and right mid-lateral lung fields are dull. Auscultation reveals bilateral diminished vesicular breath sounds. Bronchial breath sounds, rhonchi and late inspiratory crackles (are heard) in the area of the right mid-anterior and right mid-lateral lung fields. The remainder of the lung fields is clear. Percussion and auscultation of the heart reveals no significant abnormality. Examination of the fingers shows clubbing. LABORATORY: WBC 17,000/mm3; neutrophils 70%, bands 15%, lymphocytes 15%. COURSE OF ILLNESS: Following a chest x-ray PA view and Lateral which revealed an acute pneumonia in the right middle lobe, the patient was treated with antibiotics as an outpatient. During the 10 days of treatment the patient's fever abated and he felt somewhat better. A post-treatment (follow up) chest x-ray reveals a right hilar mass. Sputum cytology demonstrates atypical cells. 1.Identify the problems from the history. Answer 2. Identify and explain the significance of physical findings. Answer 3. Review the lab findings. What is your diagnosis? Answer 4. What do you understand by the terms "hospital acquired" and "community acquired " pneumonia.? Which type of pneumonia does our patient have? Answer 5. What organisms are likely to be causing his pneumonia? Answer 6. List the various host factors, or conditions which predispose a patient to developing pneumonia. What host factors may have predisposed this patient to pneumonia? Answer 7. Explain the pathogenesis of pneumococcal pneumonia? What virulence factors are important? What pathologic changes are produced in the lungs because of pneumonia? Answer 8. How is the specific diagnosis established? What is the primary disadvantage to the examination of expectorated sputum? Describe characteristic morphology/growth of S. pneumoniae. Answer 9. What antimicrobial agents would you prescribe for this patient? Would you use or avoid penicillin, and why? What is the duration of treatment? Answer 10. What is the mechanism of pneumococcal resistance to penicillin? Answer 11. What are the complications of Pneumococcal pneumonia? Answer 12. Is prevention possible? Answer Original Editor - The Open Physio project. Top Contributors - Kim Jackson, Lucinda hampton, Admin, Tony Lowe, Nikhil Benhur Abburi, Adam Vallely Farrell, Vidya Acharya, Rachael Lowe, Evan Thomas, Rishika Babburu, Naomi O'Reilly, George Prudden, WikiSysop and Karen Wilson Introduction[edit | edit source]Pneumonia is a general term in widespread use, defined as infection within the lung. It is due to material, usually purulent, filling the alveoli.[1]
Transmission[edit | edit source]Pneumonia can be spread in a number of ways.
Aetiology[edit | edit source]There are various causes of pneumonia, in most the mode of transmission is via bacteria however it can be passed from person to person and also from the environment and practising good hygiene can minimise the spread of germs. The various types of pneumonia are discussed below Infective Agent:
2. fungal pneumonia This typically occurs in people who have a weakened immune system or other underlying health issues. This is usually inhaled from the environment and does not spread from person to person. eg Pneumocystis Jirovecii Pneumonia (formerly known as Pneumocystis carinii Pneumonia) is caused by the Pneumocystis carinii fungus. This fungus does not cause illness in healthy individuals, but rather in those with a weakened immune system.[7] 3. mycobacterial pneumonia 4. Viral Pneumonia - believed to be the cause of half of all cases of pneumonia. The viruses invade the lungs and then multiply- causing inflammation. eg coronavirus [ COVID-19, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, severe acute respiratory syndrome (SARS)], varicella pneumonia,Influenza type A or B, rhinoviruses adenoviruses, respiratory syncytial virus (more common in infants and children)[6] Setting of Infection (how aquired):
The 10 minute video below is a good summary of pneumonia. The Body's Defence Against Pneumonia[edit | edit source]The body has several defence mechanisms against the agents that can cause Pneumonia:
If these mechanisms fail and a microbe is successful in colonising the alveoli they then multiple and quickly move over into the lung tissue activating an inflammatory response; the result is Pneumonia. Type and Causes[edit | edit source]There are various causes of pneumonia, in most the mode of transmission is via bacteria however it can be passed from person to person and also from the environment and practising good hygiene can minimise the spread of germs. The various types of pneumonia are discussed below. Epidemiology[edit | edit source]
Stages of Pneumonia[edit | edit source]Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution. (may be Lobar Pneumonia or bronchopneumonia, see image R)
Risk Factors[edit | edit source]The elderly, infants, young children and those with a weakened immune system are at a higher risk of acquiring Pneumonia. Other causes such as frequent exposure to asbestos and cigarette smoke have an increased risk of contracting community-acquired pneumonia than young and middle-aged adults. Some common risk factors are:
Signs and Symptoms[edit | edit source]The signs and symptoms vary according to disease severity. Common symptoms include fever, cough, sputum production (may or may not be present). The color and quality of sputum provide the clue to microbiological etiology.
Diagnosis[edit | edit source]There are several ways to diagnose pneumonia:
Complications[edit | edit source]
Medical Management[edit | edit source]Treatment will vary depending on how bad the symptoms are, and what the cause of the infection is.
Doctors will also include the following when treating patients with pneumonia:
Physiotherapy Management[edit | edit source]Respiratory physiotherapy is an adjunct commonly used in the treatment of pneumonia, however there being little reliable evidence to suggest that physiotherapy has an effect on the rate of recovery of the patient.[22] However, respiratory techniques are still commonly used to aid airway clearance and improve the rate of breathing.
A state-of-art review suggests avoiding repeated airway clearance in infants and children with acute pulmonary disease. The treatment should be based on patient assessment and presentation of symptoms[24]. A retrospective study[25] shows that skeletal muscle index measured at Intensive Care Unit Admission is a predictor of Intensive Care Unit-Acquired Weakness in patients with sepsis. Clinical Guidelines[edit | edit source]Clinical Guidelines for Physiotherapy management of Community-Acquired Pneumonia[26] For Patients admitted to hospital;
Children and Pneumonia[edit | edit source]Why Are Children Vulnerable? While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed. Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia. The following environmental factors also increase a child's susceptibility to pneumonia:
Signs and Symptoms in Children
Prevention
References[edit | edit source]
What are three physical assessment findings that are noted with the development of pneumonia?Fast, shallow breathing; difficulty breathing; and shortness of breath often are symptoms of pneumonia.
What are the expected findings of pneumonia?Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing.
What factors clinical assessment findings are commonly used to diagnose pneumonia?Overall, based on diagnostic odds ratio, cough, crackles, respiratory rate ≥20 min−1, fever with temperature ≥ 38 °C, pulse rate >100 min−1, decreased breath sounds, CRP and PCT were potential useful diagnostic indicators of pneumonia.
What are the 3 stages of pneumonia?Stages of Pneumonia. Stage 1: Congestion. During the congestion phase, the lungs become very heavy and congested due to infectious fluid that has accumulated in the air sacs. ... . Stage 2: Red hepatization. ... . Stage 3: Gray hepatization. ... . Stage 4: Resolution.. |