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Lower Respiratory Flashcards

1
Q

What is consolidation?

A

Fluid accumulation in lungs
Suggests bacterial pneumonia

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2
Q

Biggest clinical difference between bronchitis and pneumonia?

A

Pneumonia=consolidation
Bronchitis=no consolidation

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3
Q

What will lungs sound like in bronchitis?

A

Wheezing
Crackles
Usually on exertion and exhalation

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4
Q

What is the most common symptom on bronchitis?

A

Coughing (especially at night)
Sputum may be clear or purulent

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5
Q

What is pertussis and is it preventable?

A

Whooping cough
TDAP or DTAP is vaccine for it

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6
Q

What is cause of pertussis? Tx?

A

Bacteria bordetella pertussis treated by erthromycin or azithromycin.

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7
Q

Hallmark sign of pertussis?

A

Uncontrollable violent coughing
Inspiration produced a “whooping” sound when obstructed glottis narrows airway. Sounds like gasping for breath

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8
Q

Only treatment for pertussis?

A

ABx
No cough suppressants, bronchodilators, antihistamines, corticosteroids.

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9
Q

What type of precaution needed for pertussis?

A

Droplet
Highly contagious until ABx onboard for 5 days.

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10
Q

What is meant by empiric antibiotic therapy?

A

Start of ABx before we know the causative agent. This is done in many scenarios but especially pneumonia.

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11
Q

How is causative agent ID’d in pneumonia?

A

Sputum culture

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12
Q

What are some types of pneumonia?

A

Viral (most common)
Bacterial
Aspiration
Necrotizing (rare complication of bacterial pneumonia)
Opportunistic (in immunocompromised)

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13
Q

What is pathos of pneumonia?

A
  1. Pathogen enters
  2. Inflammation
  3. Edema
  4. Fluid in alveoli
  5. Hypoxia
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14
Q

What are possible clinical manifestations of pneumonia in geri population?

A

Confusion/stupor
Hypothermia (rather than fever)
Nonspecific things like:
Diaphoresis
Anorexia
Fatigue
Myalgia
Headache

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15
Q

What are s/sx of pneumonia in average patient?

A

Cough
Fever
Chills
Dyspnea
Chest pain
Tachypnea
Tachycardia
Hypotension
N/V
Hemoptysis
Fine or coarse crackles

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16
Q

What is major culprit in deaths from pneumonia?

A

Multidrug resistant pathogens (MDR)
like MRSA or gram neg bacilli

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17
Q

Common complications from pneumonia?

A

Pleurisy
Pleural effusion
Pneumothorax
ARF (this is leading cause of death)
Sepsis
Lung abscess
Empyema

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18
Q

What is empyema?

EM-PIE-EE-MUH

A

Accumulation of purulent exudate in lungs. Needs chest tube to drain

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19
Q

Why are strict I/O’s necessary for pneumonia patients?

A

Hydration is essential to thin secretions but we also have to watch for fluid overload in older population.

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20
Q

How soon should we see improvement in pneumonia after ABx start?

A

2-3 days

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21
Q

What are some possible findings on physical exam in pneumonia patient?

A

Fine or coarse crackles
Egophony
Increased fremitus
Bronchial breath sounds

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22
Q

What are two types of pneumonia vax?

A

Pneumococcal Conjugate 13 (13 types of bacteria)
Pneumococcal Polysaccharide 23 (protects against 23 types of bacteria)

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23
Q

PCV13 vaccine is recommended for what ages?

A

<2 yo
>65 yo

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24
Q

PCV23 vaccine is recommended for what ages?

A

> 50 yo
or anyone over 2 yo who is high risk
High risk:
Heart, lung disease
DM
Alcohol/cirrhosis
Sickle cell
Smoker
Cancer
Immunocompromised

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25
How is TB spread?
Airborne. Can be suspended in air for hours. Not spread by contact or even saliva
26
If a healthy person inhales TB bacteria, what usually happens?
They can kill the bacteria altogether or their immune system forms a granuloma around bacteria in lungs and prevents spread. This is considered latent TB. They cannot spread it, are asymptomatic but will test positive for TB. They will need a shortened, lighter form of treatment.
27
What are risk factors for TB?
Foreign born Homeless Around institutions IV drug users Poverty/Poor Sanitation Immunocompromised
28
S/Sx of TB.
Anorexia Malaise Chest pain Hemoptysis Prolonged productive cough Night sweats Pallor Unexplained weight loss
29
How are TB skin tests interpreted? (Called Mantoux test or TST)
Standard screening tool After intradermal injection, read 48-72 hours. If induration present (hard, raised area or swelling with no redness), TB exposure positive. Recorded in mm.
30
How long is a TB patient infectious after starting treatment?
2 weeks
31
What is MDR-TB?
Drug resistant --This is usually in patient who has previously not adhered to med regimen-- Non adherence is a BIG problem in TB.
32
What are the four medication mainstays in TB treatment?
Isoniazid Rifampin Pyrazinamide Ethambutol --Usually will be on a regimen of all 4-
33
What is major side effect of TB meds?
Non viral hepatitis
34
What are some common fungal infections that settle in lungs?
Coccidioidomycosis (in SW US) Histoplasmosis (in our area) Blastomycosis (in eastern US)
35
Pulmonary fungal infections will look like...
Bacterial pneumonia
36
How are pulmonary fungi spread?
Spores inhaled from dust Not transmitted by person
37
Drug of choice for pulmonary fungi?
Amphotericin B given IV
38
What is s/sx of flail chest?
Paradoxical chest movement
39
S/sx of cardiac tamponade
Muffled heart sounds Hypotension JVD
40
What is the most common cause of pulmonary edema?
Left sided heart failure
41
Most pulmonary embolisms arise from___
DVT in legs
42
What is VTE?
Venous thromboembolism This is term to refer to spectrum of DVT to PE.
43
Risk factors for PE
Recent surgery (within 3 months, especially pelvic or leg surgery) Cancer Obesity Smoking Hormone therapy and Birth control Air travel Pregnancy
44
S/Sx of PE.
Can be subtle depending on the size of clot. Dyspnea Tachypnea Cough Chest pain Tachycardia Adventitious lung sounds Hemoptysis
45
Treatment for PE
Anticoagulants
46
What is cor pulmonale?
Enlargement of right ventricle caused by respiratory problem, usually COPD or pulmonary HTN or both.
47
Tx for cor pulmonale?
Early detection is essential before heart failure occurs. Correct cause O2 Diuretics Calcium channel blockers Vasodilators
48
What are s/sx of cor pulmonale and pulmonary HTN?
Dyspnea on exertion Fatigue Cough Tachypnea
49
What adventitious lung sound is described as "popping fire or velcro pulled apart"? When is it usually heard?
Fine crackles or rales This is wet alveoli popping open. Heard at end of inspiration
50
What adventitious lung sound is described as "loud popping or bubbling"?
Coarse crackles or rales Air passing over mucus Heard on inspiration and expiration
51
What adventitious lung sound is a low pitched wheeze, snoring, gurgling, rattle? Lower and louder than rales
Rhonchi
52
When will a pleural friction rub be loudest?
When lungs are at max capacity At end of inspiration
53
In pneumonia, what is meant by CAP, HAP or VAP?
Community acquired (develops <48 hours of admit) Hospital acquired (develops >48 hours after admit) Vent acquired (occurs >48 hours after intubation) This is important because pneumonia has to be investigated to source.
54
What is pneumonia caused by mycoplasma pneumoniae?
Walking pneumonia Called atypical Happens in younger patient Bacterial and contagious
55
What is cytomegalogvirus pneumonia associated with?
Herpes virus Usually is an immunocompromised person
56
What is the most important treatment to be given ASAP to pneumonia?
ABx
57
Best deep breathing exercise?
4-8-8 4=inhale 4 seconds 8=hold for 8 seconds 8=exhale for 8 seconds with pursed lips Do 3 times.
58
How do you instruct patient on how to use incentive spirometer?
Inhale long and slow-set goal slide on IC. Hold for 5 seconds Remove mouthpiece Exhale Repeat 5x every hour. Cough after to clear secretions.
59
What should we teach patient about a side effect of rifampin? (TB med)
Will turn all body fluids orange This is normal
60
What are two phases of treatment for TB?
Initial>8 week Continuation>18 week
61
What is important teaching when pt is taking isoniazid? (TB med)
No alcohol
62
What is biggest precaution for TB patient during treatment?
Liver function Must have liver function tests done every month
63
What are the two major types of lung cancers?
Non-small-cell Small-cell
64
Where are common sites of metastasis of lung cancer?
Liver Brain Bones Adrenals
65
What are 10 signs of lung cancer? --Most of these are chronic smoker "normal" things-- ---So important to screen high risk patients because lung cancer can be undetectable until advanced--
Chronic cough Wheezing Chest/bone pain Hemoptysis Chest infections Difficulty swallowing (dysphagia) Raspy, hoarse voice SOB Unexplained weight loss Nail clubbing
66
What is paraneoplastic syndrome?
Cancer produces chemicals that effect endocrine glands SIADH Cushings Hypercalcemia
67
What does TNM stand for?
Tumor (size, location, depth) Node (how many involved) Metastases (how many sites)
68
What is cardiac tamponade?
Collection of blood in pericardial sac
69
At what degree should HOB be for patient with chest tube?
30-60
70
How do you empty a chest tube?
You don't You throw it away and replace
71
What is tidaling in chest tube?
Movement of air bubbling A little is normal. A lot indicates an air leak.
72
How much chest tube drainage is too much?
100 mL/hour Notify dr.
73
How is a chest tube removed? Can nurse do it?
Yes nurse can do it. Premedicate Remove sutures Valsalva while pull out Occlusive, petroleum dressing.
74
What is thoracentesis?
Like a chest tube except it goes in and out. Allow fluid to drain
75
What labs will be abnormal in pulmonary embolism?
Troponin BNP (B-natriuretic peptide) D-Dimer (but only in bigger PE)

Respiratory (4 decks)

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