pulmonary pathophysiology 2 Flashcards
- What are the mechanical barriers of the pulmonary defense mechanism?
Nose, mucociliary blanket, and cough
- What are the non-specific and immune mechanisms of the pulmonary defense mechanism?
Alveolar macrophages, neutrophils, and immune globulins
- Where are intermediate-size particles (3-5u) deposited in the respiratory tract?
The bronchi and bronchioles
- When small (<3u) particles reach the alveoli what happens to them?
The immune cells (alveolar macrophages)
- What mechanism are the cilia an important part of and what is their function?
They propel mucous out of the airway on the mucociliary escalator
- Describe the differences between acute bronchitis and bronchiolitis.
Acute bronchitis is an infection of the large airways that can be viral or bacterial, it more commonly occurs in adults and smokers. Acute bronchiolitis is an infection of the small airways that is mostly viral, and is typically seen in children.
- What is the pathophysiology of bronchitis?
Inflammation of the airways and sputum production
- Define pneumonia.
Infection of the pulmonary parenchyma (lung tissue) which can be caused by bacteria, viruses, fungi, and other organisms.
- What are the symptoms of pneumonia?
Fever, cough, sputum production, & chest pain
- What type of pneumonia can occur in healthy people but is commonly precipitated by a virus (like influenza)?
Bacterial pneumonia (strep pneumonia)
- What are the community acquired pneumonia pathogens?
Bacterial (streptococcus pneumonia, klebsiella pnemoniae, streptococcus pyogenes, staphylococcus aureus, and legionella pneumonphila), mycoplasma/chlamydia, viral (measles, varicella), and fungal (blastomycosis, histomycosis, and coccidiomycosis)
- What type of fungal pneumonia can occur in healthy individuals who visit wet, vegetative areas in the norther Midwest?
Blastomycosis
- How is the Blastomycosis (fungus) recognized on microscopy?
Broad, budding, yeasts
- Where do most community acquired pneumonia originate?
Colonization of the upper airways and aspiration of the organisms into the lungs
- What type of pneumonias occur in immunocompromised patients?
Viral (CMV and herpes), PCP, Fungi (aspergillosis), and nosocomial (anaerobes, gram negative rods, staph aureus)
- Where type of patients get nosocomial pneumonia?
Hospitalized patients
- What patients are at the highest risk for nosocomial pneumonia?
Intensive care patients on mechanical ventilators
- What organisms most often cause nosocomial pneumonia?
Gram negative rods and staph aureus and methyl resistant staph aureus (MRSA)
- As a future nurse what is the most important thing for you to provide your patients to prevent nosocomial pneumonia? Why?
Frequent and thorough oral care – especially when they are intubated! Most pneumonias originate in the mouth.
- Who gets opportunistic pneumonias? What are examples?
Patients who are immune compromised; pneumocystis pneumonia, and aspergillosis
- What is the therapy to prevent pneumocystis pneumonia?
TMP-Sulfa and monthly inhaled pentamidine
- What are the characteristics of invasive pulmonary aspergillosis?
Seen in severely neutropenic patients (chemotherapy, bone marrow transplants), invasion of pulmonary parenchyma and blood vessels, nodules and cavitations, can be fatal
- Who should receive the pneumonia vaccine?
Patients with chronic lung or heart disease, diabetes, lymphoma, alcoholism, asplenic patients, renal failure, and those aged 65 or greater should receive vaccine and/or booster
- Define ARDS.
Clinical syndrome of rapidly progressive respiratory failure, extensive radiologic opacities in both lungs and severe hypoxemia requiring mechanical ventilation
- What are the potential causes of ARDS?
Severe infections, multiple trauma, aspiration, pancreatitis, and shock
- What is the main pathologic finding of ARDS? Explain how it occurs.
Diffuse alveolar damage (DAD), which results from accumulation of inflammatory cells in the interstitial space, release of mediators, oxidants, and enzymes to destroy pathogens cause epithelial damage that results in loss of type I pneumocytes, denudation of basement membrane, and endothelial damage with causes leakage of protein rich plasma fluid causes alveolar edema
- Describe the phases of ARDS.
Exudative phase (week one): edema, inflammation, loss of type I cells. Organizing phase (week two): proliferation of type II cells and fibrosis. Resolution phase (after week 3): partial or complete resolution, patient is left with fibrotic lungs and varying degrees of long term respiratory damage
