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Veterinary Nursing > Diseases of the Respiratory System > Flashcards

Diseases of the Respiratory System Flashcards

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1
Q

What are some common causes of respiratory failure?

A 
Airway obstruction (e.g. BOAS)
Ruptured diaphragm
Pulmonary oedema / haemorrhage
Pneumo/haemo/pyo/chylothorax
Neoplasia
Infection
Toxic (e.g. paraquat intoxication)
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2
Q

What are the general signs of respiratory failure?

A 
Cyanosis
Distress
Inspiratory dyspnoea (stertor/stridor)
Expiratory dyspnoea (wheeze/crackles)
Dyspnoea/tachypnoea/orthopnoea
Tachycardia
Weak pulses
Collapse
Unconsciousness
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3
Q

How can we administer oxygen to conscious and unconscious patients?

A 
Conscious = flow-by / nasal catheter / face mask / oxygen tent / oxygen cage / incubator (may require sedation)
Unconscious = ET intubation
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4
Q

What nursing considerations should be have for respiratory disease patients?

A 
Observe/monitor (deterioration)
Medication
Care of drains/recumbent patient
Change in environment/exercise
Inhalation therapies
Feeding
Barrier nursing
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5
Q

What are the signs of URT diseases?

A 
Nasal discharge (unilateral/bilateral, appearance)
Sneezing
Reverse sneezing
Stertor/stridor
Other - systemic / CNS signs
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6
Q

How do we carry out a physical examination on an URT disease patient?

A 
Listen for noises
Nasal discharge
Facial deformity/pain
Nasal planum depigmentation
Assess airflow bilaterally
Assess regional lymph nodes
Retropulsion of the eyeballs/exophthalmia
Dental / ophthalmic disease?
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7
Q

What investigations can we carry out in conscious URT disease patients?

A

Routine bloods
Tests for bleeding disorders (platelet count/coagulation factors)
Serology for fungal disease
Viral testing in cats (PCR/ELISA)

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8
Q

What investigations can be carried out in URT disease patients under GA?

A

Full oral examination
Dental probing
Nasopharyngeal swab in cats

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9
Q

What imaging can we use in URT disease patients?

A

X-rays (intra-oral nasal views)

CT scan of head

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10
Q

How do we carry out endoscopy in URT disease patients?

A

Start with retrograde view of nasopharynx
Anterograde rhinoscopy
Nasal flush
Nasal biopsy (histopathology + culture)

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11
Q

What nursing considerations should we have post-rhinoscopy?

A 
Requires GA
Painful
Can bleed a lot (ice packs on nose, intranasal adrenaline)
Be prepared
Biopsies often required
Consider topical local agent
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12
Q

What nursing care can we provide for nasal disease patients?

A 
Must treat dyspnoea first
Try to stop haemorrhage
Must remove any foreign object
Monitor food/fluid intake
Correct and adequate nutrition
Removal of dried nasal discharges
Grooming
Decongestant therapy
Isolation for infectious patients
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13
Q

Describe aspergillosis in cats and dogs.

A 
Cats = sino-orbital aspergillosis - brachycephalics predisposed
Dogs = sino-nasal aspergillosis - meso/dolichocephalics predisposed
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14
Q

What are the clinical signs of aspergillosis?

A

Commonly: mucopurulent nasal discharge/epistaxis (unilateral or bilateral), sneezing, nasal pain, nasal depigmentation
Uncommonly: stertor, facial deformity, CNS signs

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15
Q

How can we diagnose aspergillosis?

A 
Serology
PCR
Imaging (radiography, MRI)
Rhinoscopy (plaque identification)
Cytology
Histopathology
Fungal culture
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16
Q

How can we treat aspergillosis?

A

Mechanical debridement endoscopically - may require trephination to access frontal sinuses
Topical antifungal (clotrimazole) - questionable use if not intact cribriform plate
Oral itraconazole - not generally effective
Often requires referral

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17
Q

Describe tracheal collapse.

A

Seen in small/toy breeds
Most commonly occurs at thoracic inlet
Unknown aetiology - obesity seems to predispose
Goose-honking cough
Diagnosis = physical examination, X-ray/fluoroscopy to assess tracheal positioning

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18
Q

What nursing considerations should we have for tracheal collapse patients?

A

Sedation (butorphanol)
Medication - anti-tussive, corticosteroids, bronchodilators
Cage rest, exercise restriction
Harness (no collars)
Oxygen therapy
Long-term = weight loss +/- surgery (stent)

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19
Q

What are the two types of cough receptors?

A

Mechanical receptors - mucus, foreign body etc.

Chemical receptors - acid, heat etc.

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20
Q

What are the harmful effects of a cough?

A 
Exacerbate airway inflammation/irritation
Emphysema
Pneumothorax
Weakness/exhaustion
Dissemination of infections
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21
Q

What are the clinical signs of Lower Respiratory Tract (LRT) disease?

A 
Cough
Tachypnoea / dyspnoea
Exercise intolerance
Weakness
Cyanosis
Syncope
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22
Q

How do we carry out a physical examination on a LRT disease patient?

A

Assess patient from a distance - oxygen/sedation needed?
Observe posture, rate + rhythm (inspiratory vs expiratory effort, shallow vs laboured)
Listen - URT noise (stertor/stridor), wheezing
Thoracic auscultation (crackles, wheezes, heart rate + rhythm, murmur?)

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23
Q

What investigations can we carry out on LRT disease patients?

A

Clinical pathology
Assessment of oxygenation (SpO2/PaO2)
Laryngeal examination (structure / function)
Imaging (radiography, CT scan, ultrasound)
Assessment of pleural space disease

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24
Q

What further investigations are available to LRT disease patients?

A

Bronchoscopy - collection of bronchoalveolar lavage (BAL)
BALs - cytology, bacterial culture, PCR
Removal of foreign body

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25
Q

What equipment do we need for a bronchoscopy?

A 
Endoscope
Sterile saline
Collection pots
Mouth gag?
Urinary catheter
Syringes
Emergency box/induction agent
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26
Q

What nursing considerations should we have for bronchoscopy patients?

A

Requires several people
Needs to be quick
Coupage required
Monitor patient very carefully until fully recovered
Things can go wrong very quickly - pneumothorax
Easy access to emergency drugs/oxygen +/- thoracocentesis

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27
Q

Describe Canine Chronic Bronchitis.

A

Chronic bronchial inflammation with over-secretion of mucus
Common in middle-aged to older dogs
Often concurrent morbidities (tracheal/bronchial collapse, mitral valve disease, pulmonary hypotension)

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28
Q

What are the initial predisposing factors for Canine Chronic Bronchitis?

A

Kennel cough
Irritants/allergens
Parasites

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29
Q

What is the pathophysiology of Canine Chronic Bronchitis?

A

Smaller airways become obstructed by mucus
Alteration of mucociliary escalator
Inflammation of lower airways - narrowing

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30
Q

Define bronchomalacia and bronchiectasis.

A 
Bronchomalacia = weakened cartilage
Bronchiectasis = end-stage bronchial change
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31
Q

What are the clinical signs of Canine Chronic Bronchitis?

A 
Chronic cough > 2 months (productive)
\+/- dyspnoea/tachypnoea
\+/- gagging/retching
\+/- pyrexia if concurrent pneumonia
Wheezes +/- crackles on auscultation
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32
Q

What investigations can we carry out for Canine Chronic Bronchitis?

A

X-rays/CT scan - bronchial pattern, possible interstitial pattern
Bronchoscopy - bronchoalveolar lavage

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33
Q

How do we treat Canine Chronic Bronchitis?

A

Management - weight control, harness, avoid smoke/dust/airway irritants
Medication - glucocorticoids, bronchodilators, antibiotics?, anti-tussives?, mucolytics?
Inhaled therapy - once stabilised, for corticosteroids and bronchodilators

34
Q

How do we deliver antibiotic therapy to suspected Canine Chronic Bronchitis patients?

A

Depending on BAL result and severity of signs
First line = doxycycline (broad spectrum), empirical treatment for 7-10 days, interpretation in light of BAL culture and clinical response

35
Q

What is the prognosis for Canine Chronic Bronchitis?

A

Chronic and progressive condition
Can live for years if well managed
Worse if bronchiectasis or bacterial pneumonia
Possible concurrent mitral valve disease and/or pulmonary hypertension

36
Q

Describe Canine Infectious Tracheobronchitis.

A

Also known as ‘kennel cough’
A complex of several viruses, bacteria and other microorganisms may be the cause
Most cases resolve within 14-21 days
Highly contagious!

37
Q

What nursing considerations should we have for suspected Canine Infectious Tracheobronchitis patients?

A

Highly contagious - keep away from other animals!
Antibiotic/anti-inflammatory treatment
Cough suppressants may be used
Client education - use of vaccine protocols

38
Q

Describe Feline lower airway disease.

A

Spectrum - Feline asthma and Feline bronchitis
Chronic bronchial inflammation with mucus hypersecretion
Young/middle-aged cats
Bronchoconstriction - essential difference to dogs

38
Q

What are the predisposing factors to Feline lower airway disease?

A

Bacteria
Virus
Parasites
Irritants/allergens

39
Q

What is the pathophysiology of Feline lower airway disease?

A

Type I hypersensitivity (IgE mediated) - histamine and serotonin production by mast cells
Smooth muscle contraction - bronchoconstriction
Oedema and eosinophilic inflammation of lower airways
Mucus hypersecretion
Obstruction of bronchus

40
Q

What are the clinical signs of Feline lower airway disease?

A

Wide spectrum - asymptomatic to asthmatic crisis
Cough
Dyspnoea/tachypnoea (open mouth breathing)
Cyanosis
Thoracic auscultation - wheezes (+ crackles if emphysema) (+ dull lung sounds if pneumothorax)

41
Q

What investigations can we carry out on Feline lower airway disease patients?

A

Chest X-rays/CT scan - bronchial/interstitial/alveolar pattern, overinflated lungs, pneumothorax (or none)
Bronchoscopy - bronchoalveolar lavage (cytology, PCR, parasitology, bacterial culture)

42
Q

What nursing considerations should we have for treating emergency Feline lower airway disease patients?

A 
Stress-free
Oxygen
Bronchodilators
Corticosteroids
Sedation (butorphanol)
43
Q

How can we treat Feline lower airway disease?

A

Management - dust-free litter, no smoking, limit aerosols
Medication - glucocorticoids, bronchodilators, doxycycline?, fenbendazole (parasitic infection)
Inhaled therapy - corticosteroids and bronchodilators once stabilised

44
Q

What is the prognosis for Feline lower airway disease?

A

Variable
Chronic = good if treated appropriately
Acute = can be fatal, prompt management is essential

45
Q

What are the clinical signs of Angiostrongylus vasorum infection?

A

Wide range - mild to fatal
Chronic cough, acute dyspnoea, severe pulmonary hypertension, syncope
Increased bleeding tendency
Neurologic signs - CNS haemorrhage

46
Q

What investigations can we carry out in A. vasorum infected patients?

A

Chest X-rays/CT scan - patchy bronchial, interstitial and alveolar patterns, peripheral distribution, no vascular changes

47
Q

How do we diagnose A. vasorum infection?

A 
Angio Detect (patient-side blood test) - antigen detection
PCR (diagnosis and speciation)
Faecal smear
Baermann faecal examination
Empirical treatment
48
Q

How do we treat A. vasorum infection?

A

Moxidectin - 2 doses 30 days apart
Fenbendazole - 25-50mg/kg PO SID for 10-20 days
Post treatment reaction (dyspnoea, ascites, sudden death)

49
Q

What is the prognosis for A. vasorum infected patients?

A

Depends on severity of clinical signs.

50
Q

Describe bacterial pneumonia.

A

Often mixed flora (aerobic/anaerobic bacteria)
Inhaled bacteria/haematogenous spread
Unilobar/multilobar
Acute/chronic
Associated with abscess, pleural effusion or pneumothorax

51
Q

What are the predispositions for bacterial pneumonia?

A 
Chronic bronchitis
Bronchiectasis
Immunosuppression
Foreign body
Aspiration - bacterial pneumonia/chemical pneumonitis
52
Q

What are the clinical signs of bacterial pneumonia?

A

Cough (soft + productive), mixed dyspnoea, tachypnoea, crackles and/or wheezes on auscultation
Pyrexia, lethargy, inappetence

53
Q

What investigations can we carry out on bacterial pneumonia patients?

A

Haematology
C reactive protein
SpO2 / PaO2
Chest X-rays/CT scan - alveolar pattern with ventral distribution, haematogenous spread = dorso-caudal distribution, interstitial pattern

54
Q

How do we treat bacterial pneumonia with antibiotics?

A

If possible, wait for culture result
Empirical treatment = doxycycline
No antibiotics for aspiration pneumonia - chemical pneumonitis
Duration = 10-14 days then reassessment

55
Q

What nursing considerations should we have for bacterial pneumonia patients?

A

Oxygen supplementation if hypoxic
Fluid therapy - dehydration impairs mucociliary defences
Nebulisation - increased mucus fluidity
Bronchodilators?
Mucolytics?
Consider treatment for predisposing factors

56
Q

What is the prognosis for bacterial pneumonia patients?

A

Depends on severity of clinical signs

Pneumothorax and abscessation may require lung lobectomy

57
Q

What is the pathophysiology of pleural space disease?

A

Pleural effusion = restrictive defect
Gradual collapse of lungs and increased intrathoracic pressure, becoming positive
‘Trapped lung’ secondary to active inflammation/pneumothorax

58
Q

What happens if a pleural space disease is left untreated?

A

Decreased cardiac output
Cardiac arrest
Especially for pneumothorax

59
Q

What is the clinical presentation of a pleural space disease?

A

Tachypnoea
Restrictive dyspnoea (rapid + shallow breathing)
Paradoxical breathing
Pneumothorax

60
Q

How does respiratory distress present in pleural space disease patients?

A 
Body position / orthopnoea
Mouth-breathing
Tachypnoea/hyperpnoea
Respiratory noise
Cyanosis
Restrictive dyspnoea
61
Q

Describe the three types of dyspnoea.

A 
Inspiratory = upper airway obstruction (increased inspiratory noises)
Expiratory = dynamic lower airway obstruction (abnormal auscultation)
Mixed = parenchymal disease, + restrictive pattern = pleural space disease
62
Q

How do we diagnose a pleural space disease?

A

Chest radiographs if stable
Thoracic ultrasound
Thoracocentesis
Fluid analysis

63
Q

What fluid analysis tubes do we need for pleural space disease?

A

1 EDTA tube for cytology
1 plain tube for culture
1 plain tube for biochemistry

64
Q

What is a thoracocentesis?

A

Aspiration of air/fluid from the pleural cavity by inserting a needle/catheter/drain via a caudal rib space

65
Q

How do we prep for a thoracocentesis?

A

Clipped and aseptic area of skin (usually at 8th rib)
Suitable needle - e.g. butterfly catheter
3 way tap
Extension set if needed
Sterile drapes, gloves, surgical spirit
Local anaesthetic agent
Measuring jug
Placement = cranial aspect of rib (caudal side has nerves/blood vessels)

66
Q

How do we care for a thoracic (chest) drain?

A

Can be left to drain continuously or intermittently
Always use aseptic technique
Gloves/good hand hygiene/ sterile syringes/ports/alcohol wipes
Make sure patient is comfortable and calm
Dress with sterile dressing, stocking, Buster collar
Measure if able
Record on hospital notes

67
Q

What are the four types of fluid that may be removed during thoracocentesis?

A

Pure transudate (protein-poor)
Modified transudate (protein-rich)
Exudate
Misc. - blood/chyle

68
Q

Describe pure transudate.

A

Protein-poor
Clear fluid
Hypoalbuminaemia
Causes = liver failure, protein-losing enteropathy (PLE), protein-losing nephropathy (PLN)

69
Q

Describe modified transudate.

A

Protein-rich
Yellow, blood-tinged fluid
Causes = congestive heart failure, pericardial disease, neoplasia, diaphragmatic rupture

70
Q

Describe exudate.

A

Turbid fluid
Non-septic (neutrophils/macrophages/eosinophils/lymphocytes, no organisms) - causes = FIP, neoplasia, diaphragmatic hernia, lung lobe torsion, resolving pyothorax
Septic (pyothorax) (degenerate neutrophils, possible intra/extracellular bacteria) - causes = bite, foreign bodies, iatrogenic, parapneumonic

71
Q

Describe chylothorax.

A

Milky appearance
Triglyceride in effusion higher than in plasma
Causes = idiopathic, cardiac disease (cats), cranial vena cava thrombosis/mass, heartworm disease, neoplasia

72
Q

Describe haemothorax.

A

Hypovolaemia

Causes = anticoagulant rodenticide, coagulopathy, lung lobe torsion, trauma, neoplasia

73
Q

What underlying diseases can we treat to treat pleural space disease?

A 
Neoplasia
Lung lobe torsion
Diaphragmatic rupture
Pyothorax
Chylothorax
74
Q

What are the causes of pneumothorax?

A

Traumatic
Spontaneous - blebs, bullae, chronic airway disease (asthma in cats)
Iatrogenic

75
Q

How does a pneumothorax present?

A

No lung sounds audible

Hyper-resonant percussion

76
Q

How do we diagnose a pneumothorax?

A

Radiography

Ultrasound

77
Q

How do we treat a pneumothorax?

A

Rest
Thoracocentesis as required/chest drain
Oxygen therapy
May require continuous drainage/exploratory thoracotomy

78
Q

What nursing considerations should we have for pneumothorax patients?

A 
Delay diagnostics until stable
STRESS = DEATH
Obtain SpO2 if able (ideally >95%)
Supplement oxygen
Consider mild sedation/opioid e.g. butorphanol
Thoracocentesis - prep
Cover any chest wounds
79
Q

What is the role of the vet nurse in caring for pleural space disease patients?

A 
Oxygen therapy
Observation + monitoring
Medication + analgesia
Care of wounds/chest drains
Fluid therapy
Shock treatment
Recumbent patient care
Feeding + exercise adjustments

Veterinary Nursing (65 decks)

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