Immunocompromised host Flashcards
What is the patient history?
Collection of historical subjective and objective data pertinent to diagnosis and treatment of a patient complaint
What are the standard questions we think about when considering patient history
Biographic data
Chief complaint
Present health or history of illness
Current medication
Past health
Family history
Review of body systems
What is the SAMPLE acronym
Signs and symptoms
Allergies
Medications
Past pertinent medical history
Last oral intake
Events leading up to condition or illness
When are RTs more responsible for retrieving the patient history?
Formal pulmonology visit
Nurse calls respiratory for bedside PRN
ER
Routine therapy
What is the OPQRST acronym specifically for pain
Onset of event
provokes/palliates
Quality of pain (describe it)
Region or radiation
Severity
Time (how long has this been going on)
Describe AAOx3
Awake
Alert
Oriented to person, place and time
Describe internal factors that a therapist can bring to a patient interview for more success
Empathy
Signal concern
Sit
Face the patient
Maintain open body posture
Withhold judgement
Maintain comfort
Confirm patient feelings
What internal factors are challenging in the face of how modern medicine is practiced?
Listening and recording simultaneously
What are examples of cultural differences that will need to be addressed in clinical conditions?
Religious bullshit, im looking at you jehovahs witnesses
Cultural norms (ie certain hands dont do certain things, women wont talk to you ect)
What external factors can aid in patient interviews?
Privacy
Prevent interruptions
Provide security
Provide comfort
Describe occams razor
Occam proposed that the best explanations are the simplest
What does hickams dictum say
People can have as many diseases as they want
What are the three elements of a good patient problem presentation?
Who
When
What
What information can be drawn from the “who” portion of the problem presentation?
Pertinent demographics
Relevant epidemiology
Risk factors
Medical history
What information can be drawn from the “when” portion of the problem presentation
Temporal pattern of illness
Duration (acute or chronic)
Tempo (stable or progressive)
What information can be drawn from the “what” portion of the problem presentation
Clinical syndrome
Key signs, symptoms, and other findings
What is an illness script?
Summation of providers knowledge of a condition
Describe the diagnostic schema
What we know about significant signs and symptoms in a problem representation
What is the interaction between the problem representation and the illness script?
The illness script influences the problem representation
Describe a diagnostic schema
A diagnostic schema is how you reason through a patients chief complaint and past medical history in order to reach a diagnosis
Describe what it means to be immunocompromised
People with immune systems that are slowed or blunted which impact the bodies ability to fight off infection successfully
What constitutes an immunocompromised host?
An immunocompromised host is defined by their susceptibility to infection by organisms of low virulence or severe infection with organisms of normal virulence
Define virulence
How readily a pathogen can infect a host and the potential of the disease to cause severe harm
Describe what it means to be immune dysregulated
Autoimmune diseases
Immune system attacks the hosts body
Doesnt carry a high risk of infection
Describe what it means to be immune deficient
Cells within the immune system arent working correctly, there arent enough immune cells, or they are missing all together
Describe what it means to be immunosuppressed
Process of slowing down the immune system
Usually used for organ transplants or autoimmune diseases
Describe what immunomodulatory therapies do
Slowing down or speeding up the immune system such as in autoimmune diseases or fighting cancer
What patient populations tend to be immunosupressed?
Solid organ transplant recipients
Cancer patients
Hematopoietic cell transplant recipients
Pts with autoimmune disorders
List patients who receive immunosuppressive drugs
Lupus
Rheumatoid arthritis
Scleroderma
Describe allogeneic hematopoietic cell transplant
Stem cells removed from donor
Patient receives treatment to destroy blood forming cells
Patient receives stem cells
What happens in graft vs host disease?
The donor stem cells attack the host body resulting in multiorgan failure in some cases
What conditions can provoke immunocompromise or endanger patients with immunocompromised conditions?
IV drug use
Multiple blood transfusions
Patients from prisons/homeless shelters
Elderly
T/F: Steroid use on a long term basis can cause immunocompromise
True
What circumstances may provoke illness in immunocompromised populations?
Recent travel
Occupational exposure
Prolonged duration of neutropenia
Aspiration
Frequent antimicrobial exposure
What medical circumstances or conditions may cause immunocompromise?
Vegetations on heart valves
Indwelling catheters
Septic emboli
Metastatic tumors
Diabetes mellitus
What presentation in an immunocompromised host would raise suspicion of pulmonary infection?
Infiltrates
Signs of infection
What is unique about pulmonary infections in immunocompromised populations?
Pulmonary infections are a hallmark of tissue invasive infections in immunocompromised patients
What specific risks do immunocompromised patients have when dealing with pulmonary infections?
Increased risk of pulmonary infections
Diffuse alveolar hemorrhage
Pneumonitis secondary to drug toxicity
Pulmonary edema
Progression of underlying disease
What is true regarding immunocompromised patients with pulmonary infiltrates?
They often have co-existing conditions
Why is empiric treatment not the go-to with immunocompromised patients?
Usually are on an array of meds
Vulnerable to kidney toxicity
More vulnerable to c. diff infections
Why is rapid pathogen identification required with immunocompromised hosts?
Allows for use of more specific safer antibiotics
Why are CXR and sputum cultures not necessarily effective in immunocompromised patients?
May fail to distinguish between different pathologies in a useful manner
Why is routine serologic testing helpful for immunocompromised patients?
Patients may not be producing antibodies at the time of any one test so multiple tests may be able to catch the antibodies better
What is the benefit of CT and high resolution CT scans in immunocompromised patients?
Allows for different processes to be distinguished from one another in patients with multiple comorbidities
What are the invasive strategies used in order to sample sputum and lung tissue?
Bronchoalveolar lavage
Transbronchial biopsy
Video assisted thoracoscopic biopsy
Open lung biopsy
What is an opportunistic infection?
Infection by an organism that does not normally cause disease but becomes pathogenic under circumstances such as immunocompromise
What pathogens afflict immunocompromised patients that generally do not affect the immunocompetent patients?
Cryptomegalovirus
Toxoplasma gondii
Pneumocystis jirovecii
Aspergillus
Cryptococcus
Candida
What are the two names for pneumocytis carinii pneumonia (PCP)?
Pneumocystis jirovecii (fungal infection)
Why is PCP difficult to diagnose?
Not easily seen on imaging
Cant be cultured
What is required to confirm the presence of PCP in a sputum sample?
Methenamine silver stain
What patient population is most like to contract mycobacterium tuberculosis?
HIV patients
What is the most common non-tubercular mycobacteria?
Mycobacterium avium complex (MAC)
What is the first line of prophylactic defense for pneumocystis jirovecii?
Trimethoprim sulfamethoxazole
Trim sulfa/TMP-SMX/bactrim
What is the second line of prophylactic defense for pneumocystis jirovecii?
Pentamidine isethionate
What nebulizer is used to administer pentamindine?
Respirgard II
What is the dosage and frequency for nebulized pentamidine?
300 mg every 4 weeks
