Respiratory Flashcards
Danger Signs: Lung Cancer
screening:
-chronic cough
-recurrent pneumonia in same lobe
-achy bone pain
-horner syndrome (pupil constriction with ptosis)
screening: low-dose computed tomography (LDCT) recommended for:
-smokers 55-80 yo.
-or quit smoking <15 yrs
Danger Signs: PE
-dyspnea & coughing (w/pink tinged sputum)
-tachycardia, impending doom
blood clot risk:
-a-fib
-estrogen
-smoking
-surgery
-pregnancy
-long bone fractures
-prolonged inactivity
Danger signs: Impending resp failure (Asthmatic Exacerbation)
Tx?
-tachypnea / cardia
-cyanosis
-anxiety
-fatigued
-diaphoretic
-use of accessory muscles
-“QUIET” lungs: no wheezing or breath sounds audible
-pt cannot complete sentences because they need to catch their breath
Tx:
-adreniline inj. stat
-call 911
-O2 @ 4-5 L/min
-albuterol tx
Obstructive resp dz
**difficulty with EXhaling air from their lungs.
Obstructive ABC’s
-asthma
-bronchiectasis
-bronchiolitis
-COPD (chronic broncitis + emphysema)
-cystic fibrosis
**Restrictive airway disease patients have trouble filling their lungs with air upon INSPIRATION.
COPD Objective findings:
Percussion:
Tactile Fremitus and egophony:
chest x-ray:
Percussion: Hyperresonance
Tactile Fremitus and egophony: Decreased
chest x-ray:
-flattened diaphragm w/ hyperinflation
-bullae sometimes present
Low BMI is associated with _____ outcomes in pt’s w/ COPD
Worse
-give supplementation (Ensure) to underweight pt’s
When TX COPD you want an antibiotic that works for both gram + and gram - , which are
PET: “I like to heavy PET both….”
Penicillin, erythromycin and tetracycline
CAP Signs/Symptoms:
No. 1: causing organism=
No. 1: Streptococcus pneumoniae (gram positive)
Acute onset. High fever and chills.
Productive cough and large amount of green to rust-colored sputum.
Pleuritic chest pain with cough.
Crackles; decreased breath sounds, dull.
CBC: leukocytosis; elevated neutrophils. Band forms may be seen.
Atypical pneumonia: Signs/Symptoms:
No. 1: mirco organism
No. 1: Mycoplasma pneumoniae
Gradual onset. Low-grade fever.
Headache, sore throat, cough, wheezing, rash (sometimes).
CXR: interstitial to patchy lobar infiltrates.
Tuberculosis (TB disease) Signs/Symptoms:
Cough lasting 3 weeks or longer.
Pleuritic chest pain.
Hemoptysis with fatigue, weight loss, anorexia, fever/chills, night sweats.
Patient meets the “CURB-65” criterion for hospital admission.
If score >1, patient should be hospitalized.
C -________
U -blood urea nitrogen >___
R -respiration >___
B -blood pressure <___
age_____
“CURB-65” is a tool to assess whether a patient needs hospitalization [each factor is worth 1 point].
C (confusion)
U (blood urea nitrogen >19.6 mg/dL)
R (respiration >30 breaths/min)
B (blood pressure <90/60 mmHg)
Age 65 years or older
Tuberculosis Skin Test (Mantoux Test)
Induration of ≥5 mm:
HIV-infected persons
Recent contact with infectious TB cases
CXR with fibrotic changes consistent with previous TB disease (cavitations on the upper lobes)
Immunocompromised (e.g., organ transplant, bone marrow transplant, renal failure, patients on biologic drugs)
Tuberculosis Skin Test (Mantoux Test)
Induration of ≥10 mm:
Recent immigrants (within the past 5 years) from high-prevalence countries (Latin America, Asia [except Japan], Africa, India, Pacific islands)
Child <4 years of age or children/adolescents exposed to high-risk adult
Injection drug user, healthcare worker, homeless
Employees or residents from high-risk congregate settings (jails, nursing homes)
***A PPD result may be listed as 9.5 mm. If the patient falls under the 10-mm group, then it is negative (by definition) unless the patient has the signs/symptoms and/or CXR findings suggestive of TB.
Tuberculosis Skin Test (Mantoux Test)
Induration of ≥15 mm:
Persons with no known risk factors for TB
appearance of a posterior–anterior (PA) CXR of a person with healed pulmonary TB
The classic findings are pulmonary nodules and/or cavitations (round black holes) on the upper lobes with or without fibrotic changes (scars).
