Respiratory Ch22 Flashcards
Describe the transmission of the common cold from one person to another
-aerosol spread of colds through coughing and sneezing is much less important than the spread by fingers to the nasal membrane and eyes.
0-3 days after symptoms onset
incubation 5-7 days
Common cold manifestations, and treatment of the common cold
S&S - sore scratchy throat, congestion, watery rhinorrhea, sneezing
malaise, fatigue, headache, myalgia
fever in children, infrequent in adults
self limiting
Treatment
-symptomatic, antihistamines,
decongestants (increases BP)
Rhinosinusitis causes, manifestations, and treatment
causes are conditions that obstruct the narrow ostia that drain the sinus
- upper respiratory tract infection
- allergic rhinitis
- nasal polyps
- pressure changes
- decongestant misuse
- swimming/diving
- dental infection
Rhinosinusitis can be classified as
Acute - viral. bacterial(last longer), or both. 5 to 7 days
fungal: rare (immunocompromised)
subacute - 4 to 12 days
chronic - often staphylococcus aureus or allergens 12 weeks
MANIFESTATION
-similar to cold/allergic rhinitis
-facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever, pain in teeth
-chronic (nasal obstruction, sense of fullness in ear, hoarseness, chronic cough, loss of taste and smell. Sinus pain is often absent.
TREATMENT
-antibiotics only if necessary
-intranasal corticosteroids
-topic alpha-adrenergic decongestant (3 days)
-surgery for chronic infections
Discuss the cause, transmission. usual manifestation and complications of the influenza virus
-Caused by viruses belonging to orthomyxoviridae family
-Three types A, B, C.
-A and B causes epidemic, C causes upper respiratory infecions in childrens and adults.
-A further categorizes into subtypes.
ANTIGEN drift - RNA segments alter during replication, generating new subtype
TRANSMISSION
- inhalation of droplet nuclei
- 1-4 days incubation
- contagious 24 hour prior up to 5 days
- longer for children and immunosuppressed
PATHO
- rapid onset of upper respiratory infection
- virus first targets and kills mucus-secreting, ciliated. and other epithelial cells, leaving gaping holes. which allows extra cellular fluid to escape (runny nose)
MANIFESTATION
- rapid onset of fever and chill
- malaise, muscle aching
- headache, cough, sore throat
- RAPID ONSET
COMPLICATIONS
- viral pneumonia occurs in elderly.
- fever, tachypnea, tachycadia, cyanosis, hypotension, pulmonary fibrosis, death
-sinusitis, otitis media, bronchitis, and bacterial pneumonia.
- reye syndrome (rare but often fatal)
- encephalitis & liver diease
- no aspirin for children
Discuss rationale for influenza immunization
- vaccine is altered yearly
- effectiveness depends on age. accuracy of prediction of virus strain and immunocompetence
- recommend for 50 and older, chronic health, immunosuppressed, high risk environment
- not recommend for <6 month, hypersensitive to components of vaccine
- acute febrile, or history of Guillain-barre syndrome
Discuss the etiology and manifestation of primary atypical pneumonia
Causes
- viral and mycoplasma infections that invade the alveolar septum and the interstitium of the lung
- mycoplasma pneumoniae
MANIFESTATION
- patchy lung involvement
- moderate amount of sputum, moderate elevation of WBC, lack of alveolar exudate.
causes damage to the lung epithelium
What are the difference in community-acquired and hospital-acquired pneumonia in terms of cause and pathogens
COMMUNITY
- infections from organisms found in the community. Before 48 hours admitting to the hospital.
- bacterial or virus. Most common is streptococcus pneumoniae
- H influenza
- Staphylococcus aureus
- gram negative bacilli
HOSPITAL
- acquired 48 hours in hospital
- lower respiratory tract
- usually bacteria
- psudomonas aeruginosa
- staphylococcus aureus
- enterobacter
- klebsiella pneumoniae
- escherichia coli
- seratia
- many acquired antibiotic resistance so difficult to treat
Discuss risk factors, cause and manifestations of of acute bacterial pneumonia in PNEUMOCOCCAL PNEUMONIA
Acute Bacterial
- risk factors include:
- loss of cough reflex
- damage to endothelium/cilia
- impaired immunity
- antibiotic therapy
- diabetics
PNEUMOCOCCAL PNEUMONIA
- most common bacterial
- streptococcus pneumoniae
- organism attaches & colonizes in mucous membrane of nasopharynx, but may not progress
- Polysaccharide capsule prevents, delays digestion by phagocytes
- asplenic person at risk for bacteremia becuase spleen eliminates organisms
MANIFESTATION
- depends age, health status
- sudden
- fever, malaise, chills
- initial productive cough/watery sputum, progressing to blood tinged
- decreased air entry
- pleuritic pain
- fever subsides with treatment
- elderly may not have temp change, only loss of appetite and mental status
Discuss risk factors, cause and manifestations of of acute bacterial pneumonia in LEGIONNAIRE DISEASE
- Caused by gram-negative, legionella pneumophila
- inhalation of aerosolized contaminated water or soil (not airborn). Air-conditioners
MANIFESTATION
- rapid onset
- malaise, weakness, lethargy, fever and dry cough
- diarrhea
- CNS alteration
- arthralgia
- hyponatremia and confusion
Differentiate between primary tuberculosis and reactivated tuberculosis on the basis of pathophysiology, risk factors, manifestations, diagnostic measures and treatment
Primary
- person is previously unexposed
- asymptomatic, latent phase
- granuloma surrounds bacilli and limits spread, not contagious
RISK
- living in country with high incidence
- crowded/confined living conditions
- immunocompromised
MANIFESTATION
- 5% may progress to active infection
- insidious but can be abrupt
- fever, pleuritis, weight loss, fatigue, night sweats, cough, dyspnea
- hematogenic disseminatiom is when tuberculosis eroding into the blood vessel (RARE)
REACTIVATED
- reinfection from inhaled droplet or reactivation of a previously healed primary lesion
- due to impaired body defenses
- cell-mediated hypersensitivity response is aggravating factor, evidenced by caviation
MANIFESTATION
-low grade fever, night sweats, easy fatigued, anorexia. weight loss, dry cough, blood tingued, dyspnea, orthopnea
COMPLICATION: pleural effusion
PATHOLOGY
- infected droplet inhaled settles in alveoli, macrophages engulf bacilli, bacilli multiplies, macrophages burst.
- this process invites more lymphocytes and fibroblasts that surrounds bacilli and form a granuloma (ghon complex)
- lympocyes are activated in a delayed hypersensitivity reaction releasing cytokines that can kill bacilli. (lung tissue damaged in process)
DIAGNOSIS
- identification of the organism from culture or identification using M.tuberculosis amplification techniques
- chest radiographs
-TB test is the result from a cell-mediated immune response. Implies that a person has been infected with M.tubeculosis and has mounted a cell-mediated response
TREATMENT
-isoniazid (INH), ethambutol (EMB), pyrazinamide (PZA), and rifampin.
- prophylactic treatment for those who has latent tuberculosis- INH used
- mutate and become resistant to any drug
What are risk factors associated with lung cancer
- smoking
- chemical toxins (asbestos, arsenic, chromium, nickel, vinyle-chloride dust
Describe small cell lung cancer in terms of pathology and prognosis
- small to round oval cells
- highly malignant
- rarely seen in non-smoker
- paraneoplastic disorder is common such as the syndrome of the inappropriate antidiuretic hormone
Describe non-small cell lung cancer’s pathology and prognosis
Squamous Cell
- common in men and smokers
- central bronchi initially, early detection from sputum and treatment
- metastasize slow
- paraneoplastic syndrome is hypercalcemia
Large Cell
- large polygonal cells
- involves periphery of lungs
- metastasizes early
Adenocarcinoma
-common in North American, women, and non-smokers
-associated with scarring and previous injury such as infarcts, wounds, foreign bodies
-poorer prognosis than squamous cells because metastasize easy
Paraneoplastic disorder is hematologic disorders
Describe the typical manifestations, diagnostic measures, and treatments methods for lung cancer
typical manifestation are cough, wheezing, SOB
-Diagnosis CXR Bronchoscopy Sputum/bronchial washing cytological studies Needle biopsy of lung tissue Lymph node biopsy CT/MRI/US/PET
-Treatment
Symptoms
Lobectomy
Radiation/chemotherapy
Discuss respiratory distress syndrome in terms of risk factors, pathogenesis and manifestation
-hyaline membrane disease, very common in premature infants due to surfactants deficiency and pulmonary immaturity
RISK FACTORS
- Prematurity
Male
Caucasian
Diabetic mom – insulin inhibits surfactants protections in utero
Difficult deliveries (asphyxia, cold, etc.)
C-section + prematurity
*cortisol increases surfactant production
PATHO -lack of surfactant causes large alveoli to stay open, small cannnot open -Hyaline membrane forms Proteins/fibrin pulled from circulation Decreased area of gas exchange Lung stiffens
MANIFESTATION -Central cyanosis Dyspnea Retraction in chest wall Grunting sounds with expiration RR rises 60-120/min Tidal volume falls Fatigue Patent ductus arteriosus
Describe bronchopulmonary dysplasia in terms of risk factors, pathogenesis, and manifestation
Chronic lung disease as a result of: Mechanical ventilation (d/t other disease) Prolonged oxygen supplementation
Alveolar hypoplasia and fibrosis
PATHO
- interference with normal lung maturation, prevent growth and development of lungs and heart
- Natural antioxidants are immature and unable to neutralize free radicals formed as a result of oxygen use by body
MANIFESTATION
-Hypoxemia, hypercapnia
Tachypnea, chest retraction, cough
Tachycardia
Clubbing, peri-orbital edema (RHF)
Hepatomegaly
Lung injury result in unstable growth of pulmonary/cardiac vasculature
Poor weight gain
Differentiate between upper and lower airway infections in children and name conditions under each catergory
-Upper Airway infections (prolonged inspiration)
Viral Croup
Spasmodic Croup
Epiglottitis
-Lower Airway Infections
Prolonged expiration
Bronchiolitis
Describe the cause, manifestations, and treatment for viral croup
- acute laryngotracheobronchitis, viral infection that affects the larynx, trachea, and bronchi.
- subglottic area is narrowest
- 3 month to 5 years
MANIFESTATION
-barking cough, inspiratory stridor, hoarseness
TREATMENT
- moist or cold air
- decrease stimulation
- monitor for obstruction
- administer racemic epinephrine and airway
Describe the cause, manifestations, and treatment for spasmodic croup
- similar presentation excepts no signs of viral infection
- allergic origin
- occurs at night
TREATMENT
-cold humidification
Describe the cause, manifestations, and treatment for epiglottitis
- inflammatory edema of the epiglottis and pharynx, sudden airway obstruction
- streptococcus pyogenes, staphylococcus pneumoniae, and S.Aureus
MANIFESTATION
- pale, lethargic, mouth open, chin forward
- difficulty swallowing, speaking
- fever, anxiety
- respiratory distress
TREATMENT
- endotracheal tube or tracheostomy
- antibiotics
Describe Bronchiolitis and manifestation
- viral infection of the lower airway, causes inflammatory obstruction of the small airways and necrosis of the cells lining the lower airways
- respiratory syncytial virus
- history of mild upper airway infection
MANIFESTATION
-prolonged expiration, wheezes, dyspnea, and resulting hypoxemia
