Respiratory Disorders Flashcards
infection of mucus membranes of the nose, sinuses, pharynx, upper trachea, or larynx
Upper respiratory infections (URI’s)
Peritonsillar abscess is
Pus due to an infection behind the tonsil. Very serious!
A severe sinus infection can become a
brain infection
An adenoidectomy is performed if patient has
too many infections
I&D
Incision and drainage (for abcess)
External (lungs):
gas exchange of CO2 and Oxygen
Chronic bronchitis is progressive or non-progressive?
Progressive
Common causes of atelectasis
Hypoventilation, compression, airway obstructions, adhesions
Internal (cellular):
gas exchange at cells
Closure or collapse of alveoli
Atelectasis
Clinical Manifestations of atelectasis:
SOB, cough, sputum production
Assessment findings of atelectasis:
Increased WIB, hypoxemia, decreased breath sounds, crackles
Diagnosing atelectasis:
Chest xray
Prevention of atelectasis :
frequent turning, early mobilization, strategies to expand lungs
INCENTIVE SPIROMETER
Complete obstruction of an airway caused by:
mucus plug
foreign body
tumors
bronchospasm
Resorption atelectasis
Increased volume in the pleural space caused by
fluid (transudate, exudate, blood)
Compression atelectasis
Focal or generalized fibrosis of the lung/pleura
Prevents full lung expansion
irreversible atelectasis
Contraction atelectasis
Inflammation of bronchial walls with increase mucus production
Acute Bronchitis
S/S of Acute Bronchitis
Cough, green/yellow sputum, malaise, low grade fever, headache, sore throat congestion
Causes of acute bronchitis:
Viral (90%), bacterial, environmental
R/O PNA
Rule out pneumonia
Diagnosing acute bronchitis:
R/O PNA, physical exam
Management of acute bronchitis:
Supportive – OTC to expectorate, NSAID or acetaminophen for aches, antibiotics only if bacterial, inhalers, manage symptoms, hydrate
Acute bronchitis:
When to call MD
fever comes back, hemoptysis, difficulty breathing
if acute bronchitis doesn’t resolve, it becomes
CHRONIC BROCHITIS
Parenchyma:
any form of the lung tissue: bronchioles, bronchi, blood vessels, interstitium, and alveoli
Inflammation reaction produces exudate and WBC that fills the normally air- filled spaces of alveoli & bronchiole
Pneumonia
Inflammation of Lung Parenchyma
Pneumonia
If edema and excess secretions of alveoli:
gas exchange affected
Lobar pneumonia:
large portion of 1 or more lobes involved
Bronchopneumonia:
patchy areas within the lung (more common)
With pneumonia, there is fear that the infection will go into
The bloodstream
3 Types of pneumonia:
Bacterial :staphylococcal, legionella
Viral: COVID, RSV
Aspiration: chemical or food
Streptococcal pneumonia
sudden onset -Chills, rapidly rising fever, pleuritic chest pain aggravated by deep breathing
Pt looks ill, RR 25-45
RSV not at bad as
bacterial
Orthopnea –
SOB when laying down
A peculiar broken quality of the voice sounds, like the bleating of a goat, heard about the upper level of the fluid in cases of pleurisy with effusion
egophony
Low BP, HR, may see peripheral cyanosis
with
pneumonia
Four ways of acquiring pneumonia
Community acquired
Healthcare acquired
Hospital acquired
Ventilator acquired
also known as walking pneumonia
community acquired pneumonia
Bacteria that causes pneumonia
Strep, mycoplasma, Haemophilus influenza, c. pneumonia, legionella, RSV
S. Aureus causes
sepsis
Diagnosing pneumonia
History, physical examination, chest xray
Auscultation of lungs: rhonchi
Sputum and blood cultures
When antibiotics are not working (for pneumonia), this is performed
brochoscopy
Obtaining sputum for C&S
Best if done in the morning
No mouthwash, food, or drink before
May brush teeth
Patients too weak to cough ->
suction
This device can help to trend hemoglobin
pulse oximeter
This is done to mobilize secretions
Chest PT
Pneumonia management:
Promote Fluid Intake to 2-3 liters /day unless it is
A cardiac patient
Pneumonia management:
Observe for s/s of
hypoxemia…restlessness, cyanosis (late)
Huffing and puffing can cause
fatigue
Infectious disease the affects the lung parenchyma. May travel via lymph and blood to other parts of body
Tuberculosis
Airborne transmission via talking, coughing, sneezing, laughing or singing.
Tuberculosis
Patho of tuberculosis
Bacteria is deposited in alveoli and begin to multiply – immune response is initiated
10% of latent tuberculosis will become
active
Bacteria can remain dormant in _____% of people: LATENT
90% of people
TB CLINICAL MANIFESTATIONS
Low grade fever, night sweats, fatigue, weight loss
Cough – nonproductive, mucopurulent or hemoptysis
Lungs sounds: diminished, crackles, fremitus, egophony
TB DIAGNOSIS
Chest XRAY: lesions
Sputum culture : AFB (but not all AFB is M. tuberculosis)
Mantoux test
Blood tests: QuantiFERON-TB Gold & T-SPOT
mantoux test reading
Measure the area of induration, not redness
Positive TB test could mean
active or latent
Anti-TB agents are taken for
6-12 months
Increasing drug resistance to TB – need to use
4 or more meds
Latent TB – consider
treating
How to take TB meds
Take med on empty stomach or at least 1 hr before meals
using force of gravity to promote removal of bronchial secretions
Postural drainage
rare type of TB, spread via blood to other parts of body
Miliary tb
Air gets trapped in the lungs, hard to get out
Air Trapping
Primary cause of COPD
Smoking primary cause- cilia destroyed, secretions retained, alveolar walls destroyed
Genetic COPD:
Problem with the alveoli, usually starts at age 20. alpha1-antitrypsin deficiency- effects alveoli (younger patients)
Elderly patients with COPD–
elastic recoil decreases, they can not expectorate
Abnormal distention of the airspaces & destruction of alveoli walls. Alveoli overinflate, collapse upon expiration
EMPHSEMA
Resistance to pulmonary blood flow causes increase BP in pulmonary artery
Leads to right sided heart failure (edema due to backup)
EMPHSEMA
Respiratory acidosis as carbon dioxide elimination impaired
EMPHSEMA
Presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
Irritant such as smoke, causes inflammatory response and hypersecretion of mucus
Creates narrowed spaces in bronchus
Increased mucus & plugging, impairing ciliary function
Bronchial walls thicken, adjacent alveoli become damaged and fibrosed.
CHRONIC BRONCHITIS (COPD)
Diagnosing COPD
ABG (High O2)
Pulmonary function test - (decreased)
Chest x-ray (late disease, dilated airways)
Weight loss in COPD patient because
dyspnea interferes with eating and work of breathing uses calories
COPD patients have a higher risk for
lung cancer
Cardinal Symptoms of COPD exacerbation:
Increased dyspnea, increase in sputum, and sputum purulence
Barrel chest: usually with
emphysema
Too much oxygen –
can decrease respiratory drive worsening hypercapnia
Too much CO2 in blood
hypercapnia
ABG if patient is
de-saturating , altered mental status
Oxygen level (nasal cannula) for COPD
1-2L
Bipap and Cpap blows off extra
CO2
High flow nasal cannula supplied
warmed humidified air up to 60L, usually given at low FiO2
High Flow nasal cannula can be used at a low FIO2, it rids CO2 from .
deadspace because of force it is blown in
Most common chronic disease of childhood
Asthma
Allergy is number one factor in
Asthma
Asthma triggers:
Airway irritants such as cold, heat, weather changes, smoke, strong odors, hormones, stress, exercise, URI’s, GERD
Carpeting and heavy drapes can
collect dust and dander
Med given to reduce inflammatory response in asthma
singulair
In asthma, there is very fast constriction, the lumen gets
small causing wheezing
Asthma:
Patient will not lay down because of
fear of drowning
At home Peak Flow rate Meter, colors and meanings
Green zone – normal
Yellow zone – use Rescue Inhaler
Red zone – get to some help ASAP
Labs for asthma:
ABG’s, IgE
IgE
Immunoglobin E (allergy response)
Magnesium IV counteracts
calcium
Mucus plugging from bronchospasm can lead to
asphyxia if not treated
a severe condition in which asthma attacks follow one another without pause
STATUS ASTHMATICUS
ER treatment involves
IV steroids, magnesium
SNS opens
lungs and airways
MOA of Beta 2 adrenergic agonists:
Bronchodilation-
binds to beta 2 adrenergic receptor
Quick relief asthma med that is short acting
albuterol (ventolin)
Quick relief asthma med that is used during an asthma attack
Levalbuterol, terbutaline
Long Term Inhaled (slower onset) meds
Salmeterol (Servant)
Formoterol
Long-Acting Oral used to prevent asthma before exercise
albuterol
Epinephrine Mechanism of action:
reacts on alpha and beta receptor sites in SNS to cause vasodilation
Epinephrine causes
severe cardiac effects
Quick relief anticholinergic:
Ipratropium (Atrovent)
**NOT EFFECTIVE IN EXERCISE INDUCED ATTACK
Long Term anticholinergic to prevent asthma
Tiotropium (Spiriva)
the 2 meds in duoneb
Albuterol and Ipratropium
quick acting nebulizer that causes tachycardia
Duoneb
Give bronchodilator first then
steroid
thins mucus
Mucolytics
