Acute and chronic obstructive diseases

Question 1

What is the most common type of gram-positive pneumonia that is usually acquired in the community?

Answer 1

pneumococcal (streptococcal)

Question 2

What’s the difference between gram positive and gram negative bacteria?

Answer 2

positive = acquired in community
negative = develop in a host with underlying, chronic, debilitating conditions

Question 3

T/F: A dry cough indicates viral pneumonia.

Answer 3

true, productive with blood-streaked sputum is bacterial pneumonia

Question 4

What are some indicators of pneumonia?

Answer 4

fever, chills, tachypnea (bacterial), headaches (viral), hypoxemia/hypercapnea, cough, decreased breath sounds and/or crackles

Question 5

What lung sounds might you hear with your patient that has pneumonia?

Answer 5

crackles, decreased breath sounds

Question 6

What type of pneumonia is usually found in patients with dysphagia?

Answer 6

aspiration pneumonia: causes acute inflammatory reaction within lungs

Question 7

Increased incidence of TB occurs with what population?

Answer 7

those with HIV

Question 8

What precautions must be taken for those patients with TB?

Answer 8

droplet, since that’s how it’s spread

Question 9

How long is a person that’s been infected with TB considered incubatory?

Answer 9

2-10 wks

• primary disease = 10days to 2 weeks
• postprimary can occur years after initial infection

Question 10

What is Pott’s disease?

Answer 10

tuberculous spondylitis

• form of TB that affects the thoracic and upper lumbar vertebrae
• aka kyphosis from arthritic change: PT to decrease pain, improve ROM/strength

Question 11

What type of pneumonia is often found in patients following transplantation, or in neonates?

Answer 11

pneumocystis pneumonia (PCP)

Question 12

What is pneumonia, in general terms?

Answer 12

infection/inflammation of the lung’s air sacs (grapes), which can fill with fluid

Question 13

What is sarcoidosis? Symptoms?

Answer 13

multisystem inflammatory disease consisting of granulomas in multiple organs, more often lungs, skin, lymph nodes, eyes, and liver

• symptoms: fever, cough, fatigue, chest pain, SOB
• granuloma = mass of granulation tissue in response to inflammation or infection

Question 14

What outcome measures are used to monitor sarcoidosis?

Answer 14

PFTs and 6MWT

Question 15

Is COPD considered progressive?

Answer 15

yes; not completely reversible is a characteristic

Question 16

How many stages are there in COPD?

Answer 16

4: mild, moderate, severe, very severe

Question 17

What does FEV1/FVC have to be to be considered COPD?

Answer 17

<70%

Question 18

What is COPD?

Answer 18

obstructive lung disease = aka air isnt getting in

• can be d/t retaining secretions, inflammation of airway, airsac destruction or overinflation (with break down of surfactant)
• aka can be from emphysema (air sacs blend together), asthma (constriction/spasm of airway)

Question 19

How do lungs get overinflated in COPD?

Answer 19

chronic inflammation of airways -> don’t allow them to stay open with exhalation

• air trapping occurs b/c can’t breathe out all the air, overinflation occurs
• hyperinflation causes decreased lung recoil

Question 20

What pathological process is occurs with emphysema?

Answer 20

air sacs blend together into one big sac, decreasing surface area
- limits ability to gas exchange, so air gets trapped

Question 21

What pathological process occurs in chronic bronchitis?

Answer 21

grapes are okay, but muscous and bronchoconstriction doesn’t let you get to them
- gas exchange is fine at the grapes, but air doesn’t get there b/c of airways

Question 22

What happens to the diaphragm in COPD?

Answer 22

gets flattened - poor ability to help with inhalation

• angles of pull are now flattened, so the contraction isn’t as efficient
• end up using accessory muscles more

Question 23

What is FEV?

Answer 23

forced expiratory volume = amount of air forcibly exhaled in one breath

Question 24

What is the difference between FEV1/FVC ratios for obstructive disease vs restrictive?

Answer 24

<75% = obstructive
>75% = restrictive

Question 25

What value of PaCO2 indicates respiratory failure?

Answer 25

>50mmHg (normal is 35-45)

Question 26

What can be some symptoms of increased CO2 retention?

Answer 26

drowsy, lethargic, headache, tachy, diaphoretic

Question 27

T/F: there is a decreased expiration phase for those with COPD.

Answer 27

false, it's increased (cause they have trouble getting air out, so it takes longer) - usually longer than 4s

Question 28

T/F: You want pts with COPD to tripod during your session.

Answer 28

yes!! teach it to them as a means to increase function | - do 2 min intervals of tripod, one minute standing on treadmill walks

Question 29

You read a chart of patient you're going to see later today with COPD. What are symptoms you'll see in your patient with COPD?

Answer 29

``` cough/sputum production dyspnea upon exertion adventitious breath sounds increased RR weight loss increased AP diameter postures to elevate shoulder girdle*** ```

Question 30

What is asthma?

Answer 30

increased reactivity of the trachea and bronchi to various stimuli - reversible in nature

Question 31

When do you hear wheezes, inspiration or expiration?

Answer 31

expiration - musical sound

Question 32

What pathology occurs in cystic fibrosis?

Answer 32

thickening of secretions of all exocrine glands, leading to obstruction - can be obstructive, restrictive, or mixed

Question 33

Frequent respiratory infections are commonly present in what type of chronic lung disease?

Answer 33

CF

Question 34

What causes cystic fibrosis?

Answer 34

genetically inherited

Question 35

What clinical findings might you find with patients that have bronchiectasis?

Answer 35

bronchiectasis = chronic disease that has abnormal dilation of bronchi and excessive sputum production ``` Symptoms: large amounts of mucopurulent secretions frequent secondary infections dyspnea crackles, decreased breath sounds ```

Question 36

What is RDS?

Answer 36

respiratory distress syndrome | - alveolar collapse in premature infant from lung immaturity, inadequate surfactant

Question 37

What disease is often a sequela of premature infants with RDS?

Answer 37

bronchopulmonary dysplasia | - d/t high pressures of mechanical ventilation, high fractions of inspired O2, and/or infection