Pneumonia and TB Quiz for Health Students

Learning Outcomes

• Provide safe, patient-centered, evidence-based nursing care, guided by the Caritas philosophy
• Demonstrate intermediate levels of critical thinking and clinical reasoning to provide quality patient care
• Relate the impact of quality improvement measures to improved patient care
• Explain management of care concepts for adult patients

Concept of Infection: Pneumonia

• Pneumonia is an inflammation of the lung parenchyma (bronchioles and alveoli) due to infection
• Pathogens causing pneumonia include bacteria, viruses, fungi, and protozoa
• Streptococcus pneumoniae is a common causative pathogen, accounting for roughly 50% of cases

Pathophysiology and Etiology

• Organisms enter the lungs via inhalation, bloodstream from elsewhere, or aspiration
• Pathogens colonize the alveoli
• Initiates an inflammatory and immune response
• Infectious debris and exudate fill alveoli
• Inflammation, vascular congestion, and edema occur
• Fluid accumulation and leakage
• Infiltrates (dense substance like fluid or pus)
• Consolidation (solidification of lung tissue)
• Inflammatory response and immune response
• Alveolar capillaries dilate
• Fluid accumulation in alveoli
• Fluid leaks into interstitial tissues
• Infiltrates and lung tissue consolidation

Infectious vs. Noninfectious Etiology

• Infectious etiologies include bacteria, viruses, fungi, protozoa
• Noninfectious etiologies include aspiration of gastric contents, inhalation of toxic/irritating gases, and chemical injury to the GI tract

Bacterial Etiology

• Bacterial pathogens circulate in the bloodstream, damaging cells in the lungs
• Cellular debris and mucus block airways
• Commonly results in unilateral lobar pneumonia (one lobe of lung affected)

Viral Etiology

• Viruses commonly enter through the upper respiratory tract
• Invade and replicate in alveoli near bronchi
• Viruses burst out, killing cells and releasing debris
• Rapid spread to adjacent areas, resulting in patchy distribution termed bronchopneumonia

Aspiration Etiology

• Aspiration (food, emesis, gastric reflux, etc.) produces chemical injury and inflammation
• Low pH of aspirated material further exacerbates inflammation
• Aspiration creates an environment for bacterial invasion

Pneumonia Classifications

• Community-acquired pneumonia (CAP): Infection acquired outside of healthcare facilities
• Healthcare-associated pneumonia (HCAP): Acquired in the community but in individuals with underlying risk factors like long-term care facilities
• Hospital-acquired pneumonia (HAP): Infection acquired after 48 hours of hospitalization
• Ventilator-associated pneumonia (VAP): Infection acquired while on a ventilator

Etiology- Community-Acquired Pneumonia

• Streptococcus pneumoniae: Causes about 50% of CAP cases
• Individual-to-individual transmission via droplets
• Aspiration of resident bacteria

Etiology- Primary Atypical Pneumonia

• Mycoplasma pneumoniae: Differs in presentation from other bacterial pneumonias
• Patchy inflammatory changes in alveolar septa, interstitial lung tissue; exudate and consolidation usually not found
• Typically mild disease course

Etiology- Viral Pneumonia

• Common organisms: Influenza and adenovirus
• Usually limited to the alveolar septum and interstitial spaces
• Often presents with flu-like symptoms and dry coughs
• Typically mild with community-based outbreaks

Etiology- Opportunistic Pneumonia

• Primarily in immunocompromised patients, like those with AIDS
• Pneumocystis jiroveci is a common parasite/fungi
• Causes alveoli to thicken, fill with foamy fluid, and impair gas exchange

Etiology- Aspiration Pneumonia

• Aspiration of gastric contents, chemicals (like hydrocarbons)
• Low pH of aspirated contents leads to severe inflammatory response, pulmonary edema
• Common complications: abscesses, bronchiectasis (chronic dilation), and gangrene of lung tissue

Risk Factors for Pneumonia

• Age (infants, young children, older adults)
• Altered immunity (HIV/AIDS, cancer, organ transplants)
• Frequent exposure to cigarette smoke
• Alcohol or drug use
• Impaired swallowing/cough/gag reflexes
• Emergency surgeries/obstetrical procedures
• Low pH of gastric contents

Diagnostic Tests

• Chest X-ray
• Computed tomography (CT scan)
• Sputum culture
• Complete blood count (CBC) with WBC differential
• Pulse oximetry
• Arterial blood gases (ABGs)
• Bronchoscopy
• Procalcitonin levels
• Sepsis criteria tests to detect presence of and degree of infection

Clinical Manifestations of Pneumonia

• Fever and chills

• Dyspnea (shortness of breath) with crackles in lungs

• Productive cough with purulent sputum

• Chest pain (pleuritic - sharp and localized)

• Confusion

• Headache, fatigue, muscle pains, and diminished appetite

• Bacteremia can spread to other tissues (meningitis, endocarditis, peritonitis)

• Risks: increased mortality and septic shock/septicemia

Prevention

• Identify vulnerable populations (e.g., immunocompromised, elderly, residents with long-term care facilities)
• Early identification of infecting organisms
• Vaccination (pneumococcal and influenza)
• Preventative strategies (e.g., respiratory hygiene, smoking cessation)

Pharmacologic Therapy for Pneumonia

• Antibiotics (eradicate infection based on culture findings)
• Bronchodilators (reduce bronchospasm, improve ventilation)
• Mucolytics (break up mucus, increase fluid intake)
• Oxygen therapy (depending on hypoxia, may involve intubation or mechanical ventilation)
• Antipyretics (fever reduction - acetaminophen)
• Analgesics (pain relief)

Nonpharmacologic Therapy for Pneumonia

• Supportive care o Airway management o Fluids (2500-3000 mL/day) o IV fluids as needed o Rest
• Chest physiotherapy o Percussion o Vibration o Postural drainage

Incentive Spirometry

• Used to prevent healthcare-acquired pneumonia (HAP)

Tuberculosis (TB): Overview

• Chronic infectious, recurrent disease
• Caused by Mycobacterium tuberculosis
• Slow-growing bacilli; waxy outer capsule resists destruction
• AFB (acid-fast bacilli)
• Primary site of infection: lungs
• Public health concern- reportable disease

Tuberculosis (TB): Classifications

• Active TB: Infectious and shows clinical manifestations

• Latent TB: Exposed, noninfectious, no clinical manifestations

• Reactivation TB: Latent TB becoming active later in life for reasons such as age/immunosuppressive diseases/drugs

Tuberculosis (TB): Risk Factors

• Immunocompromised individuals
• Immigrants/foreign-born (in the U.S.)
• HIV/AIDS
• Homeless/overcrowded living conditions
• Prison/detention facilities
• Poverty (no access to healthcare, poor sanitation)

Tuberculosis (TB): Clinical Manifestations

• Asymptomatic in early stages; initial infection
• Fever (typically low grade)
• Night sweats
• Dry cough, progressing to hemoptysis (blood-tinged sputum)
• Weight loss
• Fatigue
• Cough, pleuritic chest pain
• Dyspnea (shortness of breath)

Tuberculosis (TB): Diagnostic Tests and Prevention

• PPD skin tests (TST, Mantoux tests), intradermal, read 48–72 hours, measure INDURATION
• Chest X-rays
• Interferon-gamma release assays (IGRAs), “QuantiFERON-TB test" or "T-Spot test"
• Sputum cultures (time-consuming, required multiple specimens 8–24 hours apart)

Collaboration and Prevention Precautions

• TB Transmission reduction through measures like sunlight/ultraviolet light, family education, masks, patient isolation and N95 masks
• Medications for TB (isoniazid, rifampin, ethambutol, pyrazinamide) for both latent and active TB
• Active TB: first 2 months with combination of four medications, additional 4-6 months with two medications
• Latent TB: 6-9 months with isoniazid

Collaboration: Infectious No Longer Considered Infectious

• Clinical improvement demonstrated
• On medications for at least two weeks
• Three (3) consecutive AFB smears that are negative

Additional Resources

• CDC website: https://www.cdc.gov/tb/ (comprehensive disease overview and treatment protocols)
• Ohio Department of Health website