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Pathophys > INFECTIOUS & INFLAMMATORY DISEASES PART 1&2 > Flashcards

INFECTIOUS & INFLAMMATORY DISEASES PART 1&2 Flashcards

1
Q

What is the infectious disease pneumonia?

A

acute lung injury where an inflammatory process damages the parenchyma of the lungs

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2
Q

What are parenchyma generally? In the lungs?

A
  • Functional tissue of an organ
  • excludes connective tissue
  • In the lungs it is largely the alveoli
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3
Q

Describe the airways mucus and swelling with pneumonia:

A

Mucus - increased reducing airspace

swelling - narrows the airway, decreasing air flow

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4
Q

T/F Nosocomial pneumonia infections have twice the mortality and morbidity of non–hospital-acquired infections

A

True

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5
Q

Causes of pneumonia: (5)

A
  1. Bacterial
  2. Viral
  3. Fungal
  4. Inhalation of toxic or caustic chemicals, smoke, dusts, or gases via airborne transmission
  5. Aspiration of food, fluids, or vomitus
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6
Q

What are risk factors for pneumonia?

A
  1. Age
  2. Chronic bronchitis, poorly controlled diabetes mellitus, uremia, dehydration, malnutrition, and prior existing critical illnesses
  3. Confinement to an extended stay facility, ICU, or hospital
  4. Intubation, surgery, receipt of immunosuppression drugs & chemotherapy
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7
Q

What is the pathogenesis of pneumonia? What kind of damage?

A
  • Any infectious organism reach alveoli -> full-scale inflammatory (pro-inflammatory) and immune response with damaging side effects to the lung tissue
    1. Endotoxins damage bronchial and alveolocapillary membranes
    2. Damage type II alveolar cells which produce surfactant
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8
Q

What are the hallmarks of inflammation?

A
  1. Heat
  2. Redness
  3. Swelling
  4. Pain
  5. Loss of function
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9
Q

What are the systemic effects of pneumonia?

A
  1. ↑ [IL-1, TNFα]-pro inflammatory state

2. Fever, chills, malaise, and myalgias (muscle aches)

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10
Q

Inflammation and edema caused by pneumonia do what to the terminal alveoli?

A

fill with cellular debris and exudate (any fluid that filters from the circulation into lesions or areas of inflammation, pus like!)

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11
Q

Factors affecting pathogenesis of pneumonia:

A
  1. Virulence of the causative agent
  2. Status of local defenses
  3. Overall health of the individual
  4. Comorbidities
  5. Immunodeficiency
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12
Q

T/F Pneumonia is typically an upper respiratorys infection but most cases preceded by a lower respiratory infection.

A

False, Typically a lower respiratory tract infection but most cases are preceded by an upper respiratory infection

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13
Q

Poor prognosis factors for patient with pneumonia?

A
  1. Advanced age
  2. aggressive organisms
  3. Comorbidity present
  4. Respiratory failure
  5. Neutropenia (limited number white blood cells – chemo patients)
  6. Sepsis – systemic wide infection
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14
Q

What is Community-acquired pneumonia?

A
  • Develops in people with limited or no contact with medical institutions or setting
  • Remains a common and serious clinical problem
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15
Q

What is Hospital-acquired pneumonia?

A
  • Has an even higher mortality rate

- Accounts for almost 40% of hospital deaths; 90% of those fatalities occur in people older than age 65 years

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16
Q

T/F Pneumonia is a common complication of the flu

A

True

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17
Q

Signs and symptoms of Pneumonia:

A
  1. Sudden and sharp pleuritic chest pain aggravated by chest movement and accompanied by a hacking, productive cough with rust-colored or green purulent sputum.
  2. Inappropriate dyspnea, fatigue
  3. Tachypnea (abnormally rapid breathing) accompanied by decreased chest excursion on the affected side
  4. Cyanosis
  5. HA, fever, chills
  6. Altered mental status or loss of balance and may lead to falls (associated changes in gas exchange)
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18
Q

Can resolution of pneumonia occur? Expain

A

Healing occurs, quality dependent on extent of damage:

  1. large enough surviving population of type I and type II cells, normal tissue can be restored
  2. damage is more extensive, fibroblasts may dominate the repair process resulting in fibrosis
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19
Q

Medical management of pneumonia:

A
  1. Antibiotic therapy along with rest and fluids
  2. Pneumonia vaccine
  3. Chest physical therapy
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20
Q

WHat are the implications for PT in regard to pneumonia?

A
  1. Careful hand washing
  2. Teach deep breathing techniques, coughing techniques, airway clearance techniques
  3. Adequate hydration
  4. Early ambulation, proper positioning, sitting – out of bed activities, upright posture
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21
Q

What is a common viral infection that can be deadly especially in high risk groups?

A

Influenza

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22
Q

What are the symptoms of influenza?

A

(systemic secondary effects)

fever, chills, muscle aches (myalgia), cough, congestion, runny nose, headaches, and fatigue

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23
Q

How if influenza treated?

A
  • Is treated primarily with rest and fluids to let the body fight the infection on its own.
  • Over-the-counter anti-inflammatory pain relievers may help with symptoms.
24
Q

T/F Probably don’t want to treat active cases of influenza

A

True

25
Q

In patient PT and influenza:

A
  1. Focus on hydration and getting patient out of bed
  2. Be very conscious of fatigue
  3. Ease back into therapeutic exercise
  4. Monitor resting HR
26
Q

How do the proinflammatory cytokines alter skeletal muscle in patients with influenza?

A

catabolic effects of proinflammatory cytokines in various tissues contribute to local catabolism (damage skeletal muscle), with progressive atrophic alterations of the skeletal muscle

27
Q

Tuberculosis can cause infection at what sites?

A
  1. Primarily the lungs
  2. Vertebral column (Potts disease)
  3. CNS
  4. Heart
28
Q

At risk groups for TB?

A
  • Homeless, malnourished, debilitated

- Immunocompromised (HIV, transplant recipients)

29
Q

Describe the multi drug resistant strains of TB?

A
  • TB caused by bacteria that do not respond to the 2 most powerful first-line anti-TB drugs
  • Second line treatments are available but limited and require up to 2 yrs. of treatment
30
Q

How is TB transmitted?

A
  1. Airborne, unpasteurized milk

2. Inhalation of infected airborne particles or droplets generated by an infected person

31
Q

T/F Casual contact usually insufficient to lead to infection

A

True

32
Q

T/F Household exposure over a few days to develop an infection

A

False, Household exposure over many months required to develop an infection

33
Q

Describe the progression of primary TB:

A
  1. Infection in alveoli
  2. proliferation of epithelial cells surrounds and encapsulates the multiplying focus of bacilli
  3. Initial encapsulation called a tubercle (granuloma - contains infectious agent)
34
Q

What is the purpose of the formation of granulomas in the immune response to primary TB?

A
  • Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to do so
  • This walling off further isolates the bacilli are from the lung
35
Q

Describe the progression of primary TB to secondary TB?

A
  • granulomas can become necrotic in the center and eventually produce fibrosis and calcification of the tissues
  • granuloma ruptures, the bacteria can then spread and cause secondary TB
36
Q

T/F TB is symptomatic when most curable.

A

False, Asymptomatic when most curable

37
Q

Risk for developing active TB in highest when after infection and development of a positive TB skin test reaction?

A

highest in the first two years

38
Q

S&S of TB?

A
  • Productive cough, weight loss, anorexia
  • Fever, night sweats, fatigue, malaise
  • Hemoptysis (bloody sputum)
39
Q

How is drug susceptible TB disease treated medically?

A
  • Drug-susceptible TB disease is treated with a standard 6 month course of 4 antimicrobial drugs
  • The vast majority of TB cases can be cured when medicines are provided and taken properly
40
Q

T/F Most patients with primary tuberculosis are asymptomatic, and the granulomas resolve.

A

True

41
Q

What is miliary TB?

A
  • Characterized by a wide dissemination throughout the human body and by the tiny size of the lesions
  • May infect any number of organs
42
Q

What is a positive TB skin test look like?

A
  • marked by an area of reddish induration > 10 mm.

- It is the induration (firm bump) that is gently palpated that determines the size, not the area of redness

43
Q

What type of precautions required when working with a patient with active TB?

A
  • Airborne precautions

- Normal air currents can keep them suspended and airborne for days

44
Q

What type of masks/filters used for patient with active TB?

A
  1. HEPA filter - traps 99.97% of airborne particles 0.3 microns and larger
  2. N95 mask - filters >95% particles 1 micron in size
  3. PAPR - seldom used
45
Q

Tuberculosis: Implications for the PT?

A
  1. 2-step tuberculin skin testing
  2. Wear appropriate PPE
  3. When treating pulmonary patients pay attention to their history
46
Q

What type of assessment of patient with TB?

A
  • A thorough chest assessment
  • Determine amount of chest expansion
  • Postural deviations
  • Overall posture
  • Gait
  • Muscle strengthening
  • Balance
  • Functional mobility
47
Q

How do you measure chest expansion?

A
  1. Measured with a tape measure situated around the chest at or about the level of the 4th IC (level of the nipple) or just below the nipple in females
  2. Measure following a deep, maximal inspiration and on maximal expiration
  3. Take the difference between these two numbers
48
Q

Normal chest expansion:
Children -
young males -
emphysema -

A

Children - 2 cm
young males - 5-8 cm
emphysema - < 1 cm

49
Q

How to measure equal chest expansion:

A
  1. fingertips of both hands on either side of the lower rib cage so that the tips of the thumbs meet at the midline, then ask the patient to breathe deeply
  2. Posteriorly at the level of and parallel to the 10th rib
  3. If one thumb remains closer to the midline then there is diminished expansion of the chest on that side
50
Q

Medications for TB can cause peripheral neuropathy, what does that mean for the patient?

A

fall risk and safety concern

51
Q

TB medication negative effects?

A

Liver damage
fatigue
N/V
abdominal pain

52
Q

Patient education for TB:

A
  1. Wear masks when leaving room
  2. Cover nose
  3. Guests gown & mask
53
Q

Safety implications for PT working with active TB patient:

A
  1. Proper room i.e. negative pressure
  2. Airborne precautions
  3. Be appropriately trained in the use of PPE
  4. Clean equipment
54
Q

T/F Once an individual tests positive for TB, he or she will always test positive.

A

True, require periodic screening with chest x-ray studies

55
Q

What is Potts disease?

A

TB of the spine (tuberculous arthritis of the intervertebral joints)

56
Q

How do you relieve pain in patient with Potts disease?

A

Immobilization and avoidance of weight bearing may be required to relieve pain

Pathophys (16 decks)

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