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Med Surg > 27 - Lower Respiratory Problems > Flashcards

27 - Lower Respiratory Problems Flashcards

1
Q

Pneumonia

A

acute infection of lung parenchyma

-PNA + influenza is 8th leading cause of deth in US

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2
Q

incr risk for PNA

A
  • trache tube bypass filtration
  • weak cough/epiglottis incr risk asprtn
  • pollutn, cig, viral URI decr muciliary mech
  • chronic disease suppress immun
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3
Q

3 ways pathogen enters lungs 3 ways

A

1 aspiration
2 inhalation
3 hematogenous spread fr infection elsewhere in body

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4
Q

3 classifications of PNA

A

1 community-acquired pneumonia
2 hospital-acquired pneumonia
3 ventilator-assoc pneumonia

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5
Q

CAP

A

infection in pt that have NOT been hospitalized or lived in longterm care facility w/in 14 days of onset

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6
Q

HAP aka Nosocomial Pneumonia

A

NONintubated pt that begins 48 hr or longer after admission to hospital
-PNA was not present at time of admission

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7
Q

VAP

A

type of HAP

-infection occurs more than 48 hr after ET tube

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8
Q

most common type of PNA

A

viral PNA

1/3 OF CASES

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9
Q

mycoplasma PNA

A

has traits of both bacterial + viral PNA

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10
Q

bacterial PNA

A

pt may be extremely unwell + need hospital admission

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11
Q

aspiration pneumonia

A

abnormal entry of material into trachea or lungs

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12
Q

incr risk for aspiration

A
  • decr LOC
  • seizure
  • anesthesia
  • head injury
  • stoke
  • alcohol
  • difficulty swallowing
  • NG tube
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13
Q

necrotizing PNA

A

rare complication of bacterial lung infection

  • often assoc w CAP
  • lung tissue is turned into liquid mass
  • staph, klebsiella, strep
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14
Q

opportunistic PNA

A

inflammation + infection of lower resp tract in immunocompromised pt

  • due to normal flora
  • chemo, radiatn, HIV, malnourished are at risk
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15
Q

almost all pathogens trigger ___ in the lungs

A

inflammation response

> incr vasc permeability>incr neutrophils> engulfs pathogen> incr more neutrophils>edema of airway>fluid leaks fr capillaries+ tissues into alveoli> HYPOXIA

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16
Q

____ may occur in PNA but it only causes ____

A

atelectasis

shortness of breath

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17
Q

consolidation

A

common in bacterial PNA

-when normally filled alveoli is filled w water, fluid, or debris

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18
Q

over time w _____ therapy, macrophages will lyse debris.

A

ABX

-this allows lung tissue to recover + return gas exchange to normal

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19
Q

most common s/s of pneumonia

A
  • cough
  • fever
  • chills
  • dyspnea
  • tachypnea
  • pleuritic chest pain
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20
Q

s/s in older patients

A

may not have classic s/s

  • confusion + stupor
  • —-may be r/t hypoxia
  • hypothermia instead of fever
  • diaphoresis, anorexia, fatigue
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21
Q

auscultation of PNA

A
  • crackles
  • egophony (incr in sound of pt voice)
  • incr fremitus
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22
Q

PNA complications

A
  • atelectasis
  • pleurisy
  • pleural diffusion
  • bacteremia
  • pneumothorax
  • acute resp failure
  • sepsis/septic shock
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23
Q

supportive measures for PNA

A
  • o2 therapy > hypoxemia
  • analgesic>chest pain
  • antipyretic
  • 6-10 glasses/day
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24
Q

corticosteroids, antitussives, mucolytics, bronchodilators for PNA

A

debatable

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25
Q

Tx for PNA

A

no tx for viral PNA

-often self-limiting

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26
Q

TB can infect which organs

A

any organ

27
Q

most potent antitubercular drugs

A

isoniazid INH

rifampin

28
Q

if TB develops resistance to INH + rifampin, then

A

it is defined as multi-drug-resistant tuberculosis

MDR-TB

29
Q

TB

transmission

A

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
30
Q

factors that influence TB transmission

A

1 number of microbes expelled
2 concentrtn of microbes i.e. small space
3 length of time of exposure
4 immune systm of exposed

31
Q

ghon lesion or focus

A

calcified TB granuloma

-hallmark of primary TB infectn

32
Q

post primary TB or reactivation TB

A

TB disease occurs 2+ yrs after infection

-if laryngeal, then pt is infectious

33
Q

latent TB infection LTBI

A
  • positive skin test but asymptomatic, no disease

- not infectious

34
Q

onset of TB s.s

A

2-3 wks after infection/reactivation

35
Q

TB s/s

A

initial: dry cough
later: productive w mucopurulent sputum, malaise, anorexia, low grade fever, night sweats
late: dyspnea

36
Q

when properly treated, TB usually heals without complications except for ______

A

scarring + residual cavitation in lung

37
Q

miliary TB

A

widespread dissemination of TB in bloodstream

38
Q

miliary TB s/s

A 
fever
cough
lymphadenopathy
hepatomegaly
splenomegaly
39
Q

Pott’s disease

A

TB in spine

40
Q

TB skin test aka

A

Mantoux Test

41
Q

tb skin test/mantoux

A

uses purified protein derivative PPD

-standard for screening

42
Q

Interferon Gamma Release Assays

A

detects INF gamma release fr T cells in response to TB

43
Q

gold standard for Dx of TB

A

CULTURE

  • 3 consec sputum specimen
  • 8-24 hr intervals
  • atleast 1 early AM speciment
44
Q

2 phases of TB Tx

A

initial + continuation

45
Q

4 drugs in initial phase

A

isoniazid
rifampin
pyrazinamide
ethambutol

46
Q

2 drugs in continuation phase

A

isoniazid

rifampin

47
Q

LTBI Tx

A

9 mos daily isoniazid

48
Q

TB acute care

A

1 airborne isolation
2 chest x ray, sputum smeal, culture
3 appropriate drug therapy

49
Q

tb patients are in a single occupancy room w ned airflow of _____

A

6-12 exchanged per hour

50
Q

how often should sputum test or AFB smear + culture should be obtained

A

at minimum Qmonthly until 2 consec specimens are negative

51
Q

pulmo embolism can be caused by

A

thombus, fat, air, or tumor

52
Q

emboli

A

mobile clots

53
Q

most affected part of lungs

A

lower lobes

54
Q

saddle embolus

A

large thrombus lodged at an arterial bifurcation

55
Q

PE

risk factors

A
  • immobility
  • surgery in past 3mos
  • hx of VTE
  • cancer
  • obesity
  • contraceptives
  • hormone therapy
  • cig smoking
  • prolonged air travel
  • HF
  • pregnancy
  • clotting disorders
56
Q

PE

s/s

A
  • dyspnea
  • mild-mod hypoxemia
  • tachypnea
  • cough
  • chest pain
  • hemoptysis
  • crackl/wheezing
57
Q

PE

complications

A
  • 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
58
Q

PE

diagnostic test

A
  • D Dimer
  • Spiral helical CT scan
  • Vent perfusion scan
  • ABG (not diagnostic)
59
Q

D Dimer

A

measures amount of cross-linked fibrin fragments

-result of clot degradation

60
Q

most common test to diagnose PE

A

spiral helical CT scan

61
Q

warfarin alternatives

A
  • apixaban
  • dabigatran
  • edoxaban
62
Q

how long does anticoag continue for?

A

3 mons

63
Q

Pulmo hypertension

A

elevated pulmo artery pressure
rest>25mmHg
exercise>30mmHg

Med Surg (18 decks)

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