Respiratory disease pathophysiology

Question 1

Name the structures in upper respiratory tract

Answer 1

nasal passages, sinuses, nasopharynx, pharynx, larynx, tonsils, glottis

Question 2

name the structures in lower respiratory tract

Answer 2

lower trachea, right and left bronchus, bronchial tree, lungs, pleural membranes, alveolar ducts, alveoli, mediastinum

Question 3

order of conducting passages

Answer 3

Upper respiratory: nasal cavity –> pharynx –> larynx

Lower respiratory: trachea –> primary bronchi –> lungs

Question 4

what is allergic rhinitis

Answer 4

an inflammatory disorder

Question 5

clinical manifestations of allergic rhinitis

Answer 5

sneezing, rhinorrhea, pruritus, nasal congestion, and watery itchy eyes

Question 6

what is allergic rhinitis triggered by

Answer 6

allergens that bind to IgE antibodies on mast cells - release inflammatory mediators

dust mites, mold

Question 7

what is histamine

Answer 7

causes the majority of the symptoms associated with allergic reactions

• can be drug-induced, food, contacts
• hives or urticaria can develop

Question 8

what are histamines

Answer 8

stored in the mast cells (skin and soft tissue) and the basophils (blood)

Question 9

what can histamines cause when activated

Answer 9

hives and itching of skin
dilation of blood vessels resulting in erythema and hypotension
bronchoconstriction - shortness of air
effect sleep/wake cycles
increase the secretion of acid in the stomach

Question 10

upper respiratory tract infection

Answer 10

viral
self-limiting
rhinitis
sinusitis
laryngitis
laryngotracheobronchitis (croup)
acute bronchitis
influenza

Question 11

what is rhinitis

Answer 11

the common cold

respiratory droplet

Question 12

s/s of rhinitis

Answer 12

low-grade fever
headache
fatigue
nasal congestion
rhinorrhea
cough

Question 13

what is sinusitis

Answer 13

may be secondary infection

anything in the nose can increase risk

Question 14

what is rhinovirus

Answer 14

early fall, spring, and summer
lives up to 3 hrs outside body
-on skin surface and on objects (doorknobs)

Question 15

how does rhinovirus spread

Answer 15

droplet

contaminated objects

Question 16

s/s of sinusitis

Answer 16

pain above or below eyes
cloudy, green, or yellow discharge
congestion
throat irritation

Question 17

how to treat sinusitis

Answer 17

hard to treat with antibiotics
7 or more days
decongestants

Question 18

epiglottitis clinical diagnosis

Answer 18

inspiratory stridor and retractions 
rapid onset of fever 
pain 
difficulty swallowing 
drooling (absence of barking cough differentiates from croup)

Question 19

what is the steeple sign indicative of

Answer 19

epiglottal swelling

Question 20

what drugs do you use to treat URIs

Answer 20

antihistamines
sympathomimetics
antitussives
expectorants

Question 21

MOA of antihistamines

Answer 21

block histamine release from receptors

Question 22

what are the indications for antihistamines

Answer 22

allergies, cold and flu symptoms

Question 23

what does an antihistamine treat

Answer 23

edema, inflammation, itch, rash, red/watery eyes, runny nose, sneezing

Question 24

what is a first generation antihistamine

Answer 24

diphenhydramine (Benadryl)

Question 25

side effects of diphenhydramine

Answer 25

sedation, dry mouth, dizziness, low BP

Question 26

what drugs are sympathomimetics (decongestant)

Answer 26

phenylephrine and pseudoephedrine

Question 27

MOA of phenylephrine and pseudoephedrine

Answer 27

mimics the action of SNS, activates alpha 1-adrenergic receptors and causes vasoconstriction of blood vessels causing nasal turbinates to shrink and open nasal passage

Question 28

indications of phenylephrine and pseudoephedrine

Answer 28

reduce nasal congestion, allergic rhinitis, sinusitis, common cold

Question 29

SE of phenylephrine and pseudoephedrine

Answer 29

SE related to CNS –> agitation, insomnia, anxiety, tachycardia, heart palpitations

Question 30

Nursing considerations for pseudoephedrine

Answer 30

potential for abuse
one of the active ingredients in meth
limits on how much a patient can get

Question 31

patient education for sympathomimetics

Answer 31

do not use for more than 4 days –> rebound nasal congestion occurs if drug is abruptly stopped after prolonged use
-tapering off recommended

Question 32

what drugs are antitussive

Answer 32

dextromethorphan, codeine, benzonatate

Question 33

indication for antitussive

Answer 33

cough suppressant

Question 34

MOA of antitussive (dextromethorphan, codeine, benzonatate)

Answer 34

directly suppresses the cough reflex in the brain

Question 35

SE of dextromethorphan, codeine, benzonatate (Antitussive)

Answer 35

CNS depressant

• DO NOT take with other CNS depressants
• potential for abuse

Question 36

what drug is an expectorant

Answer 36

guaifenesin (Mucinex)

Question 37

MOA of guaifenesin

Answer 37

reduction in surface tension of secretion helping thin the mucus making it easier to expectorate

Question 38

SE of guaifenesin

Answer 38

few, mild GI distress

Question 39

nursing considerations for guaifenesin

Answer 39

be careful in patients with chronic cough/asthma

encourage fluid to help thin secretions as well