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Flashcards in Chapter 27 Lower Respiratory Problems Deck (131)
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1

Acute bronchitis is a self-limiting inflammation of the?

bronchi in the lower respiratory tract and a common reason for seeking medical care.
- Most acute bronchial infections are caused by viruses.
- Air pollution, dust, inhalation of chemicals, smoking, chronic sinusitis, and asthma are other triggers of acute bronchitis

2

Acute bronchitis
- most common symptom?
- The presence of colored (e.g., green) sputum is?
- Associated symptoms may include?

- Cough, which is the most common symptom, lasts for up to 3 weeks. Clear, mucoid secretions are often present, although some patients produce purulent sputum.
- The presence of colored (e.g., green) sputum is not a reliable indicator of bacterial infection.
Associated symptoms include headache, fever, malaise, hoarseness, myalgias, dyspnea, and chest pain

3

Diagnosis of acute bronchitis is based on clinical assessment. Assessment may reveal?

1) normal breath sounds or crackles or wheezes, usually on expiration and with exertion.
2) Consolidation (occurs when fluid accumulates in the lungs), suggestive of pneumonia, is ABSENT with bronchitis.
3) Chest x-rays would be normal and are therefore not indicated unless pneumonia is suspected

4

Acute bronchitis
- The goal in acute bronchitis is to?
- Treatment is?
- Generally antibiotics are not prescribed for treating a viral infection, as they may cause?

-goal to relieve symptoms and prevent pneumonia.
- Treatment is supportive, including cough suppressants, encouraging oral fluid intake, and using a humidifier. β2-agonist (bronchodilator) inhalers are useful for patients with wheezes.
- may cause side effects and promote antibiotic resistance. However, antibiotics may be prescribed for patients with underlying chronic conditions and who have a prolonged infection associated with systemic symptoms.

5

Acute Bronchitis: Patients should be encouraged not to ?
- If the acute bronchitis is due to an influenza virus, treatment with?

- encouraged not to smoke, avoid secondhand smoke, and to frequently wash their hands.
- treatment with antiviral drugs, either zanamivir (Relenza) or oseltamivir (Tamiflu), can be started. These drugs should be initiated within 48 hours of the onset of symptoms

6

Acute bronchitis 5 main points

1) Inflammation of the bronchi
2) 90% are viral
3) Most common symptom- cough
- HA, fever, malaise, hoarseness, dyspnea, CP
3) Normal breaths sounds/ rhonchi
4) Normal CXR

7

Pertussis is a highly contagious infection of the respiratory tract caused by?
- The bacteria attach to the cilia of the respiratory tract and?
- The incidence of pertussis has been steadily increasing in the United States since the 1980s, with the largest increase noted in?
- It is thought that immunity resulting from childhood vaccination with DPT (diphtheria, pertussis, tetanus) may diminish over time, allowing a milder (but still contagious) infection. The Centers for Disease Control and Prevention (CDC) currently recommends that all adults age ___ years and older who have not received a dose of Tdap (tetanus, diphtheria, and pertussis) receive a?

- caused by a gram-negative bacillus, Bordetella pertussis.
- release toxins that damage the cilia, causing inflammation and swelling.
- increase noted in adults.
- age 19 years and older who have not received a dose of Tdap (tetanus, diphtheria, and pertussis) receive a one-time vaccination as soon as possible

8

Clinical manifestations of pertussis occur in stages.
1) The first (catarrhal) stage, occurring within?
2) The second (paroxysmal) stage, from the second to tenth week of infection, is characterized by paroxysms of cough.
3) The final (convalescent) stage lasts?

1) first 2 weeks of infection, manifests as a mild upper respiratory tract infection (URI) with a low-grade or no fever, runny nose, watery eyes, and mild, nonproductive cough
2) second (paroxysmal) stage, from the second to tenth week of infection, is characterized by paroxysms of cough.
3) lasts 2 to 3 weeks and is characterized by less severe cough and weakness

9

The hallmark characteristic of pertussis is?

uncontrollable, violent coughing.
- Inspiration after each cough produces “whooping” sound as patient tries to breathe in air against obstructed glottis. The “whoop” often not present in teens and adults (especially those who have been vaccinated).
- Like acute bronchitis, coughing more frequent at night.
- Vomiting may also occur with coughing.
- Unlike bronchitis, cough with pertussis may last from 6 to 10 weeks

10

- The primary treatment for pertussis is?
- The patient is infectious from the?
- What should NOT be used to treat pertussis?

- tantibiotics, usually macrolides (erythromycin, azithromycin [Zithromax]), to minimize symptoms and prevent spread of the disease.
- infectious from the beginning of the catarrhal stage through the third week after onset of symptoms or until 5 days after antibiotic therapy has been initiated.
- Cough suppressants and antihistamines should not be used, since they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are also not useful

11

Pertussis main points

1) Highly contagious
2) Gram negative bacillus
3) Uncontrolled, violent coughing
4) Low-grade or no fever
5) Runny nose, watery eyes
6) ABX to prevent spread/minimize symptoms
7) Cough suppressants, antihistamines-ineffective
8) Vaccine Dtap
-Tetanus, diphtheria, pertussis

12

- Pneumonia is an acute infection of the?
- Until 1936, pneumonia was the leading cause of death in the United States. The discovery of _____ and ____ was pivotal in the treatment of pneumonia.
- Since that time, remarkable progress has been made in the development of ______ to treat pneumonia.
- However, despite newer antimicrobial agents, pneumonia is still associated with significant morbidity and mortality rates. The CDC reports that pneumonia and influenza are the?

- acute infection of the lung parenchyma. Until 1936, pneumonia was the leading cause of death in the United States
- discovery of sulfa drugs and penicillin was pivotal
- development of antibiotics to treat pneumonia
- pneumonia and influenza are the eighth leading cause of death in the United States

13

Pneumonia 4 main points

1) Acute infection
2) Until 1936- leading cause of death
3) Still associated with high morbidity/mortality
4) Community-acquired (CAP) 6th leading cause of death for pts >65

14

Pneumonia Etiology
Normally, the airway distal to the larynx is protected from infection by various defense mechanisms. Mechanisms that create a mechanical barrier to microorganisms entering the tracheobronchial tree include?
- Immune defense mechanisms include secretion of?

- mechanical barrier to microorganisms include air filtration, epiglottis closure over the trachea, cough reflex, mucociliary escalator mechanism, and reflex bronchoconstrictio.
- secretion of immunoglobulins A and G and alveolar macrophages

15

1) Pneumonia is more likely to occur when?
2) Decreased consciousness weakens the?
3) Tracheal intubation bypasses normal?
4) What can also impair the mucociliary mechanism?
5) Chronic diseases can?

1) defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents.
2) weakens the cough and epiglottal reflexes, which may allow aspiration of oropharyngeal contents into the lungs. 3) bypasses normal filtration processes and interferes with the cough reflex and mucociliary escalator mechanism.
4) Air pollution, cigarette smoking, viral URIs, and normal changes that occur with aging
5) suppress the immune system's ability to inhibit bacterial growth

16

Organisms that cause pneumonia reach the lung by three ways:

1. Aspiration of normal flora from the nasopharynx or oropharynx. Many organisms that cause pneumonia are normal inhabitants of the pharynx in healthy adults.
2. Inhalation of microbes present in the air. Examples include Mycoplasma pneumoniae and fungal pneumonias.
3. Hematogenous spread from a primary infection elsewhere in the body. Examples are streptococci and Staphylococcus aureus from infective endocarditis

17

Pneumonia occurs when defense mechanisms are overwhelmed and unable to fight the virus
4 types

1) Community-acquired (CAP)
2) Medical Care-associated (MCAP) – usually 48 hrs post admission
3) Aspiration – abnormal entry from mouth or stomach into lungs – triggers inflammatory response
4) Opportunistic – altered immune system – like HIV, chemo or radiation patients

18

Pneumonia patho main points

1) Inflammatory response
-Attraction of neutrophils
-Release of inflammatory mediators
2) Alveoli fill w/ fluid- consolidation
3) Increased mucous production
4) Decreased gas exchange
5) Macrophages in alveoli ingest/remove debris

19

18 Risk Factors for Pneumonia

Risk Factors for Pneumonia
• Abdominal or thoracic surgery
• Age >65 yr
• Air pollution
• Altered consciousness: alcoholism, head injury, seizures, anesthesia, drug overdose, stroke
• Bed rest and prolonged immobility
• Chronic diseases: chronic lung and liver disease, diabetes mellitus, heart disease, cancer, chronic kidney disease
• Debilitating illness
• Exposure to bats, birds, rabbits, farm animals
• Immunosuppressive disease and/or therapy (corticosteroids, cancer chemotherapy, human immunodeficiency virus [HIV] infection, immunosuppressive therapy after organ transplant)
• Inhalation or aspiration of noxious substances
• Intestinal and gastric feedings via nasogastric or nasointestinal tubes
• IV drug use
• Malnutrition
• Recent antibiotic therapy
• Resident of a long-term care facility
• Smoking
• Tracheal intubation (endotracheal intubation, tracheostomy)
• Upper respiratory tract infection

20

Organisms Causing Pneumonia
Community-Acquired Pneumonia

Organisms Causing Pneumonia
Community-Acquired Pneumonia
• Streptococcus pneumoniae*
• Mycoplasma pneumoniae
• Haemophilus influenzae
• Respiratory viruses
• Chlamydophila pneumoniae
• Chlamydophila psittaci
• Coxiella burnettii
• Legionella pneumophila
• Oral anaerobes
• Moraxella catarrhalis
• Staphylococcus aureus
• Pseudomonas aeruginosa
• Enteric aerobic gram-negative bacteria (e.g., Klebsiella species)
• Fungi
• Mycobacterium tuberculosis

21

Organisms Causing Pneumonia
Hospital-Acquired Pneumonia

• Pseudomonas aeruginosa†
• Escherichia coli†
• Klebsiella pneumoniae†
• Acinetobacter species†
• Haemophilus influenzae
• Staphylococcus aureus
• Streptococcus pneumoniae
• Proteus species
• Enterobacter species
• Oral anaerobes

22

Types of Pneumonia
- potential causes of pneumonia.
- Although pneumonia can be classified many different ways (e.g., according to the causative organism), the most widely recognized and clinically effective way is to classify pneumonia as?

- Bacteria, viruses, Mycoplasma organisms, fungi,
- community-acquired or hospital-acquired pneumonia. Classifying pneumonia is important because of the differences in the likely causative organisms and the selection of appropriate antimicrobial therapy

23

Community-acquired pneu­monia (CAP) is an acute infection of the lung occurring in patients who have?
- The decision to treat the patient at home or admit him or her to the hospital is based on several factors such as the?

- not been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms
- patient's age, vital signs, mental status, presence of co-morbid conditions, and current physiologic condition. Clinicians can use tools such as the CURB-65 scale to supplement clinical judgment

24

Community-Acquired pneumonia treatment

Empiric antibiotic therapy should be started as soon as possible. It is the initiation of treatment before a definitive diagnosis or causative agent is confirmed, and should be started as soon as CAP is suspected. Empiric antibiotic administration is based on experience and knowledge of drugs known to be effective for the most likely causative agent

25

Hospital-acquired pneumonia (HAP), also known as ______ pneumonia, is a pneumonia in a?
- VAP pneumonia?
- Once the diagnosis of HAP or VAP is made, treatment of pneumonia is initiated based on?
- Antibiotic therapy can be?
- Both HAP and VAP are associated with?

nosocomial pneumonia
- nonintubated patient that begins 48 hours or longer after admission to hospital and was not present at the time of admission.
- Ventilator-associated pneumonia (VAP), also a type of HAP, refers to pneumonia that occurs more than 48 hours after endotracheal intubation
- based on known risk factors, early versus late onset, and probable organism.
- Antibiotic therapy can be adjusted once the results of sputum cultures identify the exact pathogen.
- longer hospital stays, increased associated costs, sicker patients, and increased risk of morbidity and mortality

26

1) A major problem in treating pneumonia today is the development of?
2) Primary culprits include?
3) Risk factors for development of MDR pneumonia include?
4) Antibiotic susceptibility tests can identify MDR organisms. The virulence of these organisms can severely limit the?

1) multidrug-resistant (MDR) organisms.
2) methicillin-resistant Staphylococcus aureus and gram-negative bacilli.
3) advanced age, immunosuppression, history of antibiotic use, and prolonged mechanical ventilation.
4) Available and appropriate antimicrobial therapy. MDR organisms also increase the morbidity and mortality risks associated with pneumonia

27

1) Aspiration pneumonia results from the abnormal entry of material from the?
2) Conditions that increase the risk of aspiration include?
3) With loss of consciousness, the?

1) mouth or stomach into the trachea and lungs
2) decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric tubes with or without tube feeding
3) gag and cough reflexes are depressed, and aspiration is more likely to occur

28

Aspiration pneumonia
1) The aspirated material triggers an?
2) most common form of aspiration pneumonia is a?

1) aspirated material (food, water, vomitus, or oropharyngeal secretions) triggers an inflammatory response.
2) primary bacterial infection. Typically, more than one organism is identified on sputum culture, including aerobes and anaerobes, since they both make up the flora of the oropharynx

29

Aspiration pneumonia:
1) Until cultures are completed and results obtained, initial antibiotic therapy is based on an assessment of?
2) For patients who aspirate in hospitals, appropriate antibiotics should include coverage for both?
3) In contrast, aspiration of acidic gastric contents causes?

1) probable causative organism, severity of illness, patient factors (e.g., malnutrition, current use of antibiotic therapy), and ability to treat common community-acquired organisms.
2) gram-negative organisms and MRSA.
3) chemical (noninfectious) pneumonitis, which may not require antibiotic therapy. However, secondary bacterial infection can occur 48 to 72 hours later

30

1) Necrotizing pneumonia is a rare complication of?
2) It is characterized by?
3) Although the exact pathophysiologic mechanisms involved are controversial, causative organisms include?
4) ____ ______commonly occur.
5) Signs and symptoms of necrotizing pneumonia include?
6) Treatment often includes?

1) bacterial lung infection
2) liquefaction and, in some situations, cavitation of lung tissue. This often occurs as a result of community-acquired pneumonia (CAP).
3) Staphylococcus, Klebsiella, and Streptococcus. Lung abscesses commonly occur.
4) Lung abscesses
5) immediate respiratory insufficiency and/or failure, leukopenia, and bleeding into the airways
6) Treatment often includes long-term antibiotic therapy and possible surgery