Exam 2 Flashcards
tuberculosis
Reportable, communicable inflammatory destructive disease
extrapulmonary TB sites (6)
bones, spine, kidneys, reproductive organs, CNS, larynx
facts about mycobacterium tuberculosis
aerobic
acid fast
slow growing, sensitive to heat and UV
destroyed by sunlight, heat, and pasteurization
grows inside the body, not outside
risk factors of TB (gender, age, geographical)
alcoholism r/t malnutrition
elderly
homeless
overcrowded
men
children <15
young adults (15-44 with preexisting conditions)
africa, asia, latin america, europe, carribean
BCG vaccine
makes you test + on skin test
need to do chest x-rays or blood test to get accurate result
routes of TB
airborne (droplet)
inhalation of infected droplet nuclei from COUGHING, laughing, sneezing
large droplets settle, small ones are inhaled
treatment of TB
6-12 months
bed rest until no symptoms
isolation until - sputum
sensitization of TB
phagocytes bombard area with bacteria, lymphocytes start inflammatory response and destroy some lung tissue
2-10 weeks after primary infection
patho of TB
inhaled infected droplet deposited in lungs
inflammatory reaction at site
body attempts to phagocytize the wall-off the tubercule
ghon tubercle formed
granuloma in lung tissue
how can dormant TB become active again
mental and physical stress
immunosuppressive drugs
oncology agents
inadequate drug prescription
latent TB
lives and doesn’t grow
doesn’t make you feel sick
CAN’T spread
active TB
grows in the body
makes you feel sick
CAN spread
sputum culture for TB
identify tubercule bacilli
essential to confirm diagnosis
3 specimens on consecutive days
TB skin test
appearance of “wheal” if done properly
read result within 48-72 hours
10mm or more is +
5-9 is doubtful, repeat
for HIV, 5mm or more is +
what to do with TB converters
they are at risk for developing TB
give INH prevention
TB symptoms (8)
Fatigue
Malaise
Anorexia
Weight loss
Chronic productive cough
Night sweats
Advanced state hemoptysis=blood in sputum
Low grade fever in the late afternoon
primary resistance to TB
resistance to 1 or more TB agents with no previous treatment
secondary resistance to TB
resistant to 1+ TB agent, undergoing therapy
multidrug resistance to TB
resistant to 2+ agents (INH and rifampin)
what to give with INH (TB)
vitamin B6
anti TB drugs
INH, rifampin
pyrazinamide
ethambutol (myambutol)
foods to avoid with INH
Tuna
aged cheese
red wine
soy sauce
yeast extract bc it could have histamine (causes side effects [headaches, diaphoresis, etc] and decreased absorption)
nutrition for TB
high protein, calories, and Ca+
iron and vit B6
labs for TB
AST and ALT
purpose of alveoli
gas exchange
diffusion
separates alveolar from vascular membrane
damage permits exchange between lungs and blood
how much mucus production a day
3 oz
pleura
Lines lungs and thoracic cavity
Kept moist from fluids secreted between pleural surfaces, prevents friction and facilitates filling and emptying of lungs
Secretes pleural fluid–smooth motion of lungs within pleural cavity (air filled so it’s subject to 3rd spacing with pleural effusion)
Depends on mucus and surfactant
when does surfactant develop
34 weeks of gestation
what does surfactant do
facilitates inflation of alveoli
prevents the alveoli from collapsing (keeps them slightly open even when lungs are empty)
tidal volume (what is it, amount, and what effects it)
The amount of air inspired and expired in a normal breath
500 mL
May not vary
total lung capacity (what is it, amount, and what effects it)
the maximum amount the lungs can expand
TV+IRV+ERV+RV (5800 mL)
decreased with atelectasis and pneumonia
increased in COPD
vital capacity (what is it, amount, and what effects it)
the maximum amount of air exhaled after maximal inhalation
TV+IRV+ERV (4600 mL)
decrease in neuromuscular disease, generalized fatigue, atelectasis, pulmonary edema, COPD, and obesity
inspiratory reserve volume (what is it and amount)
the maximum amount of air inhaled after a normal inhalation
3000 mL
expiratory reserve volume (what is it, amount, and what effects it)
maximum amount of air that can be exhaled forcibly after normal exhalation
1100 mL
decreased with obesity, ascites, pregnancy
residual volume (what is it, amount, and what effects it)
volume of air remaining in lungs after maximum exhalation
1200 mL
may be increased with obstructive disease
inspiratory capacity (what is it, amount, and what effects it)
maximum amount of air inhaled after normal expiration
TV+IRV (3500 mL)
decrease in restrictive disease or obesity
functional residual capacity (what is it, amount, and what effects it)
amount of air remaining in lungs after normal expiration
ERV+RV (2300 mL)
may be increased in COPD
decreased in ARDS and obesity
what do accessory muscles do
get rid of trapped air and increase tidal volume
Why does pursed lip breathing work
increases exhalation time to reduce airway resistance and prevent airway collapse
How often to do diaphragmatic breathing
5x/hour for 1 minute with 2 min rest periods
controlled cough
breath normally for one cycle, end next cycle with cough
lordosis
inward curvature of spine
kyphosis
forward rounding of upper back
peak lung function ages
20-25
premature babies are at risk for what (no surfactant)
poor alveolar exchange
older adults respiratory
less capillaries in alveolar walls
tissues of resp tract become more rigid
inefficient diaphragm and coughs
poor compliance
dilation of air sacs (emphysema)
low O2 from smaller airway
kyphosis, barrel chest, SOB, abd breathing, decreased gas exchange
why is losing gravity in resp bad
prevents alveoli from expanding
mucus with bacterial infection
purulent and green
mucus from allergies
sticky and white
hemoptysis
blood in sputum
sputum collections
done in the morning
sterile container
RIGHT AWAY
pleural pain (avoid what)
activity that will make you breathe hard
ratio in barrel chest vs normal
barrel chest- 1:1
normal: 1:2
fine crackles
mucus in small airways
heard in emphysema with distended alveoli
heard on inspiration
high pitched
alveoli heard near the end of inspiration
coarse crackles
loud, bubbling
larger airways
may be heard in inspiration AND expiration
CHF, pneumonia, emphysema
rhonchi
gurgles
Thick secretions
Loud, harsh, low pitched, like snoring
May be cleared with coughing
Large airways
Mostly expiration but also inspiration
Asthma, bronchiectasis, emphysema, chronic bronchitis
wheezes
from swollen airways
asthma or partial obstruction
blocked by mucus or tumor
heard throughout the lung on inspiration or expiration
WITHOUT A STETHOSCOPE
abrupt cessation of wheezing is BAD!! It means complete obstruction
pleural friction rub
inflamed pleura
harsh, cracking sounds like leather
inflammation or pleural effusion
consolidation
solidification of lung tissue that causes poor ventilation in certain areas (gets filled with mucus and debris)
Q scan
detects abnormal functioning of pulmonary blood vessels and blood flow (PE)
V scan
detects abnormalities in ventilation such as emphysema
bronchoscopy
tubes examine larynx, bronchi, and trachea
flexible
NPO for 4-6 hours
what to give for throat irritation after endoscopy
warm gargle
ABG time to put pressure
5 min for radial and brachial
10 for femoral
compensation for decreased O2 in COPD
increased RBCs causing polycythemia
how long before a pulmonary function test should pts not smoke or use bronchodilators
6 hrs
what makes O2 sat ineffective
hypotension
sepsis
hypothermia
vasoconstriction (these reduce arterial blood flow)
thoracentesis
fluid removed from pleural space and send for biopsy or just for therapeutic purposes
upright position and lean forward to increase intercostal space
do VS and place pt on unaffected side
nasal cannula oxygen
1-3 Liters
oxygen toxicity (6)
dyspnea
restlessness
substernal pain
fatigue
headache
coughing
how much liquids to get rid of secretions
2-3 quarts
guaifenesin
expectorant
dextromethorphan
cough suppressant
ineffective airway clearance treatment
warm, humid air
diet for respiratory pts
high fat and protein
avoid foods that cause constipation
what stimulates peristalsis
fluids and fruit juices
who shouldn’t take flu vaccine
allergies to eggs or history of guillain-barre
community acquired pneumonia (another name, when diagnosed, who is at risk and what seasons)
legionnaires disease
on admission or within 48 hours
smokers, elderly, substance abusers
summer and fall
hospital acquires pneumonia
bacterial
nosocomial (from a hospital)
most lethal (pts already immunocompromised and abx resistant)
aspiration pneumonia
from inhaling foreign matter
keep head of bed elevated during feeding
assess gag reflex
Patho of pneumonia
bacteria gets into alveolar space, weakens the fragile membrane, capillary leak, bacteria spreads to lungs and blood stream. septicemia
RBC goes from blood vessels to damaged alveoli, causing lung infection and blood tinged sputum
slow surfactant production leads to
decrease in compliance, atelectasis and consolidation
symptoms of pneumonia
high fever (101-105) in bacterial
shaking chills
headache
productive cough (green, purulent, or rust colored sputum)
orthopnea
tachypnea/cardia
cyanosis of lips and nails
anorexia
N/V
anxiety
cerebral hypoxia
increased metabolic rate
pleural pain
malaise
what happens when you give antitussives (bad)
retains secretions, causing atelectasis and hypoxia
greenish yellow sputum
STREP
yellow or blood tinged sputum
STAPH
precautions for bronchoscopy
need consent
no jewelry, contacts, dentures, allergies
may cause lower airway spasms
gag reflex returns after 2 hours
pulse ox every 15 min
how often to do incentive spirometry
10 breaths per hour
hold for 2-10 seconds
how much fluids to drink to thin secretions
2 L
pneumonia diet
high fat, calorie, protein
avoid gassy foods or hard candies
warm liquids increase peristalsis (good)
10 glasses of fluids a day
empiemia
pus in blood
how to prevent superinfection
lactobacillus tablets or yogurt (live cultures)
strongest predisposing factor of asthma
allergies
3 chronic airflow limitations and are they COPD
asthma (not COPD)
chronic bronchitis and emphysema (COPD)
asthma risk factors
allergies (most common)
esophageal reflux
genetics
male
elderly
urban bad conditions
black, white, and hispanic
4 chemical mediators in asthma and what they do
bradykinin, histamine (immediate), prostaglandins, and leukotrienes
causes inflammatory response
capillary leak in airway
vasoactive amines
vasodilation
capillary leak
edema of airway
increased secretions
what type of oxygen for asthma pts
nasal cannula (less suffocating feeling)
clear and foamy sputum
allergies
thick, white, stringy sputum
nonallergic asthma
2 CBC results of asthma
elevated eosinophils
immunoglobin levels
