week 2 content Flashcards
distress, failure, or arrest?
________ - person stops breathing
__________ – maintain oxygenation only by increasing WOB
____________ – cant compensate for inadequate oxygenation (despite extra respiratory effort and rate), circulatory and respiratory system collapse
arrest - person stops breathing
distress – maintain oxygenation only by increasing WOB
failure – cant compensate for inadequate oxygenation (despite extra respiratory effort and rate), circulatory and respiratory system collapse
Chronic, permanent, progressive and destructive
- Air sacs in alveoli become permanently and abnormally enlarged (airway remodeling) r/t destruction of alveoli and capillary beds
- Airflow limitation is d/t loss of elastic recoil when airways collapse during exhale
- Lung hyperinflation
which obstructive lung disease?
emphysema
Prevention for __________
Vaccines
- PCV13 - Pneumococcal caused by strep ______
- PPSV23 – 23 types of ________ bacteria
PNA
pt c/o of illness that started as a URI but now they have
- fever
- chills
- dry cough
- malaise
- pleural pain – pain with breathing
- dyspnea
- hemoptysis
we would SBAR the HCP with what suspicion?
viral PNA
diagnosis for what pulomary condition
- history of allergies
- recurrent episodes of wheezing, dyspnea, and exercise intolerance
- pulmonary function tests (PFTs) – gold standard
asthma
_________ and other virus are major risk factors for developing PNA
influenza
- Most common anemia
- Pregnant women, toddlers, adolescent girls, aging women
Causes
- Diet insufficient
- Absorption insufficient
- Increased demand – pregnancy
- Excessive blood loss – GI bleed, menstruation
Iron deficiency anemia
Gas exchange and oxygenation of the body cant occur without functioning ____, ____, and ____
hgb, iron, and RBC
s/s of primary, latent, or active TB?
- fatigue
- weight loss
- lethargy
- anorexia
- low grade fever
- productive cough
- night sweats
- anxiety
active
would these s/s in an asthma pt indicate mild asthma or severe asthma attack?
- Use of accessory muscles
- Distant (decreased) breath sounds
- Diaphoresis
- Cant speak more than a couple words before taking another breath
- Respiratory failure
o Inaudible breath sounds
o Repetitive hacking cough
severe asthma attack
are these early or late signs of untreated TB?
- dyspnea
- chest pain
- hemoptysis
later in untreated TB
which gram + PNA are these
______________
o Enters via CLABSI and travels to lungs
o Most common gram + HAP, usually MRSA
_______________
o Most common CAP
o Sputum brown/red
strep pneumoniae
staph aureus
- Staph aureus
o Enters via CLABSI and travels to lungs
o Most common gram + HAP, usually MRSA - Strep pneumoniae
o Most common CAP
o Sputum brown/red
distress, failure, or arrest?
- tachypnea
- nasal falring
- pursed lips
- stridor
- wheezing
- Altered mental status /agitation
- Tachycardia
- Delayed capillary refill
- Pale
distress - maintain oxygenation only by increasing WOB
all anemia share classic s/s bc -
all anemia = lack of RBC = Less oxygen is able to be transported to the tissues = all anemia share classic s/s
which anemia?
Inability to bind hgb normally
- Fragile sickle shaped cells – deliver less oxygen to tissues
- Easily clog blood vessels and break into pieces that disrupt blood flow = ischemia and necrosis
- Genetic disorder (African descent)
Crisis triggers
- Dehydration
- Stress
- High altitudes
- Fever
- Extreme temperatures
Treatment
- Oxygen therapy
- Hydration
- Pain management
- Infection control
- Antimetabolite drug – hydroxyurea
- Blood transfusion
- Bone marrow transplant
- Genetic counseling and treatment (CRISPR)
Sickle cell anemia
Unique to _________anemia: (not going to ask specific s/s)
- Delayed growth
- Fatigue
- Dyspnea
- Hepatomegaly
- Splenomegaly
- Bone deformities
- Jaundice
Unique to thalassemia anemia
_________PNA
Not gram positive or gram negative
SATA
Pneumocytosis carini PNA
viral PNA
mycoplasma (walking PNA)
legionella
atypical
Pneumocytosis carini PNA
X viral PNA
mycoplasma (walking PNA)
legionella
s/s of ________ PNA
- Fever
- Chills
- DOE
- Cough
viral
Lab values for anemia
Hgb and Hct
- which is Best indicator ?
- which is Not affected by fluid volume level?
- which is measured in %?
- which is Affected by fluid volume level ?
Lab values
Hgb
- Best indicator
- Not affected by fluid volume level
Hct
- %
- Affected by fluid volume level
which anemia(s) would have these s/s?
- May have no symptoms
- Fatigue (low energy production, metabolism)
- Weakness (lack of oxygen to muscles)
- Tachycardia (need more oxygen = heart beats faster)
- Dyspnea (hypoxia)
- Increased HR and RR (compensating for low oxygen)
- Hypotension
- Pallor (blood redirected to major organs)
- Faintness
- Cardiovascular symptoms, chest pain, heart failure (esp with exertion) (cardiac muscles are hypoxic and dying)
- Bone pain (erythropoietin is stored in red bone marrow in bones and released with low RBC)
symptoms due to decreased oxygen carrying ability so all anemias have them
Early asthmatic response
o Activated immediately
o Inflammatory mediators are released within _____ mins or hours_______?
o Vasodilation
o Increased capillary permeability
o Mucosal edema
o Bronchoconstriction (Bronchial smooth muscle contraction)
o Mucus secretion
Late asthmatic response
o ___-____ hours after early response
o More eosinophils, neutrophils, and lymphocytes are recruited and cause another release of inflammatory mediators
o Same s/s reoccur from early asthmatic response episode
early response = minutes
late response = 4-8 hours
Chronic inflammation of the bronchial airways, with acute exacerbations
(not alveoli)
- Causes bronchial hyperresponsiveness
- Causes constriction of airways
- Causes variable airflow obstruction that is reversible
which obstructive lung disease?
asthma
PNA is successful when it gets past defenses and to lower airways.
how does it get to lower airway: SATA
- aspiration of oropharyngeal secretions
- contact with infected surface
- inhalation of droplets containing bacteria or other pathogens
- failure of cough reflex
- failure of cilia clearance
- failure of immune system
- airborne droplets expelled by infected people
how does it get to lower airway: SATA
- aspiration of oropharyngeal secretions
X- contact with infected surface
- inhalation of droplets containing bacteria or other pathogens
- failure of cough reflex
- failure of cilia clearance
- failure of immune system
X- airborne droplets expelled by infected people
pathogens that can cause pneumonia SATA
- bacterial
- viral
- fungal
- protozoa
- parasitic
all
in chronic bronchitis there are thick mucus secretions produced that can’t be cleared r/t
- Damaged ________- (airway walls become inflamed and thickened secondary to edema)
- Inflammatory cells accumulate
- Thickened smooth muscle secondary to chronic bronchospasm (fibrosis)
- Chronic bronchospasm, or narrowing of the airways, can lead to thickened smooth muscles and fibrosis (scarring) of the smooth muscle
cilia - tiny, hair-like structures found on the surface of respiratory tract cells, where they help to move mucus and trapped particles out of the lungs.
Infection of the facial sinuses and membranes of the nose
- Inflammation causes the sinus cavity to become obstructed by fluid accumulation and edema allowing for bacterial growth and infection
Cause
- May accompany
o URI
o Nasal plyps
o Deviated septum
o Allergic rhinitis
does Viral or Bacterial last longer?
acute sinusitis
- Viral = 5-7 days duration
- Bacterial = up to 4 week duration
____________
Stores in mast cells (skin and soft tissue) and basophils (blood)
Cause most s/s associated with allergic reactions
- From drugs, food, contact with surface
histamines
Normocytic = _______
Normochromic = __________ (normal concentration/function)
Anemia = ________, __________, __________
Normocytic = normal size
Normochromic = normal color (normal concentration/function)
Anemia = sickle cell anemia, aplastic anemia, r/t blood loss
treatment for ________ includes
- avoid triggers
- use peak flow meter to self-monitor and help guide treatment with established action plan
- drug therapy
asthma
asthma Teaching - T/F
- Early and late response do not both happen, it is either one or the other?
- Untreated inflammation can lead to irreversible long term airway damage (airway remodeling, chronic asthma)?
F - Early and late response can both happen, be prepared for the late response 4-8 hours after early response
T
Air trapping
Person cant full exhale bc air cant get out through narrowed airways = high or low CO2?
Air is trapped in alveoli so person has to work harder to breath and lungs are overinflated or underinflated?
Normal exhalation is obstructed
Chronic high/low co2 and high/low o2?
Air trapping
- Person cant full exhale bc air cant get out through narrowed airways = high CO2
- Air is trapped in alveoli so person has to work harder to breath and lungs are hyperinflated
- Normal exhalation is obstructed
- Chronic high co2 and low o2
Obstructive airway/pulmonary conditions = narrowed air ways
causes airway obstruction worse on inhalation or exhalation?
Causes increased work of breathing
o Use of _________ muscles
o Emptying of lungs (measured with FEV1) is rapid or slow?
Causes
o V/Q mismatch - imbalance between the amount of air reaching the alveoli (ventilation, V) and the amount of blood flowing through the pulmonary capillaries (perfusion, Q).
o This mismatch can lead to _________
- Causes airway obstruction worse on EXPIRATION
- Causes increased work of breathing
o Use of accessory muscles
o Emptying of lungs is slowed (measured with FEV1) - Causes V/Q mismatch and hypoxemia
o V/Q mismatch - imbalance between the amount of air reaching the alveoli (ventilation, V) and the amount of blood flowing through the pulmonary capillaries (perfusion, Q).
o This mismatch can lead to hypoxemia - low oxygen level in the blood.
asthma action plan
helps control asthma and prevent exacerbations
- based on personal best (baseline)
- blow in peak flow meter (tests FEV1)
- a number in the green = _______
- a number in the yellow = _________
- a number in the red = _______
- a number in the green = doing well
- a number in the yellow = asthma is getting worse, take med for exacerbation
- a number in the red = medical emergency (call 911)
Inflammation of mucous membrane of nose (Upper and lower airways, eyes, ears, sinuses, and throat can also be involved)
Triggered by allergens (dust, mold, etc.)
- Bing to IgE (Antibodies on mast cells) releases inflammatory mediators
Allergic rhinitis
sudden constriction of the bronchial muscles making breathing difficult
bronchospasm
Patho
- Inhaled irritants cause airway inflammation (narrowed)
- Neutrophils, macrophages, and lymphocytes in bronchial walls cause infiltration
- If bronchial inflammation continues = excessive mucus production
o Bronchial edema
o Increased number of goblet cells
o Increased size of goblet cells and mucus glands
- The impaired function of ciliary can’t clear the thick mucus
- The combination of inflammation, mucus buildup, and ciliary dysfunction leads to airway obstruction, making it difficult to breathe
what obstructive pulmonary disease is this describing?
what causes ciliary disfunction?
chronic bronchitis
smoking
- Bronchodilators and anti-inflammatory agents
- bronchodilators and expectorants
- bronchodilators and corticosteroids
which meds for which Obstructive airway/pulmonary conditions?
emphysema - Bronchodilators and anti-inflammatory agents
chronic bronchitis - bronchodilators and expectorants
asthma - bronchodilators and corticosteroids
PNA once in lower airway:
- inflammatory reaction is stimulated in lungs
o vasodilation or vasoconstriction?
o infection spreads to respiratory tract and ___________
- ___________ cells are stimulated = mucus is produced
o mucus builds up in alveoli and capillaries = how does this impact breathing?
once in lower airway:
- inflammatory reaction is stimulated in lungs
o vasodilation - helps to improve oxygen delivery and promote healing
o infection spreads to respiratory tract and alveoli
- goblet cells are stimulated = mucus is produced
o mucus builds up in alveoli and capillaries (less gas exchange possible and breathing is difficult)
treatment for PNA SATA
- Bacterial = supportive
- Viral = abx
- Ventilation/oxygenation
- Adequate hydration
- Good pulmonary hygiene
- Nebulizer treatments
X- Bacterial = abx
X- Viral = supportive
- Ventilation/oxygenation
- Adequate hydration
- Good pulmonary hygiene
- Nebulizer treatments
pt c/o of illness that started as a URI but now they have
- fever
- chills
- productive cough with green/red jelly substance
- malaise
- pleural pain – pain with breathing
- dyspnea
- hemoptysis
we would SBAR the HCP with what suspicion?
bacterial PNA
which anemia?
Bone marrow stem failure
- Rare
Key feature
- Pancytopenia
- All made by bone marrow
Treatment
- Blood transfusion – whole blood
- Bone marrow transplant
- Immunosuppressants
- Corticosteroids
- Drugs to stimulate Erythropoietin
Cause
- Idiopathic
- High dose exposure to toxic agents
o Radiation
o Chemicals/toxins - chemo
- Autoimmune – most common cause, RBC in bone marrow are attacked
o Could be r/t complication of infection
Aplastic anemia
diagnosis
- IGRA blood draw – high risk or non- high risk populations?
- TB skin test – high risk or non-high risk populations?
Confirming a positive IGRA or skin test
1.
2.
diagnosis
- IGRA blood draw – high risk populations
- TB skin test – non-high risk populations
Confirming a positive IGRA or skin test
1. Sputum S&C
2. CXR
Chronic bronchitis
simple bronchitis (acute)
______________ - inflammation of the bronchi and bronchioles
____________ - Bronchitis for at least 3 months out of the year, for at least 2 consecutive years
simple bronchitis (acute)- inflammation of the bronchi and bronchioles
Chronic bronchitis - Bronchitis for at least 3 months out of the year, for at least 2 consecutive years
Unique to _________ anemia:
- Low WBC = risk of infection
- Low platelets = risk of bleeding
Unique to aplastic anemia
Obstruction in emphysema caused by SATA
- allergens
- Inflammation
- Destructive changes in lung tissue
- mucus production
X- allergens
- Inflammation
- Destructive changes in lung tissue
X- not mucus production
Diagnosis of what obstructive pulmonary condition includes
- History of symptoms
- Physical exam
- Chest imaging
- PFT (low score for FEV1)
chronic bronchitis
risk factors for __________
- age extremes
- compromised immunity
- underlying lung disease
- alcoholism (aspiration)
- altered LOC (aspiration)
- impaired swallowing (aspiration)
- nursing home resident (immobility)
- hospitalization (LOC, immobility, intubation)
- influenza
PNA
s/s of _________
- proceeded by URI
- progresses to:
- fever
- chills
- cough
- malaise
- pleural pain – pain with breathing
- dyspnea
- hemoptysis
if cough is
o__________ – productive, green/red color, gram negative
o _________ – dry/scant
if _________ is severe
- tachypnea
- respiratory distress/failure
PNA
if cough is
o bacterial – productive, green/red color, gram negative
o PNA – dry/scant
PNA
mild, mild-mod, mod-severe
____________
anemia
- Increased HR and RR (compensating for low oxygen)
- Hypotension
- Pallor (blood redirected to major organs)
- Faintness
- Cardiovascular symptoms, chest pain, heart failure (esp with exertion) (cardiac muscles are hypoxic and dying)
__________
anemia - May have no symptoms
________
anemia
- Fatigue (low energy production, metabolism)
- Weakness (lack of oxygen to muscles)
- Tachycardia (need more oxygen = heart beats faster)
- Dyspnea (hypoxia)
chronic or acute s/s?
- Bone pain (erythropoietin is stored in red bone marrow in bones and released with low RBC)
mod- severe
mild
mild-mod
chronic
Usually by the time people seek treatment
- Disease is in ___________ state
- Pathological changes occurred are reversible or irreversible?
Who gets chronic bronchitis?
Usually by the time people seek treatment
- Disease is in progressive state
- Pathological changes occurred are irreversible
Who gets chronic bronchitis = smokers
