Lower Respiratory tract Flashcards
Anything that’s in lower respiratory tract is from what?
Trachea down
How many lobes on right and left?
3 right
2 left
What is atelectais ?
Collapsed, airless alveoli
Atelectasis is what? Sounds like and percussion like?
Decreased or absent breath sounds
Dullness on percussion
When the alveoli are collapsed we can’t perform what? And means?
Gas exchange
We aren’t getting enough perfusion in the body
What causes Atelectasis?
Secretions obstructing small airways
Who are at high risk of Atelectasis? (2)
Bedridden
Post op abdominal & chest surgery
What is the prevention & treatment (3)
Encourage them deep breathing incentive spirometers
Early mobility
The reason why we want our patient to get up and start moving is after getting aceletasis because it lowers the risk of ?
pneumonia
What is acute bronchitis?
And usually caused by?
Self limiting inflammation of bronchi
Caused by viruses
What are some other triggers of acute bronchitis? (5)
Pollution
Chemical inhalation
Smoking
Chronic sinusitis
Asthma
What are the symptoms of acute bronchitis? (7)
Cough
Clear/purulent sputum (pus)
Headache
Fever
Malaise
Dyspnea
Chest pain
What is the acute bronchitis diagnosis? (3)
It depends on the assessment of breath sounds
Crackles or wheezes
Do we give antibiotics to acute bronchitis? Why?
No
Because it’s mainly a virus that causes this
What is the treatment goal for acute bronchitis? (3)
Symptom relief
Prevent pneumonia
( supportive care )
What are some treatments we are going to perform on the patient with acute bronchitis? (5) and provide description of each
Cough suppressant, oral fluid, humidifier
B2 agnosit inhaler for wheezing or underlying pulmonary condition
Avoid irritants
Flu shot
Or see HCP ( healthcare professional ) if symptoms last longer than 4 weeks
What is the bacteria name for pertussis?
Bordetella pertussis
Bordetella pertussis is a what type of bacteria?
Gram negative
The gram negative Bordetella pertussis attaches to what and releases what? And results in what? (3)
Attached to cilia ( nose hair )
Releases toxins
Results in inflammation
Pertussis is highly what?
Contagious
How do we help prevent pertussis? What do we do? And when do we give it?
TDaP vaccine
At 11 years old
What are the 3 manifestations of pertussis?
Stage 1
Stage 2
Stage 3
What is stage 1 manifestations for pertussis (5)
How long too?
1 to 2 weeks
Low grade fever
Runny nose
Watery eyes
General malaise
Mild nonproductive cough
What is state 2 manifestations pertussis?
How long?
2 to 10 weeks
Paroxysms of cough
( hallmark ) whooping
What is stage 3 pertussis? And how long ? (2)
2-3 weeks
Less severe cough
Weak
What are the 3 hallmark characteristic of pertussis?
Uncontrollable
Violent
Cough with whooping sound
What is diagnosis pertussis (3)
What are we gonna do to diagnosis it
Nasopharyngeal cultures
PCR of nasopharyngeal secretions
Serology testing
What is main treatment of pertussis?
And 4 examples?
Macrolides
Erythromycin
Clarithromycin
Azithromycin
Trimethoprimsulfamethoxazole
Pertussis treatment can also be for what type of exposure other than already having it?
Close contact exposure
Pertussis have what two precautions?
Routine and droplet
For childern what vaccine do we give for pertussis?
DTaP
Why do we give pregnant women Tdap vaccine ?
In order to prevent anything to the baby
What is pneumonia?
Which can’t?
And can be from ?
Secretions or thick fluid in alveoli
And can’t gas exchange
And can be from atelectasis
Pneumonia is an acute ?
Infection of lung parenchyma
Pneumonia is associated with significant ? (2)
Morbidity and mortality rates
Pneumonia and influenza are the what leading cause of death in US?
8th
What are the common pneumonia symptoms that All pneumonia type share? (14)
Fever
Difficulty breathing !!
Sweating
Cough
Chest pain
Fast heartbeat
Shortness of breath
Loss of appetite
Nausea
Vomiting
Diarrhea
Low energy
Muscle pain
Shaking/chills
How do you tell the differences between each pneumonia?
By collecting a sputum sample
Pneumonia can start off acutely however it’s mainly found how?
When patients already have an illness and it gets progressively worse
And get a secondary increase in temp
What are the normal defense mechanisms for pneumonia? (8)
Air filtration
Epiglottis closure over trachea
Cough reflex
Mucociliary escalator
Reflex bronchoconstriction
IGA
IGG
alveolar macrophages
Defense mechanism become what for pneumonia ? (2)
Incompetent or overwhelmed
How do defense mechanisms become Incompetent or overwhelmed by pneumonia? (7)
Aspiration
Tracheal intubation
Air pollution
Smoking
Viral URI
Aging
Chronic diseases
What are the 3 ways organisms reach lungs of pneumonia?
- Aspiration of normal flora from nasopharynx or oropharynx
- Inhalation of microbes present in air
- Hematogenous spread from primary infection elsewhere in body
What are the 2 most effective classification of pneumonia? And names?
CAP community acquired pneumonia
HAP hospital acquired pneumonia
How does HAP or nosocomial pneumonia happen?
Occurs 48 hours after hospitalization and not present at time of admission
How does VAP happened and stand for?
Ventilator associated pneumonia
Occurs 48 hours after endotracheal intubation
When a patient has crackles or wheezes or other fluid in the lungs and their ferbile , not looking great and having trouble breathing, what can we do?
Provide
Empiric treatment
What empiric antibiotic therapy means? (3)
You don’t know what is causing the pneumonia
All you know is that the patient has pneumonia
Therefore you can select an antibiotic to treat them with
Will empiric treatment be effective on an virus pneumonia? Why?
No because it’s giving antibiotics
When do you want to start empiric antibiotic treatment for pneumonias? After what diagnosis (6)?
Risk factors
Early vs late onset
Presentation
Underlying medial conditions
Hemodynamic stability
Most likely causative organism
What are 2 medication examples of empirc treatment for pneumonia?
Amoxicillin & Doxycycline
What are the 6 types of pneumonia?
Viral
Bacterial - extreme unwell & hospital
Mycoplasma - bacterial & virus ( atypical )
Aspiration
Necrotizing
Opportunistic
What’s the most common pneumonia to get?
Viral
What is aspiration pneumonia?
And triggers what?
Abnormal entry of oral or gastric material into lower airway
Inflammatory response
What are the Major risk factors of aspiration pneumonia? (5)
( look at how many A’s there is )
Decreased level of consciousness
Depressed cough
Depressed gag reflex!!!
Difficulty swallowing
Insertion of nasogastric tube with or without tube feeding
Aspiration pneumonia is the primary bacterial infection? True or false?
Yes
Aspiration of ____ causes gastric pneumonia and results in what? And hours?
Acid Gastric contents
Possible bacterial infection
24-72 hours
What is necrotizing pneumonia?
What type of infection?
And results from what?
Thick/liquid mass
Destruction of the lung
Bacterial
CAP
What are the 3 signs of necrotizing pneumonia?
Immediate respiratory insufficiency/failure
Leukopenia - low WBC
Bleeding into airways
where do we see necrotizing pneumonia? (2) what type of treatment patients get
Radiation
Chemotherapy
What is the treatment of necrotizing pneumonia?(2)
Long term antibiotics
Possible surgery
Necrotizing pneumonia, we can see what type of edema ??
Pulmonary edema
What is opportunistic pneumonia?
Immunocompromised patients
Usually has already existing infection and pneumonia comes along
Who are at risk at getting opportunistic pneumonia? (4)
( like they are like severely what?)
Severe protein calorie malnutrition
Immunodeficiencies
Chemotherapy/ radiation
Immunosuppression therapy
(Long term corticosteroid therapy)
What is opporynitistic pneumonia caused by? (3)
( think literally, it can be from??)
Bacterial
Virus
Microorganism
What is pneumocystis jiroveci pneumonia?
What infection and most common in?
Fungal infection
HIV patients
____is a fungus ball that colonized in a healed lung scar or abscess from a previous disease
Aspergilloma
Pneumocystis Jiroveci pneumonia (PJP) has what type of symptoms?
Slow onset
What is the slow onset for PJP? (6)
Fever
Tachycardia
Tachypnea
Dyspnea
Nonproductive cough
Hypoxemia
PFP can be life threatening how or more so cause what?
Respiratory failure
PFP can do what to other organs?
Spread
( cause it’s a fungus )
Does antifungal medication work on PFP?
No
What’s the treatment of PJP? (2)
Trimethoprim
Sulfamethoxazole
What is cytomegalovirus (CMV) pneumonia?
Herpes virus
What will we see in patients who have CMV pneumonia? Symptoms (2)
Asymptomatic/mild
To severe
Why do we see asymptomatic in CMV pneumonia?
Because of their impaired immunity from the herpes
In who does CMV pneumonia effect?
HIV and AIDS patients
What’s the treatment of CMV pneumonia? (2)
&
#1 complication of Hematopoietic stem cell transplantation is CMV
Anti viral medications
High dose immunoglobulin
What’s the 5 steps of pathophysiology of pneumonia?
Inflammatory response
( white blood cells attraction )
Alveoli fill with fluid
( consolidation )
Decreased production of mucus
( airway obstruction )
Decreased gas exchange
Resolution of infection
( gas exchange back to normal )
What’s the most common manifestations of pneumonia ?
(7)
Cough : productive(pus) or nonproductive(nothing comes out)
Green, yellow, or rust color sputum
Fever
Chills
Dyspnea
Tachypnea
Pleurtic chest pain
What will we see in older or debilitated patients of manifestations of pneumonia? (3)
Confusion
Stupor
Hypothermia
What’s the physical examination manifestations? (5)
( what are we doing to the person )
Fine/coarse crackles
Consolidation ( fluid in lungs )
Bronchial breath sounds
Egophony
Increased fremitus
( pleural effusion - fluid of pleural cavity )
Dullness percussion
What is Egophony?
E to A sound
What does bronchial breath sounds mean?
You’ll hear more “breath” sounds on the midline of chest than on the side of the lung
What is fremits pneumonia ?
Increased or decreased vibrations
What are the complication of pneumonia and means?
MDR
multi drug resistant pathogens
Whatever antibiotics we have, the pneumonia is resistant to it
What are the risk factors of MDR? (4)
Age
Immunosuppression
History of antibiotic use
Prolonged mechanical ventilation
What are the diagnostic studies for pneumonia? (8)
History and physical exam
Chest X ray
Thoracentisis & Bronchiscopy
Pulse oximetry
Arterial blood gases
Sputum gram stain, culture, sensitivity
Blood culture
CBC with differential
What’s a thoracentesis?
Needle into the fluid in the back
Into a bag
What’s a bronchoscopy?
Looking with a camera down the nose into the bronchi
What interprocessional care can we give for pneumonia?
And names ?
Pneumococcal vaccine
prevnar 13 & pneumovax 23
Inter professional care of pneumonia
We want to prompt treatment with___ which response generally occurs within 48-72 hours
And results in 3
Then you ready chest X ray in what weeks
Antibiotics
Decreased temp
Improved breathing
Decreased chest discomfort
6-8 weeks
We may also want to give supportive care to viral pneumonia by doing 5 things?
( like what treatments can we give for like hypoxemia?)
Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics for fever
Adjuvant drugs
Rest & acitivity
What type of nutrition do we want for a pneumonia patient? (4)
Small
Frequent
High calorie
Nutritious meals
What’s the most important thing for nutritional therapy for pneumonia?
Hydration!!!
We also have to monitor weight for patient of pneumonia why?
Because they can get dehydrated and lose weight
What’s some subjective data for pneumonia? Nursing assessment
Past health history
Medications
Surgery
Tube feeding
Intubation
Health perception
Nutrition
Activity
Cognitive
What is objective data for pneumonia?
What we see on patient
Like labs, respiratory etc
What’s the nursing goal/ plan for pneumonia?
Good breath sound
Normal breathing patterns
Normal chest x ray
Abscesses of complications
Nursing implementation for pneumonia
Health promption includes?
Teach hygiene
Nutrition
Rest
Regular excerise
No smoking
Risk facts
Influenza & pneumonia vaccine
What’s acute care for nursing implementation pneumonia? (6)
Oxygen
Hydration
Nutrition
Breathing exercises
Early ambulatory
Positioning
Prevent aspiration pneumonia how?
Acute care (7)
Elevate head of bed 30^
Assist with eating.drinking.meds
Assess for gag reflex!!
Monitor reflex and gastric residual
Early mobilization
Cough & deep breathe
Twice day oral hygiene
Last acute care, what’s the best way to reduce infections? Like medical asepsis?
Hand hygiene !!!
