Management of Pts w/ Chest & LRT Disorders Flashcards
- 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
*Occurs either in the community setting
or within the first 48 hours after
hospitalization or institutionalization.
Community-Acquired Pneumonia
- Inflammation of the lung
parenchyma - Caused by bacteria,
mycobacteria, fungi, and
viruses.
Pneumonia
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)
–
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”
*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
Distribution of lung
involvement in bronchial
and lobar pneumonia
(left), patchy areas of
consolidation occur.
bronchopneumonia
- 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
Distribution of lung
involvement in bronchial
and lobar pneumonia
(right), an entire lobe is
consolidated.
lobar pneumonia
- 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
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
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
*Occurs unobserved
*If untreated, massive inhalation of gastric
contents develops in a period of several hours.
Silent aspiration
- 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)
- 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)
treatment for SARS
oseltamivir / tami flue
transmission mode of TB
Airborne and droplets transmission
cause of tb
Mycobacterium tuberculosis
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.
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
