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Pathophysiology - Diseases > Lower Respiratory diseases > Flashcards

Lower Respiratory diseases Flashcards

1
Q

What is influenza?

A

acute, highly contagious respiratory infection
highest incidence in school children, more severe in young children (tend to ahve high fevers, susceptible to pulmonary complications and Reye sundrome)
known viruses that cause influenza r orthomycovirus types A, B, C but there r mutant strains
- secondary bacterial pneumonia after influenza most often is caused by hemolytic Streptococcus, Staphylococcus and Pneumococus

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2
Q

Stats of influenza (cases in US, hospitalization, deaths, worldwide cases and deaths)

A

cases in US - 5-10%
hospitialization in US - 200,000
deaths in US - 36,000

Worldwide cases - 3-5 millions
Worldwide deaths - 250,000-500,000

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3
Q

ppl at risk of getting influenza related complications

A
  • children under age 5
  • adults over age 65
  • pregnant women
    people with:
  • immune deficiency
  • HIV/AIDS, cancer
  • diabetes mellitus
  • chronic respiratory diseases such as asthma, bronchitis, cystic fibrosis, emphysema
  • chronic diseases
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4
Q

s/s of influenza

A

s/s:
- inflammatio nof upper and lower respiratory tract mucous membranes
- fever
- cough
- muscle or body aches
- headache
- fatigue
- sore throat
- generalized maliase
- chills
- chest discomfort
- weakness
- sweating
Complications of flu:
- bacterial pneumonia
- ear infections
- sinus infections
- dehydration
- worsening of chronic medical conditions

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5
Q

When is flu most common + how is it transmitted?

A

most common in winter

transmitted by respiratory droplets

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6
Q

how to diagnose + treat flu?

A

diagnose - based on s/s, diagnostic tests, WBC count, isolation of virus from nasopharyngeal culture, sputum cultre isolates bacteria in secondary infection

treat - flu mostly self resoves in 2 weeks, increased fulid intake, light diet,antiviral meds can be used, symptomatic treatment is common like cough suppressant and acetaminophen for headaches, antipyretics and analgesics

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7
Q

What is pneumonia?

A

infection in one or both lungs affecting primarily the alveoli (alveoli r filled with pus and fluid = breathing is painful and limits O2 intake)

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8
Q

risk factors for pneumonia?

A
  • age (younger than 5 years or over 65 years)
  • mmune deficiency
  • having certain chronic diseases (asthma, heart disease, chronic obstructive pulmonary disease)
  • smoking
  • being on a mechanical ventilator
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9
Q

types of pneumonia?

A

not acquired in hospital = community-acquired pneumonia
aspiration pneumonia - aspiration of liquids or other material into tracheobrachial tree
developed in healthcare facility - healthcare-associated pneumonia splits into hospital-acquired pneumonia
and ventilator-associated pneumonia
atypical pneumonia (aka walking pneumonia) is pt who has abn in chest radioraph but doesnt appear significantly ill

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10
Q

s/s of pneumonia

A

reduced breath sounds and crackles
percussion note is dull
hemaptysis
cough (the person may cough up mucus or blood)
fever
chills
dyspnea
chest pain
SOB
sweating

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11
Q

What is the cause for pneumonia?

A

bacterial infection, most commonly streptococcus pneumoniae in US and if viral infection than influenza, parainfluenza and respiratory syncytial viruses

could also be staphylococcus aureus and adenovirus and pneumocystis jirovecii (pneumonia in AIDS pt)

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12
Q

how to diagnose and treat pneumonia

A

diagnose - medical history, physical examination, a chest x-ray, and sputum culture, abg, bronchoscopy, sputum and blood culture

treatment - varies based on etiology, if bacterial then antibodies (penicillin for pneumoxoccal pneumonia), if viral than symptomatic treatment and rest, o2 therapy, increased fluid intake, pain relivers and high cal diet

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13
Q

What is tuberculosis (TB)

A

a potentially fatal contagious disease that is mainly an infection of the lungs

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14
Q

What are the risk factors of TB?

A

weakened immune system
substance abuse
tobacco use
being a health care worker
living in a residential care facility.

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15
Q

etiology of TB?

A

Mycobacterium tuberculosis, its spread through microscopic droplets release by infected ppl

infects the lungs and induces a chronic inflammatory response that leads to necrosis

infection begins as primary lesion in lower area of lung (as body’s defense mechanisms respond to bacteria invasions, antigens that cause necrosis r produced, fibrosis, calcification)

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16
Q

What is latent TB infection?

A

when the immune system is able to stop the bacteria from growing

are asymptomatic and cant spread infection

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17
Q

what happens when TB bacteria is active?

A

pt officially have TB disease, r symptomatic and can spread the disease

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18
Q

What are the s/s of TB?

A
  • purulent sputum
  • Auscultation may reveal diminished breath sounds and crackles
  • bad cough that lasts 3 weeks or longer
  • pain in the chest
  • coughing up blood or sputum
  • weakness or fatigue,
  • weight loss
  • no appetite
  • chills
  • fever
  • night sweats
  • reduced appetitie
  • litlessness
  • dry cough
  • loss of energy
  • fever
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19
Q

What does infected TB tissue look like?

A

soft and cheeselike, called caseous lesion

heals with fibrosis and calcification or scarring that walls off baceteria into pockets for months or yr

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20
Q

what are tubercles?

A

lesions created by healing lings that walls off bacteria into pockets for months or years

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21
Q

How to diagnose tb?

A
  • medical history,
  • physical examination
  • test for TB infection (TB skin test or TB blood test)
  • chest x-ray
  • sputum smear
  • chest radiographs
  • examination of gastric washings
  • fiberoptic bronchoscopy
  • sputum cultures
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22
Q

What is the mantoux skin test for TB infection?

A

antigens from TB bacteria r injected beneath skin, if pt was previously exposed to TB skin swells with slight elevation at the injection site

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23
Q

how to treat TB?

A

treated with antibodies

latent = isoniazid

active = multipe antituberculsosi agents (Isoniazid, rifampin, ethambutol, pyrazinamide)

no vaccinations in US

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24
Q

What is Chronic obstructive pulmonary disease (COPD)?

A

a preventable and treatable disease characterized by progressive airflow limitation associated with abn inflammatory response of the lungs to noxious particles or gases (is not fully reversible)

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25
Q

what are the categories of COPD?

A

emphysema, chronic bronchitis, bronchiectasis, asthma, CF, pneumoconiosis

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26
Q

What is the 3rd leading cause of death in the US?

A

COPD

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27
Q

what are the risk factors for COPD?

A

exposure to tobacco smoke
occupational exposure to dust and chemicals
genetics (alpha-1-antitrypsin deficiency)

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28
Q

s/s of COPD?

A

Auscultation may reveal wheezing or crackles and decreased breath sounds
The percussion note is hyperresonance
dyspnea
frequent coughing
wheezing
tachypnea
tightness in the chest

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29
Q

Main cuase of COPD?

A

tobacco use

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30
Q

how to diagnose COPD?

A

diagnose - medical history, physical examination, spirometry, chest x-ray, CT scan, ABG analysis

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31
Q

how to treat COPD?

A

smoking cessation
bronchodilators to relax the muscles around the airways
inhaled steroids to decrease inflammation
supplemental oxygen
pulmonary rehabilition,
in rare cases surgery (lung reduction surgery to remove damaged lung tissue, lung transplant)

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32
Q

What is emphysema?

A

long-term, progressive obstructive lung disease in which the
alveoli are destroyed which causes SOB and loss of elasticity in remaining alveoli

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33
Q

risk factors for emphysema

A

smoking
exposure to secondhand smoke
occupational exposure to dust and chemicals
genetics (alpha-1-antitrypsin deficiency)

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34
Q

what occurs in emphysema?

A

alveolar walls break down, adjacent alveoli fuse, and the lungs lose their elasticity and surface area required for normal gaseous exchange

Air cannot be adequately exhaled to allow oxygen to enter, and the lungs become filled with air that is high in carbon
dioxide.

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35
Q

what is s/s of emphysema?

A
  • dyspnea and coughing
  • tachynpnea
  • Auscultation may reveal decreased breath sounds, crackles, and wheezing
  • The percussion note is hyperresonant.
  • cyanosis
  • edema of the feet and ankles
  • fatigue
  • headache (especially in the morning)
  • wheezing
  • barrel chest (caused by enlargement of the lungs and chest wall)
  • ineffective use of breathing muscles.
  • pursed-lip breathing
  • Patients may also have a tendency to lean forward and support themselves with their arms on a surface in front of them or on their knees
  • circumoral cynasosis (right ventricular heart failure)
  • digital clubbing
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36
Q

how to diagnose emphysema?

A

medical history
physical examination
blood tests (complete blood count and ABG)
imaging tests (chest x-ray and CT scan)
pulmonary function tests (spirometry and peak flow).

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37
Q

how to treat emphysema?

A

goal of treatment is to reduce symptoms and slow progression of the disease

  • stop smoking
  • bronchodilators
  • alpha -1 protease inhibitor for pt with familial emphysema
  • supplemental O2
  • beta2-adrenergic sympathomimetic drugs alone or w/ inhaled corticosteroids
  • antispasmodic
  • antibiotics
  • expectorants
  • treatment for GERD
  • pulmonary rehabilitation
  • surgery
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38
Q

What is chronic bronchitis?

A

chronic inflammation of the bronchi

having a cough with sputum production that last at least 3 months for 2 consecutive yrs

acute is part of a general URI (after commmon cold or other viral infection of naspharynx and pharynx), recurring may indicate focus of infection (chornic sinusitis, bronchiectasis, pneumonia), hypertrophied tonsils and adenoids, allergens, pneumonia bacteria , smoking or exposure to industrial poolution or recurrent infectiosn

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39
Q

Risk factors for chronic bronchitis

A
  • tobacco use
  • exposure to secondhand tobacco smoke
  • exposure to irritants on the job
  • decreased immunity
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40
Q

What is hypoxia?

A

insufficient oxygen of the tissue

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41
Q

What does excessive secreretion of mucus result in?

A

excessive secretion of mucus blocks airflow through the bronchi which reduce persons ability to obtain enough O2m which = infections = leading scarring destruction of cilia and tissue death

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42
Q

What are the s/s of chronic bronchitis?

A

Auscultation may show decreased breath sounds, wheezing, and crackles
The percussion note will be normal to hyerresonant.
mucus-producing cough
wheezing
fatigue
slight fever
chills
chest discomfort

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43
Q

Who are at high risk of developing chronic bronchitis?

A

People exposed to industrial dusts and fumes in the workplace, such as coal miners, grain handlers, and metal molders

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44
Q

how to diagnose chronic bronchitis?

A

medical history
physical examination
chest x-ray
spirometry
sputum analysis
pulmonary function test
ABG
other blood and sputum analysis

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45
Q

What is the treatment for chronic bronchitis?

A

the goal is to relieve symptoms, prevent complications, and slow progression of the disease

  • quit smoking
  • bronchodilator meds
  • pulmonary rehab
  • surgery
  • low-flow oxygen therapy for hypoxemia
  • postural drainiange and percussion
  • aerosolized corticosteroids
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46
Q

What is asthma?

A

condition in which the bronchial tubes in the lungs react to certain stimuli by becoming inflamed (constriction of bronchioles and inflammation of airway)
- leading cause of chronic illness and school absenteeism in children

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47
Q

What are the risk factors for asthma?

A

family history of asthma and exposure to certain irritants known as triggers

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48
Q

What is the etiology of asthma?

A

it’s idiopathic, it is known ppl with asthma have very sensitive airwats that react to many diff substnaces ,activites and conditions

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49
Q

What are common asthma triggers?

A

indoor and outdoor allergens (pollen, cockroaches and their excrement, molds, household dust mites, pet dnader)
tobacco smoke
chemical irritants (perfumes, colognes and aftershaves)
cold air
extreme emotional arousal
certain medications (aspirin and other nonsteroidal anti-inflammatories and beta blockers)
physical exercise

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50
Q

how to diagnose asthma?

A

based on s/s, med history, phyiscal exam, spirometry, peak flow, and bronchial provocation, chest xray, allergy testing, pulmonary functoin test, chest radiography, CBC and differnetial leukocyte count which may show an increaed eosinophil count and elevated serum IgE levels

51
Q

what are the s/s of asthma?

A

intercostal or sternal retraction
dyspnea
tightness in the chest
coughing
wheezing
incessant productive or nonproductive cough
expiratory wheeze
rapid shallow respirations
- labored vreathing results in rapid pulse, pallor, profuse perspiration, inabiltiy to speak more than a few words without halting to breathe
nasal flaring
pt is often anxious is exhausted and reports tight chest
Auscultation may reveal decreased breath sounds and wheezing

52
Q

What occurs during asthma?

A

bands of muscles that r normally relaxed tighten with asthma, restricting airflow, causing pt to feel SOB and create wheezing sound

53
Q

What is an asthma attack?

A

sudden worsening of asthma s/s

54
Q

How to treat asthma?

A
  1. meds - steroids and anti-inflam meds and bronchodilators
    - drugs like cromolyn sodium , albuterol, theophylline, aerosol corticosteroids, allergy evaluation and skin testing may indicate immunotherapy by desentization injection, commonly called allergy shots
    steroids, inhalation therapy, supplemental oxygen, status asthmaticus may ead to fatal respiroatry failure and thuse need for endotracheal intubation
55
Q

hat is the most important treatment for pt w/ asthma?

A

anti-inflam meds (particularly inhaled steroids)

56
Q

What are bronchodilators?

A

meds to relax muscles that can tighten around airways and help open them up

short-acting bronchodilators r rescue inhalers
long-acting bronchodilators r used with inhaled steroid for ongoing asthma s/s

57
Q

What is a nebulizer?

A

asthma inhaler that delivers asthma drugs to lungs by changing asthma meds from liquid form to mist so they can be more easily inhaled into lungs

58
Q

What is cystic fibrosis (CF)?

A

autosomal recessive inherited disease (chronic dysfunction of a gene called cystic fibrosis transmembrane conductance regulator (CFTR))
- most common fatal genetic disease
affects the exocrine glands of the lungs and pancreas causing these glands to secrete excessive thick mucus

59
Q

what is the risk factor for CF?

A

family history of CF or being Northern European or Central European

60
Q

Other CF factors?

A
  • higher levels of salt in sweat
  • thick sticky mucus secreted in lungs = dyspnea, wheezing, and persistent cough with thick sputum
  • increased susceptibility to recurrent lung infections
  • excessive mucus blocks ducts of pancreas = no release of digestive enzyme = wt loss and malnutrition
  • pancreatic glands become dilated and develo into cysts containing thick mucus
61
Q

What is bronchiectasis?

A

weakened and dilated bronchial tubing, resulting from destructio nof muscular and elastic portions of the bronchial walls

common complication/ aftermath of CF

Caused by repeated damage to bronchial wall caused by recurrent airway infections (pneumonia, TB, bronchal obstruction, inhalaltion of a corrosive gas, measles, pertussis, immunedeficiency)

62
Q

how to did cystic fibrosis get it’s name?

A

from the fibrous tissue that forms around these cysts.

63
Q

what is tested in newborns in US?

A

higher levels of immunoreactive trypsinogen (IRT) released by the pancreas

then test for genetic and sweat test

64
Q

diagnosis and treatment for CF?

A

diagnose - genetic testing prenatally, fmaily history, pulmonary fucntion, chest radiography, stool studies, sweattest

treatment:
ease s/s, reduce complications
high calorie, high soidm chloride diet
chest physiotherapy
supplementation of vitamins A, D, E and K
increase fluid intake
pancreatic enzyme supplementation to aid in digestion
exercise to loosen mucus to be coughed up
mucus-thinning meds
anti-inflam meds to reduce swelling
bronchodilators
oxygen therapy
nebulizer
percussive therapy

65
Q

What is pleurisy/ pleuritis?

A

inflammation of the pleural membrane lining the chest wall and encasing each lung

usually secondary to other diseases or infections (may result from injury or presence of tumor0

2 types: wet (extra pleural fluid btwn 2 layers of plural membranes = compression of pulmonary tissue and dynspnea) and dry (pleural fluid decreases involume = dryness btwn pleura so layers rub together)

66
Q

risk factors of pleurisy?

A

lung infection
chest trauma
pulmonary embolism

67
Q

s/s of pleurisy?

A

sharp chest pain that worsens with breathing in or coughing caused by inflamed pleura layers rubbing together

may cause dyspnea and tachypnea

auscultation reveals a pleural rub

cough, fever, chills

inspiration r shallow, rapid and restricted

68
Q

How to diagnose and treat pleurisy?

A

diagnose - based on s/s , physical exam, blood test for pathogens, imaging tests, testing pleural fluid and tissue to determine cause (and if it’s bacterial infection)

treat - maybe antibiotics, over-the-counter or prescription nonsteroidal anti-inflammatory meds, antibiotics, analgesics,

69
Q

What is pneumothorax?

A

collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse

(pressure in pleural space is higher than pressure in lungs)

70
Q

risk factors for pneumothorax:

A

being male, smoking, being tall and underwt, having certain lung diseases and history of pneumothorax

71
Q

s/s of pneumothorax?

A

sudden, sharp pain on the same side as the affected lung dyspnea
Auscultation may reveal diminished or absent breath sounds on the affected side.
The percussion note is tympanic.
mediastinal shift
severe SOB
falling bp
rapid weak pulse
cyanotic
appears anxious
increased air pressure

72
Q

What can penumothorax be caused by?

A

traumatic pneumothorax - injury to chest, damage to lungs caused by underlying lung disease (emphysema, TBB, CF< pneumonia, lung cancer)

rupture of air-filled blisters (blebs) found in lungs of some ppl who are tall and underwt

erosion of alveoli from tumor or disease

73
Q

how to diagnose and treat pneumothorax?

A

diagnose - symptoms, physical exam, ausculation of lungs, radiography or CT, thoracostomy, ABG analysis, imaging tests

treat - small portion = monitoring, if large area, a needle or chest tube is inserted into the chest cavity to relieve the pressure on the lungs to reexpand, may need surgery, fowler or semi-fowler position, thoractostomy, closed drainage system is established if air continues to leak into pleural space

74
Q

What is atelectasis?

A

collapse of lung tissue affecting part of or all of one lung

alveoli in that part can no long fill with air = no gas excgabge

75
Q

risk factors for atelectasis

A

anesthesia
prolonged bed rest with few changes in position, shallow breathing
underlying lung disease

76
Q

s/s of atelectasis?

A

substernal retraction
mediastinal shift toward side of collapse
dyspnea
chest pain
cyanosis
coughing
Auscultation may reveal diminished or absent breath sounds on the affected side
The percussion note is dull
hypoxia
anxiety
diaphoresis
tachycardia
fever

77
Q

most common cause of atelectasis?

A

blockage of bronchu or bronchioles or by pressure on the lungs through a mucus plug where drugs during surgery = less inflation in lungs = normal secretions collect in airways and smthms surgery doesnt compeltely clear them away

compression is when tumor exerts pressure on lung and doesnt allow air to enter that part

inflammaotry is result of accumnulation of fluid in pelueral cavity

78
Q

who is mucus plugs most common in?

A

Pt with CF, during severe astham attack

79
Q

diagnose atelectasis?

A

diagnose - med history, physical exam and chest xray, CT, bronchoscopy

80
Q

how to treat atelectasis?

A
  • aerosolized respiratory treatments to open the airway
  • positioning the body on the unaffected side to allow the affected lung to reexpand
  • removing obstructions by bronchoscopy
  • breathing exercises, clap, or percussion on the chest to loosen mucus
  • tilting the body (postural drainage) so that the head is lower than the chest to drain mucus
  • treating a tumor or underlying condition, if present
  • spirometry
  • analgesics
  • sirgcal drainage of pleural effusion
81
Q

What is a pulmonary embolism?

A

blockage in one or more arteries of the lungs

etiology is usually thrombi from deep vein in legs or pelvis, can be composed of air, fat globules, small piece of tissuem cluster ofg vacteira

82
Q

risk factors for PE?

A
  • prolonged immobility
  • having major surgery
  • hip or leg fractures
  • having a family history of PE
  • cancer
  • smoking
  • obesity
  • a history of heart attack or stroke
  • pregnancy
  • taking birth control pills
  • hormone therapy.
83
Q

what are the s/s of pulmonary embolism?

A

cough that may produce bloody or blood-streaked sputum
sudden dyspnea
tachypnea
chest pain
tachycardia
apprehension
cough
low-grade fever
massive can elad to cyanoisis, shock, death

84
Q

what is most common cuase of PE?

A

In most cases PE is caused by a blood clot in the leg
that breaks loose and travels to the lung

85
Q

howto diagnose and treat PE?

A

Diagnose - medical history, physical examination for ausculation (reveals crackles and pleural rubs in area of embolism in 1/2 of PE pt) and imaging tests, lunh scanning, CT angiography, ECG, auscultion, ABG for reduced partial persure of oxygen and carbon dixoide

treatments - usually anticoagulation, use clot dissolvers or surgery in extreme cases, oxygen therapy, thrombolytic drugs, early ambulation, low-dose anticoagulultiaotn agents, tnromboembolic detterent stockings

86
Q

What is lung cancer?

A

malignant neoplasm arising in lung tissue

leading cause of cancer death in men and women in US (causes 30% of all deaths)

usually caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell diviison

avg age of diagnosis is 70

87
Q

risk factors of lung cancer

A

smoking
exposure to secondhand smoke
age (over 65)
exposure to asbestos or radon
genetics, and a family history of lung cancer

88
Q

2 basic types of lung cancer

A

non-small cell lunger cancer (NSCLC) accounts for 80% of lung cancer

small cell lung cancer = 20% (almost exclusively in smoker, has rapid growth rate, metastazies early in disease process)

89
Q

s/s of lung cancer

A

develops slowly, only seen in later stages of lung cancer

coughing, chest pain, hemoptysis

blood in sputum bc erosion of bv

dyspnea, wheezing bc of airway obstruction from compression by tumor and body fluids such as mucus and blood

anorexia, wt loss and weakness

brain is common site for mtastais so headache, weakness, change in mental status, seizures

90
Q

__% of lung cancers are a result of tobacco use

A

90

91
Q

How to diagnose and treat lung cancer?

A

diagnsoe - med histro, phyiscal exam, imaging tests, and sputum cytology, bipsy, fine-needle aspiration, CT, epidermal grwoth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) (if small cell lung cancer staged by limited (only 1 lung) or extensive (both lungs or metasize)

treatment - surgery resection (lobectomy), chemotherapy, radiation, targeted therapy to decrease growth of tumor cells

92
Q

On average, _______ of the respiratory membrane is lost each year after age 30.

A

one square foot

93
Q

s/s of cystic fibrosis in lungs

A

bronchial obstruction w/ stasis of secretion
dry cough
dyspnea
tachypnea
barrel chest
pneumonia
chronic respiratory tract infection
cyanosis
clubbing of fingers and toes
Chronic pulmonary disease

94
Q

s/s of cystic fibrosis in intestines

A

malabsorption of fat and protein
vomiting
large, bulky, foul-smelling stools
distented abd
poor wt gain
failure to thrive
excessive appetite
deficiency of fat-soluble vitamins
bowel obstruction

95
Q

s/s of cystic fibrosis in pancreas

A

obstruction of pancreatic ducts
pancreatic insufficiency
atrophy of pancreas
absence of pancreatic digestive enzyme
pancreatic changes occur w/ fat and fiber replacing normal tissue

96
Q

s/s of cystic fibrosis in liver

A
  • obstruction of bile ducts
    biliary cirrhosis
    portal hypertension
97
Q

s/s of cystic fibrosis in sweat glands

A

sweat gland dysfunction
sweat glands cause increase concentration of salt in sweat
dehydration
loss of electrolytes

98
Q

What is bronchiolitis +s/s and etiology?

A
  • inflammation of bronchioles, smallest air passages of lungs and r usually caused by viruses
  • common disease in infancy
  • s/s r posttussive emsis, cough and nasal congestion that evolve into wheeze, tachypnea and respiratory distressm fever, breathing too fast to feed proplery and can become dehydrated, apnea
  • commonly caused by RSV can also be caused by parainfluenza birus and adenovirus
  • most common during winter months (OCt throug hApril)
99
Q

how to diagnose and treat bronchiolitis

A

diagnose - pt history and physical exam, chest radiograph to rule pneumonia, rapid RSV testing, viral culture from nasopharynx

treatment - supportive care, albuterol, racemic epinephrine, or hypertonic saline given my nebulizer, suplpmenetal oxygen, administered by IV fluids, intubated and mechanially bentilted in extreme cases

100
Q

What is infantile colic + s/s, etiology, diagnose and treat?

A
  • intermittent distress in newborn or during early infancy and has unclear etiolgoy
  • s/s r infant intermittently draws up legs, clenches fists, cires as if in pain (may pass gas via mouth or rectum), likely in late afternoon and evening, babies usally thrive, gain wt, appear to tolerate formulas
  • etiology is unknwon by theories r improper feeding techniques, overfeeding, swallowing excessive air, sensitivity to cow’s milk
    diagnose - symptoms and phyiscal exam
    treatment - usually outgrows condition at abt 3 months, probiots or simethicone can sometimes provide relief
101
Q

What is pulmonary abscess + s/s and etiology?

A
  • cavity of contained infectious materials in lungs
  • more common in lower poriton of lungs and in R lung
  • main s/s r alternating chills and fever, chest pain, purulent, bloody, foul-smelling sputum and foul-smelling breath
  • often a compicatio of pneumonia caused by bacteria, aspiration of food, foreign objects, bronchial stenosis, neoplasms,septic embolism,
102
Q

diagnose and treat pulmonary abscess

A

diagnose - decresed breath sounds on auculation, recent aspiration, chest radiography, blood and sputum culture

treat - use of antibiotics, surgical resection of abscess

103
Q

What is respiratory syncytial virus pneumonia + s/s

A
  • inflammatory and infectious condition of lungs (most infants, young children, and older adults)
  • s/s r coldlike symptoms, nasal congestion, otitis media, coughing, fevre, malaise, lethargy, more frequent coughing, wheezing and yspnea
  • caused by RSV (mostly in winter months)
104
Q

How to diagnose and treat RSV pneumonia?

A

-diagnose - clinical fingdings, physical exam, lavage of nasal pharynx, giant syncytial cells when grown in tissue culture

treat - mostly self-limiting, antipyretics, antibiotics, inhalaltion terhapy if invades lower respiratory tract (inhalation of 3% hypertonix saline)

104
Q

What is histoplasmosis?

A
  • fungal disease originaiting in lung and is caused by inhalaltion of dut containing Histoplasma capsulatum
  • may cayse pneumonia or become systemic, many pt r asymptomatic, not contagious, dyspnea, loss of energy, fewbrile, spleen and lympg nodes become enlarged
  • most common endemic mycosis in US (mostly in MW US)
105
Q

how to dinaogse and treat histoplasmosis?

A

diagnose - clinical findings, positive skin test result, blood serologic findsings, identification of fungus in pus, sputum, or tissue specimen, chest radiographs

treat - when self-limiiting no antifungal therapy, also corticosteroids

106
Q

What is blastomycosis?

A

0i fungal infection caused by inhaling fungus Blastomyces dermatitidis, which fgrows a a modl in moist soil and wood
- found in sp[ecific areas in North Amierca, with greatest pervalence in Upper midwest and Southward along Missippi and Ohio riverbends

107
Q

What is coccidoidomycosis?

A
  • caused by Coccidioides immitis
  • In Southwest
  • produces spores that live in soil
  • causes San Joaquin Valley
  • contract when dry soil is picked up by wind and spores r breathed in
108
Q

What is swine-origin influenza A virus (H1N1) infection + s/s, diagnose, treat

A
  • aka Swine flu
  • unusual mix of swine, bird, human flu viruses (most ppl have little or no immunity against it)
  • s/s r fevere, cough, sore throat, body ache, headache, chills, fatigue, diarrhea, vomitting
  • treat with oseltamiviris (tamiflu) and zanamivir (relenza)
  • diagnose with realt-time reverse transcription plymerase chain reation (RT-PCR) and viral culture
109
Q

S/S OF ACUTE bronchitis?

A
  • deep, persistent, prodctive cough
  • thick, yellow to gray sputum
  • SOB
  • wheezing
  • slightly elevated temp
  • pain in upper chest
    acute symptoms subside within a wk but a couhg may continue for 2 to 3 weeks
110
Q

s/s of bronchiectasis?

A
  • takes may years to develop, usually bilateral, involves lower lobes of lungs
  • chronic halitosis
  • chorinc cough
  • large quantities f purulent, foul-smellign sputum
  • hemoptysis
  • dyspnea
  • wheezing
  • fevere
  • general maliase
111
Q

how to diagnoe and treat bronchiectasis?

A

diagnose - physical exam, history of symptoms, chest radiography, high-resolution CT, bronchoscopy, sputum culture, pulmonary function

treat - antibiotics, bronchodilators, postural drainage, sputum removal management, vibratory devices, avoiding environmental irritants (such as smoke, fumes, large amounts of dusts), removal of affected part of lung if lots of hemoptysis

112
Q

What is pneumoconiosis?

A
  • any disease of lung caused by long-term mineral dust inhalation
    forms:
  • Asbestosis (exposure to asbestos fibers, slow and progressive diffuse fibrosis of lngs, most common)
  • anthracosis (black lung or coal miner’s lung, accumulation fo carbon deposits in lung from inhaling smoke or coal dust)
  • silicosis (inhaling silica (quartz) dust and causes dense fibrosis of lungs and empysema)
113
Q

s/s of pneumoconiosis?

A
  • dyspnea on exertion
  • dry cough (later turns productive, similar to cough of chronic bronchitis)
  • pulmonary hypertension
  • tachypnea
  • general malaise
  • recurrent repiratory tract infections
114
Q

how to diagnose and treat pneumoconiosis?

A

diagnose - pt history, physical exam chest radiographic studes, pulmonary function test, ABg

treat - relieving symptoms, bronchodilatior, oxygen therapy, chest physical terhapy, corticosteroids, lung transplant, treat TB aggressively, stop smoking

115
Q

What is hemothorax + s/s, etiology, diagnose and treat?

A

accumulation of blood and fluid in pleural cavity
- s/s r pale and clammy skin, weak and thready pulse, falling bp, chest pain, labored and shallow/ gasping respirations
- cause is trauma, erosion of pulmonary vessel or hematologic disordes
- diagnose with diminished or breath on affected side, radiographs, blood tests, ABG
- treat which horacostomy

116
Q

What is flail chest +s/s, etiology, diagnose and treat?

A
  • condition of instability in chest wall caused by multiple rib fracture, sternum also may be fractured
  • s/s r double fracture of 2 or more adjacent ribs, severe pain, dyspnea, cyanotic, extremely anxious, paradoxical breathing
  • caused by direct trauma from direct compression by heavy object, MVA, hard fall onto solid object or industrial accident
  • diagnose with chest truama and paradoxical movement, chest radiography
  • treat with stabilizing chest wall, allowing rib fractures to heal while maintaining respiratory integrity, mechanical ventilation and sedation of pt w/ endotracheal tube, pain meds, supplemental oxygen, rib fixation
117
Q

What is infectious mononucleosis + s/s?

A
  • epstein-barr virus infection (aka glandular fever)
  • acute herpesvirus infection
  • ss r cervical and generalized lyphadenopathy, tnsil appear coated with debris, mild transient hepatitis, atypical lymphocytosis, general maliase, anorexia, chills, sore throat, fevere, headache, fatigue,
118
Q

how to diagnose and treat infctious mononucleosis?

A
  • diagnose with history and physical exam to rule out hepatitis, leukemia, Hodgkins lyphoma, lymphosarcoma, blood smear exam, immunologic study of blood serum, infectious mononucleosis blood screening test, antinuclear antibody (ANA), total serum bilirubin, liver function tests, EBV serology
  • treat based on symtpoms: bed rest, fluid intake, IV fluids, antipyretic meds,
119
Q

What is adult respiratory distress syndrome (ARDS)

A
  • type of acte lung injury, characterized by severe pulmonary congestion, acutre respiratory distress, hypoxemia
120
Q

What is adult respiratory distress syndrome (ARDS)

A
  • type of acte lung injury, characterized by severe pulmonary congestion, acutre respiratory distress, hypoxemia
  • secondary to some agent of insult that precipitates increased capillary permeabiltiy in lungs, pulmonary edema, resulting respiratory failure, injury to cells activates leukocytes and platelets to release additional injury = albeoli fill with exudate = collapse at end of expiration
121
Q

s/s of ARDS?

A
  • severe hypoxemia
  • progressive hypercapnia
  • acidosis
  • intercosta and suprasternal retraction w/ cyanosis or mottled skin
  • septicemia
  • shock or insult to lungs
  • hemorrhagic, wet, boggy, congested, unable to diffuse oxygen lungs
  • atelectasis
  • sudden and severe dyspnea w/ rapid and shallow respiration
122
Q

diagnose and treat ARDS?

A

diagnose - have underlying cause: pneumonia, fulminating sepsis, asapiration of gastric contents, hypovolemic shock, near-drowning episode, fat embolism, cardiopulmonary bypass, chest radiograph,s, ABG

treat - no cure, only supportive, oxygenation by establishing an airway, administered humidfied oxygen, suction the air passage, protective lung ventilation strategy, mechanical ventilation w/ addition positive end-expiratory pressure (PEEP), nutritional status, cautious hydration, renal failure, superinfection

123
Q

What is sarcoidosis +s/s, etiology, diagnose and treat?

A
  • multisystem granulomatous (small lesions of inflamed cells) most common in lungs
  • s/s r dry cough, SOB, mild chest pain from loss of lung volume and abn lung stiffness, fatigue, fever, wt loss, swollen ankles, joint pain
  • cause is unknown, thought to be malfunction of immune system or caused by virus, exposure to toxins in environment or other insults
  • diagnose w/ complete medical eval, history, physical exam, chest radiography, labh tests, pulmonary function studies, biopsy
  • treat: most resolve spontaneously, may need corticosteroid therapy, immunosuppressant drug methotrexate

Pathophysiology - Diseases (22 decks)

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