Cyndi - Week 10 - Exam 5 Flashcards
what is pneumonia?
the inflammation of lung tissue, where alveolar spaces fill with bacteria, virus, fungus, or food
what are the the 4 types of pneumonia?
- community acquired pneumonia (CAP)
- hospital acquired infection (postop pneu, ventilator associated pneu)
- opportunistic
- aspiration d/t stroke, altered LOC, etc
what are the clinical manifestations of pneumonia?
- fever
- tachypnea
- tachycardia
- dyspnea
- adventitious lung sounds (crackles, wheezes)
- productive or non-productive cough
- hypoxemia
- pleuritic chest painj
what are the complications of pneumonia?
- pleural effusion
- atelectasis
- bacteremia/sepsis
- lung abcess/empyema
- acute respiratory failure
- pneumonthorax
what are the diagnostic tests used for pneumonia?
- CXR
- labs
- sputum gram stain, C+S
- oxygenation studies (ABGs, O2 sats)
- CT, MRI of chest
- bronchoscopy
- CURB 65 or pneumonia severity index
what labs are used for pneumonia?
WBC
CRP
Blood cultures
procalcitonin (PCT) r/o sepsis
what is the tx for pneumonia?
- oxygenation (bronchodilators/resp tx; oxygenation prn)
- ATBs
- antipyretics
- ↑ fluids as tolerated
- encourage nutrition
- meds (take whole prescription, drug-drug interactions)
- when to return to med (consider vax)
what are the 5 other respiratory disorders?
- fungal infections (coccidioidomycosis “valley fever”; histoplasmosis)
- lung abscess
- asbestosis
- sarcoidosis
- SARS
what is tuberculosis?
infectious disease caused by bacteria Mycobacterium Tuberculosis
- usually involves in lungs in US, but can infect abdomen, kidneys, bones, adrenal glands, lymph nodes, and meninges
- **drug resistant strains found world wide
how is TB transmitted?
- airborne transmission via droplets with cough, sputum, sneezes, singing
- *not spread by hands or objects
what is needed for an airborne transmission??
N95 mask and negative air pressure
what are the risk factors for TB?
- Health care workers
- IV drug users
- Close proximity to person with active TB
- Lack of or underserved medical care
- Country of origin
- Homeless
- Substance abuse
- Lowered immunity
- Age
- Malnutrition
- Institutional or inner city residents
- Racial or ethnic minorities
what are the diagnostics used for TB?
- intradermal placed TB skin test (TBST)
- CXR
- AFB sputum (x 3 am specimens)
- QuantiFERON - TB (QFT)
what are the characteristics of the TB skin test??
- interpreted 48-72 hrs after placement
- INDURATED area measured in mm
- positive test > 5-15 mm
- immune compromised > 5 mm
- if +, should never have TBST again
- 2 step process for health care
- should not use TBST if had BCG vaccine
what are the characteristics of quantiFERON-TB?
- rapid blood test (few hrs)
- doesn’t replace sputum cultures
TEST: what is important about the sputum collection for TB?
must have THREE am specimens
what is the BCG vaccine?
Bacille Calmette-Guerin used in areas with high TB rates to prevent and ↓ severity of TB in places like Phlippines and Mexico
In the US BCG is not used because… (3)
- low rates of infection
- unpredictable PPD result
- confuses the T-B exposure issue
what are the characteristics of latent TB?
have been exposed to bacteria
- TB germs asleep
- don’t look or feel sick
- CXR normal
- can’t spread TB to others
- tx by taking one med for 9 months
- “conversion” - immune system contains
- 5-10% will develop active TB someday
what are the characteristics of active TB?
contagious with TB
- feel sick, tests +
- germs in lungs, spreads to other people
- tx for taking 3-4 meds for 6 mo
what are the sxs of latent TB?
- no sxs
what are the sxs of early stages of TB?
- can be free of symptoms
- thus two step testing
what are the acute sxs of TB?
Flu symptoms
- high fever
- chills
- pleuritic pain
- productive cough
- malaise
what are the sxs of advanced TB?
- weight loss
- anorexia
- night sweats
- hemoptysis, rarely dyspnea
what is the tx for TB?
If hospitalized, as soon as suspected, needs:
Airborne isolation room
- anteroom
- 6-12 exchanges per hour
- either negative pressure vented outside or Hepa filtration
What must staff wear if there is a patient with TB?
- N95 mask
- perform hand hygiene
- use other PPE as needed
what is the tx for latent TB?
tx with INH for 6-9 months
- HIV patients should take INH for at least 9 months
what is the drug tx for active TB?
- Initial phase 4 drugs for 2 months:
- INH
- Rifampin
- Pyrazinamide
- Ethambutol
- Then INH + Rifampin for additional 18 wks
- If drug resistant, add a fluoroquinolone and second‐line drug regimen
what is the pt education for drug tx for active TB?
- Medication side effects – know them
- When to seek medical care
- Importance of compliance
- Liver function, vision monitored
what are the side effects for INH for active TB?
elevated ALT AST, sxs of hepatitis
what are the side effects of Rifampin?
orange discoloration of body fluid: tears, sweat
what are the side effects of Pyrazinamide?
hepatitis, joint pain, hyperuricemia
what are the side effects of Ethambutol?
lowered ability to discriminate bt red and green - monitor visual acuity
what is Directly Observed Therapy?
Public health department ensures adherence with treatment plan
what are the characteristics of directly observed therapy?
• Noncompliance ‐ major problem in development of multidrug resistance • Obtains sputum specimens • Nurse watches patient swallow the meds • Identifies people at risk/informs contacts • Communicates statewide with other PHD • Coordinates care with local agencies • Takes appropriate measures to prevent spread of disease
what are the goals for TB tx?
- comply with therapeutic regimen
- have no recurrence of disease
what are the expected outcomes for TB tx?
- complete resolution of disease
- normal pulmonary function
- absence of any complications
- no transmission of TB
what are the complications of TB?
- miliary TB (spread throughout the body0
- pleural effusion
- pneumonia
- other organ involvement
what is pulmonary embolism?
blockage of pulmonary artery by thrombus
what are the causes of PE?
- afib
- DVT
- fat emboli
what are the risk factors of PE?
- immobility
- surgery
- stroke
- hx of DVT
- HTN
- obesity
what are the sxs of PE?
- dyspnea
- chest pain
- hemoptysis
- may begin suddenly
- if large PE obstructing > 50%. R heart failure d/t pulmonary HTN, severe hypoxemia, and low BP
what are the diagnostic tests for PE?
- spiral CT with IV contrast
- VQ scan
- D Dimer
- pulmonary angiogram
- ABGs
what is the tx for PE?
- anticoags (tPA, heparin, Lovenox, Coumadin)
- supportive (SCDs)
- **prevention is key
what is pulmonary HTN?
↑ pulmonary artery pressure
what is primary pulmonary HTN?
idiopathic
- genetic or cause unknown
what is secondary pulmonary HTN?
as a result of another disease
- COPD, atherosclerosis, PE, etc.
what are the sxs of pulmonary HTN?
- dyspnea on exertion
- fatigue
what is the tx for pulmonary HTN?
can extend life, but not cure:
- diuretics, anticoags, CCB, O2
- new drugs promote PA vasodilation via a continuous infusion pump
- lung transplant
- **without tx, cor pulmonale (R sided HR) and death can result
what is pulmonary edema?
abnormal accumulation of fluid in lung tissues as a result of other disease
• interferes with gas exchange in lung
• interstitial vs alveolar edema
what is the most common cause of pulmonary edema?
heart failure
- other causes COPD, near drowning, etc.
what are the key sxs of pulmonary edema?
- pink frothy sputum refractory hypoxia with sudden, sever dyspnea
what is flash pulmonary edema?
refers to sudden onset
what is the tx for pulmonary edema?
tx related to cause
- oxygenation support, diuretics, cardiac meds if indicated
what is pulmonary fibrosis?
scarring of the lung connective tissue
what are the causes of pulmonary fibrosis?
- inflammation, smoking, occupational, environmental
* **prevention when possible
what are the sxs of pulmonary fibrosis?
severe dyspnea, dry cough
what is the tx of pulmonary fibrosis?
steroids, resp meds, cytotoxic drugs
what is the prognosis of pulmonary fibrosis?
very poor
what is sarcoidosis?
granulomas - clusters of immune cells that scars lungs
**causes, tx, prognosis varies, sxs, complication
what is pneumothorax?
complete or partial collapse lung
- spontaneous (closed)
- iatrogenic
- traumatic (open or closed)
- tension
