Pulm Flashcards
Pt presents with cough d/t inflmmation of the bronchioles, bronchi and trachea. What could the pt have?
Upper RSI - Acute bronchitis
Most common organisms for bacteria infection for acute bronchitis
Streptococcus pneumoniae (CAP) Haemophilus influenzae
how to distinguish bronchitis from pneumonia?
Think PNA if…
more productive cough
Fever >100.4
infiltrates on x-ray
Decision criteria for Chest XRAY
** only if you suspect PNA
tachypnea
hypoxia
fever
abnormal lung exam
what is referred to as the 100 day cough?
Pertussis
Non pham management for bronchitis
increase fluids
humidifier
rest
smoking cessation
honey in children <1 yr
Dextromethoprhan / Guiafenesin is what kind of medication
Cough suppressant / Expectorant combo
Contraindicated in pts with parkinsons or on SSRIs
avoid in pts who have difficulty clearing secretions
Codeine/guaifenesin
Do not take MAO inhibitor, Parkinsions, SSRI
Scheduled V medication
AVOID narcotic cough suppressants in pts with COPD//Asthma
What is a cough suppressive medication
Dextromethorphan
what is medication class that this secretions?
Expectorants
Ex: Guaifenesin
What the MOA for antitussive medications and example
MOA- Topical anesthetic effect on the respiratory stretch receptors
Ex: Benzonatate (Tessalon Pearls)
SE of Benzonatate
Do not break/chew - produces local anesthesia and reduce gag refulx
dizziniess, drowsiness, visual changes
begins 15-20mins, lasts 3-8 hrs
Avoid use in pts sensitive to or taking agents with PABA d/t possible CNS effects
Caution/ contraindications to Guaifenesin
Contra: Parkinsons & SSRI usage
Caution if nephrolithiasis
not for children < 6
Name short acting bronchodilators
Albuterol
Levalbuterol
Would you give ABX for bronchitis?
No, since MOST bronchitis is viral.
If everything has been tried and pt has refractory fever or secondary infection try amoxicillin
What is an acute infection of the lung in a patient who acquired infection in the community involving the parenchyma, alveolar spaces, and intersitital tissue
Community acquired pneumonia
What is the most common agent that causes CAP?
Streptococcus Pneumoniae (Pneumococcal PNA)
Assessment findings for CAP?
productive cough Fever Dyspnea Pleuritic CP Diminished Breath sounds Consolidation on percussion - dullness Egophony E to A changes Bronchophony: Voice sounds are louder and clearer than normal
Assessment findings for CAP?
productive cough Fever Dyspnea Pleuritic CP Diminished Breath sounds Consolidation on percussion - dullness Egophony E to A changes Bronchophony: Voice sounds are louder and clearer than normal
What is required to make a diagnosis of PNA?
Chest Xray!!!
other tests: EKG to r/o Cardiac, Flu swab, possible ABG, CBC (increased WBC), Procalcitonin
Hallmark sing of bacterial PNA?
Causative agent: Pneumococcal pneumonia
Rust colored sputum!
preceded by a URI
Causative pathogen for primary atypical pneumonia?
Mycoplasma Pneumonia
Features of Mycoplasma pneumonia
systemic symptoms predominant over lung s/s
typically in pts <35yrs
Sore Throat
dry cough
Maculopapular rash!!!
may take 6 weeks w/treatment to eradicate
Viral PNA (not covid) s/s
Headache
fever
myalgia
who is most at risk of Klebsiella Pneumoniae PNA
ETOH, Immunocompromised pts
What symptoms occur specific to Klebsiella Pneumoniae PNA?
Bacteria causes tissue necrosis of parenchyma
Currant jelly sputum (coughing up necrosed lung tissue)
HIGH mortality rate. 25-50%
What is the number one cause of epiglottitis in children & adults?
Haemophilus Influenzae
Whos most at risk of getting Haemophilus Influenzae?
Younger pts if not vaccinated (Hib vacc)
What type of PNA has Coryza as a prodrome
Coryza (stuffy nose)
Haemophilus Influenzae PNA
what patient population is Legionella Pneumophila PNA most prevelent in?
Middle aged men
Smokers
ETOH
immunosuppresed
S/S Legionella Pneumophila PNA
Prodrome resembles Flu fever headache NEUROLOGICAL manifestations Relative bradycardia
Chlamydial PNA s/s
Cough
fever
sputum production
**Not seriously Ill
*** babies of moms w/chlamydia
PNA Tx: Outpatient, health, No recent ABX
Amoxicillin (PCN) - x5 days
Or
Macrolide (Azithromycin 5 days /Clarithromycin 7-14days)
Or
Doxycycline (7-10 days)
What are the two most common bacterial causes of CAP
1st: Mycoplasma Pneumoniae ( most common walking pneumonia)
2: Streptococcus pneumoniae (most common worldwide)
PNA tx: Outpatient, healthy, RECENT abx
Respiratory fluoroquinolone (Levofloxacin) 10-14 days
or
Macrolide (azithromycin) x 5days + high dose amoxicillin (x 10days)
or
Macrolide + high dose amoxicillin/clavulanate
PNA tx: Outpatient WITH Comorbidities, NO recent Abx
Combo therapy
Amoxicillin/Clavulanate
Cephalosporin + macrolide or doxycycline
OR
Respiratory Fluroquinolone monotherapy (Levaquin)
PNA tx: outpatient, comorbidities, recent ABX
RSP fluoroquinolone (levaquin)
Macrodie + beta-lactam (high dose amoxicillin/clavulanate or cefpodoxime, or cefprozil or cefuroxime)
