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Pneumonia (PNA) - Coggle Diagram

- - - - In response to the spread of bacteria, the immune system responds with mucus membranes hypertrophy and increased capillary permeability.
        
        Excess fluid builds in the alveoli with mucus membrane hypertrophy and increased capillary permeability
        
        Fluid, along with debris, combine to form areas of consolidation within the alveoli. Consolidation is characteristic of bacterial PNA.
        
        Pt presents with s/s of bacterial PNA, including: fever, tachycardia, tachypnea, hypoexemia, cough c sputum production, crackles and bronchial breath sounds on auscultation, chest pain in the affected area, and CXR c patchy infiltrate of the entire left lung.
        
        Consolidations in the lungs blocks gas exchange. Many of the s/s (including tachycardia, tachypnea, hypoexemia,and chest pain) can be related back to this fact.
        
        Overwhelming amount of bacteria in alveoli causes decreased space for perfusion and proper gas exchange to occur
        
        With an increased need for oxygen, the blood attempts to get it from the alveoli, essentially transferring bacteria into the bloodstream as well
        
        This migration of bacteria into the blood stream is known as bacteremia
        
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        Pt presents with elevated WBC count
- - - - Endothelial cells trigger decreased nitric oxide release, which leads to hypotension of vasculature and expression of neutrophil attracting molecules on surface of the cell, causing more inflammation.
        
        Endothelal's glycoalyx begins to shed, which further enhances capillary leakage, inflammation, and loss of vascular tone, systemically.
        
        Coagulation cascade begins, and rbc with neutrophils are then clogged in microvasculature, leadinng to increased hypoxemiic state in tissues.
        
        Lack of oxygen in tissues leads to lack of oxygen in cells. This decreases mitochondria's ability to create ATP, but also triggers reactive oxygen species (ROS), which is used for cell signaling of invasive pathogens d/t hypoxemic states. ROS is used for cell phagocytosis, but has unintended consequences.
        
        ROS and nitric Oxide damaage mitochondria, and triggers apoptosis, as well as decreased energy production and cellular metabolism.
        
        Globally, this cell death leads to decreased functional units for many organs, leading to multi-organ system failure.
- - - - Some individuals are at an increased risk of developing sepsis including: the elderly, immunocompromised patients, patients with chronic illnesses, pregnant women, and infants. Although these individuals have an increased risk, sepsis can occur in any patient
        
        Patients are diagnosed with sepsis when they develop typical signs and symptoms along with the presence of infection. These include: altered mental state, systolic BP <100mmHg, RR that is 22bpm or more, fever, dyspnea, extreme aches and pains and increase in HR
        
        Treatment for sepsis includes: IV antibiotics/fluids and potentially surgery. Patients are admitted to the ICU to be monitored for the progression of sepsis to septic shock
        
        If patients are not diagnosed with sepsis or treated immediately, they can develop septic shock. When this occurs, patients have: decreased blood flow to organs, blood clots throughout organs/extremities, and significant drop in BP
        
        As a result of the overactive immune response and lack of oxygenated blood flow to organs, a patient can develop multi system organ failure
        
        Pt is currently receiving IV fluids
        
        Pt presents with elevated HR (120 bpm at admission, 146 bpm after 24 hrs); elevated RR (26 bpm at admission, 40-60 after 24 hours)
        
        Pt is a 72 yo male who has a PMH of NIDDM and MI, making him more at risk for sepsis
      - Pt is diagnosed with overwhelming PNA, which led to bacteremia, sepsis, and multisystem organ failure