PULMONARY DISORDERS TEST 3 Flashcards
TUBERCULOSIS
infectious diseases caused by mycobacterium tuberculosis
primary tuberculosis -gain access to aveoli of the lungs TB go dormant (rest) –>detect by TB skin test & treat otherwise host become immunocompromise then lungs disease will develop (once TB positive it alway positive)
secondary tuberculosis - usually pulmonary
site of pulmonary infection: APEX of the lung
Pulmonary tuberculosis –> aka secondary tuberculosis
clinical manifestation
fatigue, anorexia, wt. loss, night sweats, low grade diurnal (evening) fever, cough, chest pain r/t cough, hemoptysis, irregular menses.
Pulmonary tuberculosis (secondary TB) examination
rales in upper posterior area, may evidence of pleural effusion lymphadenopathy.
TB diagnostic testing
- -> The Mantoux Test
* *read in 48-72 hours
* *Two step testing (>45 y.o only)
* *anergy :if pt is immunocompomised - -> QTF-G Blood test
* *results in 24 hours - –CXR : if positive to exclude pulmonary disease; if negative - then prophylaxis with ISONIAZID
TB prophylaxis with INH
criteria
Positive TB skin test, other tests negative
No liver contraindication
Regardless of hx BCG vaccination (usually given to toddler in 3rd world)
side effects
Hepatitis - need baseline and monthly LFTs
Drugs that increase risk (tylenol for example)
TB prophylaxis –> peripheral neuropathy
- -> Use B6 (pyridoxine) to decrease risk if pt has DM, uremia, alcoholism, malnutrition, during pregnancy, or if pt. has a seizure disorder requiring Dilantin
- give to people who take INH**
- -> if x-ray shows active TB refer Mandatory reporting in all 50 states–must reported to local health department.
Influenza
acute infection of respiratory tract–Influenza virus type A or B
- *highly contagious: self-limiting
- *spread by droplet–virus shed 24 hours before symptoms occur
S/sx of influenza
fever (peak at 12 hours after onset), chills, H/A , malaise, loss of appetite, dry cough nasal congestion w/ clear drainage, sore throat –COUGH is most prominent
cervical lymph node enlargement
Dx testing for influenza
rapid test or cell culture for virus : takes 2-7 days
Rx for influenza
rest fluids, antipyretic/analgesic
Antiviral meds: zanamivir (Relenza) and Oseltamivir (Tamilflu)
–> if used as Rx: should be started in first 48 hours; reduces severity and duration of symptoms (1 day)
–> may be used prophylactically for persons at high risk
**influenza vaccine best prevention **
including pregnancy women
six mos and older who not allergic to eggs
nasal spray cannot given to children under 1
Asthma
chronic inflammatory disorder of the airways
6th most common reason for visit –most common respiratory disorder of all age groups
triggered by many factors, including allergens, infections, exercise, changes in weather, irritants, allergy to ASA
s/sx asthma
episodic wheezing associated with dyspnea, cough, breathlessness, anxiety, sputum production
most common symptom: COUGH
between attacks : no symptoms
exercise induced: begins 5-10 minutes after exercise (breathing air rapidly )
*dx by signs and symptoms
& spirometry
allergens cause asthma
cat dander
dust mites
cockroach
tree and grass pollen
others: viral illness, occupational exposure, socioeconomic deprivation, anxiety, depression, stress
acute severe asthma
d/t poor response to therapy
self medication beta 2 adrenergic agonist inhaler they may use weeks before seek medical help
Physical exam of asthma
wheezing-forced expiration both inspiratory and expiratory as it worsens, use of accessory muscles increases. HYPERINFLATION
Severe attack- labored breathing –> ER
Asthma Dx tests
**spirometry
–> most useful= peak expiratory flow rate (PEFR) , FEVI, MMEFR, and FVC
mild asthma= decreased PEFR, FEVI, MMEFR
bronchospasm= decreased FEVI, MMEFR and FEVI/FVC ration
-> dx. hallmark : decrease obstruction after bronchodilator.
Asthma control
avoid environmental trigger
antiinflammatory medication
pt education
acute bronchitis etiology
transient inflammation of the trachea and major bronchi
begins with URI (cold ) cough that causes burning pain in chest, nose & throat symptoms that subside but cough persists, along with wheezes, rhonchi, course rales
clinical dx of acute bronchitis
s/x low grade temp cough
no dx testing
acute bronchitis causes
viral illness, occupational exposure
socioeconomic deprivation
anxiety depression , stress
refer if not responding to tx or if symptoms linger for longer than 2 weeks
education- s/e of medication; cough may persist 10-14 days
pneumonia defined
bacterial and atypical or “walking pneumonia”
bacterial - most common organism for CAP =streptococcus pneumoniae
leading cause of death from infectious disease and 7th most common cause of death in US from all causes
different organism of pneumonia
- Gram positive bacteria : streptococcus pneumoniae
- Gram negative bacteria: Haemophilus influenza
- *Atypical pneumonia : Mycoplasma pneumoniae
bacterial pneumonia–> shaky chills productive coughs with bloody rust color sputum
tight chest pain …
consolidation –> egophony
Atypical pneumonia
teenager living in dormatory fever dry cough much less ill than bacterial pneumonia no lungs consolidation macular papular rash on skin or bullous on tympanic membrane (painful) fine rales CXR patchy palbulor wbc lightly elevate or not at all
Group 1 outpatients pneumonia TX
**MACROLIDES are first line or Doxycycline
if comorbidities or high risk for resistance –> MOXIFLOXACIN, gemifloxacin, levofloxacin, or
macrolide + augmentin
patient education : pneumonia
rest increase fluids antipyretics/analgesic
avoid cough suppressant (so they can expectorate !!)
directions for antibiotic use and side effects
follow up : 24 hours even though abt take up to 48 hr to work
smoking cessation
most preventable cause of premature death in U.S
1 in 5 deaths is related to smoking
35 million smokers try to quit each year
7% of them succeed
A few minutes of counseling is an effective way to help people stop smoking
6 phases of change
(1) precontemplation
(2) contemplation - I know I should quit, but ..
(3) determination - I want to quit (self efficacy)
(4) action- set date , specific plan –follow up with provider within 2 week
(5) maintenance- deal with urge
(6) relapse - what did you learn this time?
4 “A” for health care providers
Ask
Advise
Assist
Arrange (follow up)
General concerns about Quiting (smoke)
Women : weight gain
Men : professional athlete image
Adolescent : point out effect on appearance
Adults: more concern about health
pharmacologic intervention for smoking
nicotine replacement
bupropion (Wellbutrin, Zyban)
Varenicline (Chantix)- cause nightmare
Nic Vax -facilitates nicotine antibody development that prevents nicotine getting to the brain
“cold turkey” –> best way & withdraw symptoms does last long
