chapter 5 respiratory disorders Flashcards
What are examples of respiratory tract infections?
Common cold Rhinosinusitis (sinus infection) Influenza (flu) Pneumonias Tuberculosis Fungal Infections
What is a common cold?
Viral infection of upper respiratory tract
Most common respiratory infection
How is a common cold spread?
Very contagious, mostly spread by touch
Portal of entry: nose and eyes
How long does a common cold last?
about 7 days
What is rhinosinusitis (sinusitis)?
Infection or allergy obstructs sinus drainage
What are the acute symptoms of rhinosinusitis?
facial pain, headache, purulent nasal discharge, decreased sense of smell, fever
What are the chronic symptoms of rhinosinusitis?
nasal obstruction, fullness in the ears, postnasal drip, hoarseness, chronic cough, loss of taste and smell, unpleasant breath, headache
What are the symptoms of influenza?
Systemic: fever Pyschological: Lethargy and lack of appetite Nasopharynx: Runny nose and sore throat Respiratory: coughing Intestinal: Diarrhea Gastric: Nausea and vommiting
About how many people die from flu related illnesses each year?
36,000
How is influenza transmitted?
Transmission is by aerosol (3 or more particles) or direct contact
What 3 types of infections does influenza cause?
- Upper respiratory infection (rhinotracheitis)
–Like a common cold with
profound malaise - Viral pneumonia
–Fever, tachypnea,
tachycardia, cyanosis,
hypotension - Respiratory viral infection followed by a bacterial infection
What is Pneumonia?
Inflammation of the lung parenchyma
What causes Pneumonia?
- Aspiration of oral secretions
- Inhalation of infectious organisms
- Spread of infection from elsewhere in the body by circulation
- Inhalation of chemical irritants or other non-pathogenic agents
these then cause a Bacterial, viral, fungal, protozoan lung infection
What are the 2 types of Pneumonia?
community and hospital
What bacteria and viruses are involved with community acquired pneumonia?
Bacteria: Streptococcus pneumoniae* Staph Aureus H. Influenza Gram negative bacilli
Viral Influenza virus Respiratory syncytial virus (RSV) Adenovirus parainfluenza
What bacteria are involved with hospital acquired pneumonia?
Bacteria: Escherichia Coli Klebsiella Pseudomonas Staphylococcus Aureus Serratia
When does hospital acquired pnuemonia occur?
Occurs 48 hours or more after admission
Is community acquired or hospital acquired pneumonia more common?
community
What are the risk factors of Pneumonia?
Age very young or very old Immunocompromised Lack of cough reflex COPD Immobility Smoking Malnutrition Tracheostomy or endotracheal tube
What is the pathogenesis of pneumonia?
- Inhalation or aspiration of microorganisms
- Survival past normal defense mechanisms
- Adherence to bronchial and/or alveolar epithelial lining
- either typical bacterial or atypical mycoplasma viral pneumonia develop
What 3 things must a person have to develop pneumonia?
- Exceedingly virulent organism
- Large inoculum (large amount or dose of the virulent organism)
- Impaired host or immune response
What is the pathogenesis of typical bacterial pneumonia?
- Adherence to alveoli or bronchial walls
↓ - Inflammation within the alveoli
↓ - large amount of exudates
↓ - consolidation of exudates in lower alveoli
↓ - Shunting of perfusion around non-ventilated alveoli
↓ - Hypoxemia (V
What are the manifestations of typical bacterial pneumonia?
“Typical”
-Sudden onset
--Fever, chills, pleuritic pain,
cough, purulent sputum
possibly blood tinged
-Positive sputum culture
-Elevated wbc’s
-Pleuritic painWhat is the pathogenesis of atypical viral pneumonia?
- Inflammation of the alveolar septum and interstitial spaces
- Influenza virus is the most common etiology
What are the manifestations of atypical viral pneumonia?
Atypical”
“flu-like symptoms”
headache, fever, muscle aches, fatigue dry cough
Does bacterial develop from viral or does viral develop from bacterial?
bacterial is a complication of viral
What is the etiology of pneumococcal Pneumonia?
Streptococcus pneumoniae
-Gram + diplococcus
What are the risk factors of pneumococcal Pneumonia?
- Asplenia or splenectomy
- Immunosuppression or incompetence
What normally follows pneumococcal Pneumonia?
a viral infection
What are the clinical manifestations of pneumococcal pneumonia?
- Sudden onset
—Fever 106° F, malaise,
chills, watery sputum and
↓’d breath sounds - Later
—Bloody or rust colored
sputum, pleuritic chest pain - Elderly
—Loss of appetite and ↓’d
mental status - Complications
—Multiple drug resistance
Who should get the PCV13 vaccine?
Infants and Children
>50 with weak immunity
Who should get the PPSV23 vaccine?
> 65 years
2 years and older at risk for immune diseases.
What is the etiology of legionnaire’s disease?
Legionella pneumophilia
What are the risk factors of Legionnaire’s Disease?
Smoking
Chronic disease
Impaired immune status
What are the clinical manifestations of Legionnaire’s Disease?
- Incubation
- –2-10 days after exposure
- Fever ~104° F, dry cough,
malaise, weakness, arthralgia and lethargy
3.CNS and GI symptoms
- Classic signs and symptoms
—Pneumonia with
hyponatremia, diarrhea and
confusion
What is the etiology of tuberculosis?
Mycobacterium tuberculosis
What are the two types of tuberculosis?
primary or secondary
What are the risk factors of TB?
- Immunosuppression
- Crowded living conditions
- -Homeless shelters
- -Prisons
- -Drug-treatment facilities
What are the steps of initial TB infection?
- Macrophages begin a cell-mediated immune response
- Takes 3–6 weeks to develop positive TB test
- Results in a granulomatous lesion or Ghon focus containingMacrophages
T cells
Inactive TB bacteria
What is the disease process of TB?
- TB is inhaled
- Cell mediated response is a postive tb skin test
- the person responses normally or poorly
- -normal repsonse: dormant lesion
- - poor response: active diseas - there is a change in immune competence with a dormant lesion and the disease becomes active
What percentage of TB is primary (inactive)?
95%
What is the pathogenesis of primary tb?
Inhalation of droplet nuclei containing TB germ
↓
respiratory bronchiole implantation
Cell mediated response
Tubercle is not killed Positive TB skin test ↓ Granulomatous inflammatory response ↓ Ghon’s focus* or lesion (tb can become inactive)
What percentage of TB is secondary (active)?
5 %
What is the pathogenesis of active tb?
Inflammation & TB replication continue ↓ Cavitation ↓ Erosion of surrounding tissue Bronchioles Blood vessels
What are the clinical manifestations of the primary infection of tb?
- Maybe asymptomatic
- + skin test 2-3 weeks after exposure
What are the clinical manifestations of active tb?
-Productive cough > 3 weeks
-Systemic symptoms
–Fever, chills, night sweats,
fatigue, loss of appetite
and weight loss
What are the later symptoms of tb?
-Hemoptysis
-Dyspnea and orthopnea
“consumption”
Are most fungal infections of the lung symptomatic or asymptomatic?
asymptomatic
How is a fungal infection controlled?
Infection controlled by host cell-mediated immune response
Can a fungal infection of the lung be severe or fatal?
yes if the immune system is compromised
What is the most common kind of fungal lung infection? Where does it come from? What does it cause?
- Most common kind is Histoplasma capsulatum
- Causes histoplasmosis
- Comes from soil with bird excrement
What are the 2 types of lung cancer?
small cell and nonsmall cell
What is small cell cancer of the lung?
- Characterized by small round cells the size of a lymphocyte.
- Grow in clusters
- Strongest association with cigarette smoking
What is nonsmall cell cancer of the lung?
- Series of cancers cell types
- Squamous cell, adenocarcinoma and large cell carcinoma
What are the risk factors of lung cancer?
Smoking
Asbestos exposure
Metals and PVC
What are respiratory disorders in neonates and infants?
- Respiratory distress syndrome (RDS)
- Bronchopulmonary dysplasia (BPD)
- Bronchiolitis
What are respiratory disorders in children?
Epiglottitis
Croup
Bronchiolitis
What is the other name for RDS?
Hyaline membrane disease
What are the risk factors for Hyaline membrane disease/ RDS?
- Premature birth
- Caucasian
- Male gender
- Insulin dependent mother
- Early cesarean delivery (before 38 weeks gestation)
What is RDS?
- Lack of surfactant; infants are not strong enough to inflate their alveoli
- Protein-rich fluid leaks into the alveoli and further blocks oxygen uptake
- Treatment with mechanical ventilation may cause bronchopulmonary dysplasia and chronic respiratory insufficiency
What are the clinical manifestations of RDS?
- Respiratory distress within 24 hours of birth
- Central cyanosis
- Retractions
- Grunting expiration
- increased respiratory rate
- Fatigue
What is the treatment for RDS?
- High dose → O2 fibrosis
- Positive pressure ventilation → barotrauma
What is the clinical manifestations of BPD?
- Tachypnea & tachycardia
- Chest retractions & cough
- Barrel chest
- Finger clubbing
What is viral croup?
Acute Laryngotracheobronchitis
What is the etiology of viral croup?
Various parainfluenza and adeno viruses
What are the clinical manifestations of viral croup?
Preceded by common cold s/s
- Inspiratory stridor
- -Hoarseness - Barking cough
- -Dyspnea - Expiratory wheezing
- -(severe disease)
What is the etiology of epilglottitis?
Haemophilus influenzae, type B
When is epiglottitis life threatening?
2-7
What are the clinical manifestations of epiglottitis?
-Distinctive position
—Sitting forward, with chin
out and mouth open
-Difficulty swallowing →
drooling
- Lethargic or anxious
- High temperature
- Rapid progression to complete airway obstruction without timely intervention
What is the etiology of acute bronchiolitis?
- Viral infection of the lower airways
- Respiratory syncytial virus (RSV) (most common)
What is the pathogenesis of acute bronchiolitis?
- Inflammation of the bronchioles
- Edema and airway obstruction
What are the clinical manifestations of acute bronchiolitis?
- Upper respiratory symptoms
- Gradual development of respiratory distress
- -Tachypnea
- Wheezy cough
- Irritability
- Dyspnea
- Air trapping
- -Hypoxemia, respiratory acidosis
