What is the most common type of gram-positive pneumonia that is usually acquired in the community?
pneumococcal (streptococcal)
What’s the difference between gram positive and gram negative bacteria?
positive = acquired in community negative = develop in a host with underlying, chronic, debilitating conditions
T/F: A dry cough indicates viral pneumonia.
true, productive with blood-streaked sputum is bacterial pneumonia
What are some indicators of pneumonia?
fever, chills, tachypnea (bacterial), headaches (viral), hypoxemia/hypercapnea, cough, decreased breath sounds and/or crackles
What lung sounds might you hear with your patient that has pneumonia?
crackles, decreased breath sounds
What type of pneumonia is usually found in patients with dysphagia?
aspiration pneumonia: causes acute inflammatory reaction within lungs
Increased incidence of TB occurs with what population?
those with HIV
What precautions must be taken for those patients with TB?
droplet, since that’s how it’s spread
How long is a person that’s been infected with TB considered incubatory?
2-10 wks
- primary disease = 10days to 2 weeks
- postprimary can occur years after initial infection
What is Pott’s disease?
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
What type of pneumonia is often found in patients following transplantation, or in neonates?
pneumocystis pneumonia (PCP)
What is pneumonia, in general terms?
infection/inflammation of the lung’s air sacs (grapes), which can fill with fluid
What is sarcoidosis? Symptoms?
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
What outcome measures are used to monitor sarcoidosis?
PFTs and 6MWT
Is COPD considered progressive?
yes; not completely reversible is a characteristic
How many stages are there in COPD?
4: mild, moderate, severe, very severe
What does FEV1/FVC have to be to be considered COPD?
<70%
What is COPD?
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)
How do lungs get overinflated in COPD?
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
What pathological process is occurs with emphysema?
air sacs blend together into one big sac, decreasing surface area
- limits ability to gas exchange, so air gets trapped
What pathological process occurs in chronic bronchitis?
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
What happens to the diaphragm in COPD?
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
What is FEV?
forced expiratory volume = amount of air forcibly exhaled in one breath
What is the difference between FEV1/FVC ratios for obstructive disease vs restrictive?
<75% = obstructive >75% = restrictive
What value of PaCO2 indicates respiratory failure?
> 50mmHg (normal is 35-45)
What can be some symptoms of increased CO2 retention?
drowsy, lethargic, headache, tachy, diaphoretic
T/F: there is a decreased expiration phase for those with COPD.
false, it’s increased (cause they have trouble getting air out, so it takes longer)
- usually longer than 4s
T/F: You want pts with COPD to tripod during your session.
yes!! teach it to them as a means to increase function
- do 2 min intervals of tripod, one minute standing on treadmill walks
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?
cough/sputum production dyspnea upon exertion adventitious breath sounds increased RR weight loss increased AP diameter postures to elevate shoulder girdle***
What is asthma?
increased reactivity of the trachea and bronchi to various stimuli
- reversible in nature
When do you hear wheezes, inspiration or expiration?
expiration - musical sound
What pathology occurs in cystic fibrosis?
thickening of secretions of all exocrine glands, leading to obstruction
- can be obstructive, restrictive, or mixed
Frequent respiratory infections are commonly present in what type of chronic lung disease?
CF
What causes cystic fibrosis?
genetically inherited
What clinical findings might you find with patients that have bronchiectasis?
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
What is RDS?
respiratory distress syndrome
- alveolar collapse in premature infant from lung immaturity, inadequate surfactant
What disease is often a sequela of premature infants with RDS?
bronchopulmonary dysplasia
- d/t high pressures of mechanical ventilation, high fractions of inspired O2, and/or infection