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X Clinical Veterinary Nursing Theory > Diseases of The Respiratory System > Flashcards

Diseases of The Respiratory System Flashcards

1
Q

what forms the upper respiratory tract?

A

from the nose to the thoracic inlet (includes nasal cavity, oral cavity and cervical portion of trachea)

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2
Q

what makes up the lower respiratory tract?

A

trachea, bronchi, bronchioles and alveoli

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3
Q

define medical condition

A

abnormality/malfunction of a body system

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4
Q

what can give an idea of potential causes/differential diagnoses of medical conditions?

A

a through history and clinical exam

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5
Q

what is used to confirm a diagnosis?

A

diagnostic and labs tests

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6
Q

what can be formulated after a diagnosis is reached?

A

treatment plan

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7
Q

what is happening during acute respiratory failure?

A

lungs are unable to oxygenate blood or exchange carbon dioxide

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8
Q

is acute respiratory failure an emergency?

A

yes - patient will die without intervention

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9
Q

what are some common causes of respiratory failure?

A 
airway obstruction (e.g. BOAS)
ruptured diaphragm
pulmonary oedema/haemorrhage
pneumo/pyo/haemo/chylothorax
neoplasia
infection
toxin ingestion
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10
Q

what is chylothorax?

A

chest filled with lymphocyte rich fluid

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11
Q

what are the signs of respiratory failure?

A 
cyanosis
distress
inspiratory dyspnoea
expiratory dyspnoea
dyspnoea
tachypnoea
orthopnoea
tachycardia
weak pulses
collapse
unconciousness
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12
Q

what type of dyspnoea is associated with upper respiratory tract noises?

A

inspiratory

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13
Q

what sounds are associated with inspiratory dyspnoea?

A

snoring
stertor
stridor

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14
Q

what is stridor?

A

high pitched sound from the larynx

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15
Q

what sounds are associated with expiratory dyspnoea?

A

wheezes

crackles on auscultation

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16
Q

what is orthopnoea?

A

position adopted by dogs and cats when they are dyspnoeic

abduction of elbows and extension of neck

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17
Q

how may oxygen be administered to the conscious patient?

A 
flow by
nasal catheter
nasal prongs
face mask
oxygen tent
oxygen cage or incubator
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18
Q

what may be needed if oxygen is being provided to the conscious patient?

A

sedation (butorphanol)

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19
Q

how does a nasal catheter provide oxygen?

A

inserted into the nasal passages and connected to an oxygen supply

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20
Q

what can an oxygen tent be formed from?

A

cage covered in cling film or buster collar with cling film covering

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21
Q

what must be ensured if creating an oxygen tent?

A

that there is an escape route for expired gas/heat

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22
Q

how may oxygen be administered to the unconscious patient?

A

endotracheal intubation

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23
Q

what is ensured by ET tube use?

A

patent airway

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24
Q

how can you ensure that your patient has a patent airway?

A

ET tube
head and neck extension
tracheostomy

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25
Q

what is required if a patient has a tracheostomy tube?

A

constant monitoring

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26
Q

when may a tracheostomy tube be placed?

A

with profound disease which affects the larynx/pharynx making intubation impossible

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27
Q

what are the key nursing considerations for a patient with acute respiratory failure?

A 
observe and monitor
medication (sedation)
care of drains 
patient is likely to recumbent
change in environment where possible
exercise
inhalation therapies
feeding
barrier nursing
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28
Q

what are the 3 main sections of the respiratory system?

A

upper respiratory tract
lower respiratory tract
pleural cavity

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29
Q

what are the clinical signs of upper respiratory tract diseases?

A 
nasal discharge (uni/bilateral)
sneezing
reverse sneezing
stertor/snoring
systemic or CNS signs
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30
Q

what is reverse sneezing?

A

rapid inspiration of a large volume of air

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31
Q

how may nasal discharge appear?

A

serous
mucopurulent
haemorrhagic

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32
Q

what are you looking for in the physical examination of a patient with upper respiratory tract diseases?

A 
listen for noises
nasal discharge
facial deformity/pain
nasal planum depigmentation
assess airflow bilaterally
assess regional lymph nodes
retropulsion of the eyeballs (exophthalmia)
look for dental disease
look for ophthalmic disease
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33
Q

what are the inflammatory differential diagnoses for nasal disease?

A

idiopathic
allergic
irritation

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34
Q

what are the main differential diagnoses for nasal disease?

A 
inflammatory
infectious
neoplastic
trauma/fracture
foreign body
systemic causes
misc.
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35
Q

what are the infectious differential diagnoses for nasal disease?

A

bacterial (secondary)
virus
fungal
parasitic

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36
Q

how can nasal disease be investigated without GA?

A

routine bloods
tests for bleeding disorders
serology for fungal diseases
viral testing in cats

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37
Q

what tests are available for bleeding disorders?

A

platelet count

PT/APTT

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38
Q

what investigations of nasal disease may be performed under anaesthesia?

A

full oral exam
dental probing
nasopharyngeal swab in cats

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39
Q

what imaging techniques may be used to investigate nasal disease?

A

x rays
CT scan of the head
endoscopy

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40
Q

what x-ray views are most helpful when assessing nasal disease?

A

intra-oral nasal views

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41
Q

where should endoscopic investigation of the nasal cavity be started with?

A

retrograde view of the nasopharynx

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42
Q

what is nasal flush useful for?

A

both diagnosis and therapy

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43
Q

what must be done when performing a nasal flush?

A

pack pharynx appropriately

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44
Q

how can nasal biopsy be performed?

A

blind or endoscopic

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45
Q

why must you be careful when performing nasal biopsy?

A

ensure that biopsy is taken of the nasal cavity and not the brain (due to degeneration of cribriform plate)

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46
Q

why should you check coagulation times before you perform a nasal biopsy?

A

the nasal cavity is highly vascular and so bleeding is likely

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47
Q

what are the nursing considerations associated with rhinoscopy?

A

nose will bleed alot
be prepared
biopsy will often be needed
consider topical agents

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48
Q

what level of anaesthesia is required for rhinoscopy?

A

requires GA

local blocks LA/IV

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49
Q

what can be done to aid slowing of bleeding that occurs during rhinoscopy?

A

ice packs on the nose
intranasal adrenaline
- both to lead to vasoconstriction

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50
Q

what are the key elements of nursing care for nasal disease?

A 
treat dyspnoea first if present
try and stop haemorrhage
remove foreign object if present
monitor food/fluid intake
correct and adequate nutrition
removal of dried nasal discharge
grooming
decongestant therapy
isolate if infection suspected
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51
Q

how can nasal haemorrhage be stopped?

A

ice packs, pressure and adrenaline soaked swabs

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52
Q

what is sino-nasal aspergillosis most commonly caused by in dogs?

A

Aspergillus fumigatus

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53
Q

what dogs are predisposed to aspergillosis?

A

meso/dolichocephalic breeds

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54
Q

what is the effect of aflatoxins produced by aspergillosis on the nasal cavity?

A

profound inflammatory response

extensive turbinate and bone destruction

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55
Q

what can aspergillosis be secondary to?

A

tumor or foreign body

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56
Q

what is sino-orbital aspergillosis in cats due to?

A

Aspergillis felis

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57
Q

what cat breeds are predisposed to aspergillosis?

A

brachycephalic breeds

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58
Q

what are the common clinical signs of aspergillosis?

A

mucopurulent nasal discharge or epistaxis (uni/bilateral)
sneezing
nasal pain
nasal depigmentation

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59
Q

what are the uncommon clinical signs of aspergillosis?

A

stertor
facial deformity
CNS signs

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60
Q

how can aspergillosis be diagnosed?

A 
challenging!
serology
PCR
imaging
rhinoscopy
cytology
histopathology
fungal culture
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61
Q

how can rhinoscopy aid diagnosis of aspergillosis?

A

visualisation of plaque

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62
Q

what imaging modalities may be used for diagnosis of aspergillosis?

A

radiography
MRI
CT

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63
Q

what is shown on MRI or CT images of a patient with aspergillosis?

A

turbinate destruction
increased soft tissue opacity
increased soft tissue density in frontal sinuses

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64
Q

when is trephination required to treat aspergillosis?

A

if frontal sinuses only involved

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65
Q

what is trephination?

A

catheters inserted into frontal sinus

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66
Q

how is aspergillosis treated?

A

mechanical debridement endoscopically
topical antifungal
oral itraconazole (not generally effective)
refurral needed

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67
Q

when should topical antifungal not be used to treat aspergillosis?

A

if cribriform plate is not intact as the brain is exposed

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68
Q

what is the preferred treatment method for aspergillosis?

A

trephination and flushing with saline followed by clotrimazole flush and instillation of clotrimazole cream

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69
Q

are repeated aspergillosis treatments required?

A

often yes

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70
Q

what are BOAS conditions the result of?

A

poor breeding and body confirmation in dogs with short noses

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71
Q

what breeds is BOAS common in?

A

french bulldogs
english bulldogs
pugs

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72
Q

what is BOAS?

A

brachyocephalic obstructive airway syndrome

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73
Q

what are the primary abnormalities found in animals with BOAS?

A

excessive soft tissues in skin and airways
stenotic nares
elongated/thick soft palette
hypoplastic trachea

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74
Q

are BOAS associated congenital defects normal presentations?

A

no - severely compromise quality of life

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75
Q

why is an elongated soft palette problematic in brachycephalic dogs?

A

soft palate passes epiglottis and can block airway

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76
Q

what secondary problems can be caused by BOAS?

A

respiratory and digestive issues

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77
Q

what is the main digestive issue caused by BOAS?

A

hiatal hernia leading to regurgitation

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78
Q

what is the main secondary respiratory issue caused by BOAS?

A

laryngeal collapse

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79
Q

how do patients compensate for BOAS issues?

A

pull harder on inspiration which creates negative pressure in the throat, neck and chest leading to secondary respiratory and digestive problems

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80
Q

what are the presenting signs of BOAS syndrome?

A 
load breathing
exercise intolerance
sleep deprivation
gagging
regurgitation
vomiting
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81
Q

how is BOAS diagnosed?

A 
physical exam and owner history
exam under sedation
fluroscopy/barium swallow
CT of head
rhinoscopy
chest x-rays
CT scan
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82
Q

what are the key elements of nursing care involved with BOAS patients?

A 
owner education
discourage ownership/breeding
keep calm and stress free
avoid excessive heat
often require surgery
use harness instead of collar to prevent breathing difficulties
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83
Q

what are the main causes of laryngeal paralysis?

A

congenital
trauma
nerve infiltration

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84
Q

in what type of dog does laryngeal paralysis often occur?

A

older, large breed dog

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85
Q

why is it thought that laryngeal paralysis occurs in older dogs?

A

decline in nerve function

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86
Q

how does laryngeal paralysis present?

A

exercise intolerance
soft, ineffectual cough
inspiratory stridor
may present as an emergancy

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87
Q

how is laryngeal paralysis diagnosed?

A

laryngeal exam under sedation/GA

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88
Q

what are the main nursing considerations for laryngeal paralysis?

A 
keep animal calm - sedate
avoid collar/anything around neck
keep animal cool
provide oxygen as long as it doesnt cause stress
provide steroids 
may require surgical intervention
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89
Q

what should patients with laryngeal paralysis be monitored for?

A

aspiration pneumonia
dysphagia
megaoesophagus

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90
Q

why may laryngeal paralysis patients be given steroids?

A

to reduce laryngeal oedema

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91
Q

in what types of animal is tracheal collapse seen?

A

small / toy breeds

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92
Q

whereabouts on the trachea does tracheal collapse most often occur?

A

any part possible but most often at thoracic inlet

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93
Q

what appears to predispose patients to tracheal collapse?

A

obesity

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94
Q

what is the key sign of tracheal collapse?

A

goose honking cough

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95
Q

how is tracheal collapse diagnosed?

A

physical exam

x-ray / fluoroscopy

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96
Q

how does x-ray / fluoroscopy aid tracheal collapse diagnosis?

A

shows tracheal positioning

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97
Q

what are the key nursing considerations associated with tracheal collapse?

A 
sedation (butorphanol)
provide medication
cage rest
exercise restriction
harness only - no collar
oxygen therapy
possibly intubate if acute
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98
Q

what are the long term changes needed for a patient with tracheal collapse?

A

weight loss

surgery with possible stent

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99
Q

what medication may be given to a patient with tracheal collapse?

A

antitussive
corticosteroids
bronchodilators

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100
Q

why is intubation risky in patients with tracheal collapse?

A

will lead to further inflammation which may worsen condition

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101
Q

define cough

A

sudden expiratory effort against a closed glottis - results in sudden noisy expulsion of air from lungs

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102
Q

define dyspnoea

A

difficulty breathing, increased respiratory effort

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103
Q

define tachypnoea

A

increased rate of breathing

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104
Q

define hyperpnoea

A

increased respiratory effort without dyspnoea

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105
Q

define orthopnoea

A

adapting posture to facilitate breathing - often sit or stand with elbows abducted and neck extended

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106
Q

what is a key sign of lower respiratory tract disease?

A

cough

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107
Q

what is the aim of a cough?

A

protective reflex to clear excess secretions / foreign material

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108
Q

where are the majority of cough receptors located?

A

in large airways

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109
Q

where are fewer cough receptors located?

A

nose, sinuses, pharynx and pleura

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110
Q

what is detected in the respiratory tract by mechanical receptors?

A

mucous

foreign body

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111
Q

what is detected in the respiratory tract by chemical receptors?

A

acid

heat

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112
Q

what nerves form the afferent pathway of the cough reflex?

A

sensory vagus nerve

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113
Q

where is the cough centre located in the brain?

A

medulla oblongata

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114
Q

what nerves make up the efferent cough reflex pathway?

A

vagus, phrenic and spinal motor nerves

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115
Q

what muscles are supplied by efferent cough reflex pathways?

A

diaphragm

abdominal wall

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116
Q

what is cough associated with aside from LRT disease?

A

congestive heart failure

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117
Q

why is a cough associated with congestive heart failure?

A

airways begin to fill with fluid which stimulates mechanorecptors

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118
Q

what effect does oedema have on the respiratory system?

A

more tachypnoea

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119
Q

what are the main harmful effects of a cough?

A

exacerbate airway inflammation and irritation
emphysema
pneumothorax
weakness and exhaustion of respiratory muscle
dissemination of infections

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120
Q

what are the signs of lower respiratory tract disease?

A 
cough
tachypnoea
dyspnoea
exercise intolerance
weakness
cyanosis
syncope
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121
Q

when diagnosing a patient with LRT disease what should be assessed first?

A

patient - are they getting enough oxygen and how can stress be reduced

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122
Q

what must be considered when trying to reduce stress in respiratory patients?

A

offering sedation

calm environment

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123
Q

what must be done with a LRT patient following triage?

A

stabilise (e.g. oxygen tent)

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124
Q

what should be observed about the patient with suspected LRT disease?

A

posture

rate and rhythm of breathing

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125
Q

what must be observed about the LRT patients respiratory rate and rhythm?

A

is there inspiratory or expiratory effort / both

shallow or labored breathing

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126
Q

when observing a LRT patient from a distance what are you looking for?

A 
URT noise (e.g. stertor/stridor)
wheezing
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127
Q

when should thoracic auscultation only take place?

A

when patient is stable

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128
Q

when auscultating the chest what are you listening for?

A 
crackles
wheezes
HR and rhythm
heart murmur
muffled or lack of heart sounds
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129
Q

what are you listening for while percussing the chest?

A

increased or decreased resonance

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130
Q

what investigations may be performed on a patient to diagnose LRT disease?

A 
clinical pathology
assessment of oxygenation
laryngeal exam
imaging of chest
assessment of pleural space disease
advanced techniques
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131
Q

what test can be used for lungworm?

A

faecal smear

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132
Q

how does a faecal smear for lungworm work?

A

faeces are suspended in water and viewed under the microscope to check for worms

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133
Q

how can a patients oxygenation be assessed?

A 
pulse oximetry (SpO2)
arterial blood gas analysis (PaO2)
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134
Q

what is being assessed when performing laryngeal exam?

A 
structure of larynx (any masses/collapse)
function (any paralysis)
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135
Q

when is a laryngeal exam performed?

A

under GA

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136
Q

what are you looking for when performing radiography of the chest?

A

pulmonary patterns (bronchial, alveolar, interstitial)
heart and vessels appearance
masses
pleural space

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137
Q

when may a CT scan of the thorax be used?

A

more sensitive so can show things not seen on x ray

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138
Q

when may an ultrasound be used to assess LRT disease?

A

looking for thoracic mass

T-FAST for thoracic fluid

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139
Q

what is bronchoscopy used for?

A

collection of brochoalveolar lavage
view of lower airways
foreign body removal

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140
Q

what must cats be pre-treated with before bronchoscopy?

A

terbutaline

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141
Q

what can samples collected through BAL be used for?

A

cytology
culture
PCR

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142
Q

what can be performed if no bronchoscope available?

A

blind BAL and tracheal wash

143
Q

what equipment is needed for bronchoscopy?

A 
endoscope
sterile saline in syringes
collection pots for BAL
mouth gag (or can go through ET tube)
urinary catheter
emergency box/induction agent
144
Q

what are the key nursing considerations associated with bronchoscopy?

A

requires several people
needs to be quick
react fast if things go wrong as they can quite quickly
coupage will be required
monitor patient carefully until fully recovered
easy access to emergency drugs / oxygen
thoracocentesis may be required

145
Q

what is coupage?

A

pressing on left and right sides of chest

146
Q

what is the most common cause of coughs in dogs?

A

canine chronic bronchitus

147
Q

what is canine chronic bronchitis?

A

chronic bronchial inflammation with over secretion of mucous

148
Q

in what age of dog is canine chronic bronchitis common?

A

middle aged to older

149
Q

what co-morbidities are seen with canine chronic bronchitis?

A

tracheal / bronchial collapse
mitral valve disease
pulmonary hypertension

150
Q

what are the initial predisposing factors to canine chronic bronchitis?

A

history of kennel cough
environmental irritants or allergens
parasites

151
Q

what happens during canine chronic bronchitis?

A

smaller airways become obstructed by mucous
alteration of the mucocilliary escalator
inflammation of the lower airways

152
Q

what does obstruction of smaller airways by mucous during canine chronic bronchitis lead to?

A

progressive narrowing of airway

153
Q

what causes an alteration in the mucociliary escalator during canine chronic bronchitis?

A

due to narrowing of airway this is less effective

154
Q

what may patients become prone to is the mucociliary escalator is damaged?

A

concurrent bacterial infections

155
Q

what does inflammation of the lower airways during canine chronic bronchitis lead to?

A

narrowing of the lower airways

156
Q

what is bronchomalacia?

A

weakened cartilage of bronchi

157
Q

what is bronchiectasis?

A

extreme dilation of bronchi - end stage change

158
Q

what are the clinical signs of canine chronic bronchitis seen on exam?

A

chronic cough (>2 months) - often productive
+/- dyspnoea and tachypnoea
+/- gagging and retching
+/- pyrexia if concurrent pneumonia

159
Q

what are the clinical signs of canine chronic bronchitis seen on thoracic auscultation?

A

wheezes

+/- crackles if concurrent pneumonia / emphysema

160
Q

when investigating canine chronic bronchitis what are you looking for on x ray or CT scan?

A 
bronchial pattern (doughnuts or tramlines)
possible interstitial pattern (net curtain)
161
Q

what may be seen in healthy older dogs on x ray?

A

mild broncho-interstitial pattern

162
Q

what are you looking for when examining a dog with suspected canine chronic bronchitis with bronchoscopy?

A

mucosal erythema

excessive mucous

163
Q

what is mucosal erythema?

A

redness of MM

164
Q

what will be found on BAL of a patient with canine chronic bronchitis?

A

mucous
neutrophils
+/- bacteria

165
Q

what is suggested if eosinophils are found during BAL of a patient with canine chronic bronchitis?

A

underlying bacterial disease

166
Q

what are the nursing management considerations of a patient with canine chronic bronchitis?

A

weight control to reduce fat in chest cavity
harness only
avoid tobacco smoke, dust and airway irritants

167
Q

what medication is needed to treat canine chronic bronchitis?

A 
lowest possible does glucocorticoids
bronchodilators 
antibiotics if required
antitussives
mucolytics
168
Q

what are glucocorticoids used for in the treatment of canine chronic bronchitis?

A

anti-inflammatory

169
Q

what bronchodilators are used to treat canine chronic bronchitis?

A

theophylline

170
Q

why may antibiotic be required when treating canine chronic bronchitis?

A

concurrent bacterial infection

171
Q

when would antimicrobials be indicated in canine chronic bronchitis patients?

A

depends on BAL and severity of signs

172
Q

what is the main antimicrobial used to treat canine chronic bronchitis?

A

Doxycycline

173
Q

what is essential to remember when giving doxycycline?

A

must be given with food or water as can cause oesophageal stricture

174
Q

how long are animals with canine chronic bronchitis treated with Doxycycline if needed?

A

7-10 days

175
Q

what should happen if there is a positive response to Doxycycline treatment after 7-10 days?

A

continue for an additional 7 days past resolution of clinical signs

176
Q

what drugs may be given to canine chronic bronchitis patients via inhaled therapy?

A

corticosteroids and bronchodiator

177
Q

is inhaled therapy recommended for antimicrobials?

A

no

178
Q

when should inhaled therapy for canine chronic bronchitis patients begin?

A

once clinically stabilised or if mild signs

179
Q

what is the prognosis for patients with canine chronic bronchitis?

A

chronic and progressive condition

can live for years if managed

180
Q

when is prognosis of canine chronic bronchitis worse?

A

if bronchiectasis or bacterial pneumonia due to degeneration of mucociliary escalator

181
Q

what diseases may e seen concurrently with canine chronic bronchitis?

A

mitral valve disease and/or pulmonary hypertension

182
Q

what is canine infectious tracheobronchitis also known as?

A

kennel cough

183
Q

what is the cause of canine infectious tracheobronchitis?

A

a complex of several viruses, bacteria and other microorganisms

184
Q

what are the main viruses that cause canine infectious tracheobronchitis?

A

canine adenovirus 2
canine parainfluenza virus
canine herpes virus

185
Q

what is the main bacterial causal agent of canine infectious tracheobronchitis?

A

Bordatella bronchiseptica

186
Q

when do most cases of canine infectious tracheobronchitis resolve?

A

within 14-21 days

187
Q

what must be done if canine infectious tracheobronchitis is suspected?

A

animal should be kept away from other animals as disease is highly contagious
wait in the car rather than waiting room

188
Q

how is canine infectious tracheobronchitis treated?

A

anti-biotic/anti inflammatory treatment

cough suppressants may be used

189
Q

what can prevent canine infectious tracheobronchitis?

A

client education and vaccination protocol

190
Q

what diseases are on the spectrum of feline lower airway disease?

A

feline asthma and feline bronchitis

191
Q

what occurs during feline lower airway disease?

A

chronic bronchial inflmmation (neutrophillic and eosinophillic) with mucous hypersecretion

192
Q

in what cats is feline lower airway disease most often seen?

A

young/middle aged cats

siamese seem over represented

193
Q

what is the difference between cats and dogs in terms of LRT disease?

A

cats will present with bronchoconstriction - emergancy

194
Q

what is bronchoconstriction?

A

severe sudden narrowing of airways

195
Q

what are the initial predisposing factors of feline lower airway disease?

A 
bacteria
viruses
parasites
irritants
allergens
196
Q

what is the cause of feline lower airway disease?

A

type 1 hypersensitivity

197
Q

what happens during a type 1 hypersensitivity reaction?

A

histamine and seratonin produced by mast cells which leads to smooth muscle contraction, oedema and eosinophillic inflammation of the lower airways and mucous hypersecretion

198
Q

what is the effect of type 1 hypersensitivity mediated smooth muscle contraction?

A

bronchoconstriction

199
Q

what do all the effects of type one hypersensitivity reaction in the lungs lead to?

A

obstruction of bronchus

200
Q

what immunoglobulin mediates type 1 hypersensitivity?

A

IgE

201
Q

what are the signs of feline lower airway disease?

A 
wide spectrum (none - asthmatic crisis)
cough
dyspnoea
tachypnoea
open mouth breathing
cyanosis
202
Q

what will be found on thoracic auscultation of a patient with feline lower airway disease?

A

wheezes
+/- crackles if emphysema
+/- dull lung sounds if pneumothorax

203
Q

what may be found on the chest x ray/CT scan of a feline lower airway disease patient?

A 
generalised bronchial pattern with possible interstitial or alveolar patterns
overinflated lungs
flattened diaphragm
possible pneumothorax
may be normal!
204
Q

what are the risks associated with bronchoscopy in cats?

A

can cause bronchoconstriction

205
Q

what can be given the night and morning before bronchoscopy to cats to reduce bronchoconstriction risk?

A

SC terbutaline

206
Q

what are you looking for during bronchoscopy of a patient with feline lower airway disease?

A

inflammation
mucous
airway narrowing

207
Q

what can you test BAL sample for in feline lower airway disease patients?

A

cytology - mucous and inflammatory cells (neutrophils and eosinophils)
PCR - Bordetella bronchiseptica and Mycoplasma spp
faecal parasitology or PCR - Aelurostrongylus
culture

208
Q

how should the emergency feline lower airway disease patient be treated?

A 
stress free
supplement O2
use bronchodilators
corticosteroids
sedation
209
Q

what corticosteroids may be used in acutely ill feline lower airway disease patients?

A

dexmethasone

210
Q

what is the issue with using dexmethasone?

A

can impact subsequent cytology samples (balance risk vs reward)

211
Q

what bronchodilator may be used to treat acute feline lower airway disease?

A

terbutaline

212
Q

what is the main management involved in treating feline lower airway disease?

A

dust free litter
no smoking
reduce use of aerosols

213
Q

what medication may be given to treat feline lower airway disease?

A

lowest effective dose glucocorticoids
bronchodilators
Doxycycline if Mycoplasma infection
Fenbendazole if parasitic infection

214
Q

what is not recommended for treatment of feline lower airway disease?

A

nebulization - may lead to bronchoconstriction

215
Q

what may inhaled therapy be used for in treatment of feline lower airway disease?

A

corticosteroids and bronchodilator

216
Q

what drugs should not be given via inhalation when treating feline lower airway disease?

A

antimicrobials

217
Q

when should inhaled therapy be given to feline lower airway disease patients?

A

once clinically stabilised or mild signs

218
Q

what is the prognosis of feline lower airway disease?

A

variable

good if chronic, acute can be fatal

219
Q

what are the main groups of pulmonary parasites?

A

intestinal worms with pulmonary migration
lung worms
heart worms causing respiratory signs

220
Q

what are the main worms that have pulmonary migration before the adult reaches the gut?

A

Toxocara

Ancylostoma

221
Q

what are the main species of heartworms that cause respiratory signs?

A

Angiostrongylus vasorum

222
Q

what is Angiostrongylus vasorum also known as?

A

french heartworm

223
Q

how is Angiostrongylus vasorum infection caused?

A

by eating intermediate host (mollusk) or paratenic host (frog)

224
Q

what larvae stage of Angiostrongylus vasorum travel to pulmonary vasculature from the intestines?

A

L3

225
Q

where do adult Angiostrongylus vasorum worms live?

A

pulmonary arteries and right side of the heart

226
Q

what happens to larvae of Angiostrongylus vasorum worms in the lungs?

A

migrate to alveoli and are coughed and swallowed

227
Q

what are the clinical signs of Angiostrongylus vasorum?

A

wide range
respiratory disease
increased bleeding tendency
neurologic signs

228
Q

what are the main signs of respiratory disease resulting from Angiostrongylus vasorum?

A

inflammatory response - chronic cough and acute dyspnoea

severe pulmonary hypertension - syncope, abnormal right ventricular structure and function

229
Q

what is the most common sign of Angiostrongylus vasorum?

A

chronic cough

230
Q

what is increased bleeding tendency seen with Angiostrongylus vasorum infection caused by?

A

unknown mechanism - may be consumptive coagulopathy

231
Q

what are the neurological signs of Angiostrongylus vasorum caused by?

A

CNS haemorrhage

232
Q

what would be seen on the chest x ray/CT scan of a patient with Angiostrongylus vasorum?

A

combination of patchy bronchial, interstitial and alveolar patterns
peripheral distribution of defects
no vascular changes

233
Q

how can Angiostrongylus vasorum be diagnosed?

A 
Angio-detect - antigen detection
PCR
faecal smear
Baermann faecal examination
empirical treatment (e.g. advocate) for clinical improvement
234
Q

what does a positive Angio Detect result indicate?

A

Angiostrongylus vasorum

235
Q

what does a negative Angio Detect result indicate?

A

A. vasorum is very unlikely but another lungworm is possible

236
Q

how can Angiostrongylus vasorum be treated?

A

Moxidectin - 2 doses, 30 days apart

Fenbendazole - SID for 10-20 days

237
Q

what post treatment reaction may be seen after treatment for Angiostrongylus vasorum?

A

dyspnoea
ascites
sudden death

238
Q

what is the prognosis of Angiostrongylus vasorum?

A

depends on severity of clinical signs

239
Q

what is bacterial pneumonia caused by?

A

mixed flora - aerobic and anaerobic

240
Q

how may bacterial pneumonia be spread?

A 
inhaled bacteria
haematogenous spread (blood vessels)
241
Q

what lobes of the lung may be affected by bacterial pneumonia?

A

may be unilobar or multilobar

242
Q

what are the 2 presentations of bacterial pneumonia?

A

acute and chronic

243
Q

what is bacterial pneumonia associated with?

A

abscess
pleural effusion
pneumothorax

244
Q

why are there predisposing causes for bacterial pneumonia?

A

should not occur if the mucociliary escalator is working

245
Q

what are the predisposing causes of bacterial pneumonia?

A 
chronic bronchitis
bronchiectasis
immunosuppression
foreign body
aspiration
246
Q

what may be caused by aspiration?

A

bacterial pneumonia

chemical pneumonitis

247
Q

what is chemical pneumonitis?

A

burning of the airways by stomach acid

248
Q

what often causes aspiration pneumonia?

A

brachycephalic breeds
oesophageal disease
laryngeal disease

249
Q

what are the respiratory signs of bacterial pneumonia?

A 
soft and productive cough
mixed dyspnoea
tachypnoea
exercise intolerance
crackles or wheezes on auscultation
250
Q

what is mixed dyspnoea?

A

inspiratory and expiratory signs

251
Q

what are the systemic signs of bacterial pneumonia?

A

pyrexia
lethargy
inappetance

252
Q

does normothermia exclude bacterial pneumonia?

A

no

253
Q

what investigations will be performed to diagnose bacterial pneumonia?

A

haematology
C reactive protein
SpO2 or arterial blood gas
chest x rays / CT

254
Q

what signs are you looking for in haematology tests for bacterial pneumonia?

A

neutrophillia (left shift)

neutropenia

255
Q

what is C reactive protein useful for in a patient with bacterial pneumonia?

A

monitoring

256
Q

at what SpO2 or PaO2 is the patient classed as hypoxic?

A

<94%

<80mmHg

257
Q

what signs are you looking for in x ray or CT scans for bacterial pneumonia?

A

alveolar pattern with ventral distribution
dorso-caudal distribution (haematogenous spread)
interstitial pattern - early pneumonia

258
Q

when may x rays for bacterial pneumonia be repeated?

A

48-72 hours later

259
Q

what should you wait for if prescribing antibiotics?

A

culture result if possible

260
Q

what is the empirical treatment for bacterial pneumonia?

A

PO doxycycline

261
Q

what is the treatment for aspiration pneumonia?

A

no antibiotics if chemical pneumonitis

IV amoxycillin-clavulanic acid

262
Q

what is the treatment for bacterial pneumonia where the patient is also septic?

A

IV fluroquinolones and ampicillin or clindamycin

de-escalate if possible

263
Q

how long should bacterial pneumonia patients be treated wirth antibiotics for?

A

10-14 days and reassess (clinical exam, haematology and chest x rays)

264
Q

what are the main nursing considerations during treatment of bacterial pneumonia?

A 
oxygen supplementation if hypoxic
fluid therapy
nebulisation to increase mucous fluidity
bronchodilatiors
mucolytic?
treatment of predisposing factors
265
Q

what effect can dehydration have on mucocilliary defences?

A

impairment

266
Q

what are the issues with using mucolytics?

A

some may cause bronchoconstriction (e.g. nebulisation of N-acetylcysteine)

267
Q

what is the prognosis of bacterial pneumonia?

A

depends on severity of clinical signs

268
Q

what may be required if the bacterial pneumonia patient has pneumothorax and abscessation?

A

lung lobectomy

269
Q

what is required to keep lungs inflated?

A

negative intrathoracic pressure

270
Q

what type of defect is a pleural effusion?

A

restrictive

271
Q

what does pleural effusion lead to?

A

gradual collapse of the lungs and and increase in intrathoracic pressure which becomes positive

272
Q

what will lead to immediate relief of pleural effusion?

A

removal o fluid

273
Q

what may be seen secondary to active inflammation / pneumothorax?

A

pleural effusion (trapped lung)

274
Q

what happens if pneumothorax is left untreated?

A 
decreased cardiac output
cardiac arrest (esp. pneumothorax)
275
Q

what is the clinical presentation of pleural space diseases?

A

tachypnoea
restrictive dyspnoea
paradoxical breathing

276
Q

what is restrictive dyspnoea?

A

rapid and shallow breathing

277
Q

what diseases is restrictive dyspnoea only seen with?

A

pleural space diseases

278
Q

what are the specific signs on auscultation from pleural effusion?

A

muffled lung sounds ventrally

decreased resonance ventrally

279
Q

what are the specific signs associated with pneumothorax?

A

absent lung sounds dorsally

increased resonance dorsally

280
Q

why are pleural effusion signs seen ventrally?

A

gravity pulls fluid down

281
Q

why are pneumothorax signs seen ventrally?

A

air collects at highest point

282
Q

what are the signs of respiratory distress?

A 
orthopnoea (body position)
mouth breathing
tachypnoea/hyperpnoea
respiratory noises
cyanosis
restrictive dyspnoea
283
Q

what is inspiratory dyspnoea linked to?

A

upper airway obstruction (increased respiratory noises)

284
Q

what is expiratory dyspnoea linked to?

A

dynamic lower airway obstruction (abnormal auscultation)

285
Q

what is mixed dyspnoea linked to?

A

parenchymal (disease of the lung tissue itself) disease

286
Q

what is mixed dyspnoea with restrictive pattern linked to?

A

pleural space disease

287
Q

how serious are pleural space diseases?

A

life threatening

288
Q

how are pleural cavity diseases diagnosed?

A

chest radiographs if the patient is stable
thoracic ultrasound if not
thoracocentesis
fluid analysis

289
Q

what may be seen on a chest radiograph which indicates pleural cavity diseases?

A

decreased details

cardiac silhouette is hard to see

290
Q

what are the signs of chronic pleural effusion on chest x ray?

A

rounded lung margins

291
Q

what are the tubes needed for analysis of fluid from the thoracocentesis?

A

EDTA tube for cytology

plain tube for culture and biochemistry

292
Q

what is thoracocentesis?

A

aspiration of air or fluid from the pleural cavity by inserting a needle, catheter or drain via a caudal rib space

293
Q

what area should be prepared for thoracocentesis?

A

around the 8th rib

294
Q

what needle is usually required for thoracocentesis?

A

butterfly or simular

295
Q

how should the area of skin be prepared for thoracocentesis?

A

clipped and aseptically prepped

296
Q

what equipment is required for thoracocentesis?

A 
needle
3 way tap
extension set if needed
sterile drapes
sterile gloves
surgical spirit
LA
blade if needed
measuring drug if effusion
297
Q

where should the needle for thoracentisis be placed?

A

cranial aspect of the rib

298
Q

why shouldn’t the needle be placed on the caudal aspect of ribs during thoraentesis?

A

nerves and blood vessels on caudal side

299
Q

when may a thoracic drain be placed?

A

if there is a large effusion present

300
Q

how should thoracic drains be cared for?

A

aseptic

good hand hygiene - sterile equipment

301
Q

how should thoracic drains be dressed?

A

sterile dressing, stocking and buster collar to prevent patient interference

302
Q

what can be understood by analysing the fluid from thoracocentesis?

A

why the fluid accumulated

303
Q

what are the 4 types of fluid that can be collected from thoracentesis?

A

pure transudate
modified transudate
exudate
miscellaneous

304
Q

describe pure transudate

A

protein poor

clear fluid

305
Q

what is the total protein of pure transudate?

A

<20 g/L

306
Q

what is the total nucleated cell count of pure transudate?

A

<1.5x10^9

307
Q

describe modified transudate

A

protein rich

yellow blood tinged fluid

308
Q

what is the total protein of modified transudate?

A

> 20g/L

309
Q

what is the total nucleated cell count of pure transudate?

A

<5x10^9/L

310
Q

describe exudate

A

turbid fluid

311
Q

what condition is associated with pure transudate?

A

hypoalbuminaemia

312
Q

what are the main causes of hypoalbuminaemia?

A

liver failure
protein loosing enteropathy
protein loosing neuropathy

313
Q

what diseases can lead to modified transudate within pleural fluid?

A

congestive heart failure
pericardial disease
neoplasia
diaphragmatic rupture

314
Q

in what animals is modified transudate often found in pleural fluid during CHF?

A

cats

315
Q

what cardiac marker may be used to detect cardiac related pleural effusion in cats?

A

NT pro-BNP

316
Q

what can diagnose neoplasia from thoracentesis?

A

cytology of sample

317
Q

what are the 2 types of exudate?

A

non-septic

septic

318
Q

what cells will be seen in non-septic exudate?

A

neutrophils
marcophages
eosinophils
lymphocytes

319
Q

is there any evidence of organisms in non-septic exudate?

A

no

320
Q

what are the causes of non-septic exudate?

A 
FIP
neoplasia
diaphragmatic hernia
lung lobe torsion
resolving pyothorax
321
Q

what are the levels of TP and globulin seen in patients with FIP?

A

high total protein in effusion

high globulins in blood

322
Q

what cells are seen in septic exudate?

A

degenerate neutrophils

323
Q

what is the cause of septic exudate?

A

pyothorax

324
Q

what bacteria may been seen in septic exudate?

A

intra or extracellular bacteria

anaerobic (foul smelling)

325
Q

how is sepsis treated?

A

IVFT

antibiotics

326
Q

what are the causes of septic exudate?

A

bite
foreign body
iatrogenic (thoracentesis)
parapneumonic

327
Q

describe the appearance of chylothorax?

A

milky

328
Q

what is the TP of chylothorax?

A

> 25 g/L

329
Q

describe the total nucleated cell count of chylothorax

A

variable - small lymphocytes but may be some neutrophils id ongoing inflammation

330
Q

is the triglyceride in chylothorax effusion higher or lower than plasma?

A

higher

331
Q

what are the causes of chylothorax?

A 
idiopathic
cardiac disease
cranial vena cava thrombosis/mass
heartworm disease
neoplasia
332
Q

what is the haematocrit of haemothorax?

A

> 20%

or >50% of patient haematocrit

333
Q

what does haemothorax lead to?

A

hypovolaemia

334
Q

what are the causes of haemothorax?

A 
anticoagulant rodenticide
coagulopathy
lung lobe torsion
trauma
neoplasia (rib)
335
Q

what are the complications of thoracocentesis?

A

particularly with chronic effusion
pyothorax
pneumothorax

336
Q

how are pleural effusions diagnosed and treated?

A

thoracocentesis (with drain)

treatment of underlying disease

337
Q

how is lung neoplasia treated?

A

depends on tumor type - chemo or surgery

338
Q

how is lung lobe torsion treated?

A

lobectomy

339
Q

in what animals is lung lobe torsion the most common?

A

narrow, deep chested dogs

also reported in pugs

340
Q

what may lung lobe torsion occur secondary to?

A

other causes of effusion

341
Q

how is diaphragmatic rupture treated?

A

surgrey

342
Q

how is pyothorax treated?

A

IV fluroquinolone and penacillin or clindamycin
de-escalate antimicrobials where possible
therapeutic drain
lavage if drain present
surgery

343
Q

how is chylothorax treated?

A

manage underlying disease
Rutin to stiulate macrophages to remove lipids from effusion
surgery if idiopathic
spontaneous heal if traumatic rupture of thoracic duct

344
Q

what surgery is used to treat chylothorax?

A

thoracic duct ligation

+/- pericardiectomy

345
Q

what is pneumothorax?

A

accumulation of air in the pleural space

346
Q

what are the causes of pneumothorax?

A

trauma
spontaneous
iatrogenic

347
Q

what are the spontaneous causes of pneumothorax?

A

blebs and bullae

chronic airway disease (asthma in cats)

348
Q

what are blebs and bullae?

A

blistered lesions of the lungs

349
Q

what are the signs of pneumothorax seen on physical exam?

A

no lung sounds audible on dorsal aspect

hyper-resonant percussion

350
Q

how is pneumothorax diagnosed?

A

radiography

ultrasound

351
Q

how is pneumothorax treated?

A 
rest
thoracocentesis as required
chest drain (rapid accumulation)
O2 therapy
continuous drainage and exploratory thoracotomy may be required
352
Q

what are the main nursing considerations associated with pneumothorax?

A 
delay diagnostics until stable
low stress 
SpO2 monitoring
supplement O2 if hypoxaemia (<95%)
consider sedation if needed 
thoracocentesis prep (e.g. clipping)
cover any obvious chest wounds to prevent entry of air
353
Q

what is the role of the VN in caring for pleural space disease patients?

A 
chest drain care
O2 therapy
obs and monitoring
medication including analgesia
care of wounds and drains
fluid therapy
shock treatment
recumbent patient care
feeding and exercise adjustments
354
Q

describe how to perform thoracocentesis

A

7th to 8th intercostal space
costochondral junction for fluid, higher for air
enter chest cranial to rib then redirect caudally

X Clinical Veterinary Nursing Theory (70 decks)

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