Chapter 19 Management of patients with chest and lower respiratory tract disorder

Question 1

What is atelectasis?

Answer 1

Closure or collapse of alveoli
Is usually found during chest x-rays and clinical signs and symptoms

Question 2

When does acute atelectasis occur the most?

Answer 2

Postoperative setting after thoracic and upper abdominal procedures or in people who are immobilized and have a shallow, monotonous breathing pattern

Question 3

Explain obstructive atelectasis.

Answer 3

results from the reabsorption of gas and no air can enter the alveoli because of the bloackage and the alveoli collapse
trapped alveolar air is absorbed into the bloodstream

Question 4

What are causes of atelectasis?

Answer 4

foreign body (tumor or growth)
altered breathing patterns
retained secretions
pain
alterations in small airway function
prolonged supine positioning
increased abdominal pressure
reduced lung volumes due to musculoskeletal or neurologic disorders
restrictive defects
specific surgical procedures

Question 5

What is compressive atelectasis?

Answer 5

excessive pressure on the lung tissue and can be produced by pleural effusion( fluid within pleural space), pneumothorax (air in pleural space), hemothorax (blood in pleural space)
also pericardial effusion (pericardium distended with fluid) tumor growth in the thorax or elevated diaphragm

Question 6

What are the signs of acute atelectasis?

Answer 6

Dyspnea (SOB), cough, sputum, tachycardia. tachypnea, pleural pain, central cyanosis, difficulty breathing in supine position, anxiety

Question 7

What are the signs of chronic atelectasis?

Answer 7

Same as acute but also symptoms of pulmonary infection

Question 8

What does ICOUGH mean?

Answer 8

Incentive spirometry
Coughing and deep breathing
Oral care
Understanding
Getting out of bed at least three times daily
Head of bed elevation

Question 9

What is thoracentesis?

Answer 9

removal of the fluid by needle aspiration to decrease the compressions against the alveoli

Question 10

What is pulmonary edema?

Answer 10

Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both.
It is a severe, life threatening condition

Question 11

How does noncardiogenic pulmonary edema occur?

Answer 11

Damage of the pulmonary capillary lining
May be due to direct injury to the lung ( chest trauma, aspiration, smoke inhalation)
Hematogenous injury to the lung (sepsis, pancreatitis, multiple transfusion, and cardiopulmonary bypass)
Injury plus elevated hydrostatic pressures

Question 12

What is pulmonary embolism?

Answer 12

It is the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart.

Question 13

What is deep vein thrombosis?

Answer 13

Refers to thrombus formation in the deep veins (calf or thigh sometimes in the arm)
Especially in patients with peripherally inserted central catheters

Question 14

What is pulmonary hypertension?

Answer 14

Elevated pulmonary arterial pressure greater than 25mmHg at rest and greater than 30mmHg with exercise and secondary right heart ventricular failure

Question 15

What is the main symptom in pulmonary hypertension?

Answer 15

Dyspnea
2nd common is substernal chest pains
others are weakness, fatigue, syncope, hemoptysis, signs of right-sided heart failure, anorexia, abdominal pain

Question 16

When does a positive vasoreactivity test occue?

Answer 16

When there is a decrease of at least 10mmHg in pulmonary artery pressure with overall pressure that is less than 40mmHg in the presence of both an increase or unchanged cardiac output and a minimal decrease or unchanged systemic BP

Question 17

When is calcium channel blockers prescribed?

Answer 17

When the patient has a positive vasoreactivity test and who do not have right-sided heart failure

Question 18

What does prostanoids do?

Answer 18

They mimic the effect of the prostaglandin prostacyclin by relaxing vascular smooth muscle by stimulating the production of cyclic 3’, 5’-adenosine monophosphate and inhibits the growth of smooth muscle cells

Question 19

What long is the half-life of epoprostenol?

Answer 19

3 minutes and must be continuously given through an implanted central venous catheter using an infusion pump

Question 20

How is iloprostis taken?

Answer 20

Inhaled 6-9 times daily

Question 21

How is treprostinil taken?

Answer 21

First form would be taken parenterally but now has been approved in the inhaled formulation and they are working on a PO form
Subcut method hurts

Question 22

What is selexipag?

Answer 22

It is a prostanoid that is available in tablet taken twice a day but it cost a lot and not all insurance plans cover it

Question 23

What does endothelin receptor antagonist do?

Answer 23

They bind to vascular endothelin-1 receptors, blocking constriction of the pulmonary arteries and resulting in vasodilation. These are hepatotoxic

Question 24

What is included in endothelin receptors antagonist?

Answer 24

Bosentan, ambrisentan, and macitentan

Question 25

What medication is contraindicated in patients with liver or kidney disease?

Answer 25

Riociguat

Question 26

Explain atrial septostomy.

Answer 26

Results in shunting of blood from the right side of the heart to the left.
Decreasing the strain on the right side of the heart and maintaining left ventricular output

Question 27

What is acute tracheobronchitis?

Answer 27

inflammation of the mucous membranes of the trachea and bronchial tree
often follows infection of the upper respiratory tract as result of a viral infection

Question 28

What bacteria can cause tracheobronchitis?

Answer 28

Streptococcus pneumoniae, Haemophilus influenzae, and mycoplasma pneumoniae
fungal infection aspergillus may also cause

Question 29

What are the clinical manifestations of tracheobronchitis?

Answer 29

Dry irritating cough, scanty amount of mucoid sputum
Soreness from coughing, fever, chills, night sweats, headache, and general malaise
SOB, Stidor or wheeze, pus-filled sputum, or blood-streaked secretion

Question 30

What are the risk factors for penicillin-resistant and drug-resistant pneumococci?

Answer 30

Older than 65, alcoholism, beta-lactam therapy, HIV, exposure to child in a day care

Question 31

What are the risk factors for infection with enteric Gram-negative bacteria?

Answer 31

Live in long-term care, cardiopulmonary disease, and recent antibiotic therapy

Question 32

What are the risk factors with pseudomonas aeruginosa?

Answer 32

Structural lung disease, corticosteroid therapy, broad-spectrum antibiotic therapy, malnutrition

Question 33

What are clinical manifestations of TB?

Answer 33

Low-grade fever, cough, night sweats, fatigue, and weight loss, and hemoptysis

Question 34

What test is used for TB?

Answer 34

Mantoux test-skin
quantiferon-TB-blood
T-spot-blood
Sputum culture

Question 35

What are the first-line TB drugs?

Answer 35

Isoniazid, Rifampin, Rifebutin, Rifapentine, Pyrazinamide, Ethambutol, and combinations

Question 36

Which TB medication is a prophylactic?

Answer 36

Isoniazid 6-12months