Acute respiratory conditions Flashcards
Pneumonia Definition
inflammation of alveoli caused by viral or bacterial infection
Pneumonia patho
○ Inhalation of a foreign pathogen
§ Normally a natural defense mechanism prevents infection
§ If defense mechanism compromised (from smoking, immune system compromise) foreign pathogen enter lungs
Body’s defense mechanism triggered –> inflammation of lung parenchyma –> exudate congestion and pneunomia
Lobar pneumonia & the 4 stages
○ Lobar pneumonia
§ Diffuse consolidation involving the whole lobe (consolidation = normal air filled space in lungs is filled with fluid)
§ 4 stages
□ Congestion: vascular engorgement and accumulation of alveolar fluid with infectious organism
□ Red hepatization: infiltration of RBC, neutrophils and fibrin into alveolar fluid. Lung appear red and firm
□ Grey hepatization: RBC break down and produce exudate that causes red to grey transition
Resolution: clearing of exudate by macrophage
Bronchopneumonia
§ Inflammation localized in patches around bronchi, can impact one or multiple lobes
§ May cause lung abscess or an empyema
□ Lung abcess: tissue breakdown and formation of pus filled pocket in lung
Empyema: infection spreads to. Pleural space forming an exudate
Pneumonia etiology (Community, vs hospital vs ventilation)
○ Community
§ Most common
§ Risk factors:
□ Age <2 or >65
□ Comorbidities
□ Smoking, substance use
□ Weakened immune system
□ Cognitive impairement
○ Hospital
§ Risk factors:
□ Hospitalized >5 days
□ ICU admission
□ Co-morbidities
○ Ventilator
§ Risk factors
□ Mechanical ventilation >48hrs
□ Older age
Pneumonia clinical features
○ Increased RR
○ Fever with or without chills
○ Dullness on percussion
○ Tactile fremitus
Decreased or bronchial breath sounds pr crackles on auscultation
Pneumonia treatment and diagnosis
Diagnosis
○ Clinical history and exam
○ Chest Xray looking for infiltrates
○ Blood culture
Treatment
○ Infection prevention: vaccination, hand hygiene
○ Medication: antibiotic/antiviral/antifungal
○ At hospital: IV fluid, oxygen, respiratory support
Physio: airway clearance, breathing exercises for SOB
Acute bronchitis definition and patho
lower respiratory tract infection involving bronchi without COPD or pneumonia
Patho: acute inflammation of bronchi secondary to various triggers (virus, allergen or pollutant)
Acute bronchitis clinical features
○ Coughing 1-3 weeks, with or without sputum
○ Wheeze or mild dyspnea
Chest wall or subtle MSK pain from prolonged coughing
Acute bronchitis diagnosis and treatment
Diagnosis
○ History of acute onset of persistent cough in absence of pneumonia or COPD
○ Chest Xray to rule out pneumonia
Treatment
○ Self limiting in 1-3 weeks
OTC management of symptoms
Influenza
viral infection affecting upper and lower respiratory tract
3 main groups that mutate constantly and make it difficult to mount a immune defense
Influenza features and treatment
Clinical features: sudden, acute onset with fever, marked fatigue and aching pains
Treatment: antiviral drugs for first 2 days. Prevention via vaccination
Tuberculosis patho
○ Transmitted via aerosol droplets containing TB bacteria from coughing, sneezing or talking
○ New host inhales TB bacteria and travels to alveoli (primary infection) which triggers host response –> Macrophage ingestion
○ Immune system forms a barrier around it called granuloma
○ TB inactive in granuloma = latent TB
If immune response becomes weakened, TB bacteria can break free, multiple and can damage to lung = active TB
Tuberculosis clinical features
○ Primary infection: low fever, fatigue, cough
○ Active TB
§ Cough, may have sputum
§ Chest pain
§ Pain breathing or coughing
§ Fever, chills, night sweats
§ Weight. Loos
§ Fatigue and General malaise
Tuberculosis diagnosis and treatment
Diagnosis
○ Tuberculin tests
Treatment
○ Medication for 4,6 or 9 months
Prevention with vacine common
Atelectasis patho
on-aeration or collapse of lung tissue affecting part of lobe, whole lobe or lung
○ Alvoili become airless –> collapse due to natural elasticity of the tissue
○ This changes both ventilation and perfusion and impacts oxygen diffusion
CO2 can still difuse as its amaller
Atelectasis etiology
Can be result of
○ Obstruction: air cannot enter due to sputum or tumor
○ Non obstruction: compression on part of the lung which prevents air from entering
§ Increased surface tension in alveoli with pulmonary edema or respiratory distress syndrome prevents expansion of lung
§ Fibrotic tissue cam prevent expansion –> collapse
Postop can occur due to restricted ventilation from pain or abdominal distension, shallow respiration or increased secretions and decreased cough
Atelectasis risk factors
○ Immobolization
○ Obesity
○ Smoking
○ Lung and heart comborbidities
General aneasthetic
Atelectasis clinical features
small areas asymptomic
○ Large areas can cause
§ Dyspnea
§ Imapired gas exchange
§ Reduced chest expansion
Decreased breath sounds
Atelectasis diagnosis and treatment
Diagnosis:
○ Auscultation, percussion
○ Xray: Contents shift to the collapses side to fill empty space
Treatment
○ Oxygen therapy
○ Treat underlying pathology
○ Strategies to increase lung volume
§ Positioning, mobility
§ Breathing exercises
Positive pressure devices
Pneumothorax patho
air in pleural cavity causing collapse of some or all of the lung
Patho: pulmonary alveoli or airway become connected to the pleural cavity and air migrates from alveoli to pleural cavity until the pressures of both are equal
Spontanous pneumothorax
○ Spontaneous/closed: air enters the pleural cavity through an opening directly from internal airways
§ Tear in visceral pleura leads to air entering pleural space from lung –> atelectasis
□ This makes the kung seal itself and no more air enters
§ Primary spontaneous - pneumothorax which presents without a precipitating external event
□ Risk factors: smoking, male, tall & thin, genetics, drop in atmospheric pressure
§ Secondary: presents as a complication of underlying lung disease
Risk factor: COPD, CF, lung infection
Open pneumothorax
atmospheric air enters pleural cavity through opening in chest wall
§ Causes immediate atelectasis on affected side
§ Inspiration: mediastinum pushed to unaffected side
§ Expiration: moves back
§ This can compromise venous return
Risk factors: male, violence
Tension pneumothorax
can be the result of open or closer
§ Can be open or closed but has 1 way valve only allowing air in during inspiration
§ Causes atelectasis on affected lung and compression on mediastinum and unaffected lung–> heart failure
Severe hypoxia and respiratory distress.
