Resp Flashcards
General age related changes
Decreased elasticity - cant take a deep breathe Increased rigidity Weaker thoracic muscles - weak cough Decreased # of alveoli Decreased cilla
Acute bronchitis
Viral , self limiting
Inflammation of lower resp track
S/s: cough ( with or without flem) cough can be dry or wet and develop throughout the days
- fevers, chills, wheezes or rhonchi that clear with cough, pain from cough
Organisms : influenza A or B, parainfluenza, coronavirus, rhinovirus
Tx: symptom control, bronchodilators ( albuterol ) 2 buffs Q 4 hours up to 12 puffs a day, dextromethorphan ( cough medication) , tyenlol for fever , increase humidity , follow up in 3-4 days if not getting better
AVOID antihistamines and mucolytics
Pertussis
Incidence related to non immunized people
- must get 3 vaccines
Progresses from cold symptoms to severe cough “ whooping sounds”
Look for this if there has been a community outbreak , report to DPH
Bacteria : bacterium bordetella pertussis
S/s: violent coughing, sob, after coughing taking a deep breathe ( whooping)
Dx: nasal swap
Tx: Azithromycin 500 mg day 1 then 250 mg day 2-5
Note: pt is infected from beginning of symptoms through the 3rd week or until days 5 after effective antimicrobial treatment
Prevention : Tdap ( pregnant women should get booster in 27th-36th week)
Pleurisy
Inflammation of the pleura due to infection
S/s : fever, trouble taking a full breath, may have EENT or other resp symptoms, GI upset
Tx: pain medication and symptomatic relief
It causes pleuritic pain
Pleuritic pain
Can be caused by: pneumonia , embolism ,MI, pneumothorax , TB, auto immune, GI
Sharp pain, stabbing burning when breathing
Rule out : cardiac problems
Pulmonary embolism
Blockage of the large pulmonary artery —> often due to a break of a DVT
S/s: may have none or will have CP, SOB coughing blood, DVT symptoms
Tx: anticoagulation for 3-6 months
CAP community acquired pneumonia
An acute infection of the lower resp tract occurring a in person living in the community and has not hospitalized in the past two weeks
Elderly may present with , alt mental status, falls, poor PO intake
Other s/s: high fever, sob, fatigue, aches, headache, hypotension , high hr
Consider recent hx of pneumonia and recent antibiotics use in the last 3 months
PE: crackles that do not clear with a cough
- dull to percussion
- egophany ( increased resonance sounds indicating consolidation )
- bronchopany
- whispered perctorloquy ( increased loudness
- increased tactile fremitus ( normal finding is decreased fremitus as you go down )
Organism: Strep. Pneumonia ( sudden onset) , h. Influenza, mycoplasma ( slow onset )
TX: cough suppressants, albuterol, expectorants ( medication to bring flem up)
CAP treatment
Cough suppressants
Short course abulterol
Antibiotics:
- uncomplicated
- Azithromycin
- allergy to macrolide
- doxycycline
- complicated
- amoxicillin or Augmentin + azithroymycin
- complicated allergy
- fluoroquinolones or ( azithrymcyin + augmentin )COPD
Irreversible obstructive airway disease
Progressive decline in lung function
It can be chronic bronchitis or emphysema
Chronic Bronchitis
Persistent cough production for 3 consecutive months over two years with periodic exacerbations
Imbalance between ventilation and perfusion leading to hypoxemia and hypercarbia “ blue bloaters”
May lead to pulmonary hypertension
Cough, wheezes and course crackles
Polycythemia is common
Emphysema
Permanent and abnormal enlargement of any part of the airspace’s distal to the terminal bronchioles
Hyperinflanted increases A/P diameter SOB is more common than cough, Marked expiratory respiratory phase is prolonged PO2 is maintained = Pink puffers Weight loss noted
Hyperressont to percussion , breathe sounds are distant
COPD risk factors and PE
Risk factors : smoking, occupational hazards, outdoor air pollution
PE:
- prolonged expiratory phase
- wheezes on forces expiration
- decreased rib cage movement
- increased movement fo abdominals
- forward sitting ( late stage)
- increase resonance on percussion
- early Inspiratory crackles
COPD dx criteria
CXR, CT CHEST, SPIROMETRY ( gold standard), EKG , CBC
Presence of symptoms
- sob on exertion or rest
- cough with or w/o sputum
- progressively activity intolerance
Spirometry
Pulmonary function tests:
- measures Forced vital capacity (FVC)
- max volume of air that can be exhaled during a forced maneuver - Forced expiration volume in 1 second (FEV1)
- how quickly can the lung be emptied
Ratio is then calculated and results are expressed as % of predicted BELOW .70 = COPD
COPD PLAN : staging
GOLD + Catergories
