chapter 27: lower respiratory stuff Flashcards

Question

How long after infection do symptoms show up? cough progression early symptoms late symptoms?

Answer 1

2-3 weeks (except when it is acute) starts dry then becomes productive fatigue, malaise, weight loss, fever, chest pain dyspnea and hemoptysis *sometimes night sweats

Answer 2

HIV: less likely to have signs of infection -symptoms sometimes wrongly attributed to PJP old ppl -sometimes only display change in mental status

Answer 3

widespread dissemination of the mycobacterium -causes swelling of lymph, liver, spleen -from primary or LTBI TB

Answer 4

-extrapulmonary -from primary or LTBI -chest pain, fever, cough, PLEURAL EFFUSION -emphysema not as common -diagnosed with biopsy and AFB cultures

Answer 5

TB in spine

Answer 6

-use purified protein derivative (PPD) for M tuberculosis -check 2-3 days later for induration (no redness) -5 mm = positive -2 step testing w/ Mantoux TST for baseline

Answer 7

-blood tests that detect INF-y release fom T cells -only require one visit and are more accurate -can't differentiate bt LTBI and active

Answer 8

-chest xrays aren't great -gold standard! --> 3 specimen 8-24 hrs apart --> can take a long time though

Answer 9

-if sputum smear is positive, they're contagious for first 2 weeks after starting treatment

Answer 10

Initial and continuation phase Initial: -4 drug regimen for 8 weeks -isoniazid, rifampin, pyrazinamide, ethambutol Continuation: -2 drugs for 18 weeks -isoniazid and rifampin CAUTION: ALC AND ISONIAZID DON'T MIX -nonviral hepatitis is a possible side effect

Answer 11

-guided by sensitivity testing MDR -usually 5 drugs for 6 months -then 4 drugs for 18-24 months Sirturo and Deltyba treat MDR and XDR

Answer 12

-Watch them take the meds -Nonadherance is big issue with spread of MDR-TB -can use combo pills to make it easier for ppl

Answer 13

-usually only need 1 drug (typically isoniazid for 9 months) -6 month regimen is less effective, but better for adherence -ppl w/ HIV or fiberobtic chest lesions need full 9 months -3 month of isoniazid AND rifapentine if no MDR -4 month rifampin if resistant to isoniazid

Answer 14

-live attenuated strain of Mycobacterium bovis Not used so much in U.S. -no help with pulmonary TB -interferes with TB skin test -no effect on IGRA though

Answer 15

public health authorities

Answer 16

1. airborne precautions (fitted HEPA masks) 2. chest xray, sputum smear, culture 3. drug therapy

Answer 17

-its ok to go home if fam is already exposed -sputum for AFB every month until 2 in a row are neg -reduce exposing others --> spend time outside -stick to drug regimen -teach how to recognize relapses -STOP SMOKING

Answer 18

-acid fast mycobacteria that cause pulmonary disease -not airborne or droplet -cough, SOB, weight loss, blood-tinged sputum -can't differentiate bt this and TB w/o culture

Answer 19

-E.g. fungal pneumonia caused by endemic fungi (e.g. Coccidioides) -Opportunistic fungal infections Inhalation of spores --> not contagious similar to pneumonia antifungals given -Amphotericin B IV for serious systemic infection

Answer 20

necrosis of lung tissue -usually from aspirated bacteria, but also from IVs, cancer, pulmonary emboli, TB, parasites, and fungi usually more than one anaerobic microbe in back part of upper lobe of lung foul smelling sputum "necrotizing pneumonia"

Answer 21

Stand out symptoms: -purulent sputum that smells and tastes gross -hemoptysis when abscesses pop Others: -fever, chills, preostration, night sweats, pleuritic pain, dyspnea, weight loss Lung sounds: -less lung sounds -bronchial sounds might move peripherally -crackles in later stages

Answer 22

-goes through blood -bronchopulmonary fistula, bronchiectasis, and empyema from popping of abscess into pleural cavity

Answer 23

- chest xray -CT scan helps too -sputum isn't great bc it'll have oral flora if coughed up -Bronchoscopy can help get sample and look for cancer -pleural fluid and blood can help identify the microbe

Answer 24

-monitor vitals and look for hypoxemia -give O2 and antibiotics -food, rest, water -DONT do chest PT or postural drainage -percutaneous drainage or surgery if unresponsive to drugs

Answer 25

Hamartomas = slow, benign tumor made of fiber, fat, and blood vessels Mucous gland adenoma = benign tumor made of columbar cystic spaces in bronchi Mesotheliomas = may or may not be benign --> visceral pleura --> melignant ones assoc w/ asbestos

Answer 26

-most common injury from blunt trauma -ribs 5-9 -pain, shallow breaths, possibly atelectasis and pneumonia Don't strap chest --> limits ability to expand Use pain meds, deep breathing, spirometer

Answer 27

-happens when 3+ ribs in 2+ places are fractured, forming unstable segment -that part moves opposite of normal chest -tachycardia, shallow breaths -treat like any rib fracture

Answer 28

air enters pleural cavity ruining the neg pressure -causes lung collapse open = entering through chest wall closed = no external wound tachycardia, dyspnea, air hunger, low O2, no breath sounds

Answer 29

rupture of blebs on lung surface -blebs are there more in smokers -tall, thin males get it more

Answer 30

puncture during med procedures -barotrauma from excessive ventilation

Answer 31

air can't escape from pleural space and pressure keeps rising -crushes lung on affected side and pushes mediastinum to other side where it crushes other lung --> also heart is being crushed can happen with chest tubes that're clamped MED EMERGENCy!!! --> Needle decompression and chest tube insertion

Answer 32

blood accumulation in pleural space --> needs to be drained --> blood may be reusable

Answer 33

lymph fluid in pleural space -usually happens bc trauma or cancer fucks with thoracic duct -need meds and/or surgery

Answer 34

-cover wound secured on 3 sides -if impaled, don't remove object -chest tube connected to water-seal drainage -maybe surgery

Answer 35

20" long 36-40F for draining blood 24-36F for draining fluid 12-24F for draining air 10-14F = pigtail (also for air)

Answer 36

patient is upright (30-60*) with arms above head -incision over a rib and tube goes over rib -sutures it in place -sealed with airtight petroleum gauze

Answer 37

device used to remove air from pleural space -can walk around with it --> bag under clothes

Answer 38

1. collection chamber 2. water seal chamber which acts as a one way valve 3. suction control chamber: wet or dry -wet suction determined by water level -dry suction uses restriction device or regulator

Answer 39

nah bro -way riskier bc of tension pneumonia -just reestablish water seal ASAP

Answer 40

just temporarily when changing the drainage apparatus or checking for air leaks

Answer 41

-reexpansion pulmonary edema -severe hypotension

Answer 42

subcutaneous emphysema --> can lead to swelling of head and neck --> obstruction

Answer 43

over 200 ml Call HCP!

Answer 44

surgical incision to get to heart, lungs, esophagus, throacic aorta, or anterior spine 1. sternotomy for heart 2. posterolateral for lung 3. anterolateral for trauma victims

Answer 45

-cardiopulmonary status -chest xray ECG ABG CBC PT/INR aPTT

Answer 46

PAIN MANAGEMENT --> MOST PAINFUL INCISION -assess breathing, sputum, vitals, wound

Answer 47

aspiration of intrapleural fluid for diagnostic purposes -usually no more than 1000 to 1200

Answer 48

extrapulmonary intrapulmonary = lungs or pleura Decreased total lung capacity (stops expansion) Obstructive: if obstructive, decreased forced expiratory volume

Answer 49

collapsed, airless alveoli -often bc airways blocked by secretions -post op patients

Answer 50

inflammation of pleura -abrupt, sharp pain on inhalation -shallow rapid breathing usually a side effect, not a primary condition

Answer 51

transudate = pale yellow fluid w/o cells or protein --> usually HF or low albumin exudate = inflammatory rxn causes increased capillary permeability empyema = purulent fluid in pleura due to pneumonia, TB, lung abscesses, and infected wounds

Answer 52

pain that doesn't radiate less movement on one side

Answer 53

tissue bt air sacs of lungs is inflammed or scarred -200 dif disorders

Answer 54

SMOKING CAUSES IT WEIGHT LOSS AND FATIGUE AND CLUBBING DO A CHEST XRAY AND VATS O2 therapy and pulmonary rehab no real cure --> ppl die --> 30-50% 5 yr survival STEROIDS

Answer 55

granulomatis disease --> unknown cause -can affect a bunch of dif organs -follow up with pulmonary function, xray, and CT **ppl usually die with it, not of it **black men get this STEROIDS

Answer 56

usually bc of HF -fluid in alveoli and interstitial spaces

Answer 57

-blocking of pulmonary arteries with thrombus, fat, or air -DVT/VTE -sometimes upper extremety DVT from catheters/arterial lines

Answer 58

dyspnea and mild hypoxemia if it gets real bad there's change in mental status, hypotension, acidosis, and feeling of impending doom

Answer 59

Pulmonary infarction (death of lung tissue) --> usually accompanied by pleural effusion Pulmonary hypertesion --> can lead to hypertrophy of right ventricle

Answer 60

D-dimer --> not sensitive or specific helical CT scan!!!!!!!!!!!!!! V/Q scan = IV radioisotope and Radioactive gas (perfusion and ventilation)

Answer 61

ABG chest xray ECG troponin B-type natriuretic peptide

Answer 62

O2 = intubation/ mechanical ventilation pulmonary hygiene = prevent atelectasis shock = fluids and vasopressors HF = diuretics Pain = opioids

Answer 63

ANTICOAGULANTS + blood thiiners (heparin and warfarin) Fibrinolytic agents to dissolve clot (tPA and activase)

Answer 64

If big: pulmonary embolectomy -good if hemodynamically unstable and thrombolytic therapy is contraindicted Percutaneous catheter embolectomy or endovascular ultrasound delivered thrombolysis Inferior vena cava filter for high risk ppl who can't take anticoagulants --> stops migration of clots into pulmonary system

Answer 65

Prevention -compression devices -early ambulation -anticoagulants Immediate treatment -bed rest in semi fowlers -check cardiopulmonary status -give O2, IV fluids, meds -Monitor: coagulation and complications

Answer 66

high pulmonary artery pressure due to high resistance MAP -Normal = 12-16 -HTN = over 25 at rest; over 30 exercising can be main or secondary disease (r sided hf)

Answer 67

1) a/w meds, disease, genetics, idiopathic 2) left sided HF 3) lungs and hypoxemia 4) CV system and thromboembolic occlusion 5) multifactorial (hematologic or metabolic involvement)

Answer 68

Results in right HF and death if untreated Possible causes -CT disease, cirrhosis, HIV Results in -vascular scarring, endothelial dysfunction, smooth muscle proliferation affects females more

Answer 69

dyspnea and fatigue -chest pain, dizziness, syncope Eventually dyspnea at rest and right ventricle hypertrophy

Answer 70

RIGHT SIDED HEART CATHETERIZATION -ECG, chest xray, PFTs, echo, CT

Answer 71

Note unexplained SOB, syncope, chest pain, and edema Drugs -pulmonary vasodilation -manage edema -prevent thrombi -prevent hypoxia

Answer 72

Pulmonary thromboendarterectomy (PTE) -Atrial septostomy (AS) = palliative -lung transplant

Answer 73

Chronic increase in pulmonary artery pressure from other disease -parenchymal lung disease -LV dysfunction -intracardiac shunts -chronic PE -CT disease

Answer 74

dyspnea, fatigue, chest pain, right hypertrophy and HF Diagnosis = same as IPAH Treatment: underyig cause --> if irreversible, IPAH therapies

Answer 75

Enlarged right ventricle secondary to disorder of respiratory system; COPD -usually already has pulmonary hypertension --> maybe HF too Manifests: same as IPAH --> sometimes polycythemia -if HF: water retension and big liver

Answer 76

ESLD -COPD, pulmonary fibrosis, cystic fibrosis, IPAH, alpha antitrypsin deficiency

Answer 77

evaluateion ensure no contraindictions (cancer, HIV, Hep B/C, psych issues, smoker, poor nutrition) -need to adhere w/ post op regimen UNOS gives LAS score to determine who gets lungs

Answer 78

single lung bilateral lungs heart-lungs lobes from living related donors

Answer 79

Acute: 5-10 days -fever, fatigue, dry cough, O2 desaturation Chronic: Bronghiolitis obliterans -progressive airflow obstruction unresponsive to bronchodilators and corticosteroids

chapter 27: lower respiratory stuff Flashcards

(103 cards)