27 - Lower Respiratory Problems Flashcards
Pneumonia
acute infection of lung parenchyma
-PNA + influenza is 8th leading cause of deth in US
incr risk for PNA
- trache tube bypass filtration
- weak cough/epiglottis incr risk asprtn
- pollutn, cig, viral URI decr muciliary mech
- chronic disease suppress immun
3 ways pathogen enters lungs 3 ways
1 aspiration
2 inhalation
3 hematogenous spread fr infection elsewhere in body
3 classifications of PNA
1 community-acquired pneumonia
2 hospital-acquired pneumonia
3 ventilator-assoc pneumonia
CAP
infection in pt that have NOT been hospitalized or lived in longterm care facility w/in 14 days of onset
HAP aka Nosocomial Pneumonia
NONintubated pt that begins 48 hr or longer after admission to hospital
-PNA was not present at time of admission
VAP
type of HAP
-infection occurs more than 48 hr after ET tube
most common type of PNA
viral PNA
1/3 OF CASES
mycoplasma PNA
has traits of both bacterial + viral PNA
bacterial PNA
pt may be extremely unwell + need hospital admission
aspiration pneumonia
abnormal entry of material into trachea or lungs
incr risk for aspiration
- decr LOC
- seizure
- anesthesia
- head injury
- stoke
- alcohol
- difficulty swallowing
- NG tube
necrotizing PNA
rare complication of bacterial lung infection
- often assoc w CAP
- lung tissue is turned into liquid mass
- staph, klebsiella, strep
opportunistic PNA
inflammation + infection of lower resp tract in immunocompromised pt
- due to normal flora
- chemo, radiatn, HIV, malnourished are at risk
almost all pathogens trigger ___ in the lungs
inflammation response
> incr vasc permeability>incr neutrophils> engulfs pathogen> incr more neutrophils>edema of airway>fluid leaks fr capillaries+ tissues into alveoli> HYPOXIA
____ may occur in PNA but it only causes ____
atelectasis
shortness of breath
consolidation
common in bacterial PNA
-when normally filled alveoli is filled w water, fluid, or debris
over time w _____ therapy, macrophages will lyse debris.
ABX
-this allows lung tissue to recover + return gas exchange to normal
most common s/s of pneumonia
- cough
- fever
- chills
- dyspnea
- tachypnea
- pleuritic chest pain
s/s in older patients
may not have classic s/s
- confusion + stupor
- —-may be r/t hypoxia
- hypothermia instead of fever
- diaphoresis, anorexia, fatigue
auscultation of PNA
- crackles
- egophony (incr in sound of pt voice)
- incr fremitus
PNA complications
- atelectasis
- pleurisy
- pleural diffusion
- bacteremia
- pneumothorax
- acute resp failure
- sepsis/septic shock
supportive measures for PNA
- o2 therapy > hypoxemia
- analgesic>chest pain
- antipyretic
- 6-10 glasses/day
corticosteroids, antitussives, mucolytics, bronchodilators for PNA
debatable
Tx for PNA
no tx for viral PNA
-often self-limiting
TB can infect which organs
any organ
most potent antitubercular drugs
isoniazid INH
rifampin
if TB develops resistance to INH + rifampin, then
it is defined as multi-drug-resistant tuberculosis
MDR-TB
TB
transmission
NOT highly infectious
- airborne
- –cough, sneeze, talk, breath
- –able to suspend in air for min-hr
- CANNOT spread by touching, kissing or sharing food utensils
factors that influence TB transmission
1 number of microbes expelled
2 concentrtn of microbes i.e. small space
3 length of time of exposure
4 immune systm of exposed
ghon lesion or focus
calcified TB granuloma
-hallmark of primary TB infectn
post primary TB or reactivation TB
TB disease occurs 2+ yrs after infection
-if laryngeal, then pt is infectious
latent TB infection LTBI
- positive skin test but asymptomatic, no disease
- not infectious
onset of TB s.s
2-3 wks after infection/reactivation
TB s/s
initial: dry cough
later: productive w mucopurulent sputum, malaise, anorexia, low grade fever, night sweats
late: dyspnea
when properly treated, TB usually heals without complications except for ______
scarring + residual cavitation in lung
miliary TB
widespread dissemination of TB in bloodstream
miliary TB s/s
fever cough lymphadenopathy hepatomegaly splenomegaly
Pott’s disease
TB in spine
TB skin test aka
Mantoux Test
tb skin test/mantoux
uses purified protein derivative PPD
-standard for screening
Interferon Gamma Release Assays
detects INF gamma release fr T cells in response to TB
gold standard for Dx of TB
CULTURE
- 3 consec sputum specimen
- 8-24 hr intervals
- atleast 1 early AM speciment
2 phases of TB Tx
initial + continuation
4 drugs in initial phase
isoniazid
rifampin
pyrazinamide
ethambutol
2 drugs in continuation phase
isoniazid
rifampin
LTBI Tx
9 mos daily isoniazid
TB acute care
1 airborne isolation
2 chest x ray, sputum smeal, culture
3 appropriate drug therapy
tb patients are in a single occupancy room w ned airflow of _____
6-12 exchanged per hour
how often should sputum test or AFB smear + culture should be obtained
at minimum Qmonthly until 2 consec specimens are negative
pulmo embolism can be caused by
thombus, fat, air, or tumor
emboli
mobile clots
most affected part of lungs
lower lobes
saddle embolus
large thrombus lodged at an arterial bifurcation
PE
risk factors
- immobility
- surgery in past 3mos
- hx of VTE
- cancer
- obesity
- contraceptives
- hormone therapy
- cig smoking
- prolonged air travel
- HF
- pregnancy
- clotting disorders
PE
s/s
- dyspnea
- mild-mod hypoxemia
- tachypnea
- cough
- chest pain
- hemoptysis
- crackl/wheezing
PE
complications
- 10% die
- pulmo infarction
- —when there is occlusion or large/med size pulmo vessels, insufficient collateral blood flow, preexisting lung disease
- pulmo hypertension fr hypoxemia
PE
diagnostic test
- D Dimer
- Spiral helical CT scan
- Vent perfusion scan
- ABG (not diagnostic)
D Dimer
measures amount of cross-linked fibrin fragments
-result of clot degradation
most common test to diagnose PE
spiral helical CT scan
warfarin alternatives
- apixaban
- dabigatran
- edoxaban
how long does anticoag continue for?
3 mons
Pulmo hypertension
elevated pulmo artery pressure
rest>25mmHg
exercise>30mmHg
