Pulmonary Pneumonia

Clinical Course Day 3: The patient is transferred to the ICU due to worsening shortness of breath and hypoxemia. The patient is intubated during the night and patient received Lasix 60mg IV and continues IV fluids. In the morning following the transfer to the ICU, am labs and CXR are done. Patient has the following Vital Signs: T: 101.2; HR: 104; R: 24; B/P: 98/62; O2 sat: 98% on ventilator at 50% O2. Assessment findings: controlled Afib,; Edema 2+ pitting B/L lower extremities. Hyporesonance right lower lobe, crackles bilateral lower lobes and right mid lobe.

Labs and Diagnostics:

Na 136 meq/L K 3.6 meq/L Cl 118 meq/L HCO3 22 meq/L BUN 60 mg/dL Cr 2.9 mg/dL

WBC 15.8 x 103/mm3 Glucose 128 Hb 12.2 g/dl / Hct 53%

BNP 856pg/ml Troponin I High Sens. 12 pg/ml

CXR = Cardiomegaly. Right lower lobe consolidation, right mid lobe infiltrate consistent with pneumonia, left lower lobe and right lower lobe with small pleural effusion.

ABG: pH= 7.30; PaCo2=12; PaO2= 88; HCO3: 18 Base Excess: 1

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Answer the following questions based on the information above:

14) Loretta is diagnosed with HAP (Hospital Acquired Pneumonia or nosocomial pneumonia). What are the similarities and differences between HAP and CAP (Community Acquired Pneumonia) in terms of risk of development, pattern/timing of onset, common causal microorganisms?

15) Identify 3 risk factors that predisposed this patient to any type of pneumonia. (3 points)

16) Identify 2 clinical assessment signs ( 2 points)and 2 lab/diagnostic results that support the diagnosis of pneumonia . (2 points)

17) Given Loretta’s diagnosis of DKA and CHF, what is the acid base imbalance, including the compensatory mechanism, evidenced by the patients decreased pH, decreased pCO2, and decreased HCO3 ?(3 points). What is the pathophysiology behind each of these abnormal values? (3 points)