Exam 3 Flashcards
What is acute sinusitis? What is the difference between acute and chronic? What are some signs and symptoms? How would you assess for sinusitis? What are some interventions?
– acute sinusitis: infection of the sinuses
– acute = often due to upper respiratory infection or allergy
- viral = 5 - 7 days
- bacterial = up to 4 weeks
– chronic = more than 12 weeks
– s/s
- h/a
- pain over sinus areas
- fatigue
- nasal obstruction
- purulent nasal discharge
– assess using transillumination of sinuses with penlight
– interventions
- drugs
- antimicrobial agents
- decongestants
- saline sprays
- heated mists
What is acute rhinitis? What are some caues of acute rhinitis? What are the signs and symptoms and serum labs that might indicate acute rhinitis?
– acute rhinitis: inflammation and irritation of nasal mucosa
– causes
- viral (rhinoviruses and other viruses)
- s/s
- red nasal mucosa
- red turbinates
- yellow/green nasal discharge
- labs
- high lymphocyte levels
- s/s
- allergies
- s/s
- grey nasal mucosa
- grey turbinates
- clear nasal discharge
- labs
- high eosinophil levels
- s/s
What is the indication for topical nasal decongestants? What is their action? What are some examples of topical nasal decongestants?
– indications
- relief of nasal congestion discomfort that accompanies the common cold, sinusitis, and allergic rhinitis
– actions
- decrease overproduction of secretions by vasoconstricting BVs in the upper respiratory tract
- sympathomimetic causing vasoconstriction
- results in less inflammation and edema of nasal membrane
– examples
- oxymetazoline (Afrin)
- phenylephrine (Coricidin)
- tetrahydrozoline (Tyzine)
- xylometazoline (Otrivin)
What is asthma? What is significant about each asthma attack? What are some causes for asthma?
– asthma: hyperreactive airway disease of bronchioles; reversible airway constriction
– each attack leads to inflammatory changes, resulting in bronchial remodeling
- bronchial remodeling is the thickening of the bronchial walls as a result of chronic inflammation
– causes
- allergies
- occupational exopsure
- viral infections
- GERD (especially noctural asthma)
- exercise-induced
What are the 4 classifications of asthma, and how do pts present for each?
-
mild intermittent
- symptoms occurs < 2x/week
- attacks are brief
- FEV1 > 80% of normal during attacks
-
mild persistent
- symptoms occur > 2x/week but not daily
- FEV1 = greater than or equal to 80% of normal during attacks
-
moderate persistent
- daily symptoms
- daily quick-relief inhaler
- attacks 2+x/week
- 60% < FEV1 < 80% of normal
- FEV1/FVC ratio reduced by 5%
-
severe persistent
- continuous symptoms
- FEV1 < 60% of normal
- FEV1/FVC ratio reduced by > 5%
What are the 2 categories of asthma medications?
-
maintenance:
- long-acting bronchodilators
- anti-inflammatory corticosteroids
-
rescue:
- short-acting bronchodilators
What is a pulmonary embolism? Where do these originate from? How do pts with PE present? Why is it dangerous? What are some interventions?
– pulmonary embolism: clot that has travelled and lodged into pulmonary arterial circulation, obstructing blood flow to the lung
– can originate from DVTs or arterial thrombi
– presentation is vague and can occur without warning
– dangerous because can be fatal
– interventions
- anticoagulants
- antithrombolytics (clot busters)
- inferior vena cava filter
What is obstructive sleep apnea? What are some signs and symptoms? What are some risk factors? What are some things that could exacerbate symptoms?
– obstructive sleep apnea: when the muscles in the back of your throat relax too much during sleep and interfere with normal breathing
– s/s
- loud snoring
- choking/gasping during sleep
- unrestful sleep
- daytime sleepiness
– risk factors
- obesity
- nasal blockage
- airway anatomy
– exacerbating factors
- alcohol
- sedative-hypnotic medications
What is sleep disordered breathing? What are some signs and symptoms? How is it diagnosed? What are some interventions?
– sleep disordered breathing: syndrome of upper airway dysfunction during sleep due to upper airway resistance and pharyngeal collapsibility
– s/s
- snoring
- increased respiratory effort
– diagnosed with a polysomnography (sleep study)
– interventions
- behavioral changes
- CPAP (continuous positive airway pressure)
- prevents airway closing
- oral appliance
- pulls tongue forward to prevent obstruction
- surgery
- opens airway structures
What is acute bronchitis? What are some signs and symptoms?
– acute bronchitis: inflammation of the bronchial tubes caused by viral infection
– s/s
- usually begins with a common cold
- sore throat
- nasal discharge
- muscle aches
- fever
- persistent cough
- becomes prominent as the disease progresses
- can last 10 - 20 days
- sputum production
- clear/yellow/green/blood-tinged
- color not indicative of bacterial/viral infection
- rhonchi and wheezes
How is acute bronchitis diagnosed? What are some interventions?
– diagnosed with
- symptomatology
- sputum culture
– interventions
- broad spectrum antibiotics
- expectorant medications
- cough meds that help relieve phlegm from the airways
- mucolytic agents
- bronchodilators
- cough suppressants at night
What is rickets, and what causes it? What population typically gets rickets?
– rickets: a disease of the softening and weakening of the bones
– caused by lack of vitamin D, calcium, phosphorus, and sunlight
- reduced vitamin D decreases calcium absorption
- when serum calcium levels fall, PTH is secreted which pulls calcium from the bones, stimulating bone breakdown
– population = children, mostly infants 4 - 12 months old
- especially children with malabsorption symptoms or ESRD
What are some risk factors of rickets? What are some signs and symptoms?
– risk factors:
- lactose intolerance
- exclusive breastfeeding
- malabsorption
- malnutrition
– s/s:
- malformation of bones
- protrusion of sternum
- varus deformity of the legs (bowing)
- costochondral swelling (swelling of intercostal cartilage)
- delay in fontanelle closure
- delay in tooth development
What are the 2 kinds of osteoporosis, and how do they differ? How do hormones play a role in osteoporosis?
– primary: weak and brittle bones caused by natural aging, pathological processes such as
- prolonged negative calcium balance
- poor dietary habits
- lack of weight-bearing exercises
- lack of daily exposure to sunlight
– secondary: weak and brittle bones caused by underlying medical conditions or use of certain medications such as
- hyperparathyroidism
- corticosteroids
– hormones play a role in bone mineral density (BMD)
- estrogen slows osteoclast activity (responsible for degrading bone to start bone remodeling)
- postmenopausal women
- female triad (menstrual dysfunction, low energy availability, and decreased BMD)
- amenorrhea
- decreased body weight
- excessive exercise
How is osteoporosis diagnosed?
- dual energy x-ray absorptiometry (DEXA) = gold standard
- measures BMD
- compares BMD with reference population of healthy adults (30 years of age)
- reported as a T score
- X-rays
- do not show osteoporosis until bone loss is 40+%
- blood tests
- PTH
- estradiol
- osteocalcin
- protein in bone
- high levels indicate bone breakdown
What is degenerative disc disease (DDD)? What are some signs and symptoms? Which regions are most commonly affected?
– degenerative disc disease: condition where a damaged spinal disc causes pain; vertebral disc distortions compromise spinal nerves
–s/s:
- pain in lower back that radiates down back of leg (sciatica)
- pain on buttocks or thighs
- pain that worsens when sitting, bending, lifting, or twisting
- pain that is minimized when walking, changing positions, or lying down
- numbness, tingling, or weakness in legs
- foot drop
- difficulty lifting the front part of the foot
- top of the foot might drag on the ground when you walk
- motor weakness
- neuropathy
– regions:
- cervical
- lumbar
- L4, L5, and S1 are the most commonly affected
What is lyme disease? What is the characteristic sign of lyme disease? How do pts with lyme disease often present?
– lyme disease: a disease caused by Borrelia burgdorferi
– characteristic sign = erythema migrans (bull’s-eye rash)
– presentations:
- bacteria disseminates throughout the body infecting
- skin
- heart
- joints
- eyes
- CNS
- peripheral nerves
- arthralgia (joint pain)
- myalgia (muscle pain)
- fatigue
- h/a
What are the 3 stages of lyme disease?
-
early localized – 3 - 30 days post-bite
- most common stage of presentation
- fever
- myalgia
- arthralgia
- erythema migrans
- lymphadenopathy (swollen lymph nodes)
-
early disseminated – 3 - 12 weeks post-bite
- vague, generalized symptoms
- h/a
- lymphocytic meningitis
- neck pain
- cranial neuritis (inflammation of cranial nerve)
- paralysis of nervous system
- carditis ocular involvement (endocarditis – bacteria enters bloodstream and heart; causing ocular complications)
- unilateral blindness
- vague, generalized symptoms
-
late disseminated – months - years post-bite
- severe joint pain and swelling
- CNS involvement
- polyradiculopathy symptoms (damage to multiple nerves)
- nerve pain
What are some interventions for lyme disease?
- doxycycline
- for those with a tick bite living in an endemic lyme disease area = single prophylactic dose
- for those presenting with early localized or early disseminated stages of lyme disease = 21-day course
What is post-lyme disease syndrome?
syndrome that results after a pt has completed antibiotic therapy and they continue to display symptoms of lyme disease
