Pneumonia for NP
Pneumonia for the Nurse Practitioner Licensing Exam
Etiology
- Bacterial Pathogens:
- Streptococcus pneumoniae: The most common cause of community-acquired pneumonia (CAP), presenting with fever, productive cough, and pleuritic chest pain.
- Haemophilus influenzae: Frequently seen in patients with chronic obstructive pulmonary disease (COPD).
- Mycoplasma pneumoniae: Causes atypical pneumonia, often in younger patients, with dry cough, low-grade fever, and extrapulmonary symptoms (e.g., rash).
- Legionella pneumophila: Associated with contaminated water sources, presenting with pneumonia, gastrointestinal symptoms, and hyponatremia.
- Viral Pathogens:
- Influenza virus: A common viral cause of pneumonia, especially during flu season.
- Respiratory syncytial virus (RSV): Affects infants and older adults.
- SARS-CoV-2: Causes pneumonia in the context of COVID-19, which can progress to acute respiratory distress syndrome (ARDS).
- Aspiration Pneumonia:
- Occurs when oropharyngeal contents are aspirated into the lungs, often seen in patients with altered consciousness or swallowing disorders.
Clinical Features
- Typical Pneumonia:
- Sudden onset of high fever, productive cough with purulent sputum, pleuritic chest pain, and dyspnea. Physical exam may reveal crackles, bronchial breath sounds, and dullness to percussion.
- Atypical Pneumonia:
- Gradual onset of dry cough, low-grade fever, and extrapulmonary symptoms such as headache, myalgias, and fatigue.
- Aspiration Pneumonia:
- Often affects the right lower lobe and presents with fever, cough, and foul-smelling sputum.
Diagnosis
- Chest X-ray:
- Shows lobar consolidation in bacterial pneumonia or diffuse interstitial infiltrates in atypical or viral pneumonia.
- Microbiological Testing:
- Sputum Gram stain and culture for bacterial identification.
- Urinary antigen tests for S. pneumoniae and Legionella.
Management
- Outpatient Antibiotics:
- First-line treatment includes amoxicillin, macrolides (e.g., azithromycin), or doxycycline.
- Inpatient Management:
- For severe CAP, use ceftriaxone plus a macrolide or a fluoroquinolone.
- Oxygen therapy for hypoxia.
Prevention
- Vaccination:
- Pneumococcal vaccines (PCV13, PPSV23) for adults over 65 or those with chronic conditions.
- Annual influenza vaccination.
Key Points
- Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, presenting with fever, productive cough, and pleuritic chest pain.
- Atypical pneumonia presents with milder respiratory symptoms and extrapulmonary manifestations.
- Diagnosis is confirmed with chest X-ray, showing lobar consolidation or diffuse infiltrates.
- Empiric antibiotics include amoxicillin, macrolides, or fluoroquinolones depending on severity.
- Prevention includes pneumococcal and influenza vaccination.