The pathophysiological changes on Pneumonia. Part A Essay title;
Pneumonia in the ventilated patient: descrice the pathophysiological changes, relate these to relvant signs and symptoms and justify an appropriate chest physiotherapy/ physical rehabilitation programme for an ITU patient.
Case study
• 19 year old female, student. Smoker 10/day.
• Admitted 2 days ago to ITUwith fractured ribs on left; ribs 4-9. Injury was result of RTA (passenger), pt was extremely SOB and had sats at 81% at scene. In A&E fractures and L haemopneumothorax diagnosed, fractured L clavicle also apparent on CXR. Chest drain inserted; Type I respiratory failure concurrently worsened to the extent that pt was intubated and ventilated as oxygen levels could not be adequately maintained; pt transferred to ITU.
• Patient has been sedated and mechanically ventilated on SIMVfor 2 days; she has received 2 units of blood as Hb is was low (78). Patient has now developeda left sided ventilator acquired pneumonia (VAP). Thick secretions and wheezing are reported to you by nurses,supplemental oxygen requirements are now 40%. Pt has been nursed in supine mainly, andis rousable and can react/ respond to command as sedation is now being decreased. She is now breathing spontraneously with the ventilator assisting each breath and is maintaining normal CO2 levels.Pt able to move limbs to command. Minor desaturation observed during interventions and SOBOE. Pt anxious and frustrated at not being able to verbally communicate.
• PMH Nil, known smoker of 10 per day.
• CXR- L sided reduction in lung volume and opacities within lung field
Think about;
• Pneumonia- pathophysiology of VAP
• Consider detrimental effects of mechanical ventilation
• Relate signs and symptoms to pathological processes
• Consider suitable chest physio strategies, EBP/ effective physiological treatment strategy- explain
• Consider other concurrent strategies that may improve effectiveness of chest physio
• Consider exercise and rehab goals/ needs from now to hospital DC
• Consider patients physical goals/ needs
• Consider the limitations of the circumstances
• Consider safety in application of ALL treatments
• Consider modifications to ALL treatment- how? What? Why?
• Ethical/ legal considerations
• Consider psychosocial issues
• Emotional issues?ITU environment
• LO1,3,4
Part BPractical
• Case study based- case studies covering a range of pathology, issues and treatment strategies
• LO1, 2, 3, 4. Pathophysiology, analysis of S&S, problem recognition/ solving, appropriate treatment planning, physiological and evidence based justification of treatment.
• Practical exam; 10min read of case study selected by examiner, 30min questions to demonstrate clinical reasoning, application of therapy and practical skills.
Pneumonia is an infection of the lungs that may be caused by bacteria, viruses, or fungi. The infection causes the lungs’ air sacs (alveoli) to become inflamed and fill up with fluid or pus. That can make it hard for the oxygen you breathe in to get into your bloodstream. The symptoms of pneumonia can range from mild to severe, and include cough, fever, chills, and trouble breathing.
Many factors affect how serious a case of pneumonia is, such as the type of germ causing the lung infection, the person’s age, and their overall health. The people most at risk are infants and young children, adults 65 or older, and people who have other health problems.
Pneumonia is a leading cause of hospitalization in both children and adults. Most cases can be treated successfully, although it can take weeks to fully recover. Tens of thousands of people in the U.S. die from pneumonia every year, most of them adults over the age of 65.
Pneumonia can be caused by a wide variety of bacteria, viruses and fungi in the air we breathe. Identifying the cause of your pneumonia can be an important step in getting the proper treatment.
Learn more about what causes pneumonia.
Anyone can get pneumonia, but many factors can increase your chances of getting sick and having a more severe illness. One of the most important factors is your age. People age 65 and over are at increased risk because their immune system is becoming less able to fight off infection as years go by. Infants and children two years of age or younger are also at increased risk because their immune systems are not yet fully developed.
Other risk factors can be grouped into three main categories: medical conditions, health behaviors, and environment.
Medical conditions
Health behaviors
Environment