Respiratory Tract Infections, Neoplasms & Childhood Disorders (Ch. 30)-- Term First Flashcards
Exam 2
Respiratory Distress Syndrome
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
Respiratory Infections in Children
- 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
Pneumonia in Immunocompromised
-
Humoral immunity defects
- B-cells
- Bacterial infection
- B-cells
-
Cellular immunity defects
- T-cells
- Viral, fungal, mycobacterial, & protozoal
- T-cells
- Neutropenia & impaired granulocyte function
- Bacterial
- S. aureus
- Fungal
- Aspergillus
- Candida albicans
- Bacterial
- Time course hints to infectious agent
- Fulminant (fast onset, severe) → Bacterial
- Insidious (slow onset) → Viral, fungal, mycobacterial, & protozoal
Tuberculosis Pathogenesis
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
-
Visible on chest x-ray
- Laten TB (viable tubercle bacilli) → Secondary infection
- Macrophage infection (primarily)
Acute Rhinosinusitis
- 4 week long sinus infection
- Viral, bacterial, or mixed
- Haemophilus influenzae
- Streptococcus pneumoniae
- Ostiomeatal complex (OMC) blockage
- d/t– barotrauma or nasal polyps
Influenza Transmission
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
Tuberculosis
Typially URTI
-
Mycobacterium tuberculosis
- Strict aerobic, acid-fast bacilli
- Transmission
-
Airborne transmission of droplet nuclei
- Coughing, sneezing, talking…
- Crowded, confined conditions
-
Airborne transmission of droplet nuclei
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
-
Culture
Treatment– Multi-drug therapy (INH, Rifampin, Pyrazinamide, Ethambutol, Streptomycin), Prophylactic treatment (latent infection)
Lung Cancer Clinical Manifestations
- 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
Chronic Rhinosinusitis
- >12 week long sinus infection
- Bacterial and fungal infection
- Anaerobes (alone or in combo w/ aerobes)
- Pseudomonas aeuriginosa
- Anaerobes (alone or in combo w/ aerobes)
Nosocomial Pneumonia
Diagnosed >48 hrs. after admission to the hospital
- 30-50% Mortality rate
-
Ventilator-Associated (VAP)
- Intubation
- Tracheotomy
- Immunocompromised
- Chronic lung disease
-
Ventilator-Associated (VAP)
- Usually bacterial
- P. aeuruginosa
- Klebsiella sp
- E. coli
Influenza
-
Acute URTI
- Common among children & 65+ y.o.
- Orthomyxoviridae
- ssRNA
- Surface proteins
-
Hemagglutinin (HA)
- Virus enters cells
-
Neuraminidase (NA)
- Virus replicates
-
Hemagglutinin (HA)
- Type A
- Mammalian & avian species infected
- New HA & NA subtypes can develop
- Type B & C
- Only infects mammals
Pneumonia
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
-
Lobar
- Setting
Pneumococcal Pneumonia
Most common cause of bacterial pneumonia
- S. pneumoniae
- Immune response
- Humoral (B-cell) response
- Reticuloendothelial system
- Macrophages from spleen
- Asplenic = Highly susceptible
- Macrophages from spleen
- 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
- Lungs look like liver (red & congested)
-
Grey hepatization
- >2 days
- Macrophages phagocytose leukocytes
- Lung is firm, but congestion is diminished
-
Resolution
- Removal of alveolar exudate
- Scarring (sometimes)
-
Edema
4 Major Categories of Lung Cancer
- Squamous cell lung carcinoma
- Adenocarcinoma
- Small cell carcinoma
- Large cell carcinoma
Croup
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
- Any larynx manipulation can lead to respiratory failure
-
EMERGENCY!
- 3 months- 5 y.o
Treatment– Humidifier, Mist tent, Nebulization, Most air oxygen