Respiratory part 2

Question 1

What shape is tuberculosis?

Answer 1

Acid-fast aerobic rod

Question 2

What does tuberculosis affect?

Answer 2

Primary affects the lungs but can also affect meninges, kidneys, bones, and lymph nodes.

Question 3

How is tuberculosis spread?

Answer 3

Airborne transmission

Question 4

How does tuberculosis enter the body?

Answer 4

Mycobacteria is inhaled, settles in the alveoli, and from there can enter the blood stream & spread.

Question 5

What is the defining factor of latent TB?

Answer 5

Germs are dormant or asleep and so the patient won’t even seem sick.

Question 6

T/F

Latent TB cannot be spread to others

Answer 6

true

Question 7

What is the medication regimen like for latent TB? What is the most important thing about this?

Answer 7

Take one medication for 9-12 months. Compliancy is important

Question 8

What is active TB?

Answer 8

TB with germs that reproduce and spread causing tissue damage in the affected areas
(remember we listed those) - and you will feel sick.

Question 9

Active TB symptoms

Answer 9

Persistent cough for more than 3 weeks
Weight loss
Night sweats
Fever

Question 10

How do we diagnose the an active TB?

Answer 10

Chest xray will show it

PPD skin test

Question 11

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?

Answer 11

No - a latent TB infection will not be on xray.

Question 12

Can you spread active TB?

Answer 12

Yes if it is in your lungs and larynx/voicebox by sneezing, coughing, talking, singing

Question 13

What is a priority when dealing with a TB patient?

Answer 13

Infection control. Even if you aren’t sure, put up the airborne precaution signs.

Question 14

What are all the available test to identify TB?

Answer 14

Mantoux skin test PPD
Chest xray
Sputum
Interferon gamma blood test

Question 15

When doing the mantoux TB skin test, what is a positive result?
What test will they do next?

Answer 15

If after 72 hours theres wheel, then it is considered positive. Will need to do a chest x ray to confirm for sure.

Question 16

What is the interferon gamma release TB test?

Answer 16

It looks for TB in the blood

Question 17

Most common types of COPD

Answer 17

Chronic bronchitis

Emphysema

Question 18

T/F

Chronic bronchitis and emphysema are diagnosed seperately

Answer 18

False. We group them together now as COPD since patients usually have both symptoms

Question 19

Your patient asks how much longer they have to deal with COPD. What do you say?

Answer 19

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.

Question 20

What is the usual reason someone has COPD?

Answer 20

Breathing in airborne irritants & toxins from the environment for years and years

Question 21

What is the number one irritant that causes COPD?

What are the others?

Answer 21

Tobacco smoking

Pollution or chemical exposure at work

Question 22

COPD patient admits to smoking around their kids. What do you tell them?

Answer 22

The second hand smoke can increase the risk of the kid having copd

Question 23

COPD symptoms

Answer 23

Coughing
Wheezing
Barrel chest
Accessory muscles breathing
Tripod positioning (bent over to breath)

Question 24

When managing COPD what are the main things we focus on?

Answer 24

Prevent the progression
Preserve whatever pulmonary function is left
Avoid exacerbations

Question 25

What is the primary med class when treating COPDers who are symptomatoc?

Answer 25

Bronchodilators to help empty the lungs, reduce hyperinflation, and improve exercise.

Question 26

Explain what a pulmonary embolism is

Answer 26

When the pulmonary artery or branch is obstructed due to a thrombus or emboli

Question 27

What mismatch occurs because of a pulmonary embolism

Answer 27

Ventilation - perfusion mismatch.

- so there isn’t enough blood flow to ventilate the alveoli

Question 28

How do we measure the ventilation perfusion when dealing with a pulmonary embolism

Answer 28

V/Q scan which determine the O2 and Co2 concentration

Question 29

V meaning of the V/Q scan

Answer 29

Amount of air that reaches the alveoli

Question 30

Q meaning of the V/Q scan

Answer 30

Amount of blood that reaches the alveoli

Question 31

Explain how pulmonary embolism can lead to shock

Answer 31

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

Question 32

Pulmonary embolism symptoms

Answer 32

Dyspnea - most common
Tachypnea & tachycardia
Pleuretic chest pain that mimics angina
anxiety & fear
cough 
diaphoretic
hemoptysis 
syncope

Question 33

Your patient is expressing PE symptoms. How long do you have before they could be dead?

Answer 33

1 hour

Question 34

What is included in the pulmonary embolism work up?

Answer 34

Chest x ray
EKG - due to heart rhythms
ABG - could be normal
VQ scan or CT
D-dimer
Pulmonary angiogram

Question 35

What is the most effective form of treatment for Pulmonary embolism?

Answer 35

Prevent it from happening

-DVT prophylaxis

Question 36

Meds to prevent pulmonary embolism

Answer 36

Anticoagulation therapy - heparin, warfarin

Thrombolytics -Urokinase streptokinase, alterplase

Question 37

Common side effects of Urokinase streptokinase, alterplase

Answer 37

Bleeding (as it is with any dvt meds)

Question 38

What can we improve to treat and manage pulmonary embolism

Answer 38

Respiratory and vascular status

Question 39

How can pulmonary embolism be surgically managed

Answer 39

Embolectomy performed by cardiavascular surgeon

Question 40

What invasive placement can prevent a future PE from occurring?

Answer 40

IVC filter to prevent future PE’s