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Test 3 > pneumonia part 2 > Flashcards

pneumonia part 2 Flashcards

1
Q

What is pulse oximetry?

A

non invasive methoid to measure O2 saturation (SaO2

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2
Q

What are the diagnostic uses of bronchoscopy?

A
  • direct visualization (tracheobronchial tree, larynx,
  • biopsy of tissue
  • aspiration of deep sputum
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3
Q

What are the therapeutic uses of bronchoscopy?

A
  • aspiration
  • control of bleeding
  • removal of foreign bodies
  • brachytherapy (endobronchial radiation therapy)
  • palliative laser obliteration of bronchial neoplastic obstruction
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4
Q

What do you do before a bronchoscopy?

A
  • verify informed consent
  • NPO 4-8 hours before to reduce aspiration
  • reassure patient that he will be able to breathe
  • tell patient not to swallow local anesthetic sprayed in throat
  • provide basin for expectoration of anesthetic
  • remove dentures or prostheses
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5
Q

What do you do during a bronchoscopy?

A
  • local anesthesia or moderate sedation
  • patient in sitting or supine position
  • scope inserted in nose or mouth and into pharynx
  • monitor oxygen saturation because these patients commonly have pulmonary diseases
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6
Q

What do you do post bronchoscopy?

A
  • NPO until anesthesia has worn off and gag reflex has returned
  • postop fever is common within 24 hours, a lowgrade fever is normal
  • warm saline gargle and lozenges if throat is sore
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7
Q

What complications should be assesed after bronchoscopy?

A
  • coughing or expectoration of blood (hemoptysis) which may indicate trauma to the lung
  • evaluate for S and S of pneumothorax, tension pneumothorax, subcutaneous emphysema, and pyogenic infection (tachypnea, dyspnea, diminished breath sounds, anxiety, restlessness, fever.)
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8
Q

What are the most important things to assess for after bronchoscopy?

A
  • coughing or expectorations of blood (hemoptysis)
  • tachypnea
  • dyspnea
  • diminshed breath sounds
  • anxiety
  • restlessness
  • fever
  • diminished breath sounds (sign of pneumothorax)
    • reflex bradychardia and hypotension
      - pulmonary edema
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9
Q

What is pneumonia?

A
  • acute infection of the lung parenchyma

- inflammation or infection of the bronchioles and alveolar spaces of the lungs

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10
Q

What is the etiology of pneumonia?

A
  • results when defense mechanisms become incompetent or overwhelmed (smoking or epiglottis issue, mucociliary escalator)
  • decreased cough and epiglottal reflexes may allow aspiration
  • decreased consciousness weakens the cough and epiglottal reflexes
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11
Q

How does the mucociliary mechanism become impaired?

A 
pollution
cigarettes 
viral URI
tracheal infection 
aging 
chronic diseases supressing the immune systems ability to inhibit bacterial growth
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12
Q

What are the 3 methods that cause organisms to reach the lungs (causing pneumonia)?

A
  1. aspiration from naso/oropharynx
  2. inhalation of microbes present in air (mycoplasma pneumonia and fungal pneumonias)
  3. hematogenous psread from primary infection elsewhere in body (EX: streptococci and staph from infective endocarditis
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13
Q

Risk factors of pneumonia?

A
  • condition that produce mucous or bronchial obstruction
  • immunocompromised (heart failure, diabetes, alcoholism, COPD, and AIDS)
  • smoking
  • prolonged immobility
  • depressed cough relflex
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14
Q

How is pneumonia classified and what are the types?

A
  • according to causative organism
  • clinical classification: community acquired, health care associated, immunocompromised, aspiration, hospital acquired, ventilator associated
  • bacteria, viruses, mycoplasma, fungi, parasites, chemicals
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15
Q

What type of pneumonia has an increased risk for multidrug resistant pathogens?

A

health care associated HCAP

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16
Q

This infetion occurs in patients who have not been hospitalized or in long term care for 14 days after onset.

A

CAP: community acquired

17
Q

With CAP where is it treated and what antibiotic and when is it started?

A
  • treated at home or hospilatized depending on patient

- empiric antibiotic therapy started ASAP even before a definitive diagnosis or causative agent is confirmed

18
Q

What commonly causes CAP in outpatients?

A 
strep
mycoplasm
haemophilus influenza 
C. pneumonia 
respiratory viruses
19
Q

This occurs 48 hours or longer after hospitalizationand not present at time of admission?

A

HAP: hospital acquired

20
Q

This occurs 48 hours after endotracheal intubation.

A

VAP: ventilator acquired

21
Q

What is VAP and HAP associated with?

A

longer hospital stays, increased costs, sicker patients, increased risk of morbidity and mortality

22
Q

What is a major problem in treating HCAP (health care associated) pneumonia?

A
  • the development of multidrug-resistant (MDR) organisms.

- What are the primary culprits: S.aureus and gram negative bacilli

23
Q

What can identify the MDR organisms for HCAP? What do these MDR organisms do to the morbidity and mortality of risks?

A
  • antibiotic suseptibility tests

- MRD organisms limit appropriate therapy and increase the risks of pneumonia

24
Q

What is health care associated pneumonia?

A

occuring in nonhospitalized patient with extensive health care contact with one or more of the following:

  • hospitalization for > or equal to 2 days in acute care within 90 days of infection
  • residence in nursing home/long-term care facility
  • antibiotic therapy, chemotherapy, or wound care within 30 days of infection
  • hemodialysis in hospital or clinic
  • home infusion or wound care therapy
  • family member with infection due to multi-drug resistance bacteria
25
Q

Explain aspiration pneumonia? What are the major risk factors?

A
  • abnormal entry of secretions into lower airway
  • decreased level of consciousness
  • difficulty swallowing
  • insertion of nasogastric tube with or without feeding
26
Q

Why is aspiration pneumonia common with loss of consciousness?

A

the gag/cough reflex is depressed

27
Q

Explain pathophysiology of aspiration pneumonia?

A
  • aspirated materials trigger inflammatory response
  • primary bacterial infection most common
  • Empiric therapy based on severity, where acquired, and causative organsim
28
Q

What is tghe most common form of aspiration pneumonia?

A
  • primary bacterial infection (more than one organism is identified on sputum culture
  • normally broad spectrum antibiotics are given
29
Q

What causes chemical (noninfectious) pneumonitis?

A

aspiration of acidic gastric contents

-this may not require antibiotic therapy, but secondary bacterial infection can occur 48 to 72 hours later

30
Q

What is necrotizing pneumonia?

A
  • liquefaction and in some situations cavitation of lung tissue
  • rare complication of bacterial lung infection
  • often results from CAP
  • causative organisms: Staph, Klebsiella, Strep
  • Tx: long term antibiotic therapy and possible surgery
31
Q

What are the S and S of necrotizing pneumonia?

A
  • immediate respiratory insufficiency or failure
  • leukopenia
  • bleeding into airways
32
Q

What is opportunistic pneumonia?

A
  • inflammation and infection of the lower respiratory tract in immunocompromised patients
  • caused by bacteria, virus, microorganisms that do not normally cause disease
33
Q

Who is at risk for opportunistic pneumonia?

A
  • severe protein-calorie malnutrition
  • chemotherapy/radiation
  • immunosupression therapy (long term corticosteroid therapy)

Test 3 (28 decks)

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