Presentation on theme: "Every 20 seconds a child dies from pneumonia"— Presentation transcript:
1Every 20 seconds a child dies from pneumonia SOAPPneumoniaEvery 20 seconds a child dies from pneumoniaSaeid kashefi2nd year post.baccNovember 12, 2011, has been proclaimed World Pneumonia Day.4/6/2017
3Who Gets Pneumonia?Anyone can get pneumonia, but some people are at a higher risk than others.Risk factors include:Cigarette smokingRecent viral respiratory infection—a cold, laryngitis, influenza, etc.Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)Chronic lung disease such as COPD, bronchiectasis, or cystic fibrosisHeart disease, liver cirrhosis, or diabetes Living in a nursing facilityImpaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)Recent surgery or traumaHaving a weakened immune system due to illness, certain medications, and autoimmune disorders
4PneumoniaCommunity-acquired Pneumonia (CAP) was the 4th leading cause of death in the world in 2012 according to the WHO and 6th leading cause of death in the U.S.It’s a Inflammation of one or both lungs.What Causes Pneumonia?The infection may be bacterial, viral, fungal.Pneumonia is extremely contagiousPneumonia can be a serious and life-threatening infection. This is true especially in the elderly, children, and those who have other serious medical problems, such as COPD, heart disease, diabetes, and certain cancers.
10ICU Inpatient/community acquired Table Evidence-Based Empiric Antimicrobial Therapy for Pneumonia in AdultsClinical SettingUsual PathogensEmpiric TherapyOutpatient/community acquiredPreviously healthyS. pneumoniae, M. pneumoniae, H influenza, C. pneumoniae, M. catarrhalisMacrolide/azalide, or tetracyclineComorbidities (diabetes, heart/lung/liver/renal disease, alcoholismFluoroqinoloned or -lactam + macrolidebElderlyS. pneumoniae, Gram-negative bacilliPiperacillin/tazobactam or cephalosporine or carbapenemfInpatient/community acquiredNon-ICUS. pneumoniae, H. influenza, M. pneumoniae, C. pneumoniae, Legionellasp.Fluoroquinoloned or -lactam + macrolidebICUS. pneumoniae, S.aureus, Legionella sp, gram-negative bacilli, H. influenzaβ-lactam + macrolide or fluoroquinolone;piperacillin/tazobactammeropenem or cefepime + fluoroquinolone,β-lactam + AMG + azithromycinβ-lactam + AMG + respiratory fluoroquinoloneIf MRSA suspectedAbove + vancomycin or linezolidHospital acquired, ventilator associated, or healthcare associatedNo risk factors for MDR pathogensS. pneumoniae, H. influenzae, MSSA enteric Gram-negative bacilliCeftriaxone or fluoroquinoloned or ampicillin/sulbactam or ertapenem or doripenemRisk factors for MDR pathogenP. aeruginosa, K. pneumoniae (ESBL), Acinetobacter sp.,Antipseudomonal cephalosporine or antipseudomonal carbapenem or -lactam/-lactamase + antipseudomonal fluoroquinoloned or AMGIf MRSA or Legionella sp. suspectedAspirationMouth anaerobes, S. aereus, enteric Gram-negative bacilliPenicillin or clindamycin or piperacillin/tazobactum + AMG
18Table 116-6 Pneumonia Classifications and Risk Factors Type of PneumoniaDefinitionRisk FactorsCommunity acquired (CAP)Pneumonia developing in patients with no contact to a medical facilityAge >65 yearsDiabetes MellitusAspleniaChronic cardiovascular, pulmonary, renal and/or liver diseaseSmoking and/or alcohol abuseHealthcare associated (HCAP)Pneumonia developing in patients not in medical facility but two or more risk factors for MDR pathogensRecent hospitalization 2 days within past 90 daysNursing home or long-term care facility residentRecent (past 30 days) antibiotic use, chemotherapy, wound care or infusion therapy either at a healthcare facility or homeHemodialysis patientsContact with a family member with infection caused by MDR pathogenHospital-acquired (HAP)Pneumonia developing >48 hours after hospital admissionWitnessed aspirationCOPD, ARDS, or comaAdministration of antacids or H2-antagonistsSupine positionEnteral nutrition, nasogastric tubeReintubation, tracheostomy, or patient transportPrior antibiotic exposureHead trauma, ICP monitoringAge >60 yearsSee healthcare associated for MDR risk factorsSame as hospital acquired
19Assessment if therapy is indicated? Yes, therapy is indicated to Reduce morbidity and mortality Prevent complications and Improve quality of life.
20Ipratropium (20mcg/1puff) Levosalbutamol (50mcg) Neb. Duolin Q6H Drug with Dose & Route12/10 13/10 14/1015/1016/10Generic NameDosage formBrand Name1ICU2345Piperacillin/TazobactamInj.Tazillin 4.5 g IVStat in 50 ml of NS over 1 hrsOver 30minMethylprednisoloneSolumedrol40 mgin 40 ml NS Q8H DopamineDopamine6 ml/hrIpratropium (20mcg/1puff)Levosalbutamol (50mcg)Neb.DuolinQ6HPantoprazoleTab.Pan 40mg1-0-0 (b/f)ParacetamolDolo 650mgSOSChlorpheniramineInjAvil IV1amp SOSOndansetronEmeset 4mg IV NAInfNaMontelukastTabMontairStat-1 Salbutamol (100ml)NebAsthalinStatChlorpheniramine (4mg/5mL)/ Dextromethorphan (10mg)SypAerodil2tsp1-0-1 CapBecelac forte1-1-1
23Inj. Tazillin 4.5 g IV (Piperacillin/Tazobactam) Stat in 50 ml of NS over 1 hrs Days 1-5Class: Piperacillin : extended-spectrum beta-lactam antibiotic of the ureidopenicillin class. Tazobactam: β-lactamase inhibitor.MOA: Piperacillin inhibits bacterial cell wall synthesis.Tazobactum inhibits the action of bacterial β-lactamases.Indication: is indicated for Community-acquired pneumonia (moderate severity only), Nosocomial pneumonia (moderate to severe)Justification: It is correctly indicated according to the Infectious Diseases Society of American Guidelines on the Management of CAP in Adults.Dose, dosage and schedule were found to be correct.ADR: Prolongation of bleeding time, anaphylaxis, nausea,vomiting, diarrhea.
24Inj. Solu medrol 40 mg (Methylprednisolone) in 40 ml NS Q8H DAY 1 Class: Corticosteroid drugMOA: It inhibit the potent mediators of inflammation such as prostaglandins and leukotrienes.Indication: It is indicated for breathlessnessJustification: It is correctly indicated as patient was having breathlessness as symptoms of pneumoniaDose, dosage and schedule were found to be correct.ADR: Hypercalciuria, hypokalemic alkalosis, CHF, PUC, HTN, viral infections, itching, allergic skin reactions.
25INJ. Dopamine 6 ml/hrDAY 1MOA: increases blood pressure by acting on both α and β-1 receptors.Indication: It is given for the treatment of severe hypotension and septic shockJustification: It is correctly indicated as the patient had hypotension on day 1 and septic shockDose, dosage and schedule were found to be correct.ADR: nervousness, headache, dysrhythmias, palpitations, chest pain, dyspnea, nausea, and vomiting.
26Neb. Duolin (Ipratropium (20 mcg/1puff) Levo-salbutamol (50 mcg)) Q6H DAYS 1-3 Class: anticholinergic agent/Stimulates β- receptorsMOA: Ipratropium bromide: decreased contractility of smooth muscle/ Levosalbutamol: Stimulates β-receptorsIndication: breathlessness.Justification: It is indicated correctly because patient had breathlessness from day 1Dose, dosage and schedule were found to be correct.ADR: tremor, tachycardia, leg cramps, dizziness, vomiting
27Tab. Pan 40 mg (Pantoprazole) 1-0-0 (b/f) Day 1-5Class: proton pump inhibitor (PPI)MOA: Pantoprazole inhibit H+/K+ - ATPase enzymeIndication: for prevention of gastric irritationJustification: It is indicated to prevent gastric irritation due to poly pharmacyDose, dosage and schedule were found to be correct.ADR: Weakness, dizziness, nausea, vomiting, anxiety, dyspnea, pain, pharyngitis, cough, arthralgia, rhinitis, chest pain, bronchitis, backache, urinary frequency, UTI, hyperlipidemia.
28Tab. Dolo 650mg (Paracetamol) SOS DAYSClass: NSAIDs (antipyretic and analgesic)Indication: for chills (as symptoms of pneumonia) as well as RA.Justification: It is indicated correctly because the patient had chills on day 1 and RA according to medical history. (Patient has been taking paracetamol)Dose, dosage and schedule were found to be correct.ADR: Bronchospasm, blood dyscrasias, centribular necrosis, liver damage, hypoglycemic coma, hepatic necrosis, liver failure, skin rashes, GI adverse effects.
29Inj. Avil IV (Chlorpheniramine) 1amp SOSClass: first-generation alkylamine antihistamineMOA: it is H1-receptor antagonistIndication: cough, running nose (since 4 days back)Justification: It is correctly indicated as the patient had coughDose, dosage and schedule were found to be correct.ADR: Blurred vision, dry eyes, mydriasis, drowsiness, constipation, fatigue, headache, dizziness, psychomotor impairment, dry mouth, gastrointestinal disturbances.
30Inj. Emeset 4mg IV (Ondansetron) S.O.S. days 1-2Class: prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery.MOA: serotonin (5HT3) antagonistIndication: given for vomitingJustification: It is given due to patient suffering from vomiting.Dose, dosage and schedule were found to be correct.ADR: Headache, dizziness, drowsiness, tiredness, or constipation may occur.
31Inf. NA (Noradrenaline) day-2Class: catecholamine (adrenergic agonists)MOA: norepinephrine stimulates cardiac contractility.Indication: hypotensive states, septicaemiaJustification: It is correctly indicated as the patient had hypotension and septic shock. (Norepinephrine is used to treat shock, because it increases vascular resistance and, therefore, increases blood pressure. Other actions of norepinephrine are not considered to be clinically significant.)Dose, dosage and schedule were found to be correct.ADR: ausea, stomach upset, skin rash, acute toxicity.
32Tab. Montair (Montelukast) Stat-1 DAY- 1Class: leukotriene receptor antagonistMOA: Montelukast selectively antagonizes LTD4, preventing smooth muscle contraction.Indication: breathlessnessJustification: This reduces the bronchoconstriction caused by the leukotriene, and results in less inflammationDose, dosage and schedule were found to be correct.ADR: Angioedema, headache, restlessness, abdominal pain, agitation, oedema, allergy anaphylaxis.
33Neb. Asthalin (Salbutamol (100ml)) StatClass: β2-agonistMOA: direct-acting sympathomimetic which producing bronchodilating effects.Indication: breathlessnessJustification: It is given correctly as the patient complained of breathlessnessDose, dosage and schedule were found to be correct.ADR: Fine skeletal muscle tremor especially hands, tachycardia, palpitations, muscle cramps, headache, angioedema, urticaria, hypotension and collapse.
34Cap Becelac forte 1-1-1 day 4-5 Class: Lactobacillus acidophilus 2000lacs, Folic acid 1.5 mg, Vit.B12 15 mcg ,Niacinamide 100 mg, Calcium pantothenate 50 mg, Biotin 100mcg.MOA: It helps to prevent harmful bacterial growth.Indication: Used For vitamins and minerals deficiency due to diarreha.Justification: It is given correctly as in cases of mild Antibiotic induced diarrhea.Dose, dosage and schedule were found to be correct.
35Syrp. Aerodil (Chlorpheniramine (4mg/5mL)/ Dextromethorphan (10mg)) 2 tsp 1-0-1 day 4 Class: Antitussive agentMOA: Chlorpheniramine is an H1-antagonist. Dextromethorphan acts as antagonist to the NMDA glutamatergic receptorIndications: used for treatment and prevention of cough.Justification: correctly indicated as patient suffered from cough.Dose, dosage and schedule were found to be correct.ADR: Dependency, dizziness, drowsiness, vomiting, restlessness, mental confusion, excitation
37Goals of TherapyEradication of the offending organism through selection of the appropriate antibiotic and complete clinical cureTo decrease morbidity and mortalityTo prevent complicationsTo relieve patient symptomsTo improve quality of life
39Points to PhysicianPatient having high TSH which indicated for hypothyroidism.Blood urea nitrogen levelOndansetron is not for preventing nausea or vomiting that is caused by factors other than cancer treatment or surgery.
40Points to Patient Points to the patient: You have infection in your lung and it can be treated if you adhere to your therapy.It is contagious which can be spread easily.Hence care must be taken.
41Life Style Modification How to Strengthen Your Lungs After Having PneumoniaMethod 1: Performing Breathing Exercises1-Practice deep breathing.2-Do pursed-lip breathing.3-Try breathing from your diaphragm4-Practice huff-cough breathing.
42At HomeRest as much as possible to help speed your recovery.Drink plenty of fluids throughout the day.Take the entire course of any prescribed medications.Get enough vitamins and minerals.
43Points to Patient on Discharge Medication Tab tazillin 4.5 gm Q8hTab pan 40 mg 1-0-0Syr aerodil 2tsp 1-0-1Tab dolo 650mg sos
44Tab pan 40 mg 1-0-0 Tab tazillin 4.5 gm Q8h It is indicated to prevent gastric irritation due to multi drugs.One tablet should be taken 30 min. before breakfast.You may have weakness, dizziness, nausea, vomiting or anxiety as side effects.Tab tazillin 4.5 gm Q8hIt is antibiotic which is indicated for treatment of pneumonia.It should be taken one tablet each every 8 hours.You may have nausea, vomiting and diarrhea as side effects.
45Syr aerodil 2tsp 1-0-1 Tab dolo 650mg sos It is indicated to reduce your cough.It should be taken 2 tea spoon each 12hours.You may have dizziness, drowsiness, vomiting, restlessness as side effects.Tab dolo 650mg sosIt is indicated for your Rheumatoid Arthritis.You should take it whenever there is pain in your joints.You may have nausea, vomiting and diarrhea as side effects.