Lung Infections and Restrictive Lung Disorders Flashcards
describe the risk factors for pneumonia, including what symptoms a patient may experience and signs a nurse ought to recognize.
risk factors: babies and children that are younger than 2 years, older adults (65 and up), work environment (prison, nursing home, homeless shelter), smoking cigarettes, drinking alcohol and doing drugs, immunosuppression, inhalation of irritating fumes or aspiration of gastric contents.
sx/sx: in previously healthy people, the onset is sudden and characterized by malasie, severe shaking, chills and fever. during the initial or congestive stage, coughing brings up watery sputum and breath sounds are limited with fine crackles. as the disease progresses, the sputum character changes, it may be blood tinged or rust colored to purulent. Pleuritic pain, is common in later stages as well.
older adults may only show loss of appetite and deterioration in mental status.
what a nurse should recognize: breath sounds (fine crackles), sputum (color change?), pleuritic pain, and also monitoring older adults closely.
describe the pathogenesis of lung involvement in relation to COVID19 infection
The RBD of the S protein of SARS-CoV-2 specifically recognizes the host angiotensin-converting enzyme 2 (ACE2) receptor. It is optimized for binding to the human receptor ACE2.
The ACE2 receptor is expressed in type 2 alveolar epithelial cells in the LUNGS, heart, kidney, and gastrointestinal tract. However, the lungs seem to be particularly vulnerable to SARS-CoV-2 because of their large surface area and because alveolar epithelial type 2 cells seemingly act as a reservoir for virus replication. Direct injury to the lung tissue from a viral infection–mediated local inflammatory response is one of the proposed mechanisms behind the pulmonary manifestations of COVID-19.
explain acute respiratory distress syndrome & its relationship to COVID19 infection
ARDS is a feared complication of COVID19. ARDS is defined by the Berlin criteria by the presence of acute hypoxic respiratory failure with bilateral infiltrates without a known etiology in the presence of a known insult within 7 days. Hypoxia is graded in these patients by the means of a PaO2/FiO2 ratio, which is the ratio of the partial pressure of arterial oxygen divided by the fraction of oxygen inspired. Decreased lung compliance is also a hallmark of ARDS.
Because of the pneumonia that COVID produces, the lungs have a harder time passing air, thus making the patient short of breath and have ARDS, among other things.
identify how coccidioidomycosis and histoplasmosis are similar.
what region do they both originate in in the united states?
they both originate in the river valleys of the midwest–the ohio and the mississippi.
both coccidioidomycosis and histoplasmosis are dimorphic fungi.
what is the pathogenesis of tuberculosis?
the pathogenesis of TB is:
Infection occurs when a person inhales droplet nuclei containing tubercle bacilli that reach the alveoli of the lungs. These tubercle bacilli are ingested by alveolar macrophages; the majority of these bacilli are destroyed or inhibited. A small number may multiply intracellularly and are released when the macrophages die. If alive, these bacilli may spread by way of lymphatic channels or through the bloodstream to more distant tissues and organs (including areas of the body in which TB disease is most likely to develop: regional lymph nodes, apex of the lung, kidneys, brain, and bone). This process of dissemination primes the immune system for a systemic response.
As tuberculin bacilli multiply, the infected macrophages degrade the mycobacteria and present their antigens to T lymphocytes/ The sensitized T lymphocytes multiply and stimulate macrophages to kill the mycobacteria. However, this also damages lung tissue.
list signs and symptoms for TB. List groups at risk for TB.
groups at risk for TB would be: foreign-born people from countries with a high-risk congregate settings, people that work in congregate settings: nursing homes, correctional facilities, homeless shelters.
sx/sx of TB would be:
primary: abrupt onset of symptoms: high fever, pleuritis, lymphadenitis.
primary progressive: fever, weight loss, fatigue, night sweats.
how do abnormal accumulations in the pleural space affect lung function?
Abnormal accumulations of fluid in the pleural space will hurt lung Function and cause the lungs to not be as compliant. This will impair patient breathing and cause SOB.
Especially with pleural effusion and pneumothorax.
state patient symptoms and clinical signs of pleural effusion.
Characteristic signs of pleural effusion are dullness and flatness to percussion and diminished breath sounds.
hypoxemia may occur d/t the decreased surface area and usually is corrected with supplemental oxygen. dyspnea, the most common symptom, occurs when fluid compresses the lung, resulting in increased effort or rate of breathing. Pleuritic pain usually only occurs when inflammation is present. However, constant discomfort may be felt with large effusions.
state patient signs and clinical manifestations of hemothorax.
sudden and distressing onset of symptoms.
clinical manifestations: alterations in oxygen, ventilation, respiration effort, breath sounds (not clear).
signs of blood loss are also present: increased HR, etc.
state the patient symptoms and clinical signs of pneumothorax.
includes development of ipsilateral chest pain, immediate increase in respiratory rate, often accompanied by dyspnea, asymmetry of the chest. Hyperresonant sound occurs with percussion. Breath sounds are decreased or absent over the area of the pneumothorax.
state clinical signs and patient symptoms of tension pneumothorax.
rapid increase in pressure within the chest that causes compression atelectasis of the unaffected lung, a shift in the mediastinum to the opposite side of the chest (use position of the trachea to assess), JVD, subcutaneous emphysema, clinical signs of shock, hypoxemia if large enough.
CO decreased even though the heart rate is increased.
describe the pathogenesis and manifestations of interstitial lung diseases (ILDs). How do the ILDs, which are restrictive disorders, differ from obstructive disorders?
In contrast to the obstructive lung disease, the lungs are stiff and difficult to expand, despite normally functioning airways.
the pathogenesis of ILDs is that they involve the exert their effects on the collagen and elastic connective tissue found in the delicate interstitium of the alveolar walls. Certain ILDs affect the distal part of the alveoli and this causes physiologic restrictions and decreased lung volumes. Other ILDs impact the interstitium closer to the proximal aspect of the acinus near the bronchioles, which causes physiologic obstruction but does not impact the lung volumes.
In general, these diseases share a pattern of lung dysfunction that includes diminished lung volumes, reduced diffusing, capacity of the lung, and varying degrees of hypoxemia.
what pulmonary function tests abnormalities are characteristic of ILD?
vital capacity and TLC are reduced, arterial PO2 levels fall during exercise.
