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109: U5: Acute Respiratory > 109: U5: Acute Resp Disorders > Flashcards

109: U5: Acute Resp Disorders Flashcards

1
Q

Influenza Definition

A

Highly contagious, acute viral respiratory infection. Season for flu: October - April.

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2
Q

Influenza Etiology

A

Viral

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3
Q

Influenza Pathophys

A

3 groups of viruses - A, B, & C. Viruses have the ability to change over time.

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4
Q

Influenza S/S

A

Abrupt onset.
Headache, muscle ache, fever, chills, fatigue,, weakness, anorexia (lasts about a week).
Sore throat, cough, rhinorrhea
Dyspnea, crackles (starting to get a pulm complication)
Malaise 1-2 weeks after
Cough may persist for weeks.

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5
Q

Influenza Tx

A

Symptomatic treatment: analgesics, antipyretics, antihistamines, cough syrup, fluids, rest.
Antivirals: amantidine, tamiflu (only if taken within 24 hours of onset of s/s)
Vaccinations. Flumist (live, weakened virus) do not give to immunocompromised patients.

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6
Q

Pneumonia Definition

A

An inflammatory process of the lungs.

7th leading cause of death in the U.S.

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7
Q

Pneumonia Etiology

A

Bacterial, viral, mycoplasma, fungi, parasites, chemicals.
Decreased defense mechanisms - decreased consciousness, intubation, smoking, URI, malnutrition.
Aspiration, inhalation, hematogenous spread.

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8
Q

Pneumonia Pathophys

A 
Community acquired (come in with or develop within 2 days of hospital stay).
Hospital acquired (insurance will not pay).
4 characteristic stages.
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9
Q

Pneumonia S/S (Typical)

A

Fever
Chills, cough, sputum (rust colored)
Hypoxemia, tachypnea, tachycardia.
Pleuritic pain, myalgia, headache.
Crackles, wheezing, fatigue, dyspnea, diminished breath sounds, SOB.
Increased fremitus (feel vibration), dullness to percussion (instead of resonance).

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10
Q

Pneumonia S/S (Atypical)

A

Mycoplasma, Legionella - gradual onset, dry cough, headache, myalgia, fatigue, N, V, D, crackles.
Viral - chills, fever, dry cough

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11
Q

Pneumonia Tx

A

Viral - Supportive treatment
Antibiotics
Analgesics for aches/pains
Supportive tx: O2 if hypoxic, HOB up. Fluids (up to 3L/day).
Positioning (if on side, good lung down). HOB up.
Vaccinations

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12
Q

Pneumonia Goal

A

Start abx within 4 hours in hospital.

Usually hospitalized for decreased POX, age,, ability to care for self, dehydration.

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13
Q

Pneumonia Isolation

A

Droplet

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14
Q

TB Definition

A

An infectious disease caused by mycobacterium tuberculosis.

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15
Q

TB Etiology

A

Gram positive bacilli.
M. Tuberculosis - transmitted by aerosolization.
Repeated close contact, HIV, lower socio-economic group, IVDA, or ETOH abusers, crowded living conditions, long term care, prisoners all at high risk.

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16
Q

TB Latent Infection

A

No symptoms, pt does not feel sick and cannot spread to others.
Usually a positive skin TB or Quantiferon Gold test. Normal CXR and sputum.
Bacteria alive but inactive and can become active later.
Can develop active TB disease if they don’t receive treatment (3-6 mo of INH).

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17
Q

TB Active Infection

A 
Symptoms may include: 
Bad cough (lasting 3 weeks or longer)
Pain in the chest
Coughing up blood/sputum
Weakness/fatigue
Weight loss, no appetite
Chills, fever, NIGHT SWEATS
May spread TB to others. Positive TB skin test/Quanteferon gold. Abnormal CXR, positive AFB test.
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18
Q

TB Miliary Infection

A

Active TB may spread to other parts of the body - kidney, brain, spine. Not infectious here (less likely to spread to others as it is not in the lungs).

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19
Q

TB Isolation

A

Airborne

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20
Q

TB Drugs

A 
Use a combination of 4 drugs for active TB. 
Isonazid (INH)
Rifampin (RIF)
Ethambutol (EMB)
Amikacin
Pyrazinamide (PZA)
Streptomycin (SM)
Rifapentine Rifater
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21
Q

INH SEs

A 
Peripheral neuritis (give vit b6)
Liver toxicity
Optic neuritis
B6 neuritis
skin rash, joint pain, fever
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22
Q

INH NIs

A 
Give Vitamin B6
Monitor AST/ALT (LFT's). No ETOH, APAP.
Monitor BUN/Creat
Look up drugs (many interactions)
Avoid antacids: affects the absorption of drugs.
Wear a med-alert bracelet.
Take with meals.
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23
Q

Rifampin SEs

A 
Low incidence of SEs
Orange urine/body fluids
Drug interactions
Hepatitis
fever, GI disturbance, periph neuropathy, hypersensitivity.
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24
Q

Rifampin NIs

A

Same as INH.
Use additional birth control
Safe in pregnancy

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25
Ethambutol SEs
SEs are uncommon. Peripheral neuritis Optic neuritis: red/green color discrimination skin rash, GI disturbance
26
Ethambutol NIs
Give vitamin B6 Baseline vision/color discrimination test (and repeat every 2-3 months. Safe in pregnancy
27
Amikacin SEs
Renal and Ototoxicity
28
Amikacin NIs
Adequate hydration Monitor hearing *NOT used in pregnancy*
29
Pyrazinamide SEs
Hepatotoxicity | Fever, skin rash, jaundice, hyperuricemia, N/V
30
Pyrazinamide NIs
Monitor AST/ALT | Monitor for jaundice
31
Streptomycin SEs
Ototoxicity Nephrotoxicity Neurotoxicity Hypersensitivity
32
Streptomycin NIs
``` Hydration! Monitor BUN/creat Baseline hearing test, repeat every 1-2 months. Rhomberg test for neuro *NOT safe in pregnancy* ```
33
Rifampentine Rifater SEs
Hepatotoxic | other drugs metabolism faster, lowering blood concentrations and need a higher dose (DM meds, barbs, Abx)
34
Rifampentine Rifater NIs
Backup birth control | Take 2x/week (Q 72 hours)
35
Otitis media Definition
Effusion and infection or blockage of the middle ear. Kids <2 at greatest risk.
36
Otitis media Etiology
Bacterial (S. Pneumoniae, H. influenza) | Viral - alter hose defenses and lead to eustachian tube dysfunction.
37
Otitis media Pathophys
Eustachian tube obstruction -> drainage and ventilation of the middle ear does not occur -> negative pressure in the middle ear -> fluid and mucus accumulate -> bacterial growth -> pain
38
Otitis media S/S
Earache - pulling ears Bulging, opaque tympanic membrane, reddened, immobility Drainage (perforation) Irritable, persistent crying, poor sleep, fever.
39
Otitis media Tx
Pain relief Reassess and tx after 48-72hrs Amoxicillin 80-90mg/kg/day. Watchful waiting (80% of the time, will resolve on its own), fluids Myringotomy with tympanostomy tubes Decrease risk factors (no smoking around child, no bottle propping, no feeding in supine position).
40
Otitis media PCs
Hearing loss Speech problems Mastoiditis, meningitis, or brain abscess Scarring or perofration of tympanic membrane
41
Croup Definition
Inflammation of larynx, trachea, and bronchus Type 1: Acute Spasmodic Laryngitis (spasmodic croup) Type 2: Acute Laryngotracheobronchitis (LTB) (Severe: hospitilized) Type 3: Acute tracheitis (Severe: hospitalized)
42
Croup Etiology
Viral - Parainfluenza Age range: 6months to 6 years Season: winter Usually preceded by a cold.
43
Croup Pathophys
Inflammation of the mucosa -> swelling -> airway narrowing -> resp difficulty -> hypoxia -> acidosis -> death Larynx, Trachea, Bronchi
44
Croup S/S
Starts with cold symptoms (URI) Low grade or no fever BARKING COUGH, spasmodic sudden onset Inspiratory stridor Use of accessory muscles, anxious, agitated Hoarseness, sore throat LTB fever >104 (worse than regular croup) Sx may be worse at night. S/S last 3-4 days
45
Croup Tx
``` Cool mist, cool humid night air Racemic epinephrine (if severe) Corticosteroids (dexamethasone) APAP (pain/fever) IV fluids, POX, VS, I&O Quiet, calm environment, group cares, involve parents. Upright positioning May need ICU and intubation (worse case) Encourage fluids ```
46
Croup PCs
Hypoxia Airway obstruction Dehydration
47
Croup Teaching for parents
Likely to recur. Monitor for s/s of resp distress (retractions) and cyanosis. Cool mist humidifier while sleeping. If drooling, GO TO ER. Should have at least 6 wet diapers/day (Less than 6 indicates dehydration)
48
Epiglottitis Definition
Severe inflammatory process of the supraglottis area.
49
Epiglottitis Etiology
Bacterial (H. Influenza B) HIB vaccine given in 5 doses. Ages 3-7 Life threatening Abrupt onset, gets worse rapidly, 2-6 hours to complete obstruction.
50
Epiglottitis Pathophys
Inflammation of epiglottis - severe edema - partial or complete airway obstruction.
51
Epiglottitis Cardinal Symptoms
Drooling Dysphagia Dysphonia - muffled voice Distressed respiratory effort - tripod position
52
Epiglottitis (other) Symptoms
Usually sudden onset Toxic appearance - severe sore throat and fever (102-104F) Nasal flaring, retractions, cyanosis, tachycardia
53
Epiglottitis Tx
ICU care (need close monitoring for airway obstruction) Airway: endotracheal, intubation @ bedside, tracheostomy, O2. Abx (IV), antipyretics (rectally) IV hydration (NO SWALLOWING) NO THROAT EXAM Child/Parent anxiety control No invasive procedures until intubated.
54
Epiglottitis PCs
Hypoxia Severe resp distress Airway obstruction Dehydration
55
Epiglottitis NIs
No oral temps Elevate HOB Monitor fluid status Decrease anxiety of child and parents
56
Acute Bronchitis Definition
``` Mostly viral (Rhinovirus, RSV, influenza) Bacterial (secondary to a primary viral infection) ```
57
Acute Bronchitis Pathophys
Upper airway infection -> persistent cough
58
Acute Bronchitis S/S
``` Fever (mild) Tachypnea, tachycardia Productive cough (clear sputum) Crackles & rhonchi, wheezes Rhinitis Malaise, headache SOB on exertion ```
59
Acute Bronchitis Tx
``` CXR (infiltrate with pneumonia; clear with bronchitis) Supportive tx: humidity abx antipyretics antivirals bronchodilators rest expectorants anti-inflammatories ```
60
Acute Bronchitis PCs
Chronic lung disease with COPD
61
Bronchioloitis Definition
Inflammation of the fine bronchioles - usually 2-12 months; peaks at 6 months. Rare after 2 years.
62
Bronchioloitis Etiology
Acute viral infection: *Respiratory syncytial virus (RSV). Adenovirus Para influenza viruses Season: Sept-April
63
Bronchioloitis Pathophys
Blockage of smaller bronchioles with mucus and inflammatory products -> air cannot get in or leave -> Hyperinflation of alveoli -> atelectasis -> hypoxemia -> metabolic acidosis (worse case)
64
Bronchioloitis S/S
Simple URI (low grade fever, sneezing, anorexia, irritability) Serous nasal drainage Dry paraxysmal cough Tachypnea, retractions, wheezing, rales, flaring Hypoxia leading to tachycardia and cyanosis
65
Bronchioloitis Reason for admittance
Increased resp rate (>60), POX <90%, Dehydration
66
Bronchioloitis Tx
Assessment of breath sounds, RR Positioning HOB 30-45 degrees) Hydration/humidity Patent airway (roll behind the neck) O2 (cool and humidified) Bronchodilators/nebulizers (albuterol - will keep on if it works. does not work in all cases) Antivirals Prevention of spread (contact/droplet iso) Suctioning: nasopharyngeal (before eating and PRN) Acetaminophen
67
Bronchioloitis PCs
Dehydration
68
S/S of Dehydration in children
<2ml/kg/day (1g = 1ml) sunken fontanel weight loss dry mucus membrane

109: U5: Acute Respiratory (4 decks)

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