Module 6b Flashcards
How is pneumonia broadly categorised into 2 ways of acquisition?
• Community-acquired: usually due to Streptococcus pneumoniae, atypical bacteria (such as Mycoplasma, Chlamydia and Legionella), or viral pathogens. In approximately 50% of community-acquired pneumonia cases
no organism is identified.
• Hospital-acquired: associated with a much greater spectrum of pathogens, particularly bacterial pathogens that are usually more difficult to treat.
What are the four classifications of pneumonia categorised by the causative agent?
Viral: Influenza A is most common type of viral pneumonia.
• Often occurs as an ‘epidemic’ in small population groups such as
schoolchildren and nursing home residents
• Infection caused by virus predisposes patient to secondary bacterial
pneumonia
Bacterial: until 2000, Streptococcus pneumoniae accounted for 90% of
bacterial pneumonias
• Decline in cases is related to vaccination of infants against pneumococcus bacteria
• Peak incidence is in winter and early spring
• Vaccine now available and is effective against this type of pneumonia in adults
Mycoplasmal: caused by infection with mycoplasma pneumoniae
• Causes mild URTI in school-age children and young adults
• Transmission occurs by means of infected respiratory secretions: spreads quickly among family members
• Can be treated effectively with antibiotics
Aspiration type: inflammation of lung tissue (parenchyma)
• Results when foreign material enters tracheobronchial tree
• Common in patients who:
• Have altered level of consciousness
• Are intubated
• Have aspirated foreign bodies
What are the signs and symptoms of pneumonia?
‘Classic’ S/S of pneumonia include: • Productive cough • Pleuritic chest pain • Fever that produces “shaking chills” (usually associated with bacterial infection) • Nonspecific complaints: eg: non-productive cough, headache, fatigue, and sore throat • Dyspnoea • Occasionally haemoptysis
What is the treatment for pneumonia?
• Primary survey
• A to E with Respiratory status assessment- including
extensive auscultation
• Vital signs: GCS, HR, RR, BP, SPO2, ECG
• Focused history using OPQRST
• Bronchodilators (can be effective for some patients) and oxygen therapy
• Advanced airway management – intubation if required; assisted ventilations
• Gain IV access and consider fluid infusion
• Monitor TREND of medications
Long-term:
• Antibacterial medications
• Lifestyle support
What is the Pneumonia Severity Index (PSI)?
A validated risk stratification instrument which can help in identifying community acquired pneumonia patients who can safely be treated with outpatient antibiotics.
The PSI involves calculating a score, which places a given patient into one of 5 risk classes.
Classes I, II, and III are at low risk for death, and may be considered for
outpatient treatment.
Risk classes IV and V should usually be hospitalised.
What is (ARDS) Acute Respiratory Distress Syndrome?
a sudden and severe form of respiratory failure characterised by acute lung inflammation and diffuse alveolar-capillary injury.
All disorders that result in ARDS cause severe noncardiogenic pulmonary oedema
What can cause the development of
(ARDS) Acute Respiratory Distress Syndrome?
- Trauma
- Gastric aspiration
- Cardiopulmonary bypass surgery
- Gram-negative sepsis
- Multiple blood transfusions
- O2 toxicity
- Toxic inhalation
- Drug overdose
- Pneumonia
- Infections
What are the 3 clinical presentations that indicates Acute Respiratory Distress Syndrome (ARDS)?
- Lungs are ‘wet’, heavy, congested, haemorrhagic, and stiff
- Decreased perfusion capacity across alveolar membranes
- Lungs become noncompliant- this requires patient to increase pressure in airways to breathe
Pulmonary oedema associated with ARDS leads to…?
- Severe hypoxaemia
- Intrapulmonary shunting
- Reduced lung compliance
- In some cases, irreversible damage to lung tissue
Complications: • Respiratory failure • Cardiac dysrhythmias • Disseminated intravascular coagulation • Barotrauma • Congestive heart failure • Renal failure
What are the signs and symptoms of ARDS?
Tachypnoea
• Laboured breathing
• Impaired gas exchange 12 to 72 hours after initial injury or medical crisis
What is the treatment of ARDS?
- High-concentration O2 and ventilatory support
- Fluid replacement to maintain cardiac output and peripheral perfusion
- Drug therapy to support mechanical ventilation
- Pharmacological agents (e.g., corticosteroids) to stabilise pulmonary, capillary, alveolar walls
- Diuretics
What conditions fall under the category of an Upper Respiratory Tract Infections (URTI)?
- Sinusitis
- Laryngotrachobronchitis (coup)
- Epiglottitis
- Scarlet Fever
What conditions fall under the category of an Upper Respiratory Tract Infections (URTI)?
- Common cold (infectious rhinitis)
- Sinusitis
- Laryngotrachobronchitis (coup)
- Epiglottitis
- Scarlet Fever
What condition presents with “strawberry tongue”?
Scarlet fever
What is a pulmonary embolism?
is a blood clot or mass that obstructs
the pulmonary artery or any of its branches.
Where do 90% of pulmonary emboli originate from?
Deep vein thromboses in the legs
What are the signs and symptoms of pulmonary embolism?
Signs and symptoms:
• Transient chest pain, cough, dyspnoea—small emboli
• Larger emboli—increased chest pain with coughing or deep breathing; tachypnoea and dyspnoea develop suddenly.
• Later—haemoptysis and fever
• Hypoxia—causes anxiety, restlessness, pallor, tachycardia
• Localised wheezing
• Massive emboli
• Severe crushing chest pain, low blood pressure, rapid weak pulse,
loss of consciousness
• Distended neck veins
What information in the patient assessment may help distinguish PE from other conditions that can cause similar signs and symptoms?
What is the treatment for pulmonary embolism?
- Mainly supportive:
- Supplemental high-concentration O2
- Cardiac monitor and pulse oximeter applied
- IV access and fluids if indicated
- Transport in position of comfort
Definitive care
• Requires hospitalisation and in-hospital treatment with
fibrinolytic or heparin therapy
What is Mesothelioma?
a cancer typically related to exposure to asbestos that affects the mesothelium- a thin tissue membrane that covers internal organs of the body including the thoracic cavity (pleura), the heart sac
(pericardium) and the abdominal cavity (peritoneum).
What is Pleural mesothelioma?
a cancer that affects the pleura, the
outer lining of the lung. Formed when small asbestos fibres remain in the lung.
• The human body is usually able to remove foreign particles but
the asbestos fibres are very small and embed themselves into the
mesothelium.
• As the body’s immune system tries to rid the body of the
asbestos fibres it causes permanent scarring and hardening of the
surrounding tissue.
• As the disease progresses the lining of the lungs, in the affected
area(s), thickens.
What are the mesothelioma signs/symptoms and treatment?
Signs and Symptoms include: • Breathlessness • Dry cough • Pain in the chest or ribs area • Fatigue • Unexplained weight loss • Night sweats or fever
Treatment:
• There is currently no known treatment.
• Treat presenting s/s.
Tuberculosis is a disease caused by an infection caused by what bacteria?
Mycobacterium Tuberculosis
What is a tuberculosis infection?
• TB Infection: the TB bacteria are in the body but they are “inactive”. The body’s defences control the germs, but these germs can stay alive in an inactive state.
• While the TB bacteria are inactive, they cannot do any damage, or be spread to other people.
• The patient is “infected”, but not sick. For 90%of people the germs will always be inactive.
Infection can be detected by a positive result to a Tuberculin Skin Test.
What is a tuberculosis disease?
• TB Disease: TB can become active when the body’s defences are weakened.
• Due to ageing, serious illness, stressful event, drug or alcohol misuse, HIV infection (the virus
that causes AIDS) or other conditions.
• When inactive TB becomes active, TB disease can develop.
• Only about 10 % of people who are infected with TB bacteria will get TB disease.
• People with TB of the lungs or throat can be infectious to others.
What are the signs/symptoms and treatment of tuberculosis?
Signs and Symptoms: • A cough that lasts for more than three weeks • Fevers • Unexplained weight loss • Night sweats • Always feeling tired • Loss of appetite • Blood stained sputum • Pain/ swelling in the affected area when TB is outside the lungs.
Treatment:
• Pre-hospital treat symptomatically.
• High level of infection control
• Long-term: AB’s
What are the signs and symptoms of smoke inhalation?
• Facial burns • Singed nasal or facial hairs • Carbonaceous sputum • Oedema of the face, oropharyngeal cavity, or both • Signs of hypoxaemia • Hoarse voice • Stridor • Brassy cough • Grunting respirations
What is the treatment of smoke inhalation?
- Directed at maintaining patent airway
- Providing high-concentration oxygen
- Ventilatory support
- Specific airway and ventilatory management
- Bronchodilators
What are the 3 characteristics of carbon monoxide?
- Colourless
- Odourless
- Tasteless
What are the signs and symptoms of CO2 poisoning?
- Dizziness
- Headache
- Disorientation
- Impairment of the cerebral function
- Coma
- Visual disturbances
- Muscle weakness
- Muscle cramps
- Seizures
What is the treatment for carbon monoxide poising?
• Ensuring patent airway, providing adequate ventilation
• Administering high-concentration oxygen
• Half-life of carbon monoxide at room air is about
4 hours
• Can be reduced to 30 to 90 minutes if 100 percent
oxygen and adequate ventilation are provided
What are the categories of poising by inhalation?
Simple asphyxiants: methane, propane, inert gases
• Cause toxicity by displacing or lowering amount of O2 in air
Chemical asphyxiants: CO, cyanide
• Cause number of local and pulmonary reactions
• Toxic systemic effects prevent uptake of O2 by blood
• Can interfere with tissue oxygenation
Irritants/corrosives: chlorine, ammonia
• Cause cellular destruction and inflammation as they contact moisture
What is the treatment for poisoning by inhalation?
• Adequate airway, ventilatory and circulatory support
• Initial assessment and physical examination
• Irrigation of eyes as needed
• IV line with saline solution
• Regular monitoring of vital signs, ECG, and pulse
oximetry
• Rapid transport
What are the 5 steps in the life cycle of SARS CoV-2?
- Attachment - bind to host receptors
- Penetration - enter host cells through endocytosis or membrane fusion
- Viral contents are released inside the host cells and viral RNA enters the nucleus for replication
- Biosynthesis - Viral mRNA is used to make viral proteins
- Maturation - New viral particles are made
- Release
