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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
Q

Ethambutol SEs

A

SEs are uncommon.
Peripheral neuritis
Optic neuritis: red/green color discrimination
skin rash, GI disturbance

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26
Q

Ethambutol NIs

A

Give vitamin B6
Baseline vision/color discrimination test (and repeat every 2-3 months.
Safe in pregnancy

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27
Q

Amikacin SEs

A

Renal and Ototoxicity

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28
Q

Amikacin NIs

A

Adequate hydration
Monitor hearing
NOT used in pregnancy

29
Q

Pyrazinamide SEs

A

Hepatotoxicity

Fever, skin rash, jaundice, hyperuricemia, N/V

30
Q

Pyrazinamide NIs

A

Monitor AST/ALT

Monitor for jaundice

31
Q

Streptomycin SEs

A

Ototoxicity
Nephrotoxicity
Neurotoxicity
Hypersensitivity

32
Q

Streptomycin NIs

A 
Hydration!
Monitor BUN/creat
Baseline hearing test, repeat every 1-2 months.
Rhomberg test for neuro
*NOT safe in pregnancy*
33
Q

Rifampentine Rifater SEs

A

Hepatotoxic

other drugs metabolism faster, lowering blood concentrations and need a higher dose (DM meds, barbs, Abx)

34
Q

Rifampentine Rifater NIs

A

Backup birth control

Take 2x/week (Q 72 hours)

35
Q

Otitis media Definition

A

Effusion and infection or blockage of the middle ear. Kids <2 at greatest risk.

36
Q

Otitis media Etiology

A

Bacterial (S. Pneumoniae, H. influenza)

Viral - alter hose defenses and lead to eustachian tube dysfunction.

37
Q

Otitis media Pathophys

A

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
Q

Otitis media S/S

A

Earache - pulling ears
Bulging, opaque tympanic membrane, reddened, immobility
Drainage (perforation)
Irritable, persistent crying, poor sleep, fever.

39
Q

Otitis media Tx

A

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
Q

Otitis media PCs

A

Hearing loss
Speech problems
Mastoiditis, meningitis, or brain abscess
Scarring or perofration of tympanic membrane

41
Q

Croup Definition

A

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
Q

Croup Etiology

A

Viral - Parainfluenza
Age range: 6months to 6 years
Season: winter
Usually preceded by a cold.

43
Q

Croup Pathophys

A

Inflammation of the mucosa -> swelling -> airway narrowing -> resp difficulty -> hypoxia -> acidosis -> death
Larynx, Trachea, Bronchi

44
Q

Croup S/S

A

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
Q

Croup Tx

A 
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
Q

Croup PCs

A

Hypoxia
Airway obstruction
Dehydration

47
Q

Croup Teaching for parents

A

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
Q

Epiglottitis Definition

A

Severe inflammatory process of the supraglottis area.

49
Q

Epiglottitis Etiology

A

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
Q

Epiglottitis Pathophys

A

Inflammation of epiglottis - severe edema - partial or complete airway obstruction.

51
Q

Epiglottitis Cardinal Symptoms

A

Drooling
Dysphagia
Dysphonia - muffled voice
Distressed respiratory effort - tripod position

52
Q

Epiglottitis (other) Symptoms

A

Usually sudden onset
Toxic appearance - severe sore throat and fever (102-104F)
Nasal flaring, retractions, cyanosis, tachycardia

53
Q

Epiglottitis Tx

A

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
Q

Epiglottitis PCs

A

Hypoxia
Severe resp distress
Airway obstruction
Dehydration

55
Q

Epiglottitis NIs

A

No oral temps
Elevate HOB
Monitor fluid status
Decrease anxiety of child and parents

56
Q

Acute Bronchitis Definition

A 
Mostly viral (Rhinovirus, RSV, influenza)
Bacterial (secondary to a primary viral infection)
57
Q

Acute Bronchitis Pathophys

A

Upper airway infection -> persistent cough

58
Q

Acute Bronchitis S/S

A 
Fever (mild)
Tachypnea, tachycardia
Productive cough (clear sputum)
Crackles & rhonchi, wheezes
Rhinitis
Malaise, headache
SOB on exertion
59
Q

Acute Bronchitis Tx

A 
CXR (infiltrate with pneumonia; clear with bronchitis)
Supportive tx:
humidity
abx
antipyretics
antivirals
bronchodilators
rest
expectorants
anti-inflammatories
60
Q

Acute Bronchitis PCs

A

Chronic lung disease with COPD

61
Q

Bronchioloitis Definition

A

Inflammation of the fine bronchioles - usually 2-12 months; peaks at 6 months. Rare after 2 years.

62
Q

Bronchioloitis Etiology

A

Acute viral infection: *Respiratory syncytial virus (RSV).
Adenovirus
Para influenza viruses
Season: Sept-April

63
Q

Bronchioloitis Pathophys

A

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
Q

Bronchioloitis S/S

A

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
Q

Bronchioloitis Reason for admittance

A

Increased resp rate (>60), POX <90%, Dehydration

66
Q

Bronchioloitis Tx

A

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
Q

Bronchioloitis PCs

A

Dehydration

68
Q

S/S of Dehydration in children

A

<2ml/kg/day (1g = 1ml)
sunken fontanel
weight loss
dry mucus membrane

109: U5: Acute Respiratory (4 decks)

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