Acute Lower Respiratory Problems Flashcards
What types of Bronchitis are there?
Allergic, Non-allergic and Asthmatic
Acute Bronchitis s/s and what one thing will NOT be present
cough with mucus, chest discomfort, soreness, fever, wheezing, fatigue, SOB, NO PULMONARY CONSOLIDATION
How does asthma effect the airways in bronchitis
it can lead to narrowing of the muscles around the airways
Chronic Bronchitis cough that is different than acute bronchitis
mucus-producing cough that lasts longer that 3 months and for more than 2 years
What if chronic bronchitis occurs with emphysema, what does it become then?
COPD
rales is usually heard with what condition?
pneumonia
what diagnostic workup do you want to do for bronchitis?
CBC (look for leukocytosis), Sputum culture (if xray normal), influenza titer, chest xray, urine antigen test (can diagnose two types of pna)
which two types of pneumonia can a urine antigen test find?
Streptococcus pneumoniae and legionella pneumophila
What kind of medication can you give for bronchitis?
Antitussives, decongestants, antivirals (only within 24-48 hours of onset), Steroids
Which over the counter medications should you avoid with bronchitis and why>
Antihistamines because they dry out secretions
cough suppressants- only take at night if needed
which types of antibiotics should not be given to pregnant people
Tetracyclines and quinolones
Treatable cause of bronchitis
Pertussis
which antibiotics are top choice for pertussis?
Clarithomycin (Biaxin) 500mg q12 hr or Azithromycin (Zithromax)
which antibiotic can you use for Moraxella, chlamydia or mycoplasma infection is suspected?
Doxycycline 100mg/day for 10 days
which type of antibiotic are good for the elderly with pertussis?
Quinolones
Bordetella Pertussis 3 phases
URI with rhinorrhea, mild grade fever and congestion lasting 1-2 weeks. sudden nonproductive coughing lasts 2-4 weeks with 10-30 coughs in a row
CURB-65 score range
0-5 (5 bad)
which factors does the CURB-65 take into consideration?
confusion BUN>19 RR>30 SBP <90 or DBP <60 Age >65
what is the most consistent presenting symptom of bacterial pna and may suggest a particular pathogen?
cough
gold standard for diagnosing pna
chest xray
Level 1 evidence for treatment of pna
Macrolide or fluoroquinolone
what does necrotizing/cavitary pna raise suspicion for?
MRSA pna especially if they have a history of MRSA lesions
when should you offer antibiotic therapy for a c-reative protein level?
if its >100mg litre
if c reative protein level is 20-100 mg litre what should you do?
consider delayed antibiotic prescription (a prescription for use at a later date if symptoms worsen)
Procalcitonin
can help tell if antibiotic therapy is working. More sensitive than a c-reactive protein
mycoplasma pna is also called?
walking pna
streptococcus pneumonia colored sputum
rust-colored
Pseudomonas, Haemphilus and peumococcal species colored sputum
green
Klebsiella species colored sputum
red currant-jelly
Anaerobic infections sputum characteristics
foul-smelling, bad tasting sputum
Most common cause of community acquired pna?
Streptococcus pneumonia
Staphylococcus Aureus characteristics
follows a viral respiratory infection (flu), patient usually extremely ill, can cause lung abscesses so send to hospital
Group A Streptococci characteristics
occurs in closed groups (military), begins abruptly with fever, cough, chest pain and debility
Klebsiella Pneumoniae characteristics
found in debilitated patients like alcoholics, gram negative pna
Haemohilus influenzae is seen with which type of people
smokers, even tho its a form of flu it is still a bacteria
Do mycoplasma pneumoniae and chlamidophila pneumoniae require hospital admission?
no, they are a form of CAP but don’t usually need to hospitalize them
Atypical CAP is usually caused by which bacteria?
Staphylococcus aureus
If patient has resistance to antibiotics what antibiotic should you put them on?
Doxycycline
If patient has comorbidities (chronic heart, lung, liver or renal disease, diabetes, alcoholism, malignancies, asplenia, immunosuppression) then what antibiotics should you use for pna?
fluoroquinolone OR
beta-lactam (amoxicillin, augmentin) PLUS a macrolide
How many days should a patient be treated minimally for pna?
5 days
How long after starting antibiotics should you start to feel better with pna?
3-5 days
when do you do a repeat chest xray with pna?
4-6 weeks
How long do you reevaluate a patient who is not responding to therapy?
48-72 hours
Aspiration pna is usually found on what side?
right side
Bronchiolitis is usually affects which type of patients?
newborn-2 years old
How to treat Bronchiolitis?
supportive care unless extreme then send to ER
what extreme symptoms are needed to be present for you to send child with Bronchiolitis to ER?
Toxic appearance, Hypoxic (<94%), RR >45 with distress and apnea, underlying heart conditions
Constrictive Bronchiolitis usually effects which type of patients?
Iraq and Afghan vets
Constrictive Bronchiolitis is characterized by?
progressive, absence of parenchyma infiltrates on chest xray, mosaic appearance of perfusion on CT scan, poor response to therapy
