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Pathophysiology (NRSG 502) > Respiratory Tract Infections, Neoplasms & Childhood Disorders (Ch. 30)-- Term First > Flashcards

Respiratory Tract Infections, Neoplasms & Childhood Disorders (Ch. 30)-- Term First Flashcards

Exam 2

1
Q

Respiratory Distress Syndrome

A

Pulmonary immaturity + Surfactant deficiency → Alveolar collapse

  • S/S
    • Respiratory distress 24 hrs. after birth
    • Central cyanosis
    • Retraction
    • Grunting w/ expiration
    • Increased RR
    • Fatigue
    • Patent ductus arteriosis

Treatment– Supportive care, Incubation, Monitoring (BG & O2), Supplemental O2, CPAP, Ventilation, Exogenous surfactant therapy

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2
Q

Respiratory Infections in Children

A
  • Epiglottitis
  • Croup
  • Broncholitis

Respiratory failure S/S

  • Rapid breathing
  • Exaggerated use of accessory muscles
    • Chest & abdominal muscles
  • Retractions
    • Intercostal muscles
  • Nasal flaring
  • Grunting during expiration
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3
Q

Pneumonia in Immunocompromised

A
  • Humoral immunity defects
    • B-cells
      • Bacterial infection
  • Cellular immunity defects
    • T-cells
      • Viral, fungal, mycobacterial, & protozoal
  • Neutropenia & impaired granulocyte function
    • Bacterial
      • S. aureus
    • Fungal
      • Aspergillus
      • Candida albicans
  • Time course hints to infectious agent
    • Fulminant (fast onset, severe) → Bacterial
    • Insidious (slow onset) → Viral, fungal, mycobacterial, & protozoal
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4
Q

Tuberculosis Pathogenesis

A

Pathogenesis based on hypersensitive immune response

  • Cell-mediated (T-cells)
    • Macrophage infection (primarily)
      • Droplet deposited in alveoli → Bacteria phagocytosed → Macrophages unable to kill (d/t cell wall virulence factors) → T-cells contain infection
      • Infected macrophages degrade & present antigen to T-cells → Stimulation of macrophage production of lytic enzyme → Lung tissue damage
    • Ghon focus formation
      • Primary granulomatous lesions w/i lungs
      • Soft tissue necrosis
    • Caseous granulomas
      • lymph node granuloma
    • Ghon complex
      • Ghon focus + Caseous granulomas
      • Fibrous scarring & calcification
        • Visible on chest x-ray
          • Indicated history of TB infection
    • Laten TB (viable tubercle bacilli) → Secondary infection
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5
Q

Acute Rhinosinusitis

A
  • 4 week long sinus infection
  • Viral, bacterial, or mixed
    • Haemophilus influenzae
    • Streptococcus pneumoniae
  • Ostiomeatal complex (OMC) blockage
    • d/t– barotrauma or nasal polyps
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6
Q

Influenza Transmission

A

Droplet transmission

  • More contagious than bacterial RTIs
  • Incubation
    • 1-4 days
  • Infectious
    • 1 day prior to S/S onset
    • >1 week after S/S subside
  • Viral shedding
    • 3 weeks
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7
Q

Tuberculosis

A

Typially URTI

  • Mycobacterium tuberculosis
    • Strict aerobic, acid-fast bacilli
  • Transmission
    • Airborne transmission of droplet nuclei
      • Coughing, sneezing, talking…
      • Crowded, confined conditions

Diagnosis–

  • Tuberculin skin test (PPD)
    • Type IV hypersensitivity reaction
  • Chest x-ray
    • Active vs. latent
  • Diagnosis of active
    • Culture
      • Takes weeks to get results
    • Nucleic acid amplification
    • Acid-fast staining of sputum

Treatment– Multi-drug therapy (INH, Rifampin, Pyrazinamide, Ethambutol, Streptomycin), Prophylactic treatment (latent infection)

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8
Q

Lung Cancer Clinical Manifestations

A
  • S/S
    • Anorexia
    • Weight loss
    • Similar to chronic bronchitis
      • Chronic cough
      • SOB
      • Wheezing
    • Hemoptysis
      • Blood in sputum
    • Dull, poorly localized retrosternal pain
      • Tumors of mediastinum
    • Persistant, localized, severe pain
      • Pleura
  • Metastasis
    • Brain
    • Bone
    • Liver

Diagnosis– History, PE, Chest x-ray, Bronchoscopy, Cytology of sputum or bronchial washings, Needle biopsy, Lymph node biopsy, CT scan, MRI, Ultrasound

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9
Q

Chronic Rhinosinusitis

A
  • >12 week long sinus infection
  • Bacterial and fungal infection
    • Anaerobes (alone or in combo w/ aerobes)
      • Pseudomonas aeuriginosa
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10
Q

Nosocomial Pneumonia

A

Diagnosed >48 hrs. after admission to the hospital

  • 30-50% Mortality rate
    • Ventilator-Associated (VAP)
      • Intubation
      • Tracheotomy
    • Immunocompromised
    • Chronic lung disease
  • Usually bacterial
    • P. aeuruginosa
    • Klebsiella sp
    • E. coli
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11
Q

Influenza

A
  • Acute URTI
    • Common among children & 65+ y.o.
  • Orthomyxoviridae
    • ssRNA
    • Surface proteins
      • Hemagglutinin (HA)
        • Virus enters cells
      • Neuraminidase (NA)
        • Virus replicates
  • Type A
    • Mammalian & avian species infected
    • New HA & NA subtypes can develop
  • Type B & C
    • Only infects mammals
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12
Q

Pneumonia

A

LRTI that leads to inflammation of parenchymal structure (alveoli and bronchioles)

  • 8th leading cause of death
    • Elderly & immunocompromised
  • Classifications
    • Setting
      • Community-acquired
      • Hospital-acquired
        • Nosocomial
    • Infectious agent
      • Typical
      • Atypical
    • Pattern of distribution
      • Lobar
        • Localized to one lung lobe
      • Bronchopneumonia
        • Dispersed
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13
Q

Pneumococcal Pneumonia

A

Most common cause of bacterial pneumonia

  • S. pneumoniae
  • Immune response
    • Humoral (B-cell) response
    • Reticuloendothelial system
      • Macrophages from spleen
        • Asplenic = Highly susceptible
  • Pathology (4 stages)
    • Edema
      • Alveoli fill with protein-rich fluid
    • Red hepatization
      • Lungs look like liver (red & congested)
        • Capillary congestion
        • Movement of leukocytes into blood vessel
    • Grey hepatization
      • >2 days
      • Macrophages phagocytose leukocytes
      • Lung is firm, but congestion is diminished
    • Resolution
      • Removal of alveolar exudate
      • Scarring (sometimes)
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14
Q

4 Major Categories of Lung Cancer

A
  • Squamous cell lung carcinoma
  • Adenocarcinoma
  • Small cell carcinoma
  • Large cell carcinoma
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15
Q

Croup

A

Larynx, trachea, & bronchi

  • Parainfluenza virus
    • 3 months- 5 y.o
      • Follow symptoms of a cold
      • Stridor
      • Wet, barking cough
      • Occurs @ night
      • Relieved by exposure to cold or most air
      • May resolve
      • Cyanotic
        • EMERGENCY!
          • Any larynx manipulation can lead to respiratory failure
            • Ex: tongue depressor

Treatment– Humidifier, Mist tent, Nebulization, Most air oxygen

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16
Q

Rhinosinusitis Clinical Manifestations

A
  • Facial pain
  • Headache
  • Purulent nasal discharge
  • Decreased sense of smell
  • Fever
  • Maxillary–
    • Pain w/ bending over
    • Unilateral pain behind the eyes
    • Pain in teeth
  • Acute Viral–
    • 5-7 days
  • Acute Bacterial–
    • Worse after 5-7 days
    • Symptoms
  • Chronic–
    • Persistent sinus pressure
    • Nasal congestion
    • Constant, dull HA
  • Immunocompromised–
    • Rhinorrhea
      • Runny nose
    • Facial edema
    • Lack of purulent discharge/signs of inflammation
17
Q

Tuberculosis Clinical Manifestations

A
  • Primary
    • Unsensitized individuals
    • Latent infection
  • Primary progressive
    • Immunocompromised people
      • Disorders of cell-mediated immunity
        • HIV
    • Reinfection or reactivation
      • Bacteria never die
    • Aggravation by cell-mediated hypersensitivity
      • Cavitation (holes) w/i lungs
      • Bronchial dissemination
      • Pleural effusion
      • Empyema
  • Secondary
    • Reactivated latent infection
18
Q

Antigenic Shift

A

Influenza virus unrecognized by immune system d/t new HA & NA surface proteins

19
Q

Influenza Clinical Manifestations

A
  • Early
    • Type A or B
      • Abrupt onset of fever
      • Chills
      • Rigors
      • Malaise
      • Muscle ache
      • HA
      • Profuse watery nasal discharge
      • Nonproductive cough
      • Sore throat
    • Type C
      • Common cold
      • Milder
  • Complications
    • Viral PNA
      • 1 day after flu onset
      • Rapid progression
        • Hypoxemia
        • Death
        • Diffuse pulmonary fibrosis
  • Secondary complications
    • Sinusitis
    • Otitis media
    • Bronchitis
    • Bacterial PNA
    • Croup
      • Young children
    • Parotitis
      • Rare
    • Tracheitis
      • Rare
    • Reye syndrome
      • ASA used to treat S/S in children
20
Q

Legionnaire’s Disease Clinical Manifestations

A

Pneumonia + Diarrhea + Hyponatremia + Confusion

21
Q

Rhinosinusitis

A

Inflammation of the nasal sinuses due to infection

d/t– Blockage of ostia, Viral RTI, Nasal polyps, Barotrauma

22
Q

Neonatal Breathing

A
  • Upper airways, diaphragm, & intercostal muscles used
    • Diaphragm more horizontal
    • Highly compliant chest wall and lungs
    • Retractions
      • Airway obstruction
      • Atelectasis
23
Q

Influenza Treatment & Prevention

A

Diagnosis–

  • Rapid diagnostic test
  • Immunoassay
    • Type A or B

Treatment–

  • Rest
  • Keep warm
  • Manage fever
  • Hydrate
  • Analgesic cough medication
  • Antiviral drugs
    • Decrease duration of course of infection

Prevention

  • Immunization
    • >6 months old
  • New formulation every year (October)
    • Antigenic changes
24
Q

Antigenic Drift

A

Changes to influenza virus minor

  • Virus still recognized by immune system
  • More common w/ Influenza B & C
25
Typical Pneumonia
* Bacteria multiply extracellularly in the alveoli * Inflammation * **Exudate in air-filled spaces of alveoli** Risk factors * **Loss of cough reflex** * Brain lesions * NG tube * Sedation * **Damage to ciliated epithelium** * Loss of mucociliary blanket * Removed mucus, microorganisms, & particles from RT * Chemical irritants * **Smoking** * Immunodeficiency * **loss of IgA & IgG** w/i secretions * Impaired cell-mediated immunity * **Bacterial adherence** * Loss of epithelial surface function * **Flu** * **Antibiotic therapy** * Alters normal flora * DM * Chronic bronchitis * Viral infection
26
5 Stages of Lung Development
* **Embryonic** (4-6 wks) * Bronchial buds * **Pseudoglandular** (5-16 wks) * Conducting airways formed * **Canalicular** (17-27 wks) * Primitive alveoli * **Respiration** is possible * **Saccular** (27-35 wks) * Terminal alveolar ducts & air sacs * **Gas exchange** is possible * **Surfactant available** * Required to inhale/exhale * **Mature alveoli form after birth** * First 3 months * Slowing of alveolar growth * **First year** * **Rapid increase** in alveoli # * Alvolar
27
Non-Small Cell Lung Cancer (NSCLC)
* **TNM Staging** * Tumor, node, metastasis * Bioactive products * Paraneoplastic syndrome * **Squamous cell carcinomas** * **Most common in men w/ smoking history** * Originate in central bronchi * Early detection in sputum * Paraneoplasm * **Hypercalcemia** * **Adenocarcinomas** * Most common type * **Women & nonsmokers** * Originate in bronchiolar or alveolar tissue * More peripheral than squamous * Associated w/ lung scarring * Large cell carcinomas * Poor prognosis * Large, polygonal cells
28
Fetal Breathing
* Fetal lung * **Secretes fluid** into potential air spaces * **Alveoli development stimulated** * **Fluid cleared** from lungs **during birth**
29
Types of Influenza Vaccines
* Trivalent inactivated influenza virus **(TIIV)** * **Injection** * Live, attenuated influenza vaccine **(LAIV)** * **Intranasal** * Not given to elderly or immunocompromised
30
Bronchiolitis
* Respiratory syncytial virus * Impaired gas exchange → Risk for respiratory distress * **\<2 y.o.** * **Most severe in \<6 months** * Preceded by stuffy nose * Breathlessness * Rapid * Shallow breathing * **Wheezing w/ expiration** * Cough * **Retractions during inspiration** * Lower ribs & sternum Treatment-- Supportive treatment, possibly nebulization or intubation
31
Small Cell Lung Cancer (SCLC)
* **Limited vs. Extensive Staging** * TNM staging NOT used * Small, round to oval cells * Arise from neuroendocrine cells of bronchial epithelium * Highly malignant * **Brain metastasis often provides first evidence** * Strong association w/ smoking cigarettes * Associated w/ **paraneoplastic syndrome** * **SIADH** * **Cushing syndrome** * Hypercortisolism * **Eaton-Lambert syndrome** * Neuromuscular
32
2 Major Functions of the Respiratory Tract
* **Conducting air** * **Gas exchange**
33
Atypical Pneumonia
* Viral and *Mycoplasma* **infections of the alveolar septum and interstitium surrounding alveoli** * Mild, low mortality rate * “Walking pneumonia” * **Lack of lung consolidation** * Elevation of WBCs * Damage to epithelium * Predispose to secondary bacterial infections * ***Mycoplasma pneumoniae*** * Viruses * **Influenza, RSV, adenovirus, rhinoviruses, rubeola, varicella**
34
Community-Acquired Pneumonia
* Diagnosed **w/i 48 hrs. after admission to hospital** * Bacterial * S. pneumonia (most common) * Viral * Influenza virus Diagnosis-- History, **Chest x-ray (infiltrate present)**, Public health information Treatment-- Antibiotics (bacterial), Hospitilzation/ICU
35
Legionnaire's Disease (Typical Pneumonia)
* Bronchopneumonia * ***Legionella pneumophila*** * Consolidation of lung tissue * Impaired gas exchange * S/S **(onset 2-10 days after infection)** * Malaise * Weakness * Lethargy * Fever * Dry cough * **CNS & GI tract disturbances** Diagnosis-- Chest x-ray, **Urine antigen test** for *Legionella* bacteria Treatment-- Antibiotics (Azithromycin, Ciprofloxacin…)
36
Epiglottitis
* **URTI** * *Haemophilius influenzae* Type B * 2-7 y.o * Sudden onset * **Mouth open** * **Chin thrust forward** * **Low-pitched stridor w/ inspiration** * Dysphagia * Fever * Drooling * Anxiety * Asphyxia * Airway obstruction Treatment-- Hospitalization (intubation or tracheotomy), Antibiotic therapy
37
Influenza Pathogenesis
* **Rhinotracheitis** * Uncomplicated URTI * Targets & kills epithelial cells w/i RT lining * **ECF escape → Nasal discharge** * **Viral pneumonia** * Shedding of bronchial & alveolar cells * Viral to bacterial RTI * Compromise of RT natural defenses * Bacterial adhesion & infection → PNA * **Secondary RTI**
38
The Respiratory Tract
* **Upper Respiratory Tract (URT)** * Nose * Oropharynx * Larynx * **Lower Respiratory Tract (LRT)** * Lower airways * Lungs * **Conducting Airways** (conduct air) * Nasal passages * Mouth * Pharynx * Larynx * Trachea * Bronchi * Bronchioles * **Respiratory Airways** (gas exchange) * Lungs * Alveoli

Pathophysiology (NRSG 502) (16 decks)

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