Respiratory Disorders Flashcards
What is rhinosinusitis? What are some causes?
– rhinosinusitis (AKA sinusitis): inflammation of the mucous membranes of one or more of the sinuses
– causes
- after rhinitis
- Strep
- bacteria
- predisposing factors
- deviated septum
- nasal polyp
- nasal tumor
- facial trauma
- dental infection
What are some signs and symptoms of rhinosinusitis? What are some interventions?
– s/s
- similar to cold
- facial pressure
- tenderness to touch
– interventions
- antibiotics
- antipyretics
- decongestants
- steam humidification
- hot/wet packs
- nasal saline irrigations
- functional endoscopic sinus surgery (FESS) – removes infected areas of mucosa
What is pharyngitis? What are some causes? How is pharyngitis diagnosed? What are some signs and symptoms?
– pharyngitis: sore throat; inflammation of pharyngeal mucous membranes
– causes
- bacteria
- viruses
- irritants
- group A beta Strep –> acute glomerulonephritis
– diagnosed by rapid antigen test (RAT)
- screens group A beta hemolytic streptococcal antigen
– s/s
- odynophagia – pain during swallowing
- dysphagia
- fever
What is pneumonia? What are the 5 types of pneumonia? Which population is especially at risk?
– pneumonia: inflammation of the air sacs of the lungs caused by
- excess fluid in lungs
- infectious agents
- inhaled irritants
– 5 types:
- community-acquired – easier to treat
- healthcare-associated – more difficult to treat (antibiotic resistance)
- bacterial – caused by Strep or Staph
- viral – most common
- atypical – caused by Chlamydophila
– elderly population is at higher risk – likely to experience confusion due to hypoxia
What is bronchiolitis? How is it different than bronchitis?
– bronchiolitis: inflammation of terminal airways – common in younger kids
– bronchitis: inflammation of main airway
What are some diagnostics tests for respiratory infections?
- sputum sample
- CBC
- blood labs
- BUN
- CXR
- pulse ox
- bronchoscopy
What are some of the main interventions for respiratory infections?
- manage hypoxemia
- prevent airway obstruction
- CDB Q2H
- IV
- inhaled steroids
- manage sepsis by eradicating pathogens
- incentive spirometry
What is severe acute respiratory syndrome (SARS)? What are interventions for SARS?
– SARS: virus infection of respiratory tract cells, triggering inflammatory response
– interventions:
- no known effective treatment
- prevent spread
- airborne iso
- handwashing
Discuss TB?
- high communicable
- Mycobacterium TB pathogen
- airborne
- miliary/hematogenous TB: spread of TB throughout the body
- secondary TB: pt has TB but never presented, and then presents later
What are some signs and symptoms of TB?
- persistent cough
- night sweats
- hemoptysis – coughing blood
- weight loss
- anorexia
- SOB
- fever, chills
What are some diagnostic tests for TB?
- nucleic acid amplification test (NAAT) – detects nucleic acids for TB
- purified protein derivative (PPD) – 2 step
- induration of 10+ mm = positive
- tuberculin test (Mantoux) – intradermal PPD
- Quantiferon = gold standard
- sputum culture
What are some interventions for TB?
- combined drug therapy
- isoniazid (INH) and rifampin used throughout
- pyrazinamide
- ethambutol
- 6 month therapy with strict adherence
- airborne precautions
What is pulmonary empyema? What are some causes?
– pulmonary empyema: collection of pus in pleural space causing lung collapse
– causes:
- pulmonary infection
- pneumonia
- lung abscess
- chest surgery
- chest trauma
What are some signs and symptoms of pulmonary empyema? Interventions?
– s/s:
- recent febrile illness
- chest pain
- cough
- dyspnea
- diminished breath sounds
- fever, chills, night sweats
- collapsed lung
- medial stinal deviation
– interventions:
- chest tube in pleural space
- thoracentesis
What is thoracentesis? What is a potental complication?
– thoracentesis: removal of fluid by suction using a large needle into intrapleural space
– potential complication = rebound pulmonary edema
What are 3 diseases that are classified as chronic air flow limitation diseases?
- asthma
- chronic bronchitis
- pulmonary emphysema
What is COPD? What are some characteristic signs of COPD?
– chronic obstructive pulmonary disease: progressive disease that limits airflow due to abnormal inflammatory response to noxious particles
- includes
- emphysema – damaged alveoli – loss of tissue elasticity from hyperinflation of alveoli –> CO2 retention –> chronic acidic state
- bronchitis – inflammation of cronchi –> stimulates production of mucous
- tissue damage in COPD is irreversible and gradually increases in severity –> respiratory failure
– characterized by
- bronchospasms
- dyspnea
What are characteristic signs and symptoms of bronchitis vs. emphysema?
– bronchitis:
- “blue bloaters” = cyanotic
- overweight
- elevated hemoglobin
- peripheral edema
- rhonchi
- wheezing
– emphysema:
- “pink puffers” = CO2 retention
- thin
- severe dyspnea
- quiet chest
- CXR shows hyperinflation with flattened diaphragm
What is asthma? Which population experiences asthma most frequently?
– asthma: an intermittent, reversible airflow obstruction affecting only the bronchial airways – NOT the alveoli
– populations:
- adults – more common in women
- children – more common in boys
How do the airways become obstructed in asthma?
- exposure to an irritant
- inflammation obstructs the lumen of the airway, causing swelling and mucous production
- airway hyperresponsiveness – constriction of the bronchial smooth muscle obstructs the airways
Which antibody is involved in the inflammation associated with asthma? What chemicals become triggered by this antibody, causing inflammatory response?
– IgE
– chemicals triggered:
- histamine – immediate inflammatory response
- treat with Benadryl
- leukotriene and eotaxin – slower, prolonged inflammatory response
- treat with Singulair, Accolate, Zyflo
What are some signs and symptoms of asthma?
- audible wheeze
- increased respiratory rate
- increased cough
- use of accessory muscles
- barrel chest
- long breathing cycle –> clipped speech
- cyanosis
- hypoexmia
What are some diagnostic tests for asthma?
- ABG
- decreased O2 during asthma attack
- CO2
- decreased early in attack
- increased later
- eosinophil and IgE
- increased in allergic asthma
- sputum
- may contain eosinophils and shed epithelial cells
- pulmonary function test
- 15 - 20% decrease from predicted may indicate asthma
- 12% increase after bronchodilators indicates asthma
What are the 3 measured components of pulmonary function tests?
- forced vital capacity (FVC): volume of air exhaled from full inhale to full exhale
- forced expiratory volume in first second (FEV1): volume of air blown out as hard and fast as possible during first second of most forceful inhale and exhale
- peak expiratory flow rate (PEFR): fastest airflow rate reached at any time during exhalation
What are the 3 zones for peak flow meters?
- green zone: asthma is under good control; 80% of personal best
- yellow zone: caution; airway narrowing present; administer rescue medication
- red zone: medical alert; take rescue medication; seek medical attention
What are some interventions for asthma?
- peak flow meter used 2x/day
- drugs
- preventative – change airway responsiveness to prevent asthma attacks; used every day
- rescue – stop an attack once started
- exercise and activity – promotes ventilation and perfusion
- oxygen therapy
- heliox – mix of helium and oxygen
What are the drugs used for asthma?
- bronchodilators – increase bronchial muscle relaxation
- short-acting beta 2 agonists – rapid, short-term relief
- long-acting beta 2 agonists – taken over a period of time; long-term relief
- anticholinergics – blocks PSNS to increase bronchodilation
- methylxanthines – last resort
- cardiac and CNS side effects
- anti-inflammatories
- corticosteroids
- NSAIDs
- leukotriene antagonists
What is status asthmaticus?
severe, life-threatening, acute episode of airway obstruction; intensifies once it begins; does not often respond to common therapies
if not reversed, pneumothorax and cardiac or respiratory arrest could result
What are some interventions for status asthmaticus?
- IV fluids
- systemic bronchodilator
- steroids
- epinephrine
- oxygen
- magnesium – helps relax skeletal muscles
What are some risk factors of COPD?
- cigarette smoking – biggest risk factor
- alpha 1-antitrypsin (AAT) deficiency – enzyme made by the liver that is present in the lungs and regulate the breakdown of inhaled pollutants
- air pollution
What are some complications of COPD?
- hypoexmia
- acidosis
- respiratory infection
- cardiac failure – cor pulmonale (R side heart failure with enlargement of R ventricle)
- cardiac dysrhythmias
How do you determine smoking pack years?
- determine number of years smoked
- determine packs per day
- multiply values
What are some diagnostic tests for COPD?
- ABG
- hypoxia
- hypercarbia
- sputum
- CBC
- H&H
- electrolyte levels
- AAT levels
- CXR
- pulmonary function tests
What are some interventions for COPD?
- airway management
- breathing techniques
- positioning
- monitor respiratory changes Q2H
- effective coughing
- oxygen therapy
- pts with chronic hypercarbia require lower levels = 1 - 2 L/min
- drugs
- inhaled corticosteroids
- systemic
- mucolytics
- pulmonary rehab
- exercise to improve respiratory strength and endurance
- energy conservation
- avoid activites that arms raised
- pace activities
- gradually increase activity
- hydration – at least 2 - 3 L/day
- beverages
- humidifiers
- nutrition
- monitor prealbumin
- prevent protein-calorie malnutrition
- many small meals per day
- manage anxiety
- can worsen symptoms
- manage risk for respiratory infection
- avoid large crowds
- flu and pneumonia vaccinations
- surgery
- lung transplant for end-stage pts
What is cystic fibrosis? Which populations most commonly experience cystic fibrosis? How is it diagnosed?
– cystic fibrosis: error of chloride transport which produces a thick mucous with low water content; genetic disease that affects multiple organs and lethally impairs pulmonary function
- mucous plugs up glands, causing atrophy and organ dysfunction
- present from birth
- damages lungs, pancreas, liver
- caused usually by respiratory failure
– mostly whites are affected
– diagnosed by
- sweat chloride analysis
- normal = 35 mEq/L
- CF = 60 - 200 mEq/L
- genetic testing
- pulmonary function test
- may also see pancreatic problems, malnutrition, stunted growth, and cirrhosis
What are some signs and symptoms of cystic fibrosis?
- malnutrition
- smaller
- thinner
- vitamin deficiency
- abdominal distention
- GERD
- rectal prolapse
- foul-smelling stools
- steatorrhea
- DM – due to pancreatic failure
- respiratory infection – common
- chest congestion
- exercise intolerance
- cough and sputum production
- use of accessory muscles
What are some diagnostic tests for cystic fibrosis?
- pulmonary function tests
- CXR
- increased anteroposterior diameter
What are some interventions for cystic fibrosis?
– mainly symptom management and weight management
- nutrition
- weight management – space out meals
- vitamin supplement
- DM management
- pancreatic enzyme replacement
- chest physiotherapy
- exercise
- avoid mechanical ventilation – difficult to wean pts off of this
- supplemental oxygen
- heliox
- airway clearance techniques
- drugs
- antibiotics for chronic infections
- avoid crowds to avoid infection
- organ transplant – will not cure, but extends life 10 - 20 years
- lung
- pancreas
What is pulmonary arterial hypertension (PAH)?
– pulmonary arterial hypertention (PAH): blood vessel constriction with increasing vascular resistance in lung; cor pulmonale
- unknown cause – may be autoimmune
- death could result in 2 years without treatment
What are some interventions for PAH?
- drugs
- warfarin – prevents clot formation due to stagnant blood
- aiming for INR = 1.5 - 2.0
- calcium channel blockers – dilate pulmonary vessels to prevent clots
- diltiazem (Cardizem)
- nifedipine (Procardia)
- endothelin receptor antagonists – promote BV relaxation, decrease pulmonary artery pressure
- bosentan (Tracleer)
- digoxin – antiarrhythmic
- diuretics
- warfarin – prevents clot formation due to stagnant blood
- oxygen therapy
What is interstitial pulmonary disease?
– interstitial pulmonary disease: AKA fibrotic lung disease; restrictive disease where lung tissue thickens, reducing gas exchange because lungs cannot expand (stiff lungs)
- affects
- alveoli
- BVs
- surrounding lung tissue
- slow onset
- dyspnea is most common symptom
What is sarcoidosis? Which population most commonly experiences sarcoidosis? What are some signs and symptoms? What is the main intervention?
– sarcoidosis: granulomatous disorder (growth of granulomas – lymphocytes, macrophages, epithelial cells, etc.) that most commonly affect the lungs
- autoimmune
- T lymphocytes damage lung tissue
– affects younger population most commonly
– s/s
- cough
- SOB
- abnormal CXR
– main intervention = corticosteroids
What is idiopathic pulmonary fibrosis? Which population most commonly experiences? What are some interventions?
– idiopathic pulmonary fibrosis: common restrictive lung disease with unknown etiology
- extensive fibrosis and scarring as a result of excessive inflammation
- poor prognosis – 5 years even with proper interventions and treatment
– population = older pts with hx of smoking or exposure to lung irritants
– interventions seek to reduce inflammation:
- corticosteroids
- immunosuppressants
What is occupational pulmonary disease? How can it be prevented?
– occupational pulmonary disease: disease caused by exposure to occupational or environmental hazards
- ranges from reversible effects to chronic lung disease
- dependent on amount of exposure
- worsened by cigarette smoke
– prevented via special respirators and adequate ventilation
What is the main type of lung cancer?
bronchogenic carcinomas in bronchial epithelium
What are some interventions for lung cancer?
- chemotherapy
- targeted therapy
- targets specific phase of cancer cell division
- radiation therapy
- reduces size of tumor
- photodynamic therapy
- injected with an agent that sensitizes cancer cells to light
- medications administered – leave normal cells more rapidly
- laser treatment causes irreversible damage to cancer cells
- lobectomy
- pneumonectomy
- removal of entire lung and severing bronchus
- segmentectomy
- removal of bronchus, pulmonary artery and vein, and tissues of involved segment of lung
- wedge resection
- removal of peripheral portion of lung
What is a chest tube?
drain placed in the pleural space to restore intrapleural pressure, allowing the lung to expand again
What are the 3 chambers of chest tubes?
- chamber 1 = collects fluid draining from pt
- chamber 2 = water seal that prevents air from entering pt’s pleural space
- one-way valve allowing gas to escape but not to enter
- chamber 3 = suction control
- gentle bubbling is normal
What are some postop care interventions for thoracotomy?
– thoracotomy: incision into pleural space of chest cavity
– postop care:
- pain management
- PCAs
- respiratory management
- assess Q2H
