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

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

Exam 2

1
Q

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)
A

Pneumococcal Pneumonia

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2
Q
  • 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
A

Pneumonia in Immunocompromised

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3
Q
  • 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
A

5 Stages of Lung Development

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4
Q
  • 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…)

A

Legionnaire’s Disease (Typical Pneumonia)

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5
Q

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

A

Croup

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6
Q
  • 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

A

Bronchiolitis

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7
Q
  • Squamous cell lung carcinoma
  • Adenocarcinoma
  • Small cell carcinoma
  • Large cell carcinoma
A

4 Major Categories of Lung Cancer

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8
Q

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

A

Respiratory Distress Syndrome

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9
Q
  • 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
A

Tuberculosis Clinical Manifestations

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10
Q
  • 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
A

Rhinosinusitis Clinical Manifestations

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11
Q
  • 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
A

Small Cell Lung Cancer (SCLC)

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12
Q
  • Fetal lung
    • Secretes fluid into potential air spaces
      • Alveoli development stimulated
      • Fluid cleared from lungs during birth
A

Fetal Breathing

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13
Q
  • 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
A

Typical Pneumonia

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14
Q
  • Conducting air
  • Gas exchange
A

2 Major Functions of the Respiratory Tract

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15
Q

Pneumonia + Diarrhea + Hyponatremia + Confusion

A

Legionnaire’s Disease Clinical Manifestations

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16
Q
  • 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

A

Community-Acquired Pneumonia

17
Q

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
A

Nosocomial Pneumonia

18
Q
  • 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
A

The Respiratory Tract

19
Q
  • 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
A

Influenza Pathogenesis

20
Q

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
A

Pneumonia

21
Q

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)

A

Tuberculosis

22
Q
  • 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

A

Epiglottitis

23
Q
  • 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

A

Lung Cancer Clinical Manifestations

24
Q

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

A

Antigenic Shift

25
Q
  • 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
A

Atypical Pneumonia

26
Q
  • Trivalent inactivated influenza virus (TIIV)
    • Injection
  • Live, attenuated influenza vaccine (LAIV)
    • Intranasal
      • Not given to elderly or immunocompromised
A

Types of Influenza Vaccines

27
Q

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
A

Tuberculosis Pathogenesis

28
Q

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
A

Influenza Treatment & Prevention

29
Q
  • 4 week long sinus infection
  • Viral, bacterial, or mixed
    • Haemophilus influenzae
    • Streptococcus pneumoniae
  • Ostiomeatal complex (OMC) blockage
    • d/t– barotrauma or nasal polyps
A

Acute Rhinosinusitis

30
Q
  • >12 week long sinus infection
  • Bacterial and fungal infection
    • Anaerobes (alone or in combo w/ aerobes)
      • Pseudomonas aeuriginosa
A

Chronic Rhinosinusitis

31
Q
  • Upper airways, diaphragm, & intercostal muscles used
    • Diaphragm more horizontal
    • Highly compliant chest wall and lungs
    • Retractions
      • Airway obstruction
      • Atelectasis
A

Neonatal Breathing

32
Q

Changes to influenza virus minor

  • Virus still recognized by immune system
  • More common w/ Influenza B & C
A

Antigenic Drift

33
Q
  • 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
A

Influenza

34
Q
  • 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
A

Respiratory Infections in Children

35
Q
  • 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
A

Non-Small Cell Lung Cancer (NSCLC)

36
Q

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
A

Influenza Transmission

37
Q
  • 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
A

Influenza Clinical Manifestations

38
Q

Inflammation of the nasal sinuses due to infection

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

A

Rhinosinusitis

Pathophysiology (NRSG 502) (16 decks)

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