Respiratory part 2 Flashcards
What shape is tuberculosis?
Acid-fast aerobic rod
What does tuberculosis affect?
Primary affects the lungs but can also affect meninges, kidneys, bones, and lymph nodes.
How is tuberculosis spread?
Airborne transmission
How does tuberculosis enter the body?
Mycobacteria is inhaled, settles in the alveoli, and from there can enter the blood stream & spread.
What is the defining factor of latent TB?
Germs are dormant or asleep and so the patient won’t even seem sick.
T/F
Latent TB cannot be spread to others
true
What is the medication regimen like for latent TB? What is the most important thing about this?
Take one medication for 9-12 months. Compliancy is important
What is active TB?
TB with germs that reproduce and spread causing tissue damage in the affected areas
(remember we listed those) - and you will feel sick.
Active TB symptoms
Persistent cough for more than 3 weeks
Weight loss
Night sweats
Fever
How do we diagnose the an active TB?
Chest xray will show it
PPD skin test
Your patient who tested positive for TB in the blood gets a chest x ray. If there infection is latent, will it show up on xray?
No - a latent TB infection will not be on xray.
Can you spread active TB?
Yes if it is in your lungs and larynx/voicebox by sneezing, coughing, talking, singing
What is a priority when dealing with a TB patient?
Infection control. Even if you aren’t sure, put up the airborne precaution signs.
What are all the available test to identify TB?
Mantoux skin test PPD
Chest xray
Sputum
Interferon gamma blood test
When doing the mantoux TB skin test, what is a positive result?
What test will they do next?
If after 72 hours theres wheel, then it is considered positive. Will need to do a chest x ray to confirm for sure.
What is the interferon gamma release TB test?
It looks for TB in the blood
Most common types of COPD
Chronic bronchitis
Emphysema
T/F
Chronic bronchitis and emphysema are diagnosed seperately
False. We group them together now as COPD since patients usually have both symptoms
Your patient asks how much longer they have to deal with COPD. What do you say?
COPD will never go away entirely. They can manage it well, but they will never be normal again because the disease is progressive. It will get worse at a slow place over time.
What is the usual reason someone has COPD?
Breathing in airborne irritants & toxins from the environment for years and years
What is the number one irritant that causes COPD?
What are the others?
Tobacco smoking
Pollution or chemical exposure at work
COPD patient admits to smoking around their kids. What do you tell them?
The second hand smoke can increase the risk of the kid having copd
COPD symptoms
Coughing Wheezing Barrel chest Accessory muscles breathing Tripod positioning (bent over to breath)
When managing COPD what are the main things we focus on?
Prevent the progression
Preserve whatever pulmonary function is left
Avoid exacerbations
What is the primary med class when treating COPDers who are symptomatoc?
Bronchodilators to help empty the lungs, reduce hyperinflation, and improve exercise.
Explain what a pulmonary embolism is
When the pulmonary artery or branch is obstructed due to a thrombus or emboli
What mismatch occurs because of a pulmonary embolism
Ventilation - perfusion mismatch.
- so there isn’t enough blood flow to ventilate the alveoli
How do we measure the ventilation perfusion when dealing with a pulmonary embolism
V/Q scan which determine the O2 and Co2 concentration
V meaning of the V/Q scan
Amount of air that reaches the alveoli
Q meaning of the V/Q scan
Amount of blood that reaches the alveoli
Explain how pulmonary embolism can lead to shock
Increased pulmonary vascular resistance and pulmonary arterial pressure….. which leads to the right ventricle having to work to maintain the blood flow which leads right ventricle failure which leads to shock
Pulmonary embolism symptoms
Dyspnea - most common Tachypnea & tachycardia Pleuretic chest pain that mimics angina anxiety & fear cough diaphoretic hemoptysis syncope
Your patient is expressing PE symptoms. How long do you have before they could be dead?
1 hour
What is included in the pulmonary embolism work up?
Chest x ray EKG - due to heart rhythms ABG - could be normal VQ scan or CT D-dimer Pulmonary angiogram
What is the most effective form of treatment for Pulmonary embolism?
Prevent it from happening
-DVT prophylaxis
Meds to prevent pulmonary embolism
Anticoagulation therapy - heparin, warfarin
Thrombolytics -Urokinase streptokinase, alterplase
Common side effects of Urokinase streptokinase, alterplase
Bleeding (as it is with any dvt meds)
What can we improve to treat and manage pulmonary embolism
Respiratory and vascular status
How can pulmonary embolism be surgically managed
Embolectomy performed by cardiavascular surgeon
What invasive placement can prevent a future PE from occurring?
IVC filter to prevent future PE’s
