SCHEMATIC DIAGRAM OF HOSPITAL ACQUIRED PNEUMONIA

Modifiable risk factors: Non-modifiable risk factors:

1. Smoking 1. Gender – increased incidence among males
FIRST LAYER

2. Chronic exposure to dusts and pollution 2. Age – increased incidence in adults 65 years and older
3. Lung diseases: asthma, COPD, cystic fibrosis, bronchiectasis, and children younger than 5 years
respiratory infections 3. Race/Ethnicity – higher incidence among Blacks and
4. Other diseases: malnutrition, diabetes, heart failure, kidney disease, African-Americans
HIV 4. Heredity – genetic predisposition to pneumonia
5. Immobility, prolonged hospitalization, prolonged ventilator use
SECOND LAYER

Invasion of pathogen and alteration in bacterial lung resistance

by either:
 Decreased bactericidal activity of alveolar macrophages
 Extreme virulence of the bacteria
 Increased host susceptibility

Inflammatory response in the lung parenchyma 1. Fever

THIRD LAYER
2. Fatigue, weakness

Infiltration of RBCs, polymormophonuclear leukocytes,

FOURTH LAYER and fibrin in the alveoli 1. Leukocytosis

1. Productive cough
Containment of bacteria and cellular products in the
FIFTH LAYER pulmonary lobes Consolidation of leukocytes and
2. Ronchi
3. Tachypnea, tachycardia
fibrin within the affected area

HOSPITAL ACQUIRED PNEUMONIA

Reference: Norris, T. L. (2019). Porth’s pathophysiology: Concepts of altered health states (10th ed.). Philadelphia, PA: Wolters Kluwer