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
effects palate, tonsils, uvula
viral or bacterial
bacterial – white spots, yellow exudate, swollen tonsils
labs
- cultures
- rapid strep test!!!
pharyngitis
- pulmonary function tests (PFTs) for asthma
measures lung function in seconds
expected to have a high or low expiratory flow rate?
expected to have a high or low forced expiratory volume in 1 sec (FEV1)?
expected to have a low expiratory flow rate = how fast they can blow out
expected to have a low forced expiratory volume in 1 sec (FEV1)
manifestation of chronic bronchitis =
____________ ______________ increases pressure in pulmonary artery d/t:
o high pulmonary venous pressure - there’s a lot of pressure in the blood vessels that carry blood from the lungs back to the heart.
o increased pulmonary blood flow - If too much blood is flowing through the lungs, it can put extra strain on the pulmonary arteries.
o pulmonary vascular obstruction - Blockages in the pulmonary arteries can also increase pressure.
o hypoxemia - Low oxygen levels in the blood can cause the pulmonary arteries to constrict (narrow) in an attempt to increase oxygen delivery.
o May lead to right sided heart failure (side with the pulmonary artery)
s/s
o Syncope
o DOE
o Fatigue
are these early or late manifestations?
- Pulmonary hypertension
late
__________ TB
- neurologic deficits
- meningitis
- bone pain
- urinary problems
when would these s/s occur?
extrapulmonary
spreads outside of lungs
Unique to __________ anemia
- Low hgb
- High reticulocyte count (immature RBC)
- Jaundice
- Hemoglobinuria
hemolytic
relative polycythemia, primary (vera) polycythemia, or secondary polycythemia?
False elevation
Isolated decreases in plasma volume which elevates the hgb, hct, and RBC count
Cause
- Dehydration
relative polycythemia,
Microcytic =_____(MCV is low)
Hypochromic = ______ (reduced concentration)
Anemia = ______deficiency anemia
______ think hemoglobin production
Microcytic = small (MCV is low)
Hypochromic = pale (reduced concentration)
Anemia = iron deficiency anemia
Iron think hemoglobin production
any type of infection of the Lower respiratory system
(can’t do gas exchange) is called
pneumonia
“megaloblastic anemia”
- Hgb levels look normal but hgb doesn’t work right bc its lacking ______ an essential part of RBC DNA synthesis
- Bone marrow produces abnormal RBC
- Most common in elderly
Causes
- Atrophic gastritis – the stomach lining has thinned (no IF)
- Conditions affecting the small intestine – crohns disease, celiac disease, bacterial growth, parasite
- Autoimmune disorder – pernicious anemia (most common cause of ______ deficiency)
B12 deficiency anemia
key characterisitcs of the 3 obstructive lung disease
_______________ Alveolar destruction: The alveoli (tiny air sacs in the lungs) become damaged and lose their elasticity.
_______________ Hypersecretion of mucus and chronic cough
________________ airway inflammation and bronchial constriction
emphysema - Alveolar destruction: The alveoli (tiny air sacs in the lungs) become damaged and lose their elasticity.
chronic bronchitis - Hypersecretion of mucus and chronic cough
asthma - airway inflammation and bronchial constriction
Obstructive airway/pulmonary conditions = narrowed air ways
Causes air to get trapped in alveoli bc it is difficult for air to move through narrowed airways = results in
hypoventilation or hyperventilation?
and hypocapnia or hypercapnia?
Causes dyspnea and ____what breath sound___ (r/t inflamed airways)
Causes air to get trapped in alveoli bc it is difficult for air to move through narrowed airways = results in hypoventilation and hypercapnia
o Hypoventilation - decrease in the rate or depth of breathing. This can lead to an increase in the level of carbon dioxide (CO2) in the blood.
o Hypercapnia - abnormally high level of CO2 in the blood. It is often caused by hypoventilation.
Causes dyspnea and wheezing (r/t inflamed airways)
Sudden swelling of epiglotis
Without treatment it can block the trachea causing death
Diagnosis and s/s
- inspiratory stridor and retractions
- rapid onset of fever and sore throat
- pain
- difficulty swallowing
- SOA (esp when lying down)
- Tripod position
- Stridor (inhalation)
- drooling!!!
- no barking cough!!!
vaccine
- influenza Hib
Epiglottitis
influenza T/F
- bacterial
- Types – A, B, C
- can mutate
- Vaccine available
- s/s - Rapid onset fever, chills, body aches
- can cause Secondary pneumonia (can be deadly)
F - 1. VIRAL
2. Types – A, B, C
3. can mutate
4. Vaccine available
5. s/s - Rapid onset fever, chills, body aches
6. can cause Secondary pneumonia (can be deadly)
Unique to___________anemia
- Swelling of hands and feet (occlusion of blood vessels)
- Painful episodes/crisis (ischemia and necrosis from clogged vessels)
Unique to sickle cell anemia
is only larger bronchi affected in chronic bronchitis?
are all airways involved in chronic bronchitis?
can chronic bronchitis be cured?
if smoking is stopped before symptoms occur the risk for chronic bronchitis drops to the same risk as a nonsmoker or stays the same risk as a smoker?
Initially only larger bronchi is affected
But eventually all airways are involved
no but it can be halted
if smoking is stopped before symptoms occur the risk for chronic bronchitis drops and eventually reaches that of a person that never smoked
distress, failure, or arrest?
- RR > 60
- Retractions
- Grunting
- Mottling
- Head bobbing
- Severe air hunger
- Bradycardia
- Hypotension
failure – cant compensate for inadequate oxygenation (despite extra respiratory effort and rate), circulatory and respiratory system collapse
__________ PNA
aspergillus
- released from walls of old building, reconstruction, dead leaves
- affects lung tissues
fungal
______________ - severe asthma attack that does not respond to standard treatment.
- severe symptoms
- unrelenting asthma attack
- silent chest – no air movement
- life threatening emergency
status asthmaticus
relative polycythemia, primary (vera) polycythemia, or secondary polycythemia?
Occurs when the body is trying to compensate for hypoxemia
Body is trying to provide more oxygen carriers by stimulating erythropoietin and increasing RBC production
causes:
- COPD
- High altitude
s/s -
r/t increased blood viscosity (thick) and blood volume
- Hypertension
o h/a
o inability to concentrate
o ruddy face – red
o cyanosis of lips, nails, mucus membranes
r/t decreased blood flow
- DVT
- Hemorrhage
- Angina
- Cerebral insufficiency
- TIAs
r/t hypermetabolism
- Night sweats
- Weight loss
r/t increased RBC, hgb, and hct
- Itching
- Pain in fingers and toes
Biggest concern
- Cardiovascular event (stroke, MI) from clots
secondary polycythemia
- Cause – smoking
o If airflow obstruction occurs = COPD - May have acute exacerbation which require hospitalization/treatment
- Leads to premature morbidity (illness) and mortality (death)
simple bronchitis (acute) or Chronic bronchitis
Chronic bronchitis
relative polycythemia, primary (vera) polycythemia, or secondary polycythemia?
Stem cell mutates and overproduces all blood cells (except lymphocytes)
s/s
- Many complaints – h/a, fatigue, weight loss, dyspnea
- Hypertension
- Clotting problems
- Ruddy color – red
- Itching worsened by hot water
Biggest concern
- Cardiovascular event (stroke, MI) from clots
Typically age 60+
Men
primary (vera) polycythemia
Macrocytic = large
Normochromic = normal color
anemia = _____ and _______
Microcytic = small
Hypochromic = pale
Anemia = ________
Normocytic = normal size
Normochromic = normal color
Anemia = _________, _________, ________
B12 and folic acid deficiency anemia
iron deficiency anemia
sickle cell anemia, aplastic anemia, r/t blood loss
Treatment for _______ PNA
- Mild
- Supportive care
- No abx unless ___________
- Usually improves in 2-3 weeks, may require hospitalization
Treatment for viral PNA
- Mild
- Supportive care
- No abx unless secondary bacterial infection develops
- Usually improves in 2-3 weeks, may require hospitalization
T/F
- If the immune system is impaired
- HIV
- Immunosuppression
- Poor nutrition
- Renal failure
Reactivation of TB can occur and spread - latent TB =
- TB bacteria become active and start to multiply
- symptoms
- contagious - s/s develop gradually
- T
- F - active TB
- T
Risk factors for anemia or polycythemia?
- Chronic hypoxia
- Living in high altitude
- Smoking
- Genetic
- Long term exposure to carbon dioxide
o Coal miners, high levels of pollution, car garage workers/attendants
polycythemia
Too many RBC =
polycythemia
can bacterial PNA be gram positive, gram negative, or both?
staph aureus - gram ______
pseudomonas - gram ________
strep pneumoniae - gram ______
Acinetobacter - gram _______
klebsiella - gram ___________
both
staph aureus - gram +
pseudomonas - gram -
strep pneumoniae - gram+
Acinetobacter - gram -
klebsiella - gram -
PNA = __________ precautions
TB = _________ precautions
PNA = droplet precutions
TB = airborne precautions
Diagnosis acute bronchitis
- Supportive if =
- CBC to check =
Treatment
- abx =
- Expectorants or acytelcholine (dries up)?
- Cough suppression?
Diagnosis acute
- Supportive = viral
- CBC = to make sure its not bacterial
Treatment
- Bacterial = abx
- Expectorants
- Cough suppression
in emphysema, what are the causes of loss of elastic recoil when airways collapse during exhale SATA
- Smoking
- Second hand smoke
- Air pollution
- allergy triggers
- Frequent recurrent childhood respiratory infection
- Genetically inherited emphysema
- mucus production
- Smoking
- Second hand smoke
- Air pollution
X- allergy triggers - Frequent recurrent childhood respiratory infection
- Genetically inherited emphysema
X- mucus production
Diagnosis of PNA include SATA
- s/s on physical assessment
- pulmonary consolidations – sections of lungs have increased mucus
o dullness to percussion
o inspiratory crackles
o rhonchi wet breath sounds
o wheezing
o increased tactile fremitus – palpable vibrations when pt talks
o egophony - the sound of the letter “E” is heard as the letter “A” when auscultated over the affected area of the lung. - Tests
o CXR – shows infiltrates
o bronchoscope biopsy - test lung tissue
o CBC – shows if WBC increased = bacterial
o Sputum for C&S – shows bacteria and abx that is effective
all true except
X wheezing
lung sounds for PNA = crackles and rhonchi
X bronchoscope biopsy - test lung tissue
tests for PNA = CSR, CBC, sputum C&S
Affects: Larynx (voice box), trachea (windpipe), and bronchial tubes
Symptoms: Barking cough!!!, hoarseness, stridor, difficulty breathing
Age: Most common in children under 5 years old
Cause: Viral infection (e.g., parainfluenza, influenza, adenovirus)
croup
Unique to__________ anemia:
s/s depends on speed of _______
higher the __________ = more symptoms
ranges from:
- none
- Syncope
- Increased HR
- Low BP when sitting up or standing up
- Air hunger
- Cool/clammy skin
- Shock
- Death
blood loss
Treatment for which Obstructive airway/pulmonary condition?
- Stop smoking
- Bronchodilators and anti-inflammatory agents!!!
- Oxygen therapy
- Breathing retraining
- Relaxation techniques
- Antibiotics for acute infections
emphysema
Unique to_________ anemia:
- Glossitis – smooth tongue
- Cheilosis – mouth ulcers
- Koilonychia – spoon nails
- Pica
Unique to Iron deficient anemia
risk factors for _________
- Associated with allergies
- Family link
- Different levels of allergen exposure
- Urban residency
- Exposure to indoor and outdoor air pollution
- Tobacco smoke!!
- Recurrent respiratory tract viral infections
- GERD
- Usually starts in childhood
asthma
distress, failure, or arrest?
- Bradypnea
- Inefficient respirations
- Cyanosis/grey
- No air movement
arrest - person stops breathing
When histamines are activated cause: SATA
- Hives and itching
- Blood vessel constriction – erythema and hypotension
- Bronchoconstriction – SOA
- Affect sleep/wake cycle
- Increase secretion of acid in stomach
- Hives and itching
X - Blood vessel dilation – erythema and hypotension - Bronchoconstriction – SOA
- Affect sleep/wake cycle
- Increase secretion of acid in stomach
inflammation of larynx
Affects: Larynx (voice box)
Symptoms: Hoarseness, loss of voice, difficulty swallowing
Age: Can affect people of all ages
Causes: Viral or bacterial infection, overuse of the voice, acid reflux, allergies, or irritants
laryngitis
emphysema diagnosis
- expect PFTs and FEV1 to be high or low?
- CXR – shows hyperinflation
- ABGs – show respiratory acidosis
high or low CO2?
high or low pH? - high or low Alpha 1 antitrypsin (AAT)
- 1:1 or 2:1 AP to lateral chest diameter
- PFTs – low FEV1
- CXR – shows hyperinflation
- ABGs – show respiratory acidosis (high CO2 and low pH)
- Low Alpha 1 antitrypsin (AAT)
- 1:1 AP to lateral chest diameter – (barrel chest)
s/s Allergic rhinitis or acute sinusitis?
- Sneezing
- Rhinorrhea – runny nose
- Pruritis
- Nasal congestion
- Watery itchy eyes
Allergic rhinitis
which anemia?
Premature destruction of RBCs caused by an external agent
Cause
- Autoimmune
- Blood incompatibilities
- Drug reactions
- Physical agents – severe burn
- Microangiopathies
What happens
- Formation of immune complexes
- Lysis (RBC death)
Acquired hemolytic anemia
viral or bacterial bronchitis more common?
viral
- Drugs to stimulate Erythropoietin
good for anemia or polycythemia?
anemia
kidney makes Erythropoietin
Erythropoietin tells out bone marrow to make more RBC
RBC are made in bone marrow
Bone marrow is in large long bones
what pulomary condition?
Bronchoconstriction – narrowing of the airways in the lungs.
- #1 symptom of the disease
Inflammation – airways get inflamed and narrowed
- biggest problem and causes the seriousness of the disease
asthma
which anemia?
Cause
- Impaired erythropoietin production
______ makes Erythropoietin
Erythropoietin tells out bone marrow to make more RBC
RBC are made in bone marrow
Bone marrow is in large long bones
When the _______ don’t work nothing tells the bone marrow to make more RBC = anemia
Hgb/hct corresponded with degree of ________ function
No unique s/s
Anemia from chronic kidney disease
Hypersecretion of mucus and chronic cough
For at least 3 months of the year
For at least 2 consecutive years
which obstructive lung disease?
chronic bronchitis
s/s acute or chronic bronchitis?
- Begins as common cold
- Sore throat
- Nasal discharge
- Muscle aches
- Persistent cough
- Wheezing sputum production
- Enlarged lymph nodes
acute
HAP or CAP?
pt tests positive for PNA 72 hours after admin?
pt tests positive for PNA 24 hours after admin?
pt is admitted with PNA?
pt acquires PNA while on endotracheal tube?
which pt are we most concerned with given only this information?
HAP
CAP
CAP
VAP (HAP)
HAP = Worse outcome compared to CAP
Macrocytic = _____ (MCV is high)
Normochromic = _______ (normal concentration)
Anemia = ___ and _____ deficiency anemia
_____ and ______ think DNA synthesis of RBCs
Macrocytic = large (MCV is high)
Normochromic = normal color (normal concentration)
Anemia = B12 and folic acid deficiency anemia
Folate and B12 think DNA synthesis of RBCs
what type of PNA Alters pulmonary immune defense and makes the lungs vulnerable to an additional bacterial infection (secondary PNA)
viral
Diagnosis of which Obstructive airway/pulmonary conditions ?
- PFTs – low FEV1
- CXR – shows hyperinflation
- ABGs – show respiratory acidosis (high CO2 and low pH)
- Low Alpha 1 antitrypsin (AAT)
- 1:1 AP to lateral chest diameter – (barrel chest)
emphysema
asthma patho
- Exposure to __________
- Causes Trigger factor
- Causes __________ cells to get involved
o Dendritic cells
o T helper 2 cells
o B lymphocytes
o Mast cells
o Neutrophils
o Basophils
o Eosinophils!! - Causes airway inflammation by:
o hyper or hypo secretion of mucus?
o Airway muscle dilates or constricts?
o Swelling bronchial membranes - causes narrowed airway
- Causes wheezing, cough, SOA, tightness in chest, increased WOB
- Exposure to antigen
- Causes Trigger factor
- Causes Immune cells to get involved
o Dendritic cells
o T helper 2 cells
o B lymphocytes
o Mast cells
o Neutrophils
o Basophils
o Eosinophils!! - Causes airway inflammation by:
o Hypersecretion of mucus
o Airway muscle constriction
o Swelling bronchial membranes - causes narrowed airway
- Causes wheezing, cough, SOA, tightness in chest, increased WOB
- Exercise
- Second hand smoke
- Weather
- Dust
- Mites
- Pets
- Pollen
can trigger what?
asthma
if ICU pt is
- elderly
- compromised immunity
- underlying lung disease
- history of alcoholism
- lethargic
- history of impaired swallowing
- weak and immobile
- intubated
- developed influenza while in hospital
the nurse notices they now have
- tachypnea
- respiratory distress/failure
we would SBAR the HCP with what suspicion?
this pt is at risk for developing PNA
s/s of severe PNA
s/s Allergic rhinitis or acute sinusitis?
- h/a
- facial pain or pressure
- nasal obstruction
- fatigue
- purulent nasal discharge
- ear pain
- dental pain
- cough
- decreased sense of smell
- sore throat
acute sinusitis
Unique to __________ anemia:
- Neuropathy
- Ataxia – uncoordinated
- Glossitis
- Dementia/psychosis
B12 deficient
think brain
T/F - Treatment for chronic bronchitis
- Prevention (because it is irreversible)
- Stop smoking
- bronchodilators
- expectorants/prophylactic antibiotic therapy
- CPT
- short and long acting beta agonists
- Steroids late in disease or with acute exacerbation
- Home O2 therapy
- Prevention (because it is irreversible)
- Stop smoking
- bronchodilators
- expectorants/prophylactic antibiotic therapy
- CPT
X- thats for asthma - Steroids late in disease or with acute exacerbation
- Home O2 therapy
Types of polycythemia
- __________ – RBCs are just concentrated
- Absolute – true increase in RBC
o ____________
o ___________
relative
primary (vera)
secondary
which pulmonary condition is this:
infection occurs in Lower respiratory system
inflammation of the lung tissue
alveolar air space gets filled (with purulent, inflammatory cells, and fibrin)
cant go gas exchange
pneumonia
Biggest concern
- Cardiovascular event (stroke, MI) from clots
relative polycythemia, primary (vera) polycythemia, and/or secondary polycythemia?
primary (vera) polycythemia and secondary polycythemia
which anemia?
Cause
- Hemorrhage
Rate of blood loss is important
s/s depends on speed of blood loss
Acute = no time for body to compensate
Chronic = body can compensate and adapt
Anemia from acute blood loss
treatment of acute sinusitis - SATA
- abx
- decongestants
- antihistamines
- mucolytic agents – decrease secretions
if bacterial, why are acute sinusitis difficult to treat with abx?
all
difficult to treat bc hard for drugs to get into the sinus
airflow obstruction associated with simple (acute) bronchitis, chronic bronchitis, or both?
chronic bronchitis
risk factors for PNA - SATA
- middle aged
- adequate immunity
- underlying lung disease
- alcoholism (aspiration)
- altered LOC (aspiration)
- impaired swallowing (aspiration)
- nursing home resident (immobility)
- hospitalization (LOC, immobility, intubation)
- influenza
X - age extremes
X- compromised immunity
- underlying lung disease
- alcoholism (aspiration)
- altered LOC (aspiration)
- impaired swallowing (aspiration)
- nursing home resident (immobility)
- hospitalization (LOC, immobility, intubation)
- influenza
which anemia?
- Hgb levels look normal but hgb doesn’t work right bc its lacking _____ an essential part of RBC DNA synthesis
- Bone marrow produces abnormal RBC
- Most common in pregnant women
causes
- Decreased intake/diet insufficient
o Alcoholism or Cirrhosis – ______ stored in liver
o Diet – malnourished
- Increased need - Pregnancy
folate deficiency anemia
SATA true statements about TB
- Infection caused by mycobacterium
- aerobic which is why it affects the lungs but it could affect other places of the body
- granulomas - nodules of accumulated inflammatory cells
- slow growing – difficult to treat
- contagious
- droplets expelled by infected people
- droplet precautions
- airborne droplets expelled by infected people
- airborne precautions
- Infection caused by mycobacterium
- aerobic which is why it affects the lungs but it could affect other places of the body
- granulomas - nodules of accumulated inflammatory cells
- slow growing – difficult to treat
- contagious
X- droplets expelled by infected people
X- droplet precautions - airborne droplets expelled by infected people
- airborne precautions
- cause - bacterial or viral
o viral most common - NO AIRFLOW OBSTRUCTION
- Mild or self-limiting illness
- Requires supportive care
- Usually better in 3-4 weeks
simple bronchitis (acute) or Chronic bronchitis
simple bronchitis (acute)
CAP =
- very common reason for hospitalization
HAP =
- PNA developed atleast _____ hours after admission
- ________ outcome compared to CAP
- Associated with ICU care
VAP =
- Type of HAP
- r/t endotracheal tube
HCAP =
CAP/HAP
Community acquired PNA (CAP)
- very common reason for hospitalization
hospital acquired PNA (HAP)
- PNA developed atleast 48 hours after admission
- Worse outcome compared to CAP
- Associated with ICU care
Ventilator associated PNA (VAP)
- Type of HAP
- r/t endotracheal tube
healthcare associated PNA (HCAP)
_____________
- r/t immune suppression (HIV, transplant)
- yeast like fungus
______________
- mild PNA
- persistent cough, h/a, e/a
- bacterial like organisms, properties of both bacteria and virus
_____________
- gram negative
- spreads via water system (a/c units, mists sprayed on produce, hot tubs)
legionella
Pneumocytosis carini PNA
mycoplasma (walking PNA)
Pneumocytosis carini PNA
- r/t immune suppression (HIV, transplant)
- yeast like fungus
mycoplasma (walking PNA)
- mild PNA
- persistent cough, h/a, e/a
- bacterial like organisms, properties of both bacteria and virus
legionella
- gram negative
- spreads via water system (a/c units, mists sprayed on produce, hot tubs)
which anemia?
Abnormal hgb makes RBC small and pale
- Lacking alpha and beta globin
- Genetic disorder (Mediterranean descent)
- More deadly than sickle cell
- Severe cases - Death in childhood from heart failure
- Premature death – 30’s
Treatment
- Blood transfusion
- Bone marrow transplant
- Splenectomy
Thalassemia anemia
______________ PNA (bacterial infection most common cause)
Aspirated material from GI tract causes PNA = inflammatory response
- Severity of inflammation response depends on pH of aspirate
- high or low acid aspirate = more inflammatory response?
Aspiration PNA
- High acid aspirate = more inflammatory response
s/s what pulomary condition?
- Persistent productive cough
As disease progress
- Increased cough
- Increased congestion
- Increased SOA
chronic bronchitis
classic s/s for which Obstructive airway/pulmonary condition
- wheezing
- SOA (breathlessness, dyspnea)
- Cough
- Chest tightness
asthma
Symptoms of which Obstructive airway/pulmonary condition ?
- Gradual increase in breathlessness (especially DOE)!!!
- Eventually SOA at rest
o And prolonged expirations
o May become oxygen dependent
- Wheezing
- Malnourished (bc of increased WOB)
- Decreased muscle mass
- Barrel chest
- Pursed lip breathing (helps to get the air out)
- Decreased breath sound
emphysema
what should the nurse be concerned with if their pt is
- NG tube
- Decreased LOC
- Decreased gag reflex
- Decreased gastric emptying
what consult/evaluation should the nurse order?
aspiration pneumonia
Knowing who is at risk and ordering Dysphagia eval is crucial
