Pulmonary system Flashcards
Acute bronchitis: etiology/background/time course
inflammation of mucous membranes of bronchial tubes; diminished mucociliary fxn causes bronchioles to become congested with debris
Most are VIRAL
(U) lasts 10d to 1 mo
Acute bronchitis: sxs
cough; may be dry initially & later sputum production, sore throat, rhinorrhea, HA, myalgias, extreme fatigue
Acute bronchitis: dx and tx
dx: culture of sputum, CBC, CXR-should be WNL
txL NSAIDS, ASA, decongestants (Mucinex), ICS
if due to pertussis-> Abx (macrolides)
Influenza: etiology/background
acute febrile illness secondary to influenza A or B, transmitted by respiratory droplets, prevention w/vaccine
Influenza: risk factors
Vaccinate it: >50yo, resident of LTC facility, hx of plum dz (COPD, asthma), hx of cardiovascular dz, 2nd/3rd trimester pre go, immunocompromised, health care providers
Influenza: signs/sxs, time course
abrupt onset of fever, sore throat, HA, myalgias, malaise, non-productive cough, clear nasal d/c, cervical lymphadenopathy. May see confusion/weakness in elderly
-lasts 3d to 2 weeks w/ convalescence 1-4 weeks
Influenza dx & tax
dx: viral cultures from nose or pharynx
CXR for productive cough/fever
CBC< electrolyte/glucose
tx: supportive, bedrest, anti-pyretics; Rimantadine & amantadine can shorten the course
Zanamivir & oseltamacir
Influenza complications
bacterial pneumonia
Community acquired pneumonia (bacterial) etiology (3)
Strep pneumo
H. flu
Staph aureus
Hospital acquired pneumonia (bacterial) etiology (3)
Pseudomonas
Klebsiella
E. coli
Ventilator acquired pneumonia (bacteria):
days 1-4 (4)
>4days (3)
days 1-3: S. pneumonia, H. flu, m. cat, MSSA
> 4 days: pseudomonas, acinetobacter, MRSA
Atypical pneumonia (bacterial) (3) & sxs
legionella (GI sxs: N/V/D including LDH, hyponatremic, unilateral lower lobe consolidation)
mycoplasma
chlamydia
Bacterial pneumonia signs & sxs
fever, leukocytosis, cough, sputum, night sweats, hemoptysis, weakness, dyspnea, pleuritic chest pain, hypoxemia, hypercapnea, confusion
Atypical pneumonia signs & sxs
HA, diarrhea, myalgia, arthralgia, N/V, reflux, nonproductive cough
Elderly pneumonia signs & sxs
confusion, weakness, failure to thrive, delirium, abdominal pain tachypnea
pleural effusion signs/sxs
tachypnea, crackles, dullness to percussion, inc. tactile fremitus, egophony, diaphoretic
pneumonia dx
CXR (gold standard)
nasopharyngeal swal Ab, CT scan, blood cultures, urine antigen (legionella), CBC, BMP, ABGs/pulse ox, bronchoscopy
Community acquired pneumonia (CAP) tx; severe CAP tx
CAP–> macrolides (azithro/clarithromycin), doxyclcline, fluoroquinolones (Cipro, Levaquin, Moxi, Gati), cephalosporins (Ceftin, Rocephin, Keflex)
Severe CAP->double abx-antipseudo cephalosporin w/quinolone or macrolide
Aspiration pneumonia tx
anaerobic coverage w/quinolone with or w/o b-lactam, flagyl or clindamycin
MRSA pneumonia tx
Vancomycin or Oxacillin
Legionella pneumonia tx
B-lactams, mactrolides, fluoroquinolones
Mycoplasma penumonia tx
macrolide, tetracycline
When tx pneumonia, always do what?
f/u CXR in 1 mo to r/o lung CA
Viral pneumonia: etiology
Influenza->half of all CAP, cough & fatigue
Adenovirus-very contagious, summer months
Hantavirus (contact w/rodent excrement)
