Exemplar 9.5: Pneumonia

You have an 18-year-old male patient that has just been confirmed to have a case of acute bacterial pneumonia, caused by streptococcus pneumoniae. The doctor tells him what's wrong, and writes him a prescription for penicillin G. You go in, hand the boy the prescription, and he confides in you that he doesn't quite understand what pneumonia is and why he needs the medication. Select all the correct and appropriate information you can give to this patient. (2 of these are right)

What would you hear in your 18-year-old acute pneumococcal pneumonia patient's lungs when you auscultate? What would you see in your patient and what would the patient report to you? (4 of these are right).

Fill in the blanks with the correct pattern of lung involvement for that description. -[blank_start]Lobar[blank_end]: Early on in infectious process, bacteria spread throughout the affected lobe. Red blood cells and neutrophils, damaged epithelial cells, and fibrin accumulate in alveoli and bronchioles, causing consolidation of lung tissue. Purulent exudate forms. The process is resolved as the enzymes destroy the exudate and residual debris is coughed out. -[blank_start]Miliary[blank_end]: Spread of pathogen to lungs from bloodstream causes formation of inflammatory lesions. Primarily seen in the severely immunocompromised, so damage to pleural tissue may be significant. -[blank_start]Interstitial[blank_end]: Primarily involves the alveolar walls and connective tissue supporting the bronchial tree. Involvement may be patchy or diffuse. Alveoli typically don't contain significant exudate, but rich hyaline membranes may line the alveoli. -[blank_start]Bronchopneumonia[blank_end]: Usually involves dependent portions of lung tissue, characterized by patchy consolidation. Exudate usually remains in bronhi and bronchioles. Less edema and congestion of alveoli can be noted.

Select the patient that would NOT be at risk of getting pneumonia?

Drag and drop the correct causative organism for the antibiotics given. [blank_start]Streptococcus pneumoniae[blank_end]: Penicillin G & amoxicillin [blank_start]Chlamydia pneumoniae[blank_end]: Doxycycline [blank_start]Klebsiella pneumoniae[blank_end]: 3rd generation cephalosporins; metronidazole. [blank_start]Haemophilus influenzae[blank_end]: 2nd and 3rd generation cephalosporins, doxycycline, azithromycin, TMP-SMZ [blank_start]Mycoplasma pneumoniae[blank_end]: Erythromycin, doxycycline. [blank_start]Staphylococcus aureus[blank_end]: Penicillinase-resistant penicillin; vancomycin for methicillin-resistant organism. [blank_start]Pneumocystis jiroveci[blank_end]: TMP-SMZ, pentamidine + prednisone [blank_start]Legionella pneumophila[blank_end]: Macrolide + rifampin; fluroquinolone

Drag and drop the correct lab test with each description/ [blank_start]Chest X-ray[blank_end]: Determines the extent and pattern of lung involvement. Fluid, infiltrates, consolidated lung tissue, and atelectasis appear as densities on the film. [blank_start]Computed tomograpy[blank_end]: Provides a more detailed image of pulmonary tissue. May be used when the chest X-ray doesn't prove to be diagnostic. [blank_start]Arterial blood gas[blank_end]: Used to evaluate gas exchange. Respiratory secretions, pleuritic pain, and alveolar inflammation can all impair gas exchange, [blank_start]Sputum Gram stain[blank_end]: Rapidly identifies infecting organism as Gram-positive or Gram-negative so proper antibiotic therapy can be used. [blank_start]Sputum culture and sensitivity[blank_end]: Identifies the infecting organism using sputum from secretions in the lower respiratory tract. The most appropriate antibiotic therapy can then be chosen. [blank_start]Complete blood count with differential[blank_end]: Shows elevated white blood cell with a left shift in response to the infectious process. [blank_start]Fiberoptic bronchoscopy[blank_end]: May be done to get a sputum specimen or remove secretions from bronchial tree. [blank_start]Serology testing[blank_end]: Blood tests to detect antibodies to respiratory pathogens. May be used when both blood and sputum cultures are negative. [blank_start]Pulse oximetry[blank_end]: Measures arterial oxygen saturation so gas exchange can be continuously monitored.

Which of the following medications is NOT used for treatment of pneumonia?

You have a 65 year old female patient with COPD, with both emphysema and bronchitis, that has been diagnosed with a staphylococcus aureus pneumonia infection. The patient is on a nasal cannula running 3 L of oxygen per minute, but she seems to still have severe dyspnea, with visible cyanosis in her lips. The RN checked the patency of the patient's tubing, and saw that the tubing was completely patent. The patient reports pleuritic pain with each breath. She is running a fever of 102.5, oral, and appears to have chills. What would be some proper interventions for this patient? (6 of these are right).