Lower Respiratory Tract Infections Flashcards
List the defence mechanisms of LRT.
Mucus Cilia Swallowing, coughing, sneezing Alveolar macrophages and lymphoid tissue Immunoglobulin A Normal flora bacteria - G+ - streptococci, staphylococci
Describe acute bronchitis
Acute inflammation of the bronchial tree leading to a cough.
Cough can last 3 weeks.
Absence of pneumonia.
Usually self-limiting.
Symptoms of acute bronchitis is caused by the acute inflammation of the bronchial tree. What are these symptoms?
Increased mucus production
Oedema of the bronchus
Cough
Wheeze
May have temperature
Infection may be cleared but repair of bronchial wall takes weeks hence patient may still have cough
Pulmonary function tests show bronchial obstruction seen in asthma but will return to normal
What are some self-care treatment options for acute bronchitis?
Honey and lemon Pelargonium Paracetamol/ibuprofen OTC expectorant - guaifenesin OTC antitussive/cough suppressant - pholcodine
Describe community acquired pneumonia.
Acute infection of the lung parenchyma caused by bacteria or virus. Causes localised collapse and consolidation of alveolar sacs causing impaired gas exchange.
What are the complications of community acquired pneumonia?
Pleural effusion - build up of excess fluid between pleural membrane and lungs.
Lung abscesses - pus-filled cavity in your lung surrounded by inflamed tissue.
Acute respiratory disease syndrome (ARDS) - life-threatening lung injury that allows fluid to leak into the lungs.
Septic shock - dangerous drop in blood pressure.
What are the 8 risk factors for developing community acquired pneumonia?
Age = >65 Residence in healthcare setting COPD Smoker/exposure to cigarette smoke Alcohol abuse Poor oral hygiene Contact with children Use of acid regulating drugs
What are the symptoms (7) of community acquired pneumonia?
Dyspnea - shortness of breath Sputum production - maybe mucopurulent Pleural pain - sharp chest pain Sweating Fevers Rigors - shivering Aches and pains
What should be monitored in hospital acquired pneumonia?
Monitor pulse, BP, Respiratory Rate, temperature, oxygen saturation, mental status, CRP (if no improvement in 48-72hours).
Describe bronchiolitis.
Viral infection predominately caused by respiratory syncytial virus.
Causes inflammation of the epithelial lining of the bronchial tree.
Infected epithelial cells slough off into the small airways leading to partial or complete collapse or obstruction of the airways.
Results in impaired gas exchange.
What are the emergency/urgent signs of severe bronchiolitis in children?
Apnea Child looks very unwell Severe respiratory distress Respiratory rate >70 breaths/min Central cyanosis Sats <90% on room air or <92% if <6weeks old or underlying co-morbidities. (Sats = O2 saturation)
How to tell if bronchiolitis is getting severe in children?
Agitation and reduced consciousness Exhaustion Cyanosis Use of accessory muscles of breathing at rest Dehydration
In what cases is an immediate or backup antibiotic prescription given?
- patient systemically very unwell
- pre-existing co-morbidity
- young children born prematurely
- > 65 with 2 of the following or >80 with 1 of the following:
hospital admission in previous year, Type 1/2 diabetes history of congestive heart failure, use of oral corticosteroids, if CRP levels high.
What are the 6 signs of community acquired pneumonia?
- Patient will be moderately to severely ill.
- Focal chest signs such as decreased/asymmetric breath sounds.
- High temperature.
- May be hypoxic.
- Confusion (esp in older patients)
- Abnormal chest x-ray
What is CRB-65?
A tool used in community/primary care to assess severity of CAP in adults.
CONFUSION - new disorientation in person.
raised RESPIRATORY rate - >30 breaths/min (normal = 12-18)
low BLOOD pressure - diastolic <60mmHg or systolic <90mmHg
age = >65
