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Flashcards in Acute Respiratory (adults) Deck (48):
1

leading cause of death from infectious disease

pneumonia

2

second most common nosocomial infection

pneumonia

3

eighth leading cause of death

pneumonia

4

pneumonia etiology

bacteria, viruses, other infectious agents, inhaled/aspirated foreign material

5

pneumonia is...

infection and inflammation of the lung parenchyma, consolidation, exudation

6

pneumonia classification by...

- setting (community vs hospital)
- type of agent causing infection (typical, atypical)
- distribution within the respiratory system

7

consolidation

areas within the lung filled with infiltrate (secretions) causing it to become hard and firm (typically lung base)

8

exudation/infiltration

fluid, cells, substances moved from blood vessels into tissues or on their surfaces.

9

effusion

inflamed pleura fills with fluid pushing up and compressing the lung

10

pneumonia pathophys

uncontrolled multiplication of microorganisms invading the lower respiratory tract

OR

inflammation response to inhaled or aspirated foreign material

resulting in accumulation of neutrophils and other pro-inflammatory cytokines in the peripheral bronchi alveolar spaces

11

community acquired pneumonia bacterial pathogens (most common then other)

S. pneumonia

H. influenza, S. aureus, gram neg bacilli

12

hospital acquired pneumonia is

lower respiratory tract infection that was not present (or incubating) on admission

- develops 48 hours or more after admission
- most hospital bacteria have acquired antibiotic resistance and are more difficult to treat

13

ventilator associated pneumonia

lower respiratory tract infection developing 48 hours after INTUBATION

14

nosocomial organisms associated with hospital acquired pneumonia

Pseudomonas aeruginosa, S. aureus, enterobacter, Klebsiella pneumoniae, Escherichia coli

15

typical pneumonia

bacteria that multiply extracellularly in the alveoli and cause inflammation and exudation

16

atypical pneumonia *

viral or microplasma infections that invade the alveolar septum and the interstitium of the lung (confined to those spaces)

"patchy" lung involvement

* lack of: consolidation, exudate, productive cough

17

acute bacterial (typical) pneumonia most common cause

- pneumococcal (Strep pneumoniae)
- gram positive bacteria
(prevention via immunization recommended for at risk)

18

notable primary atypical pneumonia damage caused?

impair defenses making host susceptible to secondary bacterial infections

19

hypoxemia s/s

- cyanosis
- restlessness
- agitation
- confusion
- dyspnea
- shallow/rapid

20

important finding upon auscultation of pneumonia patient lungs

decrease in sound in areas of consolidation

21

most common symptom of pneumonia in older adult

acute confusion secondary to hypoxia

22

WBC in older adult with pneumonia?

may not initially be elevated and will not be until illness progresses.

23

pulmonary edema

abnormal accumulation of fluid outside the vascular space of lung

more fluid enters the lung than the maximum lymphatic pumping capacity can remove

24

most common form of pulmonary edema

cardiogenic pulmonary edema

25

cardiogenic pulmonary edema

- associated with volume/pressure overload
- increased hydrostatic pressure causes decreased CO

26

possible causes of cardiogenic pulmonary edema

- cardiac dysfunction, airway obstruction, pulmonary embolus

27

non-cardiogenic pulmonary edema

potential causes: inhaled irritants, infectious, hematologic or metabolic disorders, opioid or barbituate drug overdose

28

pulmonary embolus most commonly results from...

DVT formed in LEs

other sites include: right heart, deep pelvic vessels
other originations include: fat, air, amniotic fluid

29

pulmonary embolus s/s *

* dyspnea & tachypnea (90%)
* pleuritic chest pain (70%)
* cough
* apprehension, restlessness, impending doom
* hemoptysis
- rales, tachycardia, elevated temp, decreased O2 sat, petechiae

30

predisposes to development of ARDS (x2)

sepsis, Systemic Inflammatory Response Syndrome

31

ARDS interventions

- identify/treat precipitating cause
- maintain O2 sat (optimize delivery)
- decrease O2 consumption

32

ARDS mechanical ventilation criteria

- sustained RR > 35
- PaO2 < 70 (on 40% O2)
- PaCO2 > 55
- unable to protect airway

33

parietal layer is where?

outer

34

visceral layer is where?

inside

35

pleural space is where and has what?

in between parietal and visceral and filled with serous fluid

36

pleuritis aka

aka pleurisy
- inflammation of pleura

37

pleuritis s/s

abrupt unilateral chest pain worsened by movement

38

pleuritis treatment

NSAIDS for inflammation, analgesics for pain

39

pleural effusion is...

collection of fluid or junk (pus) in the pleural cavity

40

pleural effusion symptoms and treatment

cause dependent who cares

41

pneumothorax is

collapsed lung; spontaneous or traumatic

- air leaks into the area between the lung and the pleural space causing the lung to collapse (proportionate to amount of leak)

42

primary causes of pneumothorax

blebs, smoking
pressure change (flying, mountain climbing, scuba diving, listening to )
tall, thin, men ages 20-40

43

secondary causes of pneumothorax

progressive lung damage associated with history of lung disorder (CF, emphysema, lung cancer, pneumonia, tb, etc)

44

traumatic pneumothorax injuries

- blunt (closed)
- penetrating (open, includes surgeries)
- tension pneumothorax (pressure in pleural space > atmospheric pressureex: mechanical ventilation)
- hemopneumothorax

45

pneumothorax assessment

- sudden, sharp chest pain in affected lung
- tightness of the chest
- SOB (degree depends on % of collapse)
- reduction of breath sounds on auscultation
- tachycardia
- rapid drop in BP specific to tension pneumothorax

46

pneumothorax interventions

supplemental oxygen
- if 15-20% collapsed: bedrest, limited actiity
- >20% chest tube placement (assess frequently instead of placing tube immediately)

47

tension pneumothorax important point

ALWAYS LIFE THREATENING. If CT not available, needle placement

48

chest tube care

- drainage below chest level, avoid kinks
- secure connections
- assess bubbling in water chamber
- daily dressing change with site inspection
- assessment of drainage and prescribed settings
- do not "strip"
- clamp only to change receptacle
- assess tracheal deviation, sudden changes, O2 sats, excessive drainage

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