(精选)Pneumonia in the Elderly教学课件.pptVIP

PNEUMONIA IN THE ELDERLY A Primer to Clinical Documentation WI ACDIS Chapter Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDIS * PNEUMONIA Pneumonia- Infection of the aleveoli, distal airways, and interstitium of the lungs Inflammatory disease of the lung characterized by the production of a vascular response (hyperemia and vascular permeability) and an exudate Caused by bacteria, viruses, fungi, and parasites Typically classified as “community acquired” or “healthcare/hospital acquired” * PNEUMONIA Community Acquired Pneumonia- diagnosed outside the hospital or is diagnosed within 48 hours after admission to the hospital in a patient who has not been hospitalized in an acute care setting for 2 or more days within 90 days of the infection or has not been hospitalized or residing in a long term care facility for more than 14 days before the onset of symptoms. Hospital Acquired Pneumonia/Nosocomial Pneumonia- acquired in hospital setting. Develops at least 48 hrs after hospital admission Nursing Home Acquired Pneumonia- acquired in extended care setting. * HOSPITAL ACQUIRED PNEUMONIA HAP- Carries highest morbidity and mortality rates of all nosocomial infections Adds 7-9 days to hospital stays Increases costs by $2 billion annually Crude mortality rates range from 30 to 70% HAP defined as new or progressive infiltrate on CXR plus at least two of the following: Fever of 37.8? C Leukocytosis with 10,000 WBCs/uL Production of purulent sputum Dyspnea, hypoxemia, and pleuritic chest pain may occur * IMMUNOCOMPETENT VS. IMMUNOCOMPROMISED Immunocompromised Patients HIV disease Absolute neutrophil count 1000/mcL Current or recent exposure to myelosuppressive or immonosuppressive drugs Currently taking prednisone in dosage 5mg/d * CLINICAL PRESENTATION Temperature 38 ?C(100.4F) Cough with/without sputum, hemoptysis Pleuritic chest pain Myalgia Gastrointestinal symptoms Dyspnea Malaise, fatigue Rales, rhonchi, wheezing Egophony, bronchial breath s