lower respiratory Flashcards
(33 cards)
pna
acute infection of lung parenchyma (functional unit = alveoli)
rf: >65, altered LOC, weak cough, bed rest and prolonged immobility, debilitating illness, malN, smoke, tracheal intubation (vent in ICU)
pna: community acquired
no hospital or long term care facility within 14 days of onset
pna: hospital acquired
non intubated (VAP), 48+ hr after admission and was not present at admission
pna: viral
most common, mild or self limiting <-> life threatening, usually resolves 3-4 days
pna: bacterial
may require hospitalization
pna: aspiration and opportunistic
immunocompromised
asp = abn entry of material from mouth or stomach into trachea/lungs
rf = decreased LOC, dysphagia (esp with thin liquids), NG tube (why we place below sphincter)
may be silent
pna: cm
usually preceded by URI
fever, chills, cough, malaise, chest pain with inspiration and coughing, dyspnea, fatigue, myalgia, confusion in elderly!
cough: bacterial = productive, purulent (green, rusty, red currant jelly); viral = nonP/scant
resp distress = failure
pna: diagnose
s/s on PA or…
CXR: infiltrates (hazy)
wbc with diff: leukocytosis with bacterial, shift to L (increase immature neutrophils, with acute bacterial infeciton)
+ sputum for c+s
pna: nc
educate: vaccine, dont smoke, adequate rest/sleep and balanced diet
during hospitalization: know at risk (asp), pulm toilet, early ambulation, strict adherence to standard precautions and HH
acute interventions: VS/pulse ox (trend, regular, fever, tachy, increase in BP and RR), auscultate lungs (baseline at start of shift), supplemental o2, CPT, pulm toilet, fluids, ambulate, E conservation, drugs (analgesics, abx, antipyretics), teaching to stay healthy after d/c
OPD
asthma, emphysema (alveolar damage -> stretched and over inflated = COPD), chronic bronchitis (excessive secretion production)
preventable and treatable
COPD (no hospital) v exacerbations (resp infection, hospital, flare)
diagnose based on hx, s, spirometry results
OPD: cm
barrel chest: increased AP diameter d/t hyperinflation - thorax expand to create 1:1 bc increased WOB
breath sounds: diminished, wheeze, rales, +/or ronchi
prolonged expiration
OPD: S of advanced disease
pursed lip breathing (increased + P to get rid of air), neck vein distention/peripheral edema (pulmonary htn d/t extended expiration, harder for blood to get in), cachexia (v malN, v thin)
OPD: nc
dont smoke, vaccine, early detection of resp infection
inhaler therapy -> self management, adherence!: long acting beta agonist (1st!, bronchodilate), long acting muscarinic antagonist (bronchodilate), inhaled corticosteroid (decrease inflam)
o2 admin (88-92%), home or hospital
tripod, pursed lip breathing, cough techniques (huff = lots of tiny otw to big), E conservation and relaxation, extra cals, psych support - scary when you cant catch breath
OPD: manage acute exacerbation
worsening beyond day to day, need change in treatment plan
hypoxemia in hospital -> o2 therapy: >90%, never withold o2, CPAP when hypercapnic
bronchodilators (MDI or wet neb), CPT, abx
OPD: co2 narcosis
stimulus to breath is decreased oxygenation, instead of increased CO2 (need ABGs to diagnose as CO2 retainer)
cant stop breathing when given high O2 - dont withold, but will need to intubate
tb
mycobacterium
MDR if resistant to INH and rifampin
tb: rf
poor, underserved, minorities, IV drug users, low sanitization, overcrowded living conditions, immunosuppression
tb: primary
bacteria inhaled, inflam response, most mount effective response to encapsulate organism, usually asymp
tb: latent
persistent state of immune response to bacterium w/o cm of active tb, asymp, not contagious, + skin/blood test, can become active
tb: reactivated
after latent tb in 5-10%, increased risk in high risk group (old and immunocompromised is worst), transmissible
tb: cm - latent
+ tb test, may/may not have ghon nodule on CXR, asymp
tb: cm - active
+ AFB sputum, fever, night sweat, weight loss, productive cough with purulent or bloody sputum for >3wk
tm: diagnose
eval cell mediated immunity
skin (mantoux): ID injection, bled 48-72 hr, measure induration (raised), dont want
IGRA blood
if either +, step 2 -> CXR for ghon nodule
- = latent
+ = more testing
AFB sputum
15 mm induration
+ in anyone
