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NURP 532 > Week 11 Respiratory > Flashcards

Week 11 Respiratory Flashcards

1
Q

bronchitis patho

A
  • edema and inflamed mucous membranes of the trachea and bronchioles
  • release of pro-inflammatory mediators and increase in secretions
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2
Q

acute bronchitis clinical manifrestions & majority of etiology is?

A
  • cough lasting 5+ days
  • nasal congestion, h/a
  • Dyspnea→ inflammation in the airways.
  • Purulent or non-purulent sputum
  • URI before bronchitis
  • Low grade fever at onset
  • chest wall pain
  • VS normal, no consolidation
  • wheezes, rhonchi

majority viral!!

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3
Q

Indications for chest xray for acute bronchitis

A
  • NOT needed for mild or classic cases
  • get xray if (sx’s of pneumonia):
    • Dyspnea, bloody/rusty sputum
    • HR > 100
    • RR > 24
    • oral temp > 100ºF (37.8ºC)
    • Focal consolidation, egophony, or fremitus
  • If >75 yrs, have subtle sx’s of pneumonia and might not have fever or elevated HR
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4
Q

bronchitis management

A
  • Education
    • no antibiotics - mostly viral infection
  • Smoking cessation
  • Supportive care
    • Rest, fluids, hydration, stream inhalation • Medications
    • Avoid OTC antitussives and antihistamines in ages < 4 yrs old
    • honey > 1 yrs
  • Improve in 2-3 weeks
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5
Q

influenza sx’s in adults vs children

A
  • both have: fever, myalgia, headache, nausea
  • adults: coryza, cough, eye burning, tearing
  • children: rhinitis, conjunctivitis, HIGHER fever, lymphadenopathy
  • normal lung exam
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6
Q

High-Risk Groups for flu-related complications, therefore, need flu chemoprophylaxis with antiviral medication

A
  • children < 5 yrs old, esp < 2 yrs old
  • immunodeficiency or chronic medical conditions (COPD, CVD, DM, renal/neuro/hem disorders)
  • < 19 yrs on chronic aspirin therapy
  • _>_65+ yrs
  • pregnant women + 2 wks post partum
  • African Indians
  • alaskan natives
  • lives in nursing home or chronic care facilities
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7
Q

what are the chemoprophylaxis meds (neuraminidase inhibitor) should be considered for high risk pts who have been exposed to someone with flu w/in last 48 hrs

A
  • oseltamivir (Tamiflu)
    • > 3 months yrs
  • zanamivir (Relenza)
    • > 5 years yrs
  • Taken daily for the duration of exposure = shortens duration by 12-24 hrs
  • not effective if taken after 48 hrs
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8
Q

most common typical pathogen of pneumonia

A

Streptococcus pneumoniae

  • all age groups (90% in children)
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9
Q

most common atypical pathogens of pneumonia

A

mycoplasma and chlamydia pneumonia

  • NO consolidation
  • school age and adolescents
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10
Q

exam findings of pneumonia

A
  • Tachypnea**
  • Tachycardia
  • Consolidation**
  • Decreased O2 saturation
  • Crackles, rales, bronchial, asymmetric breath sounds
  • Dullness to percussion, incr tactile fremitus
  • ego phony, bronchophony
  • whisper pectoriloquy
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11
Q

On chest xray for pneumonia, how to differentiate b/t viral and bacteria?

A

**might be normal the first 24 hrs

Typical pneumonia: Lobar consolidation

bacterial: lobular consolidation, cavitation, large pleural effusion

Atypical/viral pneumonia: Bilateral, diffuse infiltrates, NO CONSOLIDATION

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12
Q

what is the CURB - 65 criteria?

A

Assesses the severity of pneumonia:

  • Confusion
  • Urea/BUN > 20
  • RR _>_30
  • SBP < 90 OR DBP < 60
  • > 65 yrs

1 pt each. severity; send inpatient or outpt

  • 0-1: outpatient
  • 2: short inpatient or closely monitored supervised outpatient
  • 3+: inpatient admission, consider ICU admin
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13
Q

if chest x ray is negative for pneumonia

A
  • can still treat for PNA if clinical presentations is suggestive!!
  • may not show up for the first 24 hrs
  • if have strong suspicion, treat!
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14
Q

initial treatment for outpatients with CAP

A
  • no comorbidites → Amoxicillin, Doxycycline or macrolide (if local pneumococcal resistance < 25%)
  • yes comorbidities → amoxicillin/clavulanate or cephalosporin AND macrolide/doxy
    • OR just fluoroquinolone
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15
Q

complications of pneumonia

A
  • Pleural effusion
    • consider if worsening after 3 days of antibiotics or worsening dyspnea or cough
  • Empyema - collection of pus in pleural space
    • need to be drained
  • bacteremia
  • sepsis
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16
Q

pneumonia prevention

A
  • PCV13 if > 65 yrs, then 1 yr later get PPSV 23
  • if got PPSV23 at > 65yrs, then 1 yr later get PCV13
  • if got 23, have to wait 5 yrs for the next 23
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17
Q

pneumonia sx’s in pediatrics

A
  • **tachypnea**
  • Respiratory distress
    • nasal flaring, retractions, rales
  • *Signs of consolidation
  • Lower lobe pneumonia
    • Abd pain, vomit
    • Poor feeding, irrit, letharagy
  • Viral pneumonia
    • More common age 1 month to 5 yrs
      • Gradual onset of fever, cough, nasal congestion
18
Q

evaluating pneumonia in peds

A
  • Ask about immunizations, maternal health, and birth complications in neonates
  • NO chest xray
  • Imaging and labs if mild → outpatient
  • Blood cultures if moderate - severe
  • Viral culture for flu considered if flu season
  • sputum culture if have sputum
  • chest xray if dx is unclear in infants/young
19
Q

management of pneumonia in peds

A
  • Hospitalization
    • < 3 months: fever, poor intake, pulmonary conditions
    • > 3 months: respiratory distress, poor feeding, <90% O2, toxic appearing, doesn’t respond to antibiotics
    • everyone: issues at home
  • Outpatient treatment
    • No antibiotic treatment if:
      • < 4 yrs old with mild symptoms
        • flu and no evidence of bacterial pneumonia
    • if not improving in few days → consider chest x ray
    • < 5 yrs → Amoxicillin 90 mg
    • > 5 yrs → Azithromycin
    • Prevention
      • Immunizations / flu shots / pneumococcal / pertussis
20
Q

indications for hospitalization in peds for pneumonia

A
  • Moderate - severe pneumonia:
    • respiratory distress-retractions tachypnea, hypoxemia
    • O2 sat < 90%
    • altered mental status
  • Suspicion of MRSA
  • Underlying cardiopulmonary conditions, metabolic disorders, neurologic disorders or developmental delay
  • Infants less than 4 to 6 months old
21
Q

risk factors for primary pneumothorax

A
  • spontaneous rupture of pulmonary or sub pleural bleb in pleural space
  • Age 20-30, male, smoking, tall stature, thin body habitus, underlying lung disease
22
Q

secondary pneumothorax

A
  • Lung disease
  • Connective tissue disease
  • lung cancer
23
Q

pneumothorax symptoms/on exam

A
  • May be asymptomatic
  • Sudden
  • Chest pain
  • Unilateral/Sharp/Pleuritic
  • Dyspnea, tachycardia, diaphoresis
  • Tracheal deviation
  • cyanosis
  • Hyper resonnance to percussion
  • decrease lung expansion
24
Q

pneumothorax diagnostics

A
  • Chest xray of PA and lateral during inspiration but only 50% sensitive
  • Visceral pleural line outlining edge of lung, absence of lung markings
  • CT gold standard
25
Q

pneumothorax management (primary vs secondary)

A
  • Tension → Medical emergency ! ED
  • Primary
    • < 2 cm between lung and chest wall and stable; no breathlessness → observation
    • Any size with breathlessness or > 2 cm → ED
      • needle aspiration
    • Risk factors
      • male, tall, thin.
      • Smokers
  • Secondary
    • Refer to ED
      • Smoking cess
      • Can recur
      • Can’t travel by airline
    • Needle aspiration or chest tube
26
Q

most common cause of Pulmonary Embolism

A

deep vein thrombosis

27
Q

risk factors for PE

A
  • 40% no predisposing RF’s
  • DVT or history of DVT or PE
  • Cancer
  • Immobilization (surgery, longdistance travel)
  • Pregnancy/postpartum
  • Medications/hormones
  • Obesity
  • > 60
  • Blood clotting disorder
  • Infection
  • Autoimmune disease
  • A-fib or MI within past 3 months
  • Smoking
28
Q

sx’s of PE

A
  • SOB
  • tachypnea
  • sharp stabbing chest pain, worsen with inhalation
  • hypotension
  • tachycardia
  • hemoptysis
  • sx’s of DVT before PE
29
Q

diagnostics of PE

A

Dx: CT angiography (CTPA)

D-dimer useful for excluding but not confirming PE [if + → get CTPA]

  • Prediction models (Wells, PERC) to guide diagnostic testing
  • Chest x-ray
  • ECG
  • Pulse oximetry
  • ABG
  • Ventilation/perfusion (V/Q) lung scan
  • Anticoagulation
  • CBC, PT/INR, BUN, C
30
Q

PE management

A
  • Anticoagulation ASAP
    • # 1 LMWH
    • unfractionated heparin
    • warfarin
    • rivaroxaban
  • Long-term therapy
    • Eliquis or xarelto
    • warfarin (heparin to warfarin bridge) x 3 months
31
Q

2 criteria testings for PE

A

Well’s criteria

PERC rule

32
Q

most common bacterial CAP in adolescents?

A

mycoplasma pneumoniae

33
Q
A

D. 48- 72 hours

34
Q

For a child treated for uncomplicated pneumonia as an outpatient, when should a repeat chest xray be obtained to document clearance for pneumonia?

A

CXR NOT needed to document clearance of pneumonia

35
Q

upper respiratory infection (common cold) sx’s

A

c/b rhinovirus (100 different types)

  • starts with a scratchy sore throat, fatigue, mild fever, and runny nose, cough, possibly conjunctivitis
  • peak around day 3 and 5; resolve by day 10. Cough last to resolve
36
Q

URI management

A
  • Supportive
    • hydration, rest
    • Infants
      • normal saline or saline nasal drops
      • humidifier
    • elevate the head of the bed.
    • > 6 yrs & adults = OTC cough suppressants or decongestants c
    • Tylenol or acetaminophen for sore throat or a mild fever.
37
Q

bronchiolitis

A
  • RSV most common
  • < 2 yrs old
  • winter
  • inflammation bronchiolar epithelium and edema of submucosa, excessive mucus production
37
Q

bronchiolitis sx’s

A
  • Fever
  • Rhinorrhea
  • Cough
  • Wheezing
  • Respiratory distress
    • Grunting • Nasal flaring • Retractions
38
Q

bronchiolitis diagnosis

A
  • Based on history and exam findings
  • Labs or imaging not needed
  • < 2 months = get Urine culture
    • increased risk of UTI
  • Assess severity
    • Risk factors for severe:
      • Infants < 3 months
      • Prematurity
      • Immunodeficiency
      • infants/children with cardiopulmonary disease
  • Pulse oximetry
  • RSV culture
39
Q

bronchiolitis management

A
  • Hospitalization if
    • Severe respiratory distress (grunting, retractions, RR >70)
    • HR > 180
    • O2 sat < 90%
    • < 3 months
    • Premature
    • Poor oral intake
  • Tx: Supportive care
    • Hydration, nasal suctioning, humidification, fever control, elevate head
    • Nebulized saline
  • Education
    • When to bring child back in, lethargic not feeding well
    • s/sx of resp distress
    • At risk of asthma or wheezing in future but most recover in 5-7 days
40
Q

epiglottis

A
  • HIB vaccine prevention
  • abrupt onset EMERGENCY! do not examine throat
  • Age 1-5
  • Severe respiratory distress
  • No barking cough
  • fever
  • Tripod position
  • Drooling
  • Toxic appearing
  • muffled voice
41
Q

epiglottitis diagnostics & management

A
  • order blood cultures
  • early consult with otolaryngologist and anesthesiologist
  • establish airway and start antimicrobials
  • NO SUPINE
  • admin IV broad spectrum ampicillin/sulbactam, cefotaxime, ceftriaxion
  • O2 & respiratory support

NURP 532 (13 decks)

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