Respiratory Flashcards
Streptococcus pneumoniae
inhabits the oropharynx, gram positive coccus in pairs of diplococci. aquired in the community. frequently follows a URI. Polysaccharide capsule responsible for most cases of nonresolving pneumonia syndromes. causes lobar pneumonia.
physical findings supporting asthma
nasal polyps, pale nasal lining indicating allergi rhinitis and allergic asthma, atopic dermatitis with lichenified plaques
consolidation with a blocked airway
percusson dull, fremitius decreased, breath sounds decreased, voice transmission decreased, crackles absent
greater prevalence of asthma within menstrual cycle
periovulatory days 12-18, perimenstruall days 26-4
pulmonary function testing
tests airflow limitation
moderate asthma
dyspnea - while at REST, prefers sitting. talks in PHRASES. usually agitated. common accessory muscles. loud wheeze through out exhalation. pulse 100-120. pulsus 10-25.
mast cells causes
smooth muscle hypertrophy
peak expiratory flow
measured during a brief forceful exhalation. take large breathe in, put peak flow in mouth then blow hard and fast three times and take the highest measurement. if peak improved by 20 percent 20 minutes after bronchodilator then dx asthma
severe asthma
dyspnea at rest, SITS UPRIGHT. talks in words, agitated, loud through out inhalation and exhalation wheeze, pulse > 120, paradoxus >25.
Staph aureus pneumonia
gram positive in clusters can occur secondary to the flu, within the oropharynx of a hospitalized patient or a complication of staph in the blood stream.
eosinophils causes
mucus hypersecretion, airflow limitation
Exercise induced asthma
exercise and 5-15 minutes after have asthma s/s resolve over 30-60 minutes
consolidation or atelectasis with a patent airway
percussion dull, fremitius increased, breath sounds bronchial, voice transmission bronchophony, whispered pectoriloquy, egophony, crackles present
chlamyodphila
tetracyclin, macrolide
aspiration pneumonia
anaerobic organisms affecting those with impared consciousness or difficultly swallowing, poor dentition - gradual onset, sputum with foul odor suggesting anaerobic infecion necrosis and abscess formation may follow. occurs in dependent areas of the lung. lower lobe in upright pts or superior lower lobe in supine patients – can have pleural effusion or empyema
H influenzae pneumonia
gram negative coccobacillary in the nasopharynx and in lower airways of patients with COPD. COPD is a predisposing factor
outpatient w history of cardiopulmonary disease
same as without cardiopulm PLUS anaerobes, aerobes gram neg bacilli – treat quinolones or beta lactam plus macrolide
bronchodilator response
2 puffs of bronchodilator and repeat spirometry 15 minutes later, increased FEV of 12 percent and FVC at least 200 is a bronchodilator response
pathological process common to all pneumonia
infection and inflammation of the distal pulmonary parenchyma
inflamm cascade of asthma
epithelial cells, mast cells, cd4, eosinophils
Extrinsic asthma
external - early in life, allergic, allergens, food, pollen, dust, occupational, aspergillosis. type 1 hypersensitivity
spirometry
maximal inhalation followed by a rapid and forceful complete exhalation into the spirometer will measure forced expiratory volume FEV1 and forced vital capacity FVC. need this baseline in all asthma pts.
Intrinsic asthma
viral infection, medication, cold, exercise, no hx of allergic reaction, develops later in life
hae influenzae pneumonia
2nd or 3rd cephalosporins (cef), bactrim
site of disease for copd and asthma
copd - peripheral airways and lung parenchyma leading to squamous metaplasia, small airway fibrosis and parencymal destruction… small bronchodilator response, poor response to steroids.
asthma - proximal airways leading to basement membrane and bronchoconstriction… large bronchodilator response. good response to steroids.
obstructive airflow pattern on spirometry level
FEV1/FVC
clinical features of copd
midlife, slowly progressive, long history of tobacco smoking, dyspnea during exercise, irreversible airflow limitation
pneumonia and contributing factors
infection and inflammation of the distal pulmonary parenchyma. contributing factors are viral upper resp tract infection, alcohol abuse, cigarette smoking, heart failure, copd
pleural effusion
dull percussion, decreased fremitus, voice and breath sounds, absent crackles
pneumonia results in this process
ventilation perfusion mismatch and hypoxemia
most common cause of bacterial pneumonia
step pneumoniae
persistent severe asthma
symptoms through out the day needing meds, awakening 7times a week, extreme limitations in activity, FEV 5%
Worse time for s/s
night and early morning
Klebsiella pneumoniae
gram negative rod found in the GI tract, found with underlying alcoholism. leads to lobar pneumonia (same as step pneumonia –> lobar)
copd inflammatory mediators
cd8, macrophages, neutrophils
outpatient no cardiopulmonary disease
common organisms: s pneumo, m pneumo, c pneumo, resp virus, h influenzae – therapy: macrolide azithromycin or clarithromycin or doxy
Triggers
allergen, cold, exercise, viral infection, cold air
bacterial pneumonia characterized by an outpouring of
PMNs polymorphocnuclear leukocytes to fight the infection
neutrophils cause
subbasement membrane fibrosis, airway hyperresponsiveness
What is asthma?
Chronic inflammatory disorder of the airways. Bronchial hyperresponse and inflammation leading to airway obstruction Recurrent, reversible
staph pneumonia
oxacillin, nafcillin, cefazolin, vancomycin
lobar pneumonia
process not limited to segmental boundaries but tending to spread through out an entire lobe of the lung from alveolus to alvelous through interalveolar pres of Kohn. Step pneumoniae and lobar pneumoniae
emphysema and pneumothorax
hyperressonant on percussion, decreased fremitus, decreased breath sounds, decreased voice, absent crackles
Allergens commonly causing asthma
furry animals, dust mites, cockroaches, mold, pollen
work induced asthma
10 percent of new asthma cases, workplace related exposure confirmed with airflow variable before and after workshift. support with igE specific antibodies in the blood
anaerobes
pcn, clindamycin
intermittent asthma
80, exacc needing corticosteroids 0-1 yearly
Pseudomonas aeroginosa
found in environmental sources within the hospital environment seen in patients who are debilitated, hospitalized and often previously treated with abx
persistent moderate asthma
daily symptoms needing meds, nighttime awakening > 1 week, some limitation with activity, fEV 60-80, FEV/FVC reduced 5%
What are the main s/s of asthma?
Wheezing, SOB, Cough
resp arrest
dyspnea while at rest, sits upright, talks in words, DROWSY CONFUSED. paradoxical abdominal accessory muscles. wheeze absent. bradycardia. no paradoxus.
Mycoplasmal pneumonia
slower, insidious onset with a *nonproductive cough,
copd inflamm cascade
macrophage, epithelial cells, cd8, neutrophils
most common causes of chronic cough
The most common etiologies of chronic cough are upper airway cough syndrome (due to postnasal drip), asthma, and gastroesophageal reflux. Cough may also be a complication of drug therapy, particularly with angiotensin converting enzyme (ACE) inhibitors.
Other less common causes of chronic cough include a number of disorders affecting the airways (nonasthmatic eosinophilic bronchitis, chronic bronchitis, bronchiectasis, neoplasm, foreign body) or the pulmonary parenchyma (interstitial lung disease, lung abscess)
s pneumoia abx
PCN, macrolide (mycins)
mild asthma
dyspnea - while WALKING, can lie down. talks in SENTENCES. alert may be agitated. Usually no accessory muscles. moderate wheeze only on expiratory.pulse
interstitial pneumonia
exuberant inflammatory process but not highly destructive. inflammatory process is within the interstitial walls rather than the alveolar spaces. classically, viral pneumonia begins like this. also, pneumococcal pneumonia behaves this way – healing process restores normal architecture… when organisms are more destructive, tissue necrosis and cavity formation will occur in the parenhyma – cavitary.
legionella
macrolides, quinalones
spirometry determines what
if obstruction is present - reduced FEV1/FVC ratio, assess the reversibility, determine severity of airflow limitation
allergic asthma eosinophil
> 1,500
clinical features in patients with pneumonia
fever with or without chills, cough w or without sputum, dyspnea, pleuritic chest pain, crackles, dullness, bronchial breath sounds and egophony with consolidation, polymorphic
most frequent cause of pneumonia in young healthy adults
mycoplasma - the smallest known free living organism
persistent mild asthma
> 2 days a week symptoms needing meds, not daily. awakening 3-4 a month, minor limits with daily activity, fEV > 80 normal, exacc > 2 times yearly.
bronchopneumonia
distal airway inflammation is prominent along with alveolar disease and spread of infection and inflammatory process occurs through airways not alveoli – patchy in distribution. staphylocci and a variety of gram neg bacilli may produce this
mycoplasma
macrolides (mycins), quinolones
gram negative rods
3rd or 4th cephalosporins, extended pcn with beta lactamase inhibitor
airway inflammation in asthma
air is trapped in alveolis, central and peropheral airways are involved, dysregulation of cells - epithelial, eosinophils, lymphocytes, mast cells, alveolar macrophages, neutrophils, – cells regulate airway inflammation and initiate airway remodeling and permanent airway structure
normal lung
percussion resonant, fremitus normal, breath sounds vesicular at bases, voice transmission normal, no crackles
staph or gram negative pneumonia appearance with pt
very ill with complex underlying health problems
bronchoprovocative testing
provocative metacholine, mannitol, exercise or hyperventilation of cold, dry air. positive test is a 20 percent decrease in FEV of methacholine 8mg or less
Aspirin and asthma
cough, wheeze or chest tightness 30-120 minutes after aspirin or cyclooxygenase inhibitor
pneumococcal pneumonia
abrupt onset with sudden development of shaking chills and high fever - cough may be productive of yellow green or blood tinged. before this pneumonia they often have an URI.
