lower respiratory

Question 1

pna

Answer 1

acute infection of lung parenchyma (functional unit = alveoli)
rf: >65, altered LOC, weak cough, bed rest and prolonged immobility, debilitating illness, malN, smoke, tracheal intubation (vent in ICU)

Question 2

pna: community acquired

Answer 2

no hospital or long term care facility within 14 days of onset

Question 3

pna: hospital acquired

Answer 3

non intubated (VAP), 48+ hr after admission and was not present at admission

Question 4

pna: viral

Answer 4

most common, mild or self limiting <-> life threatening, usually resolves 3-4 days

Question 5

pna: bacterial

Answer 5

may require hospitalization

Question 6

pna: aspiration and opportunistic

Answer 6

immunocompromised
asp = abn entry of material from mouth or stomach into trachea/lungs
rf = decreased LOC, dysphagia (esp with thin liquids), NG tube (why we place below sphincter)
may be silent

Question 7

pna: cm

Answer 7

usually preceded by URI
fever, chills, cough, malaise, chest pain with inspiration and coughing, dyspnea, fatigue, myalgia, confusion in elderly!
cough: bacterial = productive, purulent (green, rusty, red currant jelly); viral = nonP/scant
resp distress = failure

Question 8

pna: diagnose

Answer 8

s/s on PA or…
CXR: infiltrates (hazy)
wbc with diff: leukocytosis with bacterial, shift to L (increase immature neutrophils, with acute bacterial infeciton)
+ sputum for c+s

Question 9

pna: nc

Answer 9

educate: vaccine, dont smoke, adequate rest/sleep and balanced diet
during hospitalization: know at risk (asp), pulm toilet, early ambulation, strict adherence to standard precautions and HH
acute interventions: VS/pulse ox (trend, regular, fever, tachy, increase in BP and RR), auscultate lungs (baseline at start of shift), supplemental o2, CPT, pulm toilet, fluids, ambulate, E conservation, drugs (analgesics, abx, antipyretics), teaching to stay healthy after d/c

Question 10

OPD

Answer 10

asthma, emphysema (alveolar damage -> stretched and over inflated = COPD), chronic bronchitis (excessive secretion production)
preventable and treatable
COPD (no hospital) v exacerbations (resp infection, hospital, flare)
diagnose based on hx, s, spirometry results

Question 11

OPD: cm

Answer 11

barrel chest: increased AP diameter d/t hyperinflation - thorax expand to create 1:1 bc increased WOB
breath sounds: diminished, wheeze, rales, +/or ronchi
prolonged expiration

Question 12

OPD: S of advanced disease

Answer 12

pursed lip breathing (increased + P to get rid of air), neck vein distention/peripheral edema (pulmonary htn d/t extended expiration, harder for blood to get in), cachexia (v malN, v thin)

Question 13

OPD: nc

Answer 13

dont smoke, vaccine, early detection of resp infection
inhaler therapy -> self management, adherence!: long acting beta agonist (1st!, bronchodilate), long acting muscarinic antagonist (bronchodilate), inhaled corticosteroid (decrease inflam)
o2 admin (88-92%), home or hospital
tripod, pursed lip breathing, cough techniques (huff = lots of tiny otw to big), E conservation and relaxation, extra cals, psych support - scary when you cant catch breath

Question 14

OPD: manage acute exacerbation

Answer 14

worsening beyond day to day, need change in treatment plan
hypoxemia in hospital -> o2 therapy: >90%, never withold o2, CPAP when hypercapnic
bronchodilators (MDI or wet neb), CPT, abx

Question 15

OPD: co2 narcosis

Answer 15

stimulus to breath is decreased oxygenation, instead of increased CO2 (need ABGs to diagnose as CO2 retainer)
cant stop breathing when given high O2 - dont withold, but will need to intubate

Question 16

tb

Answer 16

mycobacterium
MDR if resistant to INH and rifampin

Question 17

tb: rf

Answer 17

poor, underserved, minorities, IV drug users, low sanitization, overcrowded living conditions, immunosuppression

Question 18

tb: primary

Answer 18

bacteria inhaled, inflam response, most mount effective response to encapsulate organism, usually asymp

Question 19

tb: latent

Answer 19

persistent state of immune response to bacterium w/o cm of active tb, asymp, not contagious, + skin/blood test, can become active

Question 20

tb: reactivated

Answer 20

after latent tb in 5-10%, increased risk in high risk group (old and immunocompromised is worst), transmissible

Question 21

tb: cm - latent

Answer 21

+ tb test, may/may not have ghon nodule on CXR, asymp

Question 22

tb: cm - active

Answer 22

+ AFB sputum, fever, night sweat, weight loss, productive cough with purulent or bloody sputum for >3wk

Question 23

tm: diagnose

Answer 23

eval cell mediated immunity
skin (mantoux): ID injection, bled 48-72 hr, measure induration (raised), dont want
IGRA blood
if either +, step 2 -> CXR for ghon nodule
- = latent
+ = more testing
AFB sputum

Question 24

15 mm induration

Answer 24

+ in anyone

Question 25

10 mm induration

Answer 25

immigrant <5yr, IV drug user, high risk job/work, lab personnel, high risk clinical conditions, <4yo, kids exposed to high risk adults

Question 26

5 mm induration

Answer 26

HIV, recent contact with TB, fibrotic change on chest radiograph consistent with prior TB, organ transplant, immunosuppressed

Question 27

tb: nc

Answer 27

eradicate, interpret diagnostic results, identify contacts
drugs: adherence! (mo - yrs), direct observation therapy prn, assess adverse effects
prevent transmission: airborne, private room (- P so air goes to outside world), HEPA mask, monitor hc workers annually, prevent drug therapy to high risk contacts; home care = preventative drug therapy to high risk, cover mouth/nose, wear mask in crowds, AFB sputum q2 wk (3 “-“ cultures = not infectious)

Question 28

tb: isoniazid SE

Answer 28

hepatotoxicity, peripheral neuropathy

Question 29

tb: rifampin SE

Answer 29

red/orange excretions

Question 30

tb: ethambutol SE

Answer 30

decreased visual acuity, inability to differentiate btw red and green

Question 31

lung cancer: cm

Answer 31

CXR - usually for other reason like pna, majority of time silent -> nonspecific S late in disease, often masked by chronic underlying cough (smokers)
most common S = productive persistent cough

Question 32

lung cancer: diagnose

Answer 32

CXR = mass (consolidation)/infiltrate
CT/MRI to assess for metastasis
sputum for cytology: many wont test +
definitive = biopsy -> provider preference to which type (percutaneous fine needle asp, bronchoscopy, VAT - in OR or endoscopy suite)

Question 33

lung cancer: collaborative care

Answer 33

health promo (smoking), anx reduction (bc hypoxia, raport), sx (pneumonectomy - lung removal), lobectomy, segmental or wedge resection), radiation, chemo