Unit 2 Module 3: Respiratory Flashcards
emphysema or chronic bronchitis:
Respiratory rate on the low side (12-14/min)
chronic bronchitis
Right lower lobe pneumonia is a type of [lobar/broncho] pneumonia
lobar
lobar: consolidation in a part of all of the lung of a lobe.
bronchopneumonia: patchy consolidation involving more than one lobe of the lung
emphysema or chronic bronchitis:
Patient has productive cough with a lot of thick tenacious sputum
chronic bronchitis
emphysema or chronic bronchitis: most VQ mismatch and therefore would have greater cyanosis?
Patient with primarily chronic bronchitis
emphysema or chronic bronchitis: can be caused by a genetic deficiency in alpha-1 antitrypsin
emphysema
infectious TB or not: positive ppd and positive sputum culture and has had a 10 lb weight loss, chronic cough and low grade fevers in the afternoon.
infectious
Four respiratory symptoms of pneumonia
cough, sputum production, dyspnea, tachypnea
What distinguishes asthma from COPD?
Asthma is a reversible lung disorder that is often triggered by an allergen.
Adequate perfusion but not ventilation
shunt
Define dyspneic
short of breath
Which is worse for a patient with asthma:
patient with wheezing, chest tightness, use of accessory muscles (intercostal retractions seen)
patient with a silent chest (no wheezing) and a pCO2 of 70 mmHg
silent chest and acidotic
When they are hyperventilating, they are more prone to respiratory alkalosis, but when they tire out and their respirations slow down, they retain pCO2 can become acidotic. At that point, they are not moving air at all and their chest becomes silent (no breath sounds).
emphysema or chronic bronchitis: thin, low weight individual
emphysema
Four agents that can cause pneumonia
microbe
smoke
aspiration
respiratory suctioning
Reduced oxygen in arterial blood
hypoxemia
emphysema or chronic bronchitis: assumes the tripod position to help breathing
emphysema
t/f: TB is only found in the lungs
TB is primarily a pulmonary infection, but can be found in lots of different areas in the body, such as the brain, prostate, intestine, etc.
What is in thick, white sputum
Inflammatory cells that have phagocytized the invader
emphysema or chronic bronchitis: Greater Ventilation/perfusion mismatch (VQ) resulting in more hypoxemia
chronic bronchitis
How do we know that cellular immunity has started working in someone with TB?
Positive PPD test
Cellular immunity helps to contain the bacilli in the lungs but it takes 2-10 weeks for this to occur. The production of antibodies against TB is what is seen with the positive PPD.
Decreased oxygen of cells in the tissues (could be related to problems with oxygenation, anemia, or necrosis)
hypoxia
When a granuloma forms, what happens to the TB bacilli?
The bacilli become dormant
Which symptoms are seen with patients with COPD with primarily emphysema symptoms?
prolonged expiration, barrel chested, pursed lip breathing
emphysema or chronic bronchitis: Works hard to breathe with higher respiratory rate (24/min) and pursed lip breathing
emphysema
infectious TB or not: AIDS patient with a negative ppd, positive AFB smear and asymptomatic
not – suspected MAC, not TB
A patient received the BCG vaccination as a child. Which screening test is recommended for this patient to determine TB infection?
Quantiferon Gold
A person has been exposed to someone with TB and gets infected. What is most likely going to happen?
latent TB infection
Only 5% develop active disease
Which WBC respond to TB infection?
Phagocytes and macrophages engulf the bacilli and eventually wall it off by forming a granuloma. As the inside macrophages in granuloma die off, it develops a caseous (cheese like consistency) necrosis and it eventually forms a ghon complex, which can be seen on X-ray.
A patient has a RLL infiltrate. What does that mean?
Right lower lobe pneumonia
Gas exchange occurs in the alveoli. What are some diseases that affect gas exchange?
pulmonary embolism, pneumonia, viral bronchitis, pulmonary edema
The ease that hemoglobin gives up oxygen and accepts carbon dioxide. (Ex: state of acidosis, hgb has decreased affinity for picking up oxygen).
oxyhemoglobin dissociation
Four systemic symptoms of pneumonia
fever, chills, fatigue, loss of appetite
The body works to contain a TB infection by forming a:
granuloma
Adequate ventilation but poor perfusion
dead air space
Order from best to worst:
- active TB
- multi-drug resistant TB
- latent TB
- extensively drug resistant TB
From least troubling to most concerning= latent TB, active TB, MDR-TB and then XDR-TB
Latent TB infection—positive ppd; no symptoms; may or may not have ghon complex. Active TB infection= responsive to normal therapy.
MDR-TB: multidrug resistant TB–Resistant to INH + Rifampin
XDR-TB: extensively drug resistant TB–Resistant to INH + Rifampin + fluroquinolones and at least one IV second line therapy
emphysema or chronic bronchitis: loss of elastin
emphysema
emphysema or chronic bronchitis: hypertrophy of mucus glands, goblet cells, and airway epithelium occurs
chronic bronchitis
Where is nosocomial pneumonia acquired?
Hospital
Nosocomial refers to hospital acquired pneumonia and infections occur after 48 hours in the hospital and are usually bacterial and antibiotic resistant. VAP=ventilator associated pneumonia is an example.
infectious TB? positive ppd with a CXR showing suspicious signs and patient asymptomatic
not – latent without symptoms
emphysema or chronic bronchitis: Barrel chested
emphysema
t/f: One week post TB exposure, ppd is > 15mm in induration
false
5mm is positive. Earliest positive result is 2 weeks.
emphysema or chronic bronchitis: cyanosis common
chronic bronchitis
What isolation should be placed on a patient with active TB?
airborne
TB is transmitted as a droplet, but patients are placed on airborne isolation, which is a more strict type of isolation because it can “hang out” in the air for a period of time and doesn’t just drop to the ground.
How is pulmonary embolism related to perfusion and ventilation?
ventilation without perfusion
What are the two hallmarks of an asthma attack?
inflammation and bronchoconstriction
t/f: Uncontrolled asthma with frequent attacks can lead to long term bronchial remodeling and chronic obstructive pulmonary disease (COPD).
true, in a small population
Increased levels of carbon dioxide in the blood
hypercapnia
Pneumonia is most often caused by the microbe
S. pneumoniae
S.pneumoniae is the most common infectious agent. Pneumonia can be cause by bacteria, viruses and fungi.
Why do patients with pneumonia have compromised gas exchange?
Inflammatory process leads to the accumulation of WBCs, causes capillary leak, edema and exudate in the alveoli.
