Chapter 15 Pneumonia Mosby items and derived items
![Chapter 15 Pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc. Chapter 15 Pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc.](https://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-1.jpg)
Chapter 15 Pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 1
![Figure 15 -1. Cross-sectional view of alveolar consolidation in pneumonia. Mosby items and derived Figure 15 -1. Cross-sectional view of alveolar consolidation in pneumonia. Mosby items and derived](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-2.jpg)
Figure 15 -1. Cross-sectional view of alveolar consolidation in pneumonia. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 2
![Anatomic Alterations of the Lungs Inflammation of the alveoli Alveolar consolidation Atelectasis (e. g. Anatomic Alterations of the Lungs Inflammation of the alveoli Alveolar consolidation Atelectasis (e. g.](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-3.jpg)
Anatomic Alterations of the Lungs Inflammation of the alveoli Alveolar consolidation Atelectasis (e. g. , aspiration pneumonia) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 3
![Etiology Lobar pneumonia: Involvement of the entire lung lobe Double pneumonia: Involvement of both Etiology Lobar pneumonia: Involvement of the entire lung lobe Double pneumonia: Involvement of both](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-4.jpg)
Etiology Lobar pneumonia: Involvement of the entire lung lobe Double pneumonia: Involvement of both lungs Walking pneumonia: Mild case of pneumonia. Patient remains ambulatory Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 4
![Box 15 -1 Causes of Pneumonia and Classifications Bacterial Causes Gram-positive organisms Ø Ø Box 15 -1 Causes of Pneumonia and Classifications Bacterial Causes Gram-positive organisms Ø Ø](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-5.jpg)
Box 15 -1 Causes of Pneumonia and Classifications Bacterial Causes Gram-positive organisms Ø Ø Streptococcus Staphylococcus Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 5
![Figure 15 -2. The Streptococcus organism is a gram-positive, nonmotile coccus that occurs singly, Figure 15 -2. The Streptococcus organism is a gram-positive, nonmotile coccus that occurs singly,](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-6.jpg)
Figure 15 -2. The Streptococcus organism is a gram-positive, nonmotile coccus that occurs singly, in pairs, and in short chains. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 6
![Figure 15 -3. The Staphylococcus organism is a gram-positive, nonmotile coccus that is found Figure 15 -3. The Staphylococcus organism is a gram-positive, nonmotile coccus that is found](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-7.jpg)
Figure 15 -3. The Staphylococcus organism is a gram-positive, nonmotile coccus that is found singly, in pairs, and in irregular clusters. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 7
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Gram-negative organisms Haemophilus influenzae Klebsiella Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Gram-negative organisms Haemophilus influenzae Klebsiella](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-8.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Gram-negative organisms Haemophilus influenzae Klebsiella Pseudomonas aeruginosa Moraxella catarrhalis Escherichia coli Serratia species Enterobacter species Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 8
![Figure 15 -4. The bacilli are rod-shaped microorganisms and are the major gramnegative organisms Figure 15 -4. The bacilli are rod-shaped microorganisms and are the major gramnegative organisms](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-9.jpg)
Figure 15 -4. The bacilli are rod-shaped microorganisms and are the major gramnegative organisms responsible for pneumonia. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 9
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Atypical organisms Mycoplasma pneumoniae Legionella Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Atypical organisms Mycoplasma pneumoniae Legionella](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-10.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Atypical organisms Mycoplasma pneumoniae Legionella pneumophila Chlamydia psittaci Chlamydia pneumoniae Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 10
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Anaerobic bacterial infections Peptostreptococcus species Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Anaerobic bacterial infections Peptostreptococcus species](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-11.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Anaerobic bacterial infections Peptostreptococcus species Bacteroides melaninogenicus Fusobacterium necrophorum Bacteroides asaccharolyticus Porphyromonas endodontalis Porphyromonas gingivalis Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 11
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Viral causes Influenzavirus Respiratory syncytial Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Viral causes Influenzavirus Respiratory syncytial](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-12.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Viral causes Influenzavirus Respiratory syncytial virus Parainfluenza virus Adenovirus Coronavirus (SARS) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 12
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Other causes Rickettsial infections Varicella Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Other causes Rickettsial infections Varicella](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-13.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Other causes Rickettsial infections Varicella Rubella Aspiration pneumonitis Lipoid pneumonitis Pneumocystis carinii Cytomegalovirus Tuberculosis Fungal infections Avian Influenza A Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 13
![Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Acquired pneumonia classification Community-acquired pneumonia Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Acquired pneumonia classification Community-acquired pneumonia](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-14.jpg)
Box 15 -1 Causes of Pneumonia and Classifications (Cont’d) Acquired pneumonia classification Community-acquired pneumonia (CAP) Nursing home–acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 14
![Etiology Acquired pneumonia classification Community-acquired pneumonia (CAP) Nursing home–acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Etiology Acquired pneumonia classification Community-acquired pneumonia (CAP) Nursing home–acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-15.jpg)
Etiology Acquired pneumonia classification Community-acquired pneumonia (CAP) Nursing home–acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 15
![Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumonia The following clinical manifestations result Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumonia The following clinical manifestations result](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-16.jpg)
Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumonia The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Ø Ø Alveolar Consolidation Increased Alveolar-Capillary Membrane Thickness Atelectasis Excessive Bronchial Secretions • During the resolution stage of pneumonia Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 16
![Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-17.jpg)
Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 17
![Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-18.jpg)
Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 18
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Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 19
![Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-20.jpg)
Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 20
![Clinical Data Obtained at the Patient’s Bedside Mosby items and derived items © 2011, Clinical Data Obtained at the Patient’s Bedside Mosby items and derived items © 2011,](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-21.jpg)
Clinical Data Obtained at the Patient’s Bedside Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 21
![The Physical Examination Vital Signs Ø Increased • Respiratory rate (Tachypnea) • Heart rate The Physical Examination Vital Signs Ø Increased • Respiratory rate (Tachypnea) • Heart rate](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-22.jpg)
The Physical Examination Vital Signs Ø Increased • Respiratory rate (Tachypnea) • Heart rate (pulse) • Blood pressure Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 22
![The Physical Examination (Cont’d) Chest pain/decreased chest expansion Cyanosis Cough, sputum production, and hemoptysis The Physical Examination (Cont’d) Chest pain/decreased chest expansion Cyanosis Cough, sputum production, and hemoptysis](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-23.jpg)
The Physical Examination (Cont’d) Chest pain/decreased chest expansion Cyanosis Cough, sputum production, and hemoptysis Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 23
![The Physical Examination (Cont’d) Chest Assessment Findings Increased tactile and vocal fremitus Dull percussion The Physical Examination (Cont’d) Chest Assessment Findings Increased tactile and vocal fremitus Dull percussion](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-24.jpg)
The Physical Examination (Cont’d) Chest Assessment Findings Increased tactile and vocal fremitus Dull percussion note Bronchial breath sounds Crackles and rhonchi Pleural friction rub • if process extends to pleural surface Ø Whispered pectoriloquy Ø Ø Ø Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 24
![Clinical Data Obtained from Laboratory Tests and Special Procedures Mosby items and derived items Clinical Data Obtained from Laboratory Tests and Special Procedures Mosby items and derived items](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-25.jpg)
Clinical Data Obtained from Laboratory Tests and Special Procedures Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 25
![Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Forced Expiratory Flow Rate Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Forced Expiratory Flow Rate](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-26.jpg)
Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Forced Expiratory Flow Rate Findings FVC FEVT N or FEF 50% N or FEV 1/FVC ratio N or FEF 200 -1200 N or FEF 25%-75 N or PEFR MVV N or Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 26
![Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Lung Volume & Capacity Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Lung Volume & Capacity](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-27.jpg)
Pulmonary Function Test Findings Moderate to Severe (Restrictive Lung Pathophysiology) Lung Volume & Capacity Findings VT IRV ERV N or IC FRC TLC RV VC RV/TLC ratio Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. N 27
![Arterial Blood Gases Pneumonia Mild to Moderate Stages Acute Alveolar Hyperventilation with Hypoxemia (Acute Arterial Blood Gases Pneumonia Mild to Moderate Stages Acute Alveolar Hyperventilation with Hypoxemia (Acute](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-28.jpg)
Arterial Blood Gases Pneumonia Mild to Moderate Stages Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis) p. H Pa. C 02 HCO 3 (slightly) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. Pa 02 28
![Pa. O 2 and Pa. CO 2 trends during acute alveolar hyperventilation. Mosby items Pa. O 2 and Pa. CO 2 trends during acute alveolar hyperventilation. Mosby items](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-29.jpg)
Pa. O 2 and Pa. CO 2 trends during acute alveolar hyperventilation. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 29
![Arterial Blood Gases Pneumonia Severe Stage Acute Ventilatory Failure with Hypoxemia (Acute Respiratory Acidosis) Arterial Blood Gases Pneumonia Severe Stage Acute Ventilatory Failure with Hypoxemia (Acute Respiratory Acidosis)](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-30.jpg)
Arterial Blood Gases Pneumonia Severe Stage Acute Ventilatory Failure with Hypoxemia (Acute Respiratory Acidosis) p. H Pa. C 02 HCO 3 (Slightly) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. Pa 02 30
![Pa. O 2 and Pa. CO 2 trends during acute or chronic ventilatory failure. Pa. O 2 and Pa. CO 2 trends during acute or chronic ventilatory failure.](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-31.jpg)
Pa. O 2 and Pa. CO 2 trends during acute or chronic ventilatory failure. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 31
![Oxygenation Indices QS/QT D 02 V 02 C(a-v)02 02 ER Sv 02 N N Oxygenation Indices QS/QT D 02 V 02 C(a-v)02 02 ER Sv 02 N N](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-32.jpg)
Oxygenation Indices QS/QT D 02 V 02 C(a-v)02 02 ER Sv 02 N N Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 32
![Abnormal Laboratory Tests and Procedures Abnormal sputum examination (see Box 15 -1) Mosby items Abnormal Laboratory Tests and Procedures Abnormal sputum examination (see Box 15 -1) Mosby items](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-33.jpg)
Abnormal Laboratory Tests and Procedures Abnormal sputum examination (see Box 15 -1) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 33
![Radiologic Findings Chest Radiograph Increased density (from consolidation and atelectasis) Ø Air bronchograms Ø Radiologic Findings Chest Radiograph Increased density (from consolidation and atelectasis) Ø Air bronchograms Ø](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-34.jpg)
Radiologic Findings Chest Radiograph Increased density (from consolidation and atelectasis) Ø Air bronchograms Ø Pleural effusions Ø Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 34
![Figure 15 -5. Chest X-ray film of a 20 -year-old woman with severe pneumonia Figure 15 -5. Chest X-ray film of a 20 -year-old woman with severe pneumonia](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-35.jpg)
Figure 15 -5. Chest X-ray film of a 20 -year-old woman with severe pneumonia of the left lung and patchy pneumonia in the right middle and lower lobes. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 35
![Figure 15 -6. Air bronchogram. The branching linear lucencies within the consolidation in the Figure 15 -6. Air bronchogram. The branching linear lucencies within the consolidation in the](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-36.jpg)
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. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 36
![Radiologic Findings (Cont’d) CT Scan Ø Ø Alveolar consolidation Air bronchograms Mosby items and Radiologic Findings (Cont’d) CT Scan Ø Ø Alveolar consolidation Air bronchograms Mosby items and](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-37.jpg)
Radiologic Findings (Cont’d) CT Scan Ø Ø Alveolar consolidation Air bronchograms Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 37
![Figure 15 -7. Air bronchogram shown by CT in a patient with pneumonia. Mosby Figure 15 -7. Air bronchogram shown by CT in a patient with pneumonia. Mosby](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-38.jpg)
Figure 15 -7. Air bronchogram shown by CT in a patient with pneumonia. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 38
![General Management of Pneumonia The treatment of pneumonia is based on: 1. The specific General Management of Pneumonia The treatment of pneumonia is based on: 1. The specific](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-39.jpg)
General Management of Pneumonia The treatment of pneumonia is based on: 1. The specific etiology of the pneumonia, and 2. The severity of symptoms demonstrated by the patient. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 39
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-40.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them Organism Responsible for Pneumonia Gram-Positive Organisms Staphylococcus aureus Common Treatment Choices Methicillin-susceptible strains: nafcillin or oxacillin with or without rifampin Methicillin-resistant strains: vancomycin with or without rifampin Alternative choice: cephalosporins, clindamycin, Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 40
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-41.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Streptococcus Common Treatment Choices Penicillins: procaine penicillin G or aqueous penicillin G, amoxicillin Alternative choice: macrolides, cephalosporins, doxycycline, quinolones cefotaxime or ceftriaxone; antipseudomonal fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin). Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 41
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-42.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Gram-Negative Organisms Haemophilus influenzae Common Treatment Choices Ampicillin, third-or fourth-generation cephalosporin, macrolides (azithromycin, clarithromycin), fluoroquinolones Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 42
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-43.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Gram-Negative Organisms Klebsiella pneumoniae Common Treatment Choices Third-and/or fourth-generation cephalosporins (cefotaxime, ceftriaxone) plus aminoglycoside, antipseudomonal penicillin, monobactam (aztreonam), or quinolone Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 43
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-44.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Gram-Negative Organisms Pseudomonas aeruginosa Common Treatment Choices Tobramycin (TOBI), Aminoglycoside and antipseudomonal agents (ticarcillin, piperacillin, mezlocillin, ceftazidine) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 44
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-45.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Atypical Organisms Mycoplasma pneumoniae Common Treatment Choices Doxycycline, macrolides or fluoroquinolones Legionella pneumophila Erythromycin +/- rifampin (in severely compromised patient) or clarithromycin, or a macrolide (azithromycin), or a fluoroquinolone (ofloxacin, levofloxacin, sparfloxacin) Chlamydia pneumoniae Tetracycline, erythromycin, macrolide, quinolone. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 45
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-46.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Anaerobic bacterial infections Peptostreptococcus species Bacteroides melaninogenica Fusobacterium necrophorum Bacteroides asaccharolyticus Porphyromonas endodontalis Porphyromonas gingivalis Common Treatment Choices Most of these organisms are oral contaminants. For anaerobic coverage use metronidazole (Flagyl) or clindamycin; or Metronidazole + ceftriaxone; or penicillin + amoxicillin. Infections respond slowly. 4 -6 weeks of therapy is generally recommended. Most of the problem with aspiration pneumonia is secondary to the acid present in stomach contents, causing a chemical pneumonia. Quinolones, penicillins are also useful. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 46
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-47.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Anaerobic bacterial infections Peptostreptococcus species Bacteroides melaninogenica Fusobacterium necrophorum Bacteroides asaccharolyticus Porphyromonas endodontalis Porphyromonas gingivalis Common Treatment Choices Aspiration fluid should be cultured immediately (even with bronchoscopy and special culture) then patient started on coverage medication while awaiting culture results. If the culture is negative, stop the antibiotics. Then reculture if CXR, or patient, gets worse. Monitor closely for superinfections such as candida, other yeasts. May add vancomycin and Diflucan to cover nosocomial suprainfections. Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 47
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-48.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Common Treatment Choices Viral Causes Influenza virus Type A: amantadine and rimantadine Type A/B: zanamivir, oseltamivir phosphate Respiratory syncytial virus Ribavirin (Virazole), palivizumab (Synagis) Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 48
![Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-49.jpg)
Table 15 -1 Commonly Encountered Organisms Responsible for Pneumonia and the Therapeutic Agents Used to Treat Them (Cont’d) Organism Responsible for Pneumonia Common Treatment Choices Other Common Causes Pneumocystis carintii Fungal infections Tuberculosis (mycobacterium tuberculosis) Pentamidine (Nebu. Pent), Trimethoprimsulfamethoxazole (TMP-SMZ), dapsonetrimethoprim, primaquine plus clindamycin Amphotericin B, itraconazole, fluconazole, ketoconazole Isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 49
![Respiratory Care Treatment Protocols Oxygen Therapy Protocol Bronchopulmonary Hygiene Therapy Protocol Lung Expansion Therapy Respiratory Care Treatment Protocols Oxygen Therapy Protocol Bronchopulmonary Hygiene Therapy Protocol Lung Expansion Therapy](http://slidetodoc.com/presentation_image_h2/e21ca7d8ccbdec6973dc4a4c00908008/image-50.jpg)
Respiratory Care Treatment Protocols Oxygen Therapy Protocol Bronchopulmonary Hygiene Therapy Protocol Lung Expansion Therapy Protocol Mosby items and derived items © 2011, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 50
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