Management of Pts w/ Chest & LRT Disorders Flashcards by Calen Avelino

Refers to closure or collapse of alveoli
Acute or chronic

*Acute is the most common (post-op/immobilized)

Excess secretions or mucous

Chronic (e.g. tumor)

ATELECTASIS

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*Occurs either in the community setting
or within the first 48 hours after
hospitalization or institutionalization.

Community-Acquired Pneumonia

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Inflammation of the lung
parenchyma
Caused by bacteria,
mycobacteria, fungi, and
viruses.

Pneumonia

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pneumonia

low risk = w/ symptoms but no xray findings
moderate = may symptoms and findings sa xray
high risk = in pts with HPN, commatose, decrease sensorium (needs intubation)

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Pneumonia in the Immunocompromised Host

common virus cause __
*Occurs with use of corticosteroids,
chemotherapy, nutritional depletion
* Antimicrobial agents, AIDS, genetic immune
disorders, mechanical ventilation

“Pneumocystis pneumonia”

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*Onset of pneumonia symptoms more than 48
hours after admission in patients with no
evidence of infection at the time of admission.

Ventilator-associated pneumonia is considered a
type of nosocomial pneumonia

*Impaired host defenses

Hospital-Acquired Pneumonia

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Distribution of lung
involvement in bronchial
and lobar pneumonia

(left), patchy areas of
consolidation occur.

bronchopneumonia

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Refers to the pulmonary consequences resulting
from entry of endogenous or exogenous
substances into the lower airway
Most common is bacterial infection from aspiration
of bacteria that normally reside in the upper
airways
Gastric contents, exogenous chemical contents, or
irritating gases

Aspiration pneumonia

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Distribution of lung
involvement in bronchial
and lobar pneumonia

(right), an entire lobe is
consolidated.

lobar pneumonia

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Aspiration of stomach contents into the lungs
*It can occur when the protective airway reflexes
are decreased or absent
Can result in tachycardia, dyspnea, central
cyanosis, hypertension, hypotension, and finally
death.

Aspiration

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Vaccination against pneumococcal infection is
advised for the following:
* People 65 years of age or older
* People with functional or anatomic asplenia
* People living in environments or social settings in
which the risk of disease is high
* Immunocompromised people at high risk for
infection

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*Occurs unobserved

*If untreated, massive inhalation of gastric
contents develops in a period of several hours.

Silent aspiration

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Caused by a coronavirus
Transmitted via respiratory droplets
Close contact with a person who has been diagnosed with
the disease or a history of travel or residence in an area
with known cases
May also be spread when a person touches a surface
contaminated by the droplets and then touches his or
her mucous membranes.

Severe acute respiratory syndrome (SARS)

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Primarily affects the lung parenchyma
*It also may be transmitted to the meninges,
kidneys, bones, and lymph nodes.
Associated with poverty, malnutrition, overcrowding, substandard housing, and inadequate health care

Tuberculosis (TB)

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treatment for SARS

oseltamivir / tami flue

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transmission mode of TB

Airborne and droplets transmission

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cause of tb

Mycobacterium tuberculosis

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mantoux test
* A reaction of 5 mm or greater may be significant in people who are considered to be at risk

*An induration of 10 mm or greater is usually considered significant in people who have normal or
mildly impaired immunity.

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Pulmonary TB is treated primarily with antituberculosis agents for ___ months

6 to 12 months

BGC vaccine is given to protect from what kind of TB?

CNS

Prophylactic taking daily doses for 6 to 12 months
* Household family members of patients with active disease
* HIV infection – 5mm or more induration

Old TB detected on CXR – 5mm or more induration
Patients whose current PPD test results show a change from former test
results.
Users of IV/injection drugs – 10mm or more induration
High-risk comorbid conditions – 10mm or more induration

Accumulation of thick, purulent fluid within the
pleural space
Complications of bacterial pneumonia or lung
abscess.
At first the pleural fluid is thin, with a low
leukocyte count but progresses to a
fibropurulent stage to loculated empyema

Empyema

is necrosis of the
pulmonary parenchyma
* It is generally caused by aspiration
of anaerobic bacteria.

lung abscess

*Inflammation of both layers of the pleurae
(parietal and visceral).
* May develop with URTI, trauma, PE, CA and
after thoracotomy.

Pleurisy (Pleuritis)

* Collection of fluid in the pleural space * Complication of heart failure, nephrotic syndrome, PE * TB, pneumonia, neoplastic tumors * Most common is bronchogenic carcinoma

Pleural Effusion

Medical Management of EMPYEMA *Drain the pleural cavity and achieve complete expansion of the lung * The fluid is drained, and appropriate antibiotics * Sterilization of the cavity requires 4 to 6 weeks of antibiotics.

*Needle aspiration with a thin percutaneous catheter, if the volume is small and the fluid is not too purulent or too thick

Thoracentesis

* Chest drainage using a large diameter intercostal tube attached to water-seal

Tube thoracostomy

* Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both. * Severe, life-threatening condition.

Pulmonary Edema

* Sudden and life-threatening deterioration of the gas exchange function of the lung * Failure of the lungs to provide adequate oxygenation for the blood.

Acute Respiratory Failure

Type of Acute Respiratory Failure - Decrease in arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia)

TYPE 1

is a critical part of the treatment of ARDS. improves oxygenation, but it does not influence the natural history of the syndrome * helps increase functional residual capacity (FRC) and reverse alveolar collapse by keeping the alveoli open, resulting in improved arterial oxygenation

PEEP

Type of Acute Respiratory Failure - Increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg(hypercapnia), with an arterial pH of less than 7.35.

TYPE 2

* Severe form of acute lung injury. * Characterized by a sudden and progressive pulmonary edema *Increasing bilateral infiltrates on chest x-ray, *Hypoxemia unresponsive to oxygen supplementation

Acute Respiratory Distress Syndrome(ARDS)

* deterioration in the gas exchange function that has persisted for a long period after an episode of acute respiratory failure * Develop a tolerance to the gradually worsening hypoxemia and hypercapnia.

Chronic respiratory failure

* Most frequent cause of Cor Pulmonale is severe COPD * Any disease affecting the lungs and accompanied by hypoxemia may result in cor pulmonale

* Exists when the mean pulmonary artery pressure exceeds 25 mmHg with a pulmonary capillary wedge pressure of less than 15 mmHg * Must be measured directly during right-sided heart catheterization. *Not clinically evident until late in its progression.

Pulmonary Arterial Hypertension

* Condition in which the right ventricle of the heart enlarges * Type of pulmonary arterial hypertension due to a known cause.

Pulmonary Heart Disease (Cor Pulmonale)

Refers to the obstruction of the pulmonary artery or one of its branches by a thrombus Venous thromboembolism (VTE) is a term that includes both DVT and PE. Associated with trauma, surgery, pregnancy, heart failure, older than 50 years, hypercoagulable states, and prolonged immobility.

Pulmonary Embolism

*Death from Pulmonary Embolism commonly occurs within 1 hour after the onset of symptoms

---

* considered the best method to diagnose PE * allows for direct visualization arterial obstruction

Pulmonary angiography

*If the patient has suffered massive embolism and is hypotensive, an indwelling urinary catheter is inserted to monitor urinary output. * Small doses of IV morphine or sedatives are administered to relieve patient anxiety

* Resolves the thrombi or emboli quickly * Used in treating PE, particularly in patients who are severely compromised * Bleeding is a significant side effect

Thrombolytic Therapy

* Removal of the actual clot on cardiopulmonary bypass. * Very risky

surgical embolectomy

* A vacuum-cupped catheter is introduced transvenously * Suction is applied to the end of the embolus, and the embolus is aspirated into the cup. * Catheters are available that pulverize the clot with high-velocity jets of normal saline solution.

Transvenous catheter embolectomy

*Inserted through the internal jugular vein or common femoral vein * The perforated umbrella permits the passage of blood but prevents the passage of large thrombi.

Greenfield filter