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Lower Respiratory ProblemsMedical Surgical Nursing

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Question Answer
What organisms are attributed to both Community Acquired and Hospital Acquired cases of pneumonia? (2)
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Streptococcus pneumoniae Staphylococcus aureus All the others (in the chart) are attributed to either CA or HA, not both
What are the differences in Hospital Acquired Pneumonia (HAP) and Healthcare Acquired Pneumonia (HCAP)?
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Considered HAP: develops 48 hours or more after admission Considered HCAP: if it develops after being in the hospital for more than 2 days within the last 90 days, occurs in a resident of a LTC facility, occurs within 30 days of IV antibiotic or chemotherapy OR wound care, or if the patient was at a hospital or hemodialysis clinic.
T/F A patient has a fungal pneumonia. It is most likely community-acquired.
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True
T/F A patient has viral pneumonia. It is most likely hospital acquired.
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False, hospital acquired pneumonia is normally bacterial and comes from the patient's flora within the oropharynx
In your outpatient clinic you have a patient that has pneumonia. They haven't been sick or been on any other antibiotics rencently (over 3 months). What types of medications should be considered for treatment?
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A macrolide (Erythromycin, Azithromycin, Clarithromycin) OR Doxycycline
In your outpatient clinic you have a patient that has pneumonia. They had recently been on an antibiotic for bronchitis (within the past 3 months). What medications should be considered for treatment of this patient?
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A respiratory fluoroquinolone like Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin OR An advanced macrolide like Azithromycin or Clarithromycin with a high dose Amoxicillin or Amoxicillin/Clavulanate (Augmentin)
In your outpatient clinic you have a patient with pneumonia and renal disease (or any other comorbidity, pick your favorite). They haven't been on any other antibiotics in the past three months, which medications should be considered for their treatment?
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An advanced macrolide (Clarithromycin or Azithromycin) OR A fluoroquinolone (Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin)
In your outpatient clinic you have a patient with heart disease who has just come down with pneumonia. They were on antibiotics last month to treat a UTI. What medications should be considered to treat them?
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A fluoroquinolone (Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin) OR An advanced macrolide (Clarithromycin or Azithromycin) with a beta lactam antibiotic (High dose amoxicillin, Augmentin, Vantin, Cefzil, or Ceftin)
In your outpatient clinic you have a patient with heart disease and pneumonia. You suspect they have aspiration with infection. What medications should be considered?
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Augmentin or Clindamycin
In your outpatient clinic you have a patient with COPD, bacterial pneumonia with a superinfection and the flu. Aside from knowing they feel like crap, you also know that the following medications should be considered for their treatment:
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A beta lactam like high dose Amoxicillin, Augmentin, Vantin, Ceftin or Cefzil OR A fluoroquinolone (Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin)
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In your unit you have a patient that has pneumonia. They haven't been sick or been on any other antibiotics rencently (over 3 months). What types of medications should be considered for treatment?
Show Answer
A fluoroquinolone (Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin) OR An advanced macrolide (Clarithromycin or Azithromycin) with a beta lactam antibiotic (High dose amoxicillin, Augmentin, Vantin, Cefzil, or Ceftin)
In your unit you have a patient that has pneumonia. They had recently been on an antibiotic for bronchitis (within the past 3 months). What medications should be considered for treatment of this patient?
Show Answer
A respiratory fluoroquinolone like Moxifloxacin, Gatifloxacin, Gemifloxacin or Levofloxacin with or without Clindamycin
You have a patient in the ICU with pneumonia. Pseudomonas isn't an issue for this patient, so you know the medications the doctor might order are:
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A fluoroquinolone (Moxifloxacin, Gatifloxacin, Levofloxacin or Gemifloxacin) OR An advanced macrolide (Clarithromycin or Azithromycin) with a beta lactam antibiotic (High dose amoxicillin, Augmentin, Vantin, Cefzil, or Ceftin)
You have a patient in the ICU that has pneumonia. Pseudomonas isn't a concern for this patient, but they are allergic to one of the usual treatments (Beta Lactam Allergy). You know that in this case the doctor will probably order:
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A respiratory fluoroquinolone like Moxifloxacin, Gatifloxacin, Gemifloxacin or Levofloxacin with or without Clindamycin
You have a patient in the ICU with pneumonia and pseudomonas. You know the medications to treat these conditions include:
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An antipseudomonal agent (like piperacillin, Primaxin, Merrem IV, Maxipime or Zosyn) with clindamycin OR An antipseudomonal agent plus an aminoglycoside and either a fluroquinolone or a macrolide
You have a patient in the ICU that is allergic to Beta Lactam antibiotics. They have pneumonia and a pseudomonas infection. What medications can be used to treat them?
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-Aztreonam plus levofloxacin -Aztreonam plus Moxifloxacin -Aztreonam plus Gatifloxacin *each option can be with or without an aminoglycoside
_______ pneumonia refers to the sequelae occurring from abnormal entry of secretions or substances from the mouth or stomachinto the trachea and subsequently the lungs.
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Aspiration
What are the risk factors for aspiration pneumonia?
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Any loss of consciousness/altered level of consciousness or tube feedings
What parts of the lungs are most commonly affected by aspiration pneumonia and why?
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The superior segments of the lower lobes and posterior segments of the upper lobes...these are the most dependent lung fields when lying supine SLUP Superior/Lower, Posterior/Upper
What materials are involved in aspirate pneumonia?
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Food, water, vomitus or toxic fluids (like barium)
Mechanical obstruction is usually the first sign of aspiration pneumonia if the substance is...
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An inert substance like Barium
  
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