Respiratory Flashcards
upper respiratory tract
nasal passages
Sinuses
Nasopharynx
Pharynx
Larynx
Tonsils
Glottis
Allergic rhinitis
inflammation of upper airway, lower airway, or eyes
Sx allergic rhinitis
sneezing
Rhinorrhea
Pruritus
Nasal congestion
Water, itchy eyes
Allergic rhinitis triggers
allergens – binds to IgE antibodies on mast cells to release, inflammatory mediators
Environmental Dash dust, mites, mold, pollen
histamine
Causes majority of symptoms with allergic reactions
Can be drug induced, food, or contact
Where is histamine stored?
mast cells – skin and soft tissue
Basophils– blood
What occurs when histamine is activated?
Hives and itching skin
Dilation of blood vessels
Erythema
Hypotension
Bronchoconstriction – SOA, wheezing
Affect sleep/wake cycles
Increased secretion of stomach acid
Upper respiratory infection – bacterial manifestations
White patches
Swollen tonsils
Red throat
Gray/furry tongue
Swollen uvula
Upper respiratory infection –viral manifestations
red/swollen tonsils and throat
No white patches
will antibiotics work against viral upper respiratory infections?
No, negative strep test
rhinitis
Common cold
how is rhinitis transmitted?
Droplet
sx rhinitis
Low-grade fever <104
Headache
Fatigue
Nasal congestion
Runny nose
Cough
sinusitis
Can occur as secondary infection
Anything in nose can increase risk
Reduces or blocks sinus drainage
rhinovirus
Cause for common cold
how is rhino virus spread?
Droplet
Contaminated objects
how long can run a virus live outside the body?
Up to three hours
Skin surface, objects
sx sinusitis
Pain above or below eyes
Cloudy, green or yellow discharge
Congestion
Throat, irritation
How is sinusitis treated?
difficult to treat
Fluids, decongestants, treat symptoms
pharyngitis
Inflammationinfection of pharynx
palate, tonsils, uvula
Bacterial or viral
how is pharyngitis diagnosed?
Culture and rapid, strep test
sx pharyngitis
difficulty swallowing
White patches (bacterial)
Redness (viral)
Laryngitis
inflammation of Larynx
(vocal cords)
sx laryngitis
Difficulty speaking
Scratchy/hoarse voice
croup
Inflammation of larynx, trachea and bronchi
Who is croup common in?
Children
Distinguisher’s of croup
Bark like cough
Strider breath sounds
Expiratory wheezing
Acute bronchitis
increased cough, and sputum production
Inflammation of bronchial tree
Is acute bronchitis, viral, or bacterial?
Viral
Influenza
viral infection
A, B, C types
sx influenza
fever
Chills
Body ache
are flu symptoms rapid, or slow onset?
Rapid
What can be deadly as a result of the flu?
Secondary conditions – pneumonia
sputum
Mucus secreted by respiratory tract
Traps particles that enter bronchioles
Cilia help move, mucus in captured particles out
normal sputum
Clear, whitish
thin
Infected sputum
Yellow, brown color
epiglottitis
Swelling of epiglottis
what blocks the trachea when swallowing?
Epiglottis
sx epiglottitis
Inspiratory stridor and retractions
Rapid onset, fever
Pain
difficulty swallowing
Drooling
what is the difference between croup and epiglottitis?
epiglottitis: The absence of a barking cough
what sign is indicative of epiglottal swelling?
Steeple sign
obstructive airway condition
Narrowed, causes airway obstruction
Worse on expiration
Causes increase work of breathing
Emptying of lungs is slowed
What kind of mismatch occurs in obstructive airway conditions?
Perfusion and ventilation
Air trapping
occurs when patient isn’t able to fully exhale
High carbon dioxide levels
Air is trapped in alveoli
what is seen on a chest x-ray for air trapping?
Lungs are hyperinflated
asthma
Chronic information of bronchial airways
Bronchial hyper responsiveness
Inconsistent airflow obstruction
Chronic disease state with acute exacerbations
is asthma reversible?
Yes
risk factors for asthma
Children
Allergies
Familia link
Level of allergen exposure
Urban residency
Exposure to indoor and outdoor pollution
Tobacco exposure/smoke
Recurrent respiratory viral infections
Pathophys of asthma
trigger factor
Airway inflammation
1- hypersecretion of mucus
2- airway muscle construction
3- swelling bronchial membranes
Narrow, breathing passages
Wheezing, cough, SOB, tight chest
what is the number one trigger of asthma?
Exertion from exercise
other triggers from asthma
Second hand smoke
Climate
Dust, pollen, pet dander
early asthmatic response
Immediate
Release of inflammatory mediators within minutes
Vasodilation
Increased capillary permeability
Mucosal edema
Smooth muscle contraction
Mucus secretions
late asthmatic
4 to 8 hours after early response
Another release of inflammatory mediators
Teach – keep meds nearby, identify triggers
What phase of asthma is irreversible?
Airway remodeling – chronic asthma
what is the number one symptom of an asthma attack?
Bronchoconstriction
Difficulty breathing
what is the biggest problem/seriousness of asthma?
Inflammation
Causes airway remodeling – long-term
diagnosis of asthma
History – allergies, recurrent, wheezing, episodes, exercise intolerance
Pulmonary function test **
sx of asthma
wheezing
Breathlessness, SOB
Cough
Chest tightness
sx severe asthma attack
Use of accessory muscles
Distant breath sounds
Sweating
Inability to speak
sx respiratory failure
inaudible breath sounds
Patient decline
Repetitive hacking cough
Status asthmaticus
unrelenting asthma attack
Life-threatening emergency
IV epi needed
pCO2 >70mmHg
chronic bronchitis
Hypersecretion of mucus and chronic, productive cough
timeline for chronic bronchitis
Three months for two consecutive years
acute bronchitis
Inflammation of bronchi and bronchioles
viral or bacterial
Usually better in 3 to 4 weeks
Chronic bronchitis cause
cigarettes
Positive airflow obstruction
s/sx chronic bronchitis
hypoxic
Overweight and cyanotic
Elevated hemoglobin
Peripheral edema
rhonchi and wheezing
dx chronic bronchitis
History – symptoms, physical exam, chest imaging, PFTs
pathophys of chronic bronchitis
inhaled irritants – airway inflammation
infiltration into bronchial walls
Increase in number and size of goblet cells
why can thick secretions not be cleared and chronic bronchitis?
Damaged cilia bronchial walls become inflamed
late sx of chronic bronchitis
Pulmonary hypertension
Syncope
Fatigue
Dyspnea
cor pulmonale
right sided heart failure
Late symptom of chronic bronchitis
does smoking cessation reverse, chronic bronchitis?
No, but can be halted
If smoking is stopped before symptoms, the risk decreases
emphysema
Abnormal, permanent enlargement of gas exchange airways
Destruction of alveolar walls
Obstruction from inflammatory and destructive changes in lung tissues
Loss of elastic recoil
Is emphysema destruction by tissue changes or mucus production?
Tissue changes
genetic emphysema
Inherited deficiency of enzyme, alpha – antitrypsin
s/sx emphysema
Gradual increase in breathlessness with exertion
Eventually, SOB at rest
Prolonged, expiratory phase
May become oxygen dependent
Wheezing, malnourished, decreased muscle mass, barrel chest, pursed, lip breathing, decreased breath sounds
dx tests for emphysema
Pulmonary function test
FEV1
Chest x-ray
ABG
AP diameter
signs of emphysema
Older and thin
Severe dyspnea
Quiet chest, diminished
Hyperinflated lungs with flattened diaphragms
Hypercarbonic
pneumonia
Any type of infection in lower respiratory system
Causes inflammation of the lungs tissues
Alveolar air spaces filled with purulant, inflammatory cells and fibrin
transmission of pneumonia
Inhaled, infectious droplets
Who and when is pneumonia? More common in?
Winter
Men
risk factors for pneumonia
Age extremes
Compromised immunity
Underlying lung disease
Alcoholism
Altered LOC
Impaired swallowing
Nursing home resident
Intubated, anesthesia, Immobile
What is the most common cause of pneumonia?
Flu
what are the age extremes for pneumonia?
<5
>70
CAP
Community acquired pneumonia
most common reason for hospitalization
Easier to treat
risk groups for CAP
Elderly
Healthy people with underlying disease
HAP
Hospital acquired pneumonia
Developed within 48 hours after admin
ventilator associated pneumonia
Which type of pneumonia is more violent and deadly?
Hospital acquired pneumonia
risk groups for HCAP
Nursing homes
Hospitalization for chronic disease
Outpatients – dialysis, chemo
pneumonia pathogenesis
aspiration of oral pharyngeal secretions
Inhalation of droplets containing bacteria/pathogens
pathogenesis cont.
inflammation reaction stimulated in lungs – vasodilation
Goblet cells stimulated – mucus secreted between alveoli and capillaries
Decreased gas exchange
main problem of pneumonia
Failure of mucociliary defense mechanism allows exudated fluid and inflammatory cells to invade alveoli
what group of people have ineffective mucociliary clearance?
Smokers
s/sx pneumonia
Preceded by URI – fever, chills, cough, malaise, plural pain, hemoptysis, dyspnea
Bacterial cough with pneumonia
Productive/purulent
Green, rusty, red currant jelly
Gram negative in HAP
viral cough pneumonia
Non-productive
CAP
severe pneumonia cough
tachypnea
Respiratory distress and failure
Respiratory distress
Increase in work of breathing
Respiratory failure
can compensate for inadequate 02
Extra respiratory effort and rate
Circulatory and respiratory system collapse
Diagnosis of pneumonia– physical exam
wet breath sounds – rhonchi
Pleuritic chest pain
Exercise intolerance
pulmonary consolidations
Dullness due to percussion, inspiratory crackles, tactilefremitus, egophony
diagnostic tests
chest x-ray – infiltrates
CBC – leukocytosis with bacterial
Positive sputum for C & S
bacterial pneumonia
Gram positive staph
Enters the bloodstream through IV to lungs
HAP, MRSA
What color is the sputum in bacterial pneumonia?
Brown, Rusty, colored tinge
Are gram-positive or gram-negative more difficult to treat?
Gram negative
pseudomonas, klebsiella , acerietobacter
Aspiration pneumonia
material from G.I. tract
Stimulates inflammatory reaction
What does the severity of information in aspiration pneumonia depend on?
PH of aspirate
What does a more acidic pH indicate?
Increased inflammation
what type of inhibitor is given to decrease acidity of gastric contents?
Protein pump inhibitor
Who is at risk for aspiration pneumonia
NG tube
Decreased LOC, gag, reflex, gastric, emptying
viral pneumonia
Flu – most common cause of CAP
Adenovirus, RSV
Alters pulmonary immune defense – lungs vulnerable to secondary bacterial infection
Pneumo-cytosis Carini
atypical pneumonia
HIV, transplant patients
yEast like fungus
mycoplasma
Atypical “ walking “ pneumonia
Mild – complains of persistent, cough, headache, Ear ache
Bacterial and viral properties
Legionella
gram-negative, atypical, pneumonia
Spread by water systems, old AC, mist sprayed on produce, hot tubs
Aspergillus
A typical fungal pneumonia
Walls of old buildings, reconstruction, dead leaves, compost
PCV 13 vaccine
Prevents pneumococcal caused by 13 strains of strep
PPSV 23 vaccine
Prevents additional 23 types of pneumonia bacteria
tuberculosis
Infection by mycobacterium
Aerobic bacillus – rod shaped, needs lots of oxygen to grow in proliferate
Granulomas in lungs – nodular accumulations
transmission of tuberculosis
Humans, cattle, birds
Airborne droplets- tubercle bacilli
is tuberculosis slow or fast growing?
Slow growing
Harder to treat
latent TB
Infected bacilli are isolated in granulomas
Remain dormant for life
No clinical signs or symptoms of disease
when can TB be reactivated
HIV
Immunosuppression meds
Poor nutritional status
Renal failure
Active TB
symptoms develop gradually –
Fatigue, weight, loss, lethargic, anorexia, low-grade fever, productive, cough, night sweats, anxiety
Fever in afternoon
extra pulmonary TB
Decrease in neuro function
Meningitis symptoms
Bone pain
Urinary problems
Screening for high risk populations
IGRA blood test
screening for non-high-risk populations
TB skin test
what to do if positive result
Confirm through sputum stain & culture
Chest x-ray – granulomas
Who is affected by drug resistant TB
HIV community
Homeless, undernourished, substance users, cancer, patients, immuno, suppressed, people, living in crowded/poor sanitation housing
** Asian and Hispanic
drug resistant TB
MDR – TB
how is MDR-TB TREATED
Second line drugs
Hemoglobin
carries oxygen
Iron is center of him unit
binds to: carbon monoxide, glucose
anemia
Not enough RBC to bind or deliver to tissues
Low RBC
what is anemia caused by?
Blood loss
Low nutrition
Defective hemoglobin
Bone marrow disorders
Chronic diseases
Iron deficiency
Maturation disorders
Bleeding
what indicates more red blood?
High SPO2
Absolute anemia
not enough RBC
Decrease in number
Relative anemia
delusional
Increase in plasma volume
Pregnancy, fluid, volume overload, athletes
polycythemia
Too many RBC
dehydration
Decrease in plasma volume
s/sx anemia
Pale
Fatigue quickly
Increased heart rate and respiratory rate
s/sx of mod-severe anemia
Increased RR and HR
Hypotension
Pallor
Faintness
Angina with exertion
s/sx of mild anemia
May have none
s/sx of mild-mod anemia
Fatigue
Weakness
Tachycardia
Dyspnea
abnormal hemoglobin anemia
Increased rate of destruction
Decreased lifespan
Sickle cell disease
Thalassemia
is the count or shape abnormal for hemoglobin?
Shape
Sickle cell disease
inability to bind to hemoglobin normally
HGBS distorts shape
when cells Sickle, they clump together and block blood flow where?
Liver
Spleen
Heart
Kidneys
Retina
Thalassemia
genetic, defective hemoglobin
Destroyed in bone marrow or spleen
How is hemoglobin classified?
Size and shape of RBC
what indicates a lower MCV?
Microcytic anemia
Decreased iron
Sickle cell disease
what indicates a higher MCV?
Vitamin B 12/folate deficiency
Macrocytic, anemia
what is the most common cause of anemia?
Iron deficiency
causes of iron deficiency
Decreased intake
Decreased absorption
Increased demand – pregnancy
Excessive loss – bleeding
what drinks can decrease absorption of iron?
Coffee and tea
s/sx iron deficiency
Epithelial atrophy
Brittle hair and nails
Spoon nails - koilonychia
Smooth tongue
Mouth sores
Dysphasia
PICA
koilonychia
spoon nails
PICA
craving of non-food
Pagophagia- craving and chewing ice, clay, starch, dirt
Causes of folate deficiency
Decreased intake – alcoholism, diet, liver disease
Increase need – pregnancy
vitamin B 12 deficiency
Intrinsic factor needed for absorption in terminal ileum
conditions that decrease intrinsic factor or reduce absorption of vitamin B 12
Gastric bypass
Gastrectomy
Bowel resection
neuro s/sx B12 deficiency
depression
Paranoia
Confusion
Anger/irritable
Anxiety
Balance issues
Memory loss
decreased number of circulating erythrocytes
Chronic kidney disease – impaired erythropoietin production
aplastic anemia
Primary condition of bone marrow stem cells
Pancytopenia
Causes of a plastic anemia
idiopathic – unknown
High-dose exposure to toxic agents – radiation, chemicals, insecticides, chemo
Auto immune – viral, hepatitis, mono
Acquired hemolytic anemia
premature destruction of RBC by external agents
causes of acquired hemolytic anemia
Auto immune
Blood incompatibility
Drug reactions
Severe burns
hemolytic anemia
Formation of immune complex- leads to lysis
What to look for in hemolytic anemia
Low hemoglobin
Increased reticulocyte count
Mild jaundice
Bloody urine
Decreased haptoglobin
blood loss anemia
Results from: gross, occult
Acute/rapid loss – unable to compensate
Slow loss – body able to compensate
Chronic blood loss
slower rate, insidious
Body able to compensate
Maybe asymptomatic
G.I. bleed, erosion
what organ should you watch for with chronic blood loss?
Heart
Brain
Lungs
Kidneys
10% blood loss symptoms
Rarely any, syncope
20% blood loss symptoms
None at rest
Increased heart rate with exercise
30% blood loss symptoms
flat neck veins when supine
Increased heart rate with exercise
Decreased blood pressure with sitting up/standing
40% blood loss symptoms
increased heart rate, decreased blood pressure when supine
Air hungry, clammy skin
50% blood loss symptoms
Shock and death
Relative polycythemia
isolated decrease in plasma volume
Increased, hemoglobin, hematocrit, RBC
causes of relative polycythemia
Severe dehydration
Smokers
primary polycythemia
Polycythemia vera
>60 years old
Overproduction of blood cells
Easy blood, clotting, thick blood
is primary polycythemia benign or malignant
Malignant
Neoplastic disease, uncontrolled proliferation
Precursor to leukemia
s/sx primary polycythemia
Headache
Fatigue
Dyspnea
Weight loss
Hypertension
Clotting problems
Rudy color/redness
Pathogenesis of primary polycythemia
Single stem cell mutate into sell that over produces all blood cells
cause of secondary polycythemia
Adaptive compensatory response to tissue hypoxia
purpose of secondary polycythemia
Provide more oxygen carriers by increasing RBC production
Who is at risk for polycythemia?
COPD
Chronic hypoxia
Living at high altitudes – chronic mountain disorder
Long-term smoking
Genetic predisposition
Long-term exposure to carbon monoxide – tunnel worker, high levels of pollution, garage attendants
pathogenesis of secondary polycythemia
Hypoxemia, long-term
Stimulation of erythropoietin in kidneys
Increased RBC production
Increased blood viscosity and volume consequences
HTN. – headache, inability to concentrate, Rudy, cyanosis in lips, nails, mucous membrane.
decrease blood flow consequences
DVT
Hemorrhage
Angina
Cerebral insufficiency, stroke
Hypermetabolism consequences
Night sweats
Weight loss
increased RBC, H&H consequences
Pruritus
Pain in fingers and toes
