CAP-MR

Pathophysiology:

Precipitating Factor: Predisposing Factor:

- Exposure to chemical and bacterial - Age
agents - Gender
- Previous hospital admission - Genetics
- Acid-reducing agents (proton - Smoking
pump inhibitors and H2 blockers - Alcoholism
- Alterations in level of
consciousness (eg. Stroke,
seizures) which predispose to
aspiration
- COPD

Virulent Microorganism - Streptococcus Pneumoniae

- Organisms (staphylococcus and Gram-negative bacilli) may
enter the respiratory tract through inspiration or aspiration
of oral secretions

Microorganism enters the nose (nasal passages)

Passes through the larynx, pharynx, trachea

Microorganism enters and affects both airway and lung parenchyma

Airway damage Lung invasion

Infiltration of bronchi Flattening of epithelial cells

Infectious organism lodges Macrophages and leukocytes

Stimulation in bronchioles Necrosis of bronchial tissues

Alveolar collapse Narrowing of air passage Mucus and phlegm production

DIFFICULTY OF BREATHING COUGHING

Increase pyrogen in the body (Productive / non-productive)

FEVER
Lab Results:

Radiological Result:

- Pulmonary bullae (singular: bulla) are focal regions of emphysema with no discernible wall which measure more
than 1 or 2 cm in diameter.
- Pulmonary tuberculosis may develop in an area of lung which is the site of pre-existing emphysematous bullae.
The combined process may present a bizarre picture suggesting extensive caseation and cavitation. Fluid levels
may develop in such bullae, apparently due to tuberculous changes in their walls.
- Cavitating pulmonary TB: Extensive necrosis with cavitation, usually occurring in the upper lung or apex, is a
characteristic feature of "secondary" or "adult type" tuberculosis. This is probably related to persistence of M
tuberculosis from a prior primary infection.

Microbiology:

Gram’s Stain:

– Smear shows many Gram Positive Cocci in singles, in pairs, and in clusters with occasional Gram Negative
Bacilli. Occasional fungal elements seen (spores and hyphae). Moderate and epithelial cells and pus cells
seen.
DRUG STUDY
Drug Name Indication
1. Generic Name: -Dexamethasone is a corticosteroid
Dexamethasone hormone (glucocorticoid). It
decreases your body's natural
Brand Name: defensive response and reduces
Dexamethasone
symptoms such as swelling and
allergic-type reactions.
Class:
Corticosteroids; Anti- - Oral dexamethasone reduced
Inflammatory Agents length of stay in ICU admissions in
adults with community-acquired
pneumonia
Contraindication
- Systemic fungal infection
- acute infections
- vaccinia
- varicella
- administration of live virus
vaccines (to patient, family
members)
- Latent or active amebiasis.
Side Effects Nursing Consideration
 vision changes, - Monitor signs of thrombophlebitis (lower
extremity swelling, warmth, erythema,
 swelling, tenderness) and thromboembolism (shortness of
breath, chest pain, cough, bloody sputum). Notify
 rapid weight gain,
physician or nursing staff immediately, and
 sleep problems (insomnia), request objective tests (Doppler ultrasound, lung
scan, others) if thrombosis is suspected.
 mood changes,
- Monitor and report signs of peptic ulcer, including
 acne, heartburn, nausea, vomiting blood, tarry stools,
and loss of appetite.
 dry skin,
- Monitor signs of allergic reactions, including
 thinning skin, pulmonary symptoms (tightness in the throat and
chest, wheezing, cough, dyspnea) or skin
 bruising or discoloration, reactions (rash, pruritus, urticaria). Notify
physician or nursing staff immediately if these
 slow wound healing,
reactions occur.
 increased sweating,
- Assess any muscle or joint pain. Report persistent
 headache, or increased musculoskeletal pain to determine
presence of bone or joint pathology (aseptic
 dizziness, necrosis, fracture).
 spinning sensation, - Assess muscle strength periodically to determine
degree of muscle wasting during long-term use.
 nausea,
- Measure blood pressure periodically and compare
 stomach pain, to normal values . Report a sustained increase in
blood pressure (hypertension) to the physician.
 bloating,
- Assess peripheral edema using girth
 muscle weakness, or measurements, volume displacement, and
measurement of pitting edema (See Appendix N).
 changes in the shape or
Report increased swelling in feet and ankles or a
location of body fat (especially
sudden increase in body weight due to fluid
 in your arms, legs, face, neck, retention.
breasts, and waist).
- Give the once-daily dose in the A.M. with food or
liquid of patient's choice.

- Monitor for S&S of a hypersensitivity reaction (.

The acetate and sodium phosphate formulations
may contain bisulfites, parabens, or both; these
inactive ingredients are allergenic to some
individuals.

- Report lack of response to medication or malaise,

orthostatic hypotension, muscular weakness and
pain, nausea, vomiting, anorexia, hypoglycemic
reactions (see Appendix F), or mental depression
to physician. These symptoms may signal
hypoadrenocorticism.

- Report changes in appearance and easy bruising to

physician. These symptoms may signal
hyperadrenocorticism.

- Note: Hiccups that occur for several hours

following each dose may be a complication of
high-dose oral dexamethasone.

- Keep appointments for checkups; make sure

electrolytes and BP are evaluated during therapy
at regular intervals.

- Add potassium-rich foods to diet; report signs of

hypokalemia (see Appendix F). Concomitant
potassium-depleting diuretic can enhance
dexamethasone-induced potassium loss.

2. Generic Name: - Erdosteine contains two - Known hypersensitivity to  Stomach pain - This drug can be taken with or without food
Erdosteine sulfhydryl groups, which erdosteine.  Nausea
are freed after metabolic - Because of a possible  Vomiting - For the reason that of a probable intrusion of
Brand Name: interference of erdosteine  loose stools erdosteine metabolites with the methionine
transformation in the liver.
Erdosteine metabolites with the methionine  spasmodic colitis metabolism, erdosteine is no recommended in
Class: Mucolytic The liberated sulfhydryl
agent or thiol groups break the disulphide
derivative bonds, which hold the
glycoprotein fibres of
mucus together. This makes
the bronchial secretions
more fluid and enhances
elimination.
- Treatment of acute
bronchitis, chronic
bronchitis and its
exacerbations. Respiratory
disorders characterized by
abnormal bronchial
secretions and impaired
mucus transport.
3. Generic Name: - Rifampin, used in
Rifampin combination with other
active anti-tuberculosis
Brand Name:
drugs, is indicated in the
Rifampin
treatment of all forms of
tuberculosis, including
Class:
fresh, advanced, chronic
Antimycobacterials
and drug-resistant cases.
Rifampicin is also effective
against most atypical strains
of mycobacteria.
- Rifampin is indicated in the
treatment of brucellosis,
legionnaires disease, and
serious staphylococcal
infections. Rifampicin
should be used in
combination with another
appropriate antibiotic to
metabolism, erdosteine is
contraindicated in patients
suffering from hepatic cirrhosis
and deficiency of the
cystathionine-synthetase
enzyme.
- Phenylketonuria, due to the
presence of aspartame.
- Hypersensitivity to rifampin
- obstructive biliary disease
- meningococcal disease
- intermittent rifampin therapy
 headache subjects experiencing hepatic cirrhosis and
insufficiency of the cystathionine synthetase
enzyme.
- Ectrin Suspension is also contraindicated for
Phenylketonuria, because of existence of
aspartame.
 temporary discoloration - Check prothrombin time daily or as necessary to
(yellow, reddish-orange, or establish and maintain required anticoagulant
brown color) of your skin, activity when patient is also receiving an
teeth, saliva, urine, stool,
anticoagulant.
sweat, and tears)
 itching - Do not interrupt prescribed dosage regimen.
 flushing Hepatorenal reaction with flu-like syndrome has
 headache
occurred when therapy has been resumed
 drowsiness
following interruption.
 dizziness
 lack of coordination - Be aware that drug may impart a harmless red-
 difficulty concentrating orange color to urine, feces, sputum, sweat, and
 confusion
tears. Soft contact lenses may be permanently
 changes in behavior
stained.
 muscle weakness
 numbness - Report onset of jaundice, hypersensitivity
 pain in the arms, hands, feet, reactions, and persistence of GI adverse effects to
or legs
physician.
 heartburn
 stomach cramps
 loss of appetite
prevent emergence of  nausea
resistant strains of the  vomiting
infecting organism.  diarrhea
 gas
 painful or irregular menstrual
periods
 vision changes