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MD 4910 NCP I > 4923 C21 Diseases of the Respiratory System > Flashcards

4923 C21 Diseases of the Respiratory System Flashcards

1
Q

cystic fibrosis (CF)

A

Disease characterized by abnormally thick mucus secretions from the epithelial surfaces of various organ systems, including the respiratory tract, the GI tract, liver, genitourinary system, & the sweat glands.

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2
Q

What is the most common autosomal recessive disease in the US?

A

cystic fibrosis

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3
Q

autosomal recessive

A

method of hereditary disease transmission in which the patient receives 2 chromosomes bearing the gene anomaly, one from each parent.

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4
Q

Etiology of CF

A

Is caused by a mutation of the CFTR (cystic fibrosis transmembrane conductance regulator, a type of ABC transporter, it does not function normally.

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5
Q

Aerosol therapies used to treat CF?

A

inhaled bronchodilators, inhaled anti-inflammatory agents, inhaled mucolytics

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6
Q

chest physiotherapy

A

PT that includes a variety of techniques designed to reduce or prevent infection by clearing pooled secretions &/or infected materials from the lungs.

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7
Q

How is CF diagnosed?

A

Sweat chloride test. CFTR gene mutation blood test. Sputum cultures. Pancreatic function tests.

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8
Q

sweat chloride test

A

a test to measure the amount of chloride in the sweat by stimulating the skin to produce a large amount of sweat that is then absorbed by a special filter paper & analyzed for chloride content.

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9
Q

plasma prothrombin concentrations

A

a measure of blood clotting ability. A measure of vitamin K nutriture.

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10
Q

pancreatic enzyme dose for infants

A

1,000-4,000 lipase units /120mL of formal/breast milk

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11
Q

pancreatic enzyme dose for children

A

begins at 1,000 units /kg/meal for children < 4. 500 lipase units /kg/meal for children > 4. Require less per kg with age due to decreased fat intake.

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12
Q

Recommended fat intake for CF patients

A

35-40% of kcal due to decreased absorption.

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13
Q

signs and symptoms of CF

A

Usually develop in the first year of life. Persistant diarrhea. Bulky, greasy, foul smelling stools. Wheezing & pneumonia. Chronic cough, thick mucous. Salty tasting skin. Poor growth.

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14
Q

Sings and symptoms of CF that may begin to appear after the 1st yr of life?

A

Clubbing. SOB

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15
Q

How are newborns tested for CF

A

Immunoreactive trypsinogen. A high amount suggests pancreatic damage, but is not specific for CF.

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16
Q

How are respiratory infections treated in CF?

A

Inhaled antibiotic Tobramycin for P. areuginosa. Mucolytics. Lung transplant

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17
Q

Pulmozyme

A

Mucolytic agent

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18
Q

pancreatic enzyme dose for adults

A

500-2500 lipase units /kg/meal. < 10,000u lipase per kg body wt. /day.

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19
Q

Overall nutrition goal for CF

A

Increase fat & kcal intake. Maintain LBM

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20
Q

Benefits of Aerobic activity in CF

A

Loosen chest congestion. Encourages coughing to clear mucous. Improve overall physical condition.

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21
Q

Bronchopulmonary dysplasia (BPD)

A

A chronic lung disorder that may affect infants who have been exposed to high levels of oxygen therapy and ventilator support. Have received oxygen for at least 28 days, & are less than 32 weeks.

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22
Q

Factors associated with BPD

A

Extreme prematurity <1500g. Perinatal infection, Patent ductus arteriosus (PDA).

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23
Q

What causes BPD

A

Genetics play a role. Is linked to ventilator trauma. ROS which the neonate has no antioxidants to neutralize. < 28 weeks. Poor Vit A nutriture.

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24
Q

How is vitamin A nutriture related to BPD

A

is important in normal alveolar development and surfactant production as well as regeneration of respiratory epithelial cells.

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25
Q

Medical treatment of BPD

A

Mechanical ventilation. EN/PN. Vit A supplementation.

26
Q

hypoxemia

A

too little O2 in the blood.

27
Q

Estimated kcal needs for infants with BPD

A

120-130 kcal/kg. May be as high as 160kcal/kg for increased metabolic demand.

28
Q

Protein needs for BPD infants

A

3-4g/kg. Due to protein breakdown caused by corticosteroids.

29
Q

What Vit & mineral deficiencies are BPD infants at risk for?

A

Vit A. Electrolyte imbalance. Delayed skeletal maturation and osteopenia.

30
Q

Vit A needs in BPD

A

1500-2800 IU/kg/day, or 450-840µg/day

31
Q

necrotizing enterocolitis (NEC)

A

Occurs primarily in premature infants, or sick newborns. Intestinal tissue dies. The cause is unknown, but in likely due to decreased blood flow to the bowel, which keeps it from producing the normal protective mucus. Feedings are stopped to allow bowel to rest.

32
Q

How to prevent NEC

A

administer probiotics to the pre-term infant.

33
Q

Consensus Definition of ALI

A

Acute Lung Injury. Acute onset of diffuse bilateral pulmonary infiltrates by chest radiograph; a partial pressureof arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) < 18mmHg, or no clinical evidence of fluid overload.

34
Q

ARDS

A

Acute Respiratory Distress Syndrome. Acute onset of diffuse bilateral pulmonary infiltrates by chest x-ray; a partial pressure of arterial oxygen/fraction if inspired oxygen (PaO2/FiFO2) <18mmHg or no clinical evidence of fluid overload.

35
Q

What is the average duration of mechanical ventilation?

A

10-14 days.

36
Q

What are the two most common general caused of ALI or ARDS

A

Direct lung injury eg, aspiration, smoke inhalation, etc. And, Indirect lung injury caused by incitation of a systemic inflammatory response (e.g. sepsis, shock, parcreatitis, etc.).

37
Q

Pathophysiology of ALI & ARDS

A

Pulmonary edema increases the thickness of the alveolar & capillary space which impairs gas exchange leading to hypoxia and increased work of breathing (WOB).

38
Q

Treatment of ALI & ARDS

A

O2 therapy via nasal cannula, CPAP, mask. Mechanical ventilation via PEEP. Treatment of underlying cause.

39
Q

Pharmacologic Treatment of ALI & ARDS

A

Respiratory stimulants. Bronchodilators. Antibiotics. Steroids. Sedatives & narcotics. Paralytic agents such as propofol.

40
Q

propofol

A

2 kcal/mL. A type of anesthetic

41
Q

Nutrition support should be initiated…

A

within 24-28 hours of achieved hemodynamic stability.

42
Q

Rapid nutrition support in ALI and ARDS may help

A

Blunt the stress response. Prevent stress ulceration. May prevent nosocomial pneumonia

43
Q

Why might indirect calorimetry by limited in ALI & ARDS?

A

IC may be limited in this population by prohibitive levels of FiO2 (>0.6).

44
Q

In general, an RQ >1 indicates ? in ALI & ARDS

A

Excess CO2 production, lipogenesis, & overfeeding. But can be affected by other factors such a stress and hypermetabolism.

45
Q

Protein requirements in ALI and ARDS

A

Protein needs are increased with respiratory failure. 1.2-1.5g/kg. Evaluate needs with N balance.

46
Q

RQ is changed by?

A

TOTAL amount of calories fed, not by the particular substrate.

47
Q

Hypocaloric feeding of the obese ALI/ARDS pt

A

Goals of 60-70% or target or 11-14 kcal/g (20-22 kcal/kg per Nelms). 2.0-2.5g/kg of protein

48
Q

minute ventilation

A

The total lung ventilation per minute, the product of tidal volume and respiration rate. It is measured by expired gas collection for a period of 1 to 3 minutes.

49
Q

Overfeeding in ALI & ARDS can lead to?

A

Increased lipogenesis. Increased glucose levels. Hepatic dysfunction. Inability to wean from the vent.

50
Q

Prokinetics

A

Increase gastric emptying and promote gut motility

51
Q

metoclopramide

A

Stimulates gastric & duodenal motility. Good for short term use, but less effective over time. Has parkinsonian side effects.

52
Q

Erythromycin

A

Antibiotic acts as a motilin. Only effective over the short term as receptors are down regulated.

53
Q

Enteral naloxone & Enteral glutamine

A

Show promise at reducing gastric residual volumes and promoting tube feed tolerance

54
Q

Oxepa

A

Calorically dense: 1.5 kcal/mL - good for fluid restricted pt. Antioxidants C, E, beta-carotene. Oil blend: 4.6gL EPA, 4g/L GLA - modulates inflammatory response. Meets 24 RDIs in 946mL.

55
Q

Benefits of omega-3 in ALI & ARDS

A

Reduced vent days. Decreased ICU LOS. Decreased new organ failure.

56
Q

Omega-3 fats are the building blocks for

A

anti-inflammatory EPA and DHA

57
Q

How to feed ALI & ARDS pt

A

Continuous infusion. NG, ND, NJ-prefered. 10-40mL/hr, increase 10-20mL/hr q 8-12 hrs. Calculate for 22hrs to accommodate predicted time off EN.

58
Q

Maximum glucose infusion rate in the critically ill

A

3-5 mg/kg/minute. PN

59
Q

Specific electrolytes to monitor in respiratory failure

A

Phosphorous. Magnesium. Potassium

60
Q

Refeeding syndrome

A

Intracellular shift of K, Mg, and PO4. Risk of HF. Can occur with any type of feeding: PO, EN, PN.

61
Q

When to wean from EN?

A

When PO intake reaches 60% of EER.

MD 4910 NCP I (15 decks)

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