Respiratory Disorders Flashcards
T or F: respiratory exchange is more efficient in pregnancy
true
T or F: respiratory disease (e.g. asthma, pneumonia) are typically improved in pregnancy
false
increased oxygen requirements and adaptations
What is the effect of estrogen and increased blood volume on respiration?
capillary engorgement –> swelling and increased mucous production
What is the effect of progesterone on respiration?
1) relaxation of veins –> increased pooling –> swelling of mucous membranes
2) hyperventilation
3) respiratory alkalosis w/ increased expired CO2
What is the effect of relaxin on respiration?
increased chest cartilage pliability –> increased chest circumference
What is the effect of the growing uterus on respiration?
diaphragm rises ~4cm + thoracic circumference increases ~6gm + costal angle widens –> increased thoracic breathing + diaphragmatic breathing
What is the effect of reduced PCO2?
helps move:
- fetal CO2 waste to gestational carrier
- O2 from gestational carrier to fetus
What is the cause of bronchitis?
usually viral
s/sx bronchitis
cough lasting median 18 days
bronchitis tx
- supportive care
- sx management: humidifier, OTC cough suppressants, cough drops
s/sx flu
- fever
- HA
- fatigue
- body aches
- malaise
- cough
flu dx
- clinical dx
- flu swab
- CXR, depending on sx
flu tx
1) tamiflu 75mg BID for 5 days
2) Zanamivor 10mg (2 inhalations) for 5 days
What is the most significant complication of pneumonia?
preterm delivery
- outcome of hypoxemia and acidosis
- also poor fetal growth and perinatal loss
T or F: pneumonia vaccine is not safe in pregnancy
false
s/sx pneumonia
- productive, purulent cough
- pleuritic chest pain
- dyspnea
- chills
- fever! differentiate b/w bacterial and viral
What are maternal complications of pneumonia?
- respiratory failure
- mechanical ventilation
- emphysema
pneumonia dx
- CXR* –> +lobular pattern
- r/o flu w/ swab
- do not need to identify microbe
What are the 2 most common pneumonia pathogen?
1) streptococcus pneumoniae
2) H. influenzae
How should pneumonia be managed?
AGGRESSIVELY
- start abx w/in 4h of admission to hospital
- macrolide for mild illness
- add beta-lactam for severe illness
- avoid quinolones* unless life-saving (fetal cartilage damage)
pneumonia monitoring
- maintain PO2 70mmHg (necessary level for fetal oxygenation)
- no fever/sx for 48h
- d/c IV –> 10-14 day course of PO tx (cephalosporin, macrolid)
What tx of a pregnancy comorbidity can induce asthma?
aspirin for preeclampsia
T or F: asthma meds are safe in breastfeeding
true
T or F: fetal surveillance is necessary regardless of asthma control
false
not necessary if well-controlled; serial growth and NST in moderate to severe asthma
What are the most significant poor outcomes of asthma in pregnancy?
1) PTB
2) increased preeclampsia if daily sx
3) increased c-section w moderate to severe disease
What are objectives measures for assessment and monitoring of asthma?
1) Forced expiratory volume 1 (FEV1) = BEST measure of pulm function; <80% = poor pregnancy outcomes
2) self-monitoring using peak expiratory flow (PEF) w/ peak flow monitor; PEF does not change w/ pregnancy
Describe monitoring w/ peak flow monitors
- 380-550 L/min = typical in pregnancy
- should achieve at least 80% of best PEF
- moderate to severe disease should test BID
List methods to avoid/control potential asthma triggers
- use allergen-impermeable mattress and pillow covers
- remove carpet
- wash bedding weekly in hot water
- avoid tobacco smoke
- reduce humidity
- leave house while being vacuumed
- no pets/stuffed animals in bedroom
Describe asthma rescue therapy
short-acting beta-agonist (e.g. albuterol)
1-2 inhalations q4-6h PRN
also available as nebulizer sol’n, syrup, tablet; prednisone also acceptable
Describe long-term asthma control
inhaled corticosteroids (ICS); long-acting bronchodilators
- if not well-controlled, start low/medium dose ICS and refer
- can be advanced to ICS + LABA (mod-severe) or ICS + LABA + PO prednisone (severe persistent)
What populations are at high risk for TB?
- close contact w/ infected people
- birth in country w/ high rate TB
- low income
- alcohol addiction
- IV drug use
- residency in long-term facility or prison
- health professionals that work in these facilities
What are risk factors for TB?
- HIV
- recent TB infection
- IV drug use
- solid organ transplant
- chronic renal failure
- DM
- underweight by >15%
s/sx TB
- cough
- weight loss
- fever
- malaise and fatigue
- hemoptysis
T or F: latent disease presents equal risk of poor pregnancy outcomes as active disease
false
carries no risk
What values indicate a positive PPD?
high-risk population: >5
“normal” population: 10-15
What is PP management of a pt w/ active TB?
- separate mother from newborn
- CAN breastfeed
What is management of a newborn born to parent w/ active TB?
- require multivitamin supplement
- must have PPD at birth and 3mo
- isoniazid (INH) prophylaxis until maternal disease has been resolved for 3mo
To add a row,
What are risk factors for pulmonary embolism?
- age > 35yo
- obesity
- trauma
- immobility
- infection
- smoking
- nephrotic syndrome
- hyperviscosity syndrome
- cancer
- surgery, esp ortho
- prior DVT or PE
- hospital admission
What are pregnancy-related risk factors for pulmonary embolism?
- increased parity
- PP endomyometritis
- operative vaginal delivery
- c-section
PE dx
- EKG
- CXR - canNOT confirm dx!!
- V/Q scanning = modality of choice
- no role for D-dimer
- ABGs and O2 sat = limited value in assessment
What will be seen on CXR w/ PE?
- pleural effusion
- pulmonary infiltrates
- atelectasis
- elevated hemidiaphragm
How is PE treated?
20wk heparin course, then prophylactic heparin PRN
