Acute Respiratory (adults)

Question 1

leading cause of death from infectious disease

Answer 1

pneumonia

Question 2

second most common nosocomial infection

Answer 2

pneumonia

Question 3

eighth leading cause of death

Answer 3

pneumonia

Question 4

pneumonia etiology

Answer 4

bacteria, viruses, other infectious agents, inhaled/aspirated foreign material

Question 5

pneumonia is…

Answer 5

infection and inflammation of the lung parenchyma, consolidation, exudation

Question 6

pneumonia classification by…

Answer 6

• setting (community vs hospital)
• type of agent causing infection (typical, atypical)
• distribution within the respiratory system

Question 7

consolidation

Answer 7

areas within the lung filled with infiltrate (secretions) causing it to become hard and firm (typically lung base)

Question 8

exudation/infiltration

Answer 8

fluid, cells, substances moved from blood vessels into tissues or on their surfaces.

Question 9

effusion

Answer 9

inflamed pleura fills with fluid pushing up and compressing the lung

Question 10

pneumonia pathophys

Answer 10

uncontrolled multiplication of microorganisms invading the lower respiratory tract

OR

inflammation response to inhaled or aspirated foreign material

resulting in accumulation of neutrophils and other pro-inflammatory cytokines in the peripheral bronchi alveolar spaces

Question 11

community acquired pneumonia bacterial pathogens (most common then other)

Answer 11

S. pneumonia

H. influenza, S. aureus, gram neg bacilli

Question 12

hospital acquired pneumonia is

Answer 12

lower respiratory tract infection that was not present (or incubating) on admission

• develops 48 hours or more after admission
• most hospital bacteria have acquired antibiotic resistance and are more difficult to treat

Question 13

ventilator associated pneumonia

Answer 13

lower respiratory tract infection developing 48 hours after INTUBATION

Question 14

nosocomial organisms associated with hospital acquired pneumonia

Answer 14

Pseudomonas aeruginosa, S. aureus, enterobacter, Klebsiella pneumoniae, Escherichia coli

Question 15

typical pneumonia

Answer 15

bacteria that multiply extracellularly in the alveoli and cause inflammation and exudation

Question 16

atypical pneumonia *

Answer 16

viral or microplasma infections that invade the alveolar septum and the interstitium of the lung (confined to those spaces)

“patchy” lung involvement

• lack of: consolidation, exudate, productive cough

Question 17

acute bacterial (typical) pneumonia most common cause

Answer 17

• pneumococcal (Strep pneumoniae)
• gram positive bacteria
  (prevention via immunization recommended for at risk)

Question 18

notable primary atypical pneumonia damage caused?

Answer 18

impair defenses making host susceptible to secondary bacterial infections

Question 19

hypoxemia s/s

Answer 19

• cyanosis
• restlessness
• agitation
• confusion
• dyspnea
• shallow/rapid

Question 20

important finding upon auscultation of pneumonia patient lungs

Answer 20

decrease in sound in areas of consolidation

Question 21

most common symptom of pneumonia in older adult

Answer 21

acute confusion secondary to hypoxia

Question 22

WBC in older adult with pneumonia?

Answer 22

may not initially be elevated and will not be until illness progresses.

Question 23

pulmonary edema

Answer 23

abnormal accumulation of fluid outside the vascular space of lung

more fluid enters the lung than the maximum lymphatic pumping capacity can remove

Question 24

most common form of pulmonary edema

Answer 24

cardiogenic pulmonary edema

Question 25

cardiogenic pulmonary edema

Answer 25

• associated with volume/pressure overload

- increased hydrostatic pressure causes decreased CO

Question 26

possible causes of cardiogenic pulmonary edema

Answer 26

• cardiac dysfunction, airway obstruction, pulmonary embolus

Question 27

non-cardiogenic pulmonary edema

Answer 27

potential causes: inhaled irritants, infectious, hematologic or metabolic disorders, opioid or barbituate drug overdose

Question 28

pulmonary embolus most commonly results from…

Answer 28

DVT formed in LEs

other sites include: right heart, deep pelvic vessels
other originations include: fat, air, amniotic fluid

Question 29

pulmonary embolus s/s *

Answer 29

• dyspnea & tachypnea (90%)
• pleuritic chest pain (70%)
• cough
• apprehension, restlessness, impending doom
• hemoptysis
• rales, tachycardia, elevated temp, decreased O2 sat, petechiae

Question 30

predisposes to development of ARDS (x2)

Answer 30

sepsis, Systemic Inflammatory Response Syndrome

Question 31

ARDS interventions

Answer 31

• identify/treat precipitating cause
• maintain O2 sat (optimize delivery)
• decrease O2 consumption

Question 32

ARDS mechanical ventilation criteria

Answer 32

• sustained RR > 35
• PaO2 < 70 (on 40% O2)
• PaCO2 > 55
• unable to protect airway

Question 33

parietal layer is where?

Answer 33

outer

Question 34

visceral layer is where?

Answer 34

inside

Question 35

pleural space is where and has what?

Answer 35

in between parietal and visceral and filled with serous fluid

Question 36

pleuritis aka

Answer 36

aka pleurisy

- inflammation of pleura

Question 37

pleuritis s/s

Answer 37

abrupt unilateral chest pain worsened by movement

Question 38

pleuritis treatment

Answer 38

NSAIDS for inflammation, analgesics for pain

Question 39

pleural effusion is…

Answer 39

collection of fluid or junk (pus) in the pleural cavity

Question 40

pleural effusion symptoms and treatment

Answer 40

cause dependent who cares

Question 41

pneumothorax is

Answer 41

collapsed lung; spontaneous or traumatic

• air leaks into the area between the lung and the pleural space causing the lung to collapse (proportionate to amount of leak)

Question 42

primary causes of pneumothorax

Answer 42

blebs, smoking
pressure change (flying, mountain climbing, scuba diving, listening to )
tall, thin, men ages 20-40

Question 43

secondary causes of pneumothorax

Answer 43

progressive lung damage associated with history of lung disorder (CF, emphysema, lung cancer, pneumonia, tb, etc)

Question 44

traumatic pneumothorax injuries

Answer 44

• blunt (closed)
• penetrating (open, includes surgeries)
• tension pneumothorax (pressure in pleural space > atmospheric pressureex: mechanical ventilation)
• hemopneumothorax

Question 45

pneumothorax assessment

Answer 45

• sudden, sharp chest pain in affected lung
• tightness of the chest
• SOB (degree depends on % of collapse)
• reduction of breath sounds on auscultation
• tachycardia
• rapid drop in BP specific to tension pneumothorax

Question 46

pneumothorax interventions

Answer 46

supplemental oxygen

• if 15-20% collapsed: bedrest, limited actiity
• > 20% chest tube placement (assess frequently instead of placing tube immediately)

Question 47

tension pneumothorax important point

Answer 47

ALWAYS LIFE THREATENING. If CT not available, needle placement

Question 48

chest tube care

Answer 48

• drainage below chest level, avoid kinks
• secure connections
• assess bubbling in water chamber
• daily dressing change with site inspection
• assessment of drainage and prescribed settings
• do not “strip”
• clamp only to change receptacle
• assess tracheal deviation, sudden changes, O2 sats, excessive drainage