27 - Lower Respiratory Problems

Question 1

Pneumonia

Answer 1

acute infection of lung parenchyma

-PNA + influenza is 8th leading cause of deth in US

Question 2

incr risk for PNA

Answer 2

• trache tube bypass filtration
• weak cough/epiglottis incr risk asprtn
• pollutn, cig, viral URI decr muciliary mech
• chronic disease suppress immun

Question 3

3 ways pathogen enters lungs 3 ways

Answer 3

1 aspiration
2 inhalation
3 hematogenous spread fr infection elsewhere in body

Question 4

3 classifications of PNA

Answer 4

1 community-acquired pneumonia
2 hospital-acquired pneumonia
3 ventilator-assoc pneumonia

Question 5

CAP

Answer 5

infection in pt that have NOT been hospitalized or lived in longterm care facility w/in 14 days of onset

Question 6

HAP aka Nosocomial Pneumonia

Answer 6

NONintubated pt that begins 48 hr or longer after admission to hospital
-PNA was not present at time of admission

Question 7

VAP

Answer 7

type of HAP

-infection occurs more than 48 hr after ET tube

Question 8

most common type of PNA

Answer 8

viral PNA

1/3 OF CASES

Question 9

mycoplasma PNA

Answer 9

has traits of both bacterial + viral PNA

Question 10

bacterial PNA

Answer 10

pt may be extremely unwell + need hospital admission

Question 11

aspiration pneumonia

Answer 11

abnormal entry of material into trachea or lungs

Question 12

incr risk for aspiration

Answer 12

• decr LOC
• seizure
• anesthesia
• head injury
• stoke
• alcohol
• difficulty swallowing
• NG tube

Question 13

necrotizing PNA

Answer 13

rare complication of bacterial lung infection

• often assoc w CAP
• lung tissue is turned into liquid mass
• staph, klebsiella, strep

Question 14

opportunistic PNA

Answer 14

inflammation + infection of lower resp tract in immunocompromised pt

• due to normal flora
• chemo, radiatn, HIV, malnourished are at risk

Question 15

almost all pathogens trigger ___ in the lungs

Answer 15

inflammation response

> incr vasc permeability>incr neutrophils> engulfs pathogen> incr more neutrophils>edema of airway>fluid leaks fr capillaries+ tissues into alveoli> HYPOXIA

Question 16

____ may occur in PNA but it only causes ____

Answer 16

atelectasis

shortness of breath

Question 17

consolidation

Answer 17

common in bacterial PNA

-when normally filled alveoli is filled w water, fluid, or debris

Question 18

over time w _____ therapy, macrophages will lyse debris.

Answer 18

ABX

-this allows lung tissue to recover + return gas exchange to normal

Question 19

most common s/s of pneumonia

Answer 19

• cough
• fever
• chills
• dyspnea
• tachypnea
• pleuritic chest pain

Question 20

s/s in older patients

Answer 20

may not have classic s/s

• confusion + stupor
• —-may be r/t hypoxia
• hypothermia instead of fever
• diaphoresis, anorexia, fatigue

Question 21

auscultation of PNA

Answer 21

• crackles
• egophony (incr in sound of pt voice)
• incr fremitus

Question 22

PNA complications

Answer 22

• atelectasis
• pleurisy
• pleural diffusion
• bacteremia
• pneumothorax
• acute resp failure
• sepsis/septic shock

Question 23

supportive measures for PNA

Answer 23

• o2 therapy > hypoxemia
• analgesic>chest pain
• antipyretic
• 6-10 glasses/day

Question 24

corticosteroids, antitussives, mucolytics, bronchodilators for PNA

Answer 24

debatable

Question 25

Tx for PNA

Answer 25

no tx for viral PNA | -often self-limiting

Question 26

TB can infect which organs

Answer 26

any organ

Question 27

most potent antitubercular drugs

Answer 27

isoniazid INH | rifampin

Question 28

if TB develops resistance to INH + rifampin, then

Answer 28

it is defined as multi-drug-resistant tuberculosis | MDR-TB

Question 29

TB | transmission

Answer 29

NOT highly infectious - airborne - --cough, sneeze, talk, breath - --able to suspend in air for min-hr - CANNOT spread by touching, kissing or sharing food utensils

Question 30

factors that influence TB transmission

Answer 30

1 number of microbes expelled 2 concentrtn of microbes i.e. small space 3 length of time of exposure 4 immune systm of exposed

Question 31

ghon lesion or focus

Answer 31

calcified TB granuloma | -hallmark of primary TB infectn

Question 32

post primary TB or reactivation TB

Answer 32

TB disease occurs 2+ yrs after infection | -if laryngeal, then pt is infectious

Question 33

latent TB infection LTBI

Answer 33

- positive skin test but asymptomatic, no disease | - not infectious

Question 34

onset of TB s.s

Answer 34

2-3 wks after infection/reactivation

Question 35

TB s/s

Answer 35

initial: dry cough later: productive w mucopurulent sputum, malaise, anorexia, low grade fever, night sweats late: dyspnea

Question 36

when properly treated, TB usually heals without complications except for ______

Answer 36

scarring + residual cavitation in lung

Question 37

miliary TB

Answer 37

widespread dissemination of TB in bloodstream

Question 38

miliary TB s/s

Answer 38

``` fever cough lymphadenopathy hepatomegaly splenomegaly ```

Question 39

Pott's disease

Answer 39

TB in spine

Question 40

TB skin test aka

Answer 40

Mantoux Test

Question 41

tb skin test/mantoux

Answer 41

uses purified protein derivative PPD | -standard for screening

Question 42

Interferon Gamma Release Assays

Answer 42

detects INF gamma release fr T cells in response to TB

Question 43

gold standard for Dx of TB

Answer 43

CULTURE - 3 consec sputum specimen - 8-24 hr intervals - atleast 1 early AM speciment

Question 44

2 phases of TB Tx

Answer 44

initial + continuation

Question 45

4 drugs in initial phase

Answer 45

isoniazid rifampin pyrazinamide ethambutol

Question 46

2 drugs in continuation phase

Answer 46

isoniazid | rifampin

Question 47

LTBI Tx

Answer 47

9 mos daily isoniazid

Question 48

TB acute care

Answer 48

1 airborne isolation 2 chest x ray, sputum smeal, culture 3 appropriate drug therapy

Question 49

tb patients are in a single occupancy room w ned airflow of _____

Answer 49

6-12 exchanged per hour

Question 50

how often should sputum test or AFB smear + culture should be obtained

Answer 50

at minimum Qmonthly until 2 consec specimens are negative

Question 51

pulmo embolism can be caused by

Answer 51

thombus, fat, air, or tumor

Question 52

emboli

Answer 52

mobile clots

Question 53

most affected part of lungs

Answer 53

lower lobes

Question 54

saddle embolus

Answer 54

large thrombus lodged at an arterial bifurcation

Question 55

PE | risk factors

Answer 55

- immobility - surgery in past 3mos - hx of VTE - cancer - obesity - contraceptives - hormone therapy - cig smoking - prolonged air travel - HF - pregnancy - clotting disorders

Question 56

PE | s/s

Answer 56

- dyspnea - mild-mod hypoxemia - tachypnea - cough - chest pain - hemoptysis - crackl/wheezing

Question 57

PE | complications

Answer 57

- 10% die - pulmo infarction - ---when there is occlusion or large/med size pulmo vessels, insufficient collateral blood flow, preexisting lung disease - pulmo hypertension fr hypoxemia

Question 58

PE | diagnostic test

Answer 58

- D Dimer - Spiral helical CT scan - Vent perfusion scan - ABG (not diagnostic)

Question 59

D Dimer

Answer 59

measures amount of cross-linked fibrin fragments | -result of clot degradation

Question 60

most common test to diagnose PE

Answer 60

spiral helical CT scan

Question 61

warfarin alternatives

Answer 61

- apixaban - dabigatran - edoxaban

Question 62

how long does anticoag continue for?

Answer 62

3 mons

Question 63

Pulmo hypertension

Answer 63

elevated pulmo artery pressure rest>25mmHg exercise>30mmHg