Infectious Lung Diseases

Question 1

Pneumonia

Definition

Answer 1

An acute inflammation of the lungs associated with alveolar filling by exudate (consolidation)
- Lots of secretions & retention

Common complications & cause of morbidity / mortality in hospitalized patients
- Longer the stay = INC chances of aquiring pneumonia

Question 2

Pneumonia: Pathophysiology

(2)

Answer 2

• Infectious agent (typically a virus or bacteria) or irritant reaches the lungs triggering an inflammatory reaction.
• May also be a result of an auto-immune disease

** Leading cause of death in Canada - infectious diseases/agent

Question 3

Pneumonia: Etiology

(5)

Answer 3

1. Aspiration
2. Contact (ie trauma or chest tube)
   Laceration (open-wound injury) OR lung contusion causing an inflammatory response
3. Inhalation - droplet
4. Hematogenous - circulation
5. INC risk: infants, the elderly, those with chronic cardiac or respiratory disease & immunosuppressed patients (HIV, rheumatological disease, post-transplant, meds)

Question 4

Pneumonia: Clinical Presentation
(depends on etiology)

(6)

Answer 4

Inspection:
- Dyspnea
- Cyanosis - hypoxeamia
- INC RR + shallow breathing (tachypneic breathing)
- Cough (productive = bacterial, non-productive = viral)
- Fever (high fever = bacterial, moderate fever = viral)

Palpation:
- Tactile Fremitus: INC (b/c of consolidation)

Percussion:
- Dull

Auscultation:
- Wet inspiratory crackles (anytime there is a lot of secretions)
- Broncial or bronchovesicular (normal EXCEPT when they are heard somewhere they shouldnt be)

ABGs:
- DEC PaO2 - poor ventilation - blood is passing by w/o picking up O2 (shunt)
- May have DEC PaCO2 (if hyperventilation - INC RR)

CXR:
- Air bronchograms
- Opacities in surround alveoli

Question 5

Tuberculosis

Definition & Pathophysiology & Etiology

Answer 5

An infectious, systemic, inflammatory disease that primarily affects the lungs & other organs
- Presentations are related to the lungs

Patho:
- Mycobacterium tuberculosis (airborne precautions) - extra precautions when treating pt
- Most infectious do not have symptoms (latent TB). May lay dormant then reactivate when immune system weakens (post-primary tuberculosis)

Common: 3rd world countries & low-economic status

Question 6

Tuberculosis: Clinical Presentation

(2) - 1 + 5

Answer 6

Respiratory:
- Cough > 2 weeks
Dry cough (early)
Productive cough (mucus / blood) < physical examination - common character of TB

Systemic:
- Fever
- Fatigue
- Night sweats
- Weight loss (poor appetite)
- May have swollen lymph nodes - fighting off infection

Question 7

Tuberculosis: Diagnosis

(2)

Answer 7

TB Infection
- TB Skin Test
- TB Blood Test

TB disease (ACTIVE)
- CXR
1. Infiltrates (white spots) & cavitation in the upper lobes (apical segments)
Cavitation = gas fillled area in the lung in the center of a nodule or area w/ consolidation
2. May have pleural involvement &/or parenchymal fibrosis - not neccessarily
- Sputum sample
- Medical history - immunocompromised (INC hypo), recently travelled to a country w/ TB
- Physical examination

Question 8

Tuberculosis: Intervention

(5)

Answer 8

1. Medication (cocktail of meds for 6-8 months)
2. Prevent exposure to others
   Negative pressure room
   Anyone entering the room must follow universal precautions & an N-95 respirator mask (airborne diseases)
3. Secretion clearance techniques - manual
4. Deep breathing
5. Coughing - proper cough to expel secretions