Lower Respiratory diseases Flashcards
(124 cards)
1
Q
What is influenza?
A
acute, highly contagious respiratory infection
highest incidence in school children, more severe in young children (tend to ahve high fevers, susceptible to pulmonary complications and Reye sundrome)
known viruses that cause influenza r orthomycovirus types A, B, C but there r mutant strains
- secondary bacterial pneumonia after influenza most often is caused by hemolytic Streptococcus, Staphylococcus and Pneumococus
2
Q
Stats of influenza (cases in US, hospitalization, deaths, worldwide cases and deaths)
A
cases in US - 5-10%
hospitialization in US - 200,000
deaths in US - 36,000
Worldwide cases - 3-5 millions
Worldwide deaths - 250,000-500,000
3
Q
ppl at risk of getting influenza related complications
A
- children under age 5
- adults over age 65
- pregnant women
people with: - immune deficiency
- HIV/AIDS, cancer
- diabetes mellitus
- chronic respiratory diseases such as asthma, bronchitis, cystic fibrosis, emphysema
- chronic diseases
4
Q
s/s of influenza
A
s/s:
- inflammatio nof upper and lower respiratory tract mucous membranes
- fever
- cough
- muscle or body aches
- headache
- fatigue
- sore throat
- generalized maliase
- chills
- chest discomfort
- weakness
- sweating
Complications of flu:
- bacterial pneumonia
- ear infections
- sinus infections
- dehydration
- worsening of chronic medical conditions
5
Q
When is flu most common + how is it transmitted?
A
most common in winter
transmitted by respiratory droplets
6
Q
how to diagnose + treat flu?
A
diagnose - based on s/s, diagnostic tests, WBC count, isolation of virus from nasopharyngeal culture, sputum cultre isolates bacteria in secondary infection
treat - flu mostly self resoves in 2 weeks, increased fulid intake, light diet,antiviral meds can be used, symptomatic treatment is common like cough suppressant and acetaminophen for headaches, antipyretics and analgesics
7
Q
What is pneumonia?
A
infection in one or both lungs affecting primarily the alveoli (alveoli r filled with pus and fluid = breathing is painful and limits O2 intake)
8
Q
risk factors for pneumonia?
A
- age (younger than 5 years or over 65 years)
- mmune deficiency
- having certain chronic diseases (asthma, heart disease, chronic obstructive pulmonary disease)
- smoking
- being on a mechanical ventilator
9
Q
types of pneumonia?
A
not acquired in hospital = community-acquired pneumonia
aspiration pneumonia - aspiration of liquids or other material into tracheobrachial tree
developed in healthcare facility - healthcare-associated pneumonia splits into hospital-acquired pneumonia
and ventilator-associated pneumonia
atypical pneumonia (aka walking pneumonia) is pt who has abn in chest radioraph but doesnt appear significantly ill
10
Q
s/s of pneumonia
A
reduced breath sounds and crackles
percussion note is dull
hemaptysis
cough (the person may cough up mucus or blood)
fever
chills
dyspnea
chest pain
SOB
sweating
11
Q
What is the cause for pneumonia?
A
bacterial infection, most commonly streptococcus pneumoniae in US and if viral infection than influenza, parainfluenza and respiratory syncytial viruses
could also be staphylococcus aureus and adenovirus and pneumocystis jirovecii (pneumonia in AIDS pt)
12
Q
how to diagnose and treat pneumonia
A
diagnose - medical history, physical examination, a chest x-ray, and sputum culture, abg, bronchoscopy, sputum and blood culture
treatment - varies based on etiology, if bacterial then antibodies (penicillin for pneumoxoccal pneumonia), if viral than symptomatic treatment and rest, o2 therapy, increased fluid intake, pain relivers and high cal diet
13
Q
What is tuberculosis (TB)
A
a potentially fatal contagious disease that is mainly an infection of the lungs
14
Q
What are the risk factors of TB?
A
weakened immune system
substance abuse
tobacco use
being a health care worker
living in a residential care facility.
15
Q
etiology of TB?
A
Mycobacterium tuberculosis, its spread through microscopic droplets release by infected ppl
infects the lungs and induces a chronic inflammatory response that leads to necrosis
infection begins as primary lesion in lower area of lung (as body’s defense mechanisms respond to bacteria invasions, antigens that cause necrosis r produced, fibrosis, calcification)
16
Q
What is latent TB infection?
A
when the immune system is able to stop the bacteria from growing
are asymptomatic and cant spread infection
17
Q
what happens when TB bacteria is active?
A
pt officially have TB disease, r symptomatic and can spread the disease
18
Q
What are the s/s of TB?
A
- purulent sputum
- Auscultation may reveal diminished breath sounds and crackles
- bad cough that lasts 3 weeks or longer
- pain in the chest
- coughing up blood or sputum
- weakness or fatigue,
- weight loss
- no appetite
- chills
- fever
- night sweats
- reduced appetitie
- litlessness
- dry cough
- loss of energy
- fever
19
Q
What does infected TB tissue look like?
A
soft and cheeselike, called caseous lesion
heals with fibrosis and calcification or scarring that walls off baceteria into pockets for months or yr
20
Q
what are tubercles?
A
lesions created by healing lings that walls off bacteria into pockets for months or years
21
Q
How to diagnose tb?
A
- medical history,
- physical examination
- test for TB infection (TB skin test or TB blood test)
- chest x-ray
- sputum smear
- chest radiographs
- examination of gastric washings
- fiberoptic bronchoscopy
- sputum cultures
22
Q
What is the mantoux skin test for TB infection?
A
antigens from TB bacteria r injected beneath skin, if pt was previously exposed to TB skin swells with slight elevation at the injection site
23
Q
how to treat TB?
A
treated with antibodies
latent = isoniazid
active = multipe antituberculsosi agents (Isoniazid, rifampin, ethambutol, pyrazinamide)
no vaccinations in US
24
Q
What is Chronic obstructive pulmonary disease (COPD)?
A
a preventable and treatable disease characterized by progressive airflow limitation associated with abn inflammatory response of the lungs to noxious particles or gases (is not fully reversible)
25
what are the categories of COPD?
emphysema, chronic bronchitis, bronchiectasis, asthma, CF, pneumoconiosis
26
What is the 3rd leading cause of death in the US?
COPD
27
what are the risk factors for COPD?
exposure to tobacco smoke
occupational exposure to dust and chemicals
genetics (alpha-1-antitrypsin deficiency)
28
s/s of COPD?
Auscultation may reveal wheezing or crackles and decreased breath sounds
The percussion note is hyperresonance
dyspnea
frequent coughing
wheezing
tachypnea
tightness in the chest
29
Main cuase of COPD?
tobacco use
30
how to diagnose COPD?
diagnose - medical history, physical examination, spirometry, chest x-ray, CT scan, ABG analysis
31
how to treat COPD?
smoking cessation
bronchodilators to relax the muscles around the airways
inhaled steroids to decrease inflammation
supplemental oxygen
pulmonary rehabilition,
in rare cases surgery (lung reduction surgery to remove damaged lung tissue, lung transplant)
32
What is emphysema?
long-term, progressive obstructive lung disease in which the
alveoli are destroyed which causes SOB and loss of elasticity in remaining alveoli
33
risk factors for emphysema
smoking
exposure to secondhand smoke
occupational exposure to dust and chemicals
genetics (alpha-1-antitrypsin deficiency)
34
what occurs in emphysema?
alveolar walls break down, adjacent alveoli fuse, and the lungs lose their elasticity and surface area required for normal gaseous exchange
Air cannot be adequately exhaled to allow oxygen to enter, and the lungs become filled with air that is high in carbon
dioxide.
35
what is s/s of emphysema?
- dyspnea and coughing
- tachynpnea
- Auscultation may reveal decreased breath sounds, crackles, and wheezing
- The percussion note is hyperresonant.
- cyanosis
- edema of the feet and ankles
- fatigue
- headache (especially in the morning)
- wheezing
- barrel chest (caused by enlargement of the lungs and chest wall)
- ineffective use of breathing muscles.
- pursed-lip breathing
- Patients may also have a tendency to lean forward and support themselves with their arms on a surface in front of them or on their knees
- circumoral cynasosis (right ventricular heart failure)
- digital clubbing
36
how to diagnose emphysema?
medical history
physical examination
blood tests (complete blood count and ABG)
imaging tests (chest x-ray and CT scan)
pulmonary function tests (spirometry and peak flow).
37
how to treat emphysema?
goal of treatment is to reduce symptoms and slow progression of the disease
- stop smoking
- bronchodilators
- alpha -1 protease inhibitor for pt with familial emphysema
- supplemental O2
- beta2-adrenergic sympathomimetic drugs alone or w/ inhaled corticosteroids
- antispasmodic
- antibiotics
- expectorants
- treatment for GERD
- pulmonary rehabilitation
- surgery
38
What is chronic bronchitis?
chronic inflammation of the bronchi
having a cough with sputum production that last at least 3 months for 2 consecutive yrs
acute is part of a general URI (after commmon cold or other viral infection of naspharynx and pharynx), recurring may indicate focus of infection (chornic sinusitis, bronchiectasis, pneumonia), hypertrophied tonsils and adenoids, allergens, pneumonia bacteria , smoking or exposure to industrial poolution or recurrent infectiosn
39
Risk factors for chronic bronchitis
- tobacco use
- exposure to secondhand tobacco smoke
- exposure to irritants on the job
- decreased immunity
40
What is hypoxia?
insufficient oxygen of the tissue
41
What does excessive secreretion of mucus result in?
excessive secretion of mucus blocks airflow through the bronchi which reduce persons ability to obtain enough O2m which = infections = leading scarring destruction of cilia and tissue death
42
What are the s/s of chronic bronchitis?
Auscultation may show decreased breath sounds, wheezing, and crackles
The percussion note will be normal to hyerresonant.
mucus-producing cough
wheezing
fatigue
slight fever
chills
chest discomfort
43
Who are at high risk of developing chronic bronchitis?
People exposed to industrial dusts and fumes in the workplace, such as coal miners, grain handlers, and metal molders
44
how to diagnose chronic bronchitis?
medical history
physical examination
chest x-ray
spirometry
sputum analysis
pulmonary function test
ABG
other blood and sputum analysis
45
What is the treatment for chronic bronchitis?
the goal is to relieve symptoms, prevent complications, and slow progression of the disease
- quit smoking
- bronchodilator meds
- pulmonary rehab
- surgery
- low-flow oxygen therapy for hypoxemia
- postural drainiange and percussion
- aerosolized corticosteroids
46
What is asthma?
condition in which the bronchial tubes in the lungs react to certain stimuli by becoming inflamed (constriction of bronchioles and inflammation of airway)
- leading cause of chronic illness and school absenteeism in children
47
What are the risk factors for asthma?
family history of asthma and exposure to certain irritants known as triggers
48
What is the etiology of asthma?
it's idiopathic, it is known ppl with asthma have very sensitive airwats that react to many diff substnaces ,activites and conditions
49
What are common asthma triggers?
indoor and outdoor allergens (pollen, cockroaches and their excrement, molds, household dust mites, pet dnader)
tobacco smoke
chemical irritants (perfumes, colognes and aftershaves)
cold air
extreme emotional arousal
certain medications (aspirin and other nonsteroidal anti-inflammatories and beta blockers)
physical exercise
50
how to diagnose asthma?
based on s/s, med history, phyiscal exam, spirometry, peak flow, and bronchial provocation, chest xray, allergy testing, pulmonary functoin test, chest radiography, CBC and differnetial leukocyte count which may show an increaed eosinophil count and elevated serum IgE levels
51
what are the s/s of asthma?
intercostal or sternal retraction
dyspnea
tightness in the chest
coughing
wheezing
incessant productive or nonproductive cough
expiratory wheeze
rapid shallow respirations
- labored vreathing results in rapid pulse, pallor, profuse perspiration, inabiltiy to speak more than a few words without halting to breathe
nasal flaring
pt is often anxious is exhausted and reports tight chest
Auscultation may reveal decreased breath sounds and wheezing
52
What occurs during asthma?
bands of muscles that r normally relaxed tighten with asthma, restricting airflow, causing pt to feel SOB and create wheezing sound
53
What is an asthma attack?
sudden worsening of asthma s/s
54
How to treat asthma?
1. meds - steroids and anti-inflam meds and bronchodilators
- drugs like cromolyn sodium , albuterol, theophylline, aerosol corticosteroids, allergy evaluation and skin testing may indicate immunotherapy by desentization injection, commonly called allergy shots
steroids, inhalation therapy, supplemental oxygen, status asthmaticus may ead to fatal respiroatry failure and thuse need for endotracheal intubation
55
hat is the most important treatment for pt w/ asthma?
anti-inflam meds (particularly inhaled steroids)
56
What are bronchodilators?
meds to relax muscles that can tighten around airways and help open them up
short-acting bronchodilators r rescue inhalers
long-acting bronchodilators r used with inhaled steroid for ongoing asthma s/s
57
What is a nebulizer?
asthma inhaler that delivers asthma drugs to lungs by changing asthma meds from liquid form to mist so they can be more easily inhaled into lungs
58
What is cystic fibrosis (CF)?
autosomal recessive inherited disease (chronic dysfunction of a gene called cystic fibrosis transmembrane conductance regulator (CFTR))
- most common fatal genetic disease
affects the exocrine glands of the lungs and pancreas causing these glands to secrete excessive thick mucus
59
what is the risk factor for CF?
family history of CF or being Northern European or Central European
60
Other CF factors?
- higher levels of salt in sweat
- thick sticky mucus secreted in lungs = dyspnea, wheezing, and persistent cough with thick sputum
- increased susceptibility to recurrent lung infections
- excessive mucus blocks ducts of pancreas = no release of digestive enzyme = wt loss and malnutrition
- pancreatic glands become dilated and develo into cysts containing thick mucus
61
What is bronchiectasis?
weakened and dilated bronchial tubing, resulting from destructio nof muscular and elastic portions of the bronchial walls
common complication/ aftermath of CF
Caused by repeated damage to bronchial wall caused by recurrent airway infections (pneumonia, TB, bronchal obstruction, inhalaltion of a corrosive gas, measles, pertussis, immunedeficiency)
62
how to did cystic fibrosis get it's name?
from the fibrous tissue that forms around these cysts.
63
what is tested in newborns in US?
higher levels of immunoreactive trypsinogen (IRT) released by the pancreas
then test for genetic and sweat test
64
diagnosis and treatment for CF?
diagnose - genetic testing prenatally, fmaily history, pulmonary fucntion, chest radiography, stool studies, sweattest
treatment:
ease s/s, reduce complications
high calorie, high soidm chloride diet
chest physiotherapy
supplementation of vitamins A, D, E and K
increase fluid intake
pancreatic enzyme supplementation to aid in digestion
exercise to loosen mucus to be coughed up
mucus-thinning meds
anti-inflam meds to reduce swelling
bronchodilators
oxygen therapy
nebulizer
percussive therapy
65
What is pleurisy/ pleuritis?
inflammation of the pleural membrane lining the chest wall and encasing each lung
usually secondary to other diseases or infections (may result from injury or presence of tumor0
2 types: wet (extra pleural fluid btwn 2 layers of plural membranes = compression of pulmonary tissue and dynspnea) and dry (pleural fluid decreases involume = dryness btwn pleura so layers rub together)
66
risk factors of pleurisy?
lung infection
chest trauma
pulmonary embolism
67
s/s of pleurisy?
sharp chest pain that worsens with breathing in or coughing caused by inflamed pleura layers rubbing together
may cause dyspnea and tachypnea
auscultation reveals a pleural rub
cough, fever, chills
inspiration r shallow, rapid and restricted
68
How to diagnose and treat pleurisy?
diagnose - based on s/s , physical exam, blood test for pathogens, imaging tests, testing pleural fluid and tissue to determine cause (and if it's bacterial infection)
treat - maybe antibiotics, over-the-counter or prescription nonsteroidal anti-inflammatory meds, antibiotics, analgesics,
69
What is pneumothorax?
collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse
(pressure in pleural space is higher than pressure in lungs)
70
risk factors for pneumothorax:
being male, smoking, being tall and underwt, having certain lung diseases and history of pneumothorax
71
s/s of pneumothorax?
sudden, sharp pain on the same side as the affected lung dyspnea
Auscultation may reveal diminished or absent breath sounds on the affected side.
The percussion note is tympanic.
mediastinal shift
severe SOB
falling bp
rapid weak pulse
cyanotic
appears anxious
increased air pressure
72
What can penumothorax be caused by?
traumatic pneumothorax - injury to chest, damage to lungs caused by underlying lung disease (emphysema, TBB, CF< pneumonia, lung cancer)
rupture of air-filled blisters (blebs) found in lungs of some ppl who are tall and underwt
erosion of alveoli from tumor or disease
73
how to diagnose and treat pneumothorax?
diagnose - symptoms, physical exam, ausculation of lungs, radiography or CT, thoracostomy, ABG analysis, imaging tests
treat - small portion = monitoring, if large area, a needle or chest tube is inserted into the chest cavity to relieve the pressure on the lungs to reexpand, may need surgery, fowler or semi-fowler position, thoractostomy, closed drainage system is established if air continues to leak into pleural space
74
What is atelectasis?
collapse of lung tissue affecting part of or all of one lung
alveoli in that part can no long fill with air = no gas excgabge
75
risk factors for atelectasis
anesthesia
prolonged bed rest with few changes in position, shallow breathing
underlying lung disease
76
s/s of atelectasis?
substernal retraction
mediastinal shift toward side of collapse
dyspnea
chest pain
cyanosis
coughing
Auscultation may reveal diminished or absent breath sounds on the affected side
The percussion note is dull
hypoxia
anxiety
diaphoresis
tachycardia
fever
77
most common cause of atelectasis?
blockage of bronchu or bronchioles or by pressure on the lungs through a mucus plug where drugs during surgery = less inflation in lungs = normal secretions collect in airways and smthms surgery doesnt compeltely clear them away
compression is when tumor exerts pressure on lung and doesnt allow air to enter that part
inflammaotry is result of accumnulation of fluid in pelueral cavity
78
who is mucus plugs most common in?
Pt with CF, during severe astham attack
79
diagnose atelectasis?
diagnose - med history, physical exam and chest xray, CT, bronchoscopy
80
how to treat atelectasis?
- aerosolized respiratory treatments to open the airway
- positioning the body on the unaffected side to allow the affected lung to reexpand
- removing obstructions by bronchoscopy
- breathing exercises, clap, or percussion on the chest to loosen mucus
- tilting the body (postural drainage) so that the head is lower than the chest to drain mucus
- treating a tumor or underlying condition, if present
- spirometry
- analgesics
- sirgcal drainage of pleural effusion
81
What is a pulmonary embolism?
blockage in one or more arteries of the lungs
etiology is usually thrombi from deep vein in legs or pelvis, can be composed of air, fat globules, small piece of tissuem cluster ofg vacteira
82
risk factors for PE?
- prolonged immobility
- having major surgery
- hip or leg fractures
- having a family history of PE
- cancer
- smoking
- obesity
- a history of heart attack or stroke
- pregnancy
- taking birth control pills
- hormone therapy.
83
what are the s/s of pulmonary embolism?
cough that may produce bloody or blood-streaked sputum
sudden dyspnea
tachypnea
chest pain
tachycardia
apprehension
cough
low-grade fever
massive can elad to cyanoisis, shock, death
84
what is most common cuase of PE?
In most cases PE is caused by a blood clot in the leg
that breaks loose and travels to the lung
85
howto diagnose and treat PE?
Diagnose - medical history, physical examination for ausculation (reveals crackles and pleural rubs in area of embolism in 1/2 of PE pt) and imaging tests, lunh scanning, CT angiography, ECG, auscultion, ABG for reduced partial persure of oxygen and carbon dixoide
treatments - usually anticoagulation, use clot dissolvers or surgery in extreme cases, oxygen therapy, thrombolytic drugs, early ambulation, low-dose anticoagulultiaotn agents, tnromboembolic detterent stockings
86
What is lung cancer?
malignant neoplasm arising in lung tissue
leading cause of cancer death in men and women in US (causes 30% of all deaths)
usually caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell diviison
avg age of diagnosis is 70
87
risk factors of lung cancer
smoking
exposure to secondhand smoke
age (over 65)
exposure to asbestos or radon
genetics, and a family history of lung cancer
88
2 basic types of lung cancer
non-small cell lunger cancer (NSCLC) accounts for 80% of lung cancer
small cell lung cancer = 20% (almost exclusively in smoker, has rapid growth rate, metastazies early in disease process)
89
s/s of lung cancer
develops slowly, only seen in later stages of lung cancer
coughing, chest pain, hemoptysis
blood in sputum bc erosion of bv
dyspnea, wheezing bc of airway obstruction from compression by tumor and body fluids such as mucus and blood
anorexia, wt loss and weakness
brain is common site for mtastais so headache, weakness, change in mental status, seizures
90
__% of lung cancers are a result of tobacco use
90
91
How to diagnose and treat lung cancer?
diagnsoe - med histro, phyiscal exam, imaging tests, and sputum cytology, bipsy, fine-needle aspiration, CT, epidermal grwoth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) (if small cell lung cancer staged by limited (only 1 lung) or extensive (both lungs or metasize)
treatment - surgery resection (lobectomy), chemotherapy, radiation, targeted therapy to decrease growth of tumor cells
92
On average, _______ of the respiratory membrane is lost each year after age 30.
one square foot
93
s/s of cystic fibrosis in lungs
bronchial obstruction w/ stasis of secretion
dry cough
dyspnea
tachypnea
barrel chest
pneumonia
chronic respiratory tract infection
cyanosis
clubbing of fingers and toes
Chronic pulmonary disease
94
s/s of cystic fibrosis in intestines
malabsorption of fat and protein
vomiting
large, bulky, foul-smelling stools
distented abd
poor wt gain
failure to thrive
excessive appetite
deficiency of fat-soluble vitamins
bowel obstruction
95
s/s of cystic fibrosis in pancreas
obstruction of pancreatic ducts
pancreatic insufficiency
atrophy of pancreas
absence of pancreatic digestive enzyme
pancreatic changes occur w/ fat and fiber replacing normal tissue
96
s/s of cystic fibrosis in liver
- obstruction of bile ducts
biliary cirrhosis
portal hypertension
97
s/s of cystic fibrosis in sweat glands
sweat gland dysfunction
sweat glands cause increase concentration of salt in sweat
dehydration
loss of electrolytes
98
What is bronchiolitis +s/s and etiology?
- inflammation of bronchioles, smallest air passages of lungs and r usually caused by viruses
- common disease in infancy
- s/s r posttussive emsis, cough and nasal congestion that evolve into wheeze, tachypnea and respiratory distressm fever, breathing too fast to feed proplery and can become dehydrated, apnea
- commonly caused by RSV can also be caused by parainfluenza birus and adenovirus
- most common during winter months (OCt throug hApril)
99
how to diagnose and treat bronchiolitis
diagnose - pt history and physical exam, chest radiograph to rule pneumonia, rapid RSV testing, viral culture from nasopharynx
treatment - supportive care, albuterol, racemic epinephrine, or hypertonic saline given my nebulizer, suplpmenetal oxygen, administered by IV fluids, intubated and mechanially bentilted in extreme cases
100
What is infantile colic + s/s, etiology, diagnose and treat?
- intermittent distress in newborn or during early infancy and has unclear etiolgoy
- s/s r infant intermittently draws up legs, clenches fists, cires as if in pain (may pass gas via mouth or rectum), likely in late afternoon and evening, babies usally thrive, gain wt, appear to tolerate formulas
- etiology is unknwon by theories r improper feeding techniques, overfeeding, swallowing excessive air, sensitivity to cow's milk
diagnose - symptoms and phyiscal exam
treatment - usually outgrows condition at abt 3 months, probiots or simethicone can sometimes provide relief
101
What is pulmonary abscess + s/s and etiology?
- cavity of contained infectious materials in lungs
- more common in lower poriton of lungs and in R lung
- main s/s r alternating chills and fever, chest pain, purulent, bloody, foul-smelling sputum and foul-smelling breath
- often a compicatio of pneumonia caused by bacteria, aspiration of food, foreign objects, bronchial stenosis, neoplasms,septic embolism,
102
diagnose and treat pulmonary abscess
diagnose - decresed breath sounds on auculation, recent aspiration, chest radiography, blood and sputum culture
treat - use of antibiotics, surgical resection of abscess
103
What is respiratory syncytial virus pneumonia + s/s
- inflammatory and infectious condition of lungs (most infants, young children, and older adults)
- s/s r coldlike symptoms, nasal congestion, otitis media, coughing, fevre, malaise, lethargy, more frequent coughing, wheezing and yspnea
- caused by RSV (mostly in winter months)
104
How to diagnose and treat RSV pneumonia?
-diagnose - clinical fingdings, physical exam, lavage of nasal pharynx, giant syncytial cells when grown in tissue culture
treat - mostly self-limiting, antipyretics, antibiotics, inhalaltion terhapy if invades lower respiratory tract (inhalation of 3% hypertonix saline)
104
What is histoplasmosis?
- fungal disease originaiting in lung and is caused by inhalaltion of dut containing Histoplasma capsulatum
- may cayse pneumonia or become systemic, many pt r asymptomatic, not contagious, dyspnea, loss of energy, fewbrile, spleen and lympg nodes become enlarged
- most common endemic mycosis in US (mostly in MW US)
105
how to dinaogse and treat histoplasmosis?
diagnose - clinical findings, positive skin test result, blood serologic findsings, identification of fungus in pus, sputum, or tissue specimen, chest radiographs
treat - when self-limiiting no antifungal therapy, also corticosteroids
106
What is blastomycosis?
0i fungal infection caused by inhaling fungus Blastomyces dermatitidis, which fgrows a a modl in moist soil and wood
- found in sp[ecific areas in North Amierca, with greatest pervalence in Upper midwest and Southward along Missippi and Ohio riverbends
107
What is coccidoidomycosis?
- caused by Coccidioides immitis
- In Southwest
- produces spores that live in soil
- causes San Joaquin Valley
- contract when dry soil is picked up by wind and spores r breathed in
108
What is swine-origin influenza A virus (H1N1) infection + s/s, diagnose, treat
- aka Swine flu
- unusual mix of swine, bird, human flu viruses (most ppl have little or no immunity against it)
- s/s r fevere, cough, sore throat, body ache, headache, chills, fatigue, diarrhea, vomitting
- treat with oseltamiviris (tamiflu) and zanamivir (relenza)
- diagnose with realt-time reverse transcription plymerase chain reation (RT-PCR) and viral culture
109
S/S OF ACUTE bronchitis?
- deep, persistent, prodctive cough
- thick, yellow to gray sputum
- SOB
- wheezing
- slightly elevated temp
- pain in upper chest
acute symptoms subside within a wk but a couhg may continue for 2 to 3 weeks
110
s/s of bronchiectasis?
- takes may years to develop, usually bilateral, involves lower lobes of lungs
- chronic halitosis
- chorinc cough
- large quantities f purulent, foul-smellign sputum
- hemoptysis
- dyspnea
- wheezing
- fevere
- general maliase
111
how to diagnoe and treat bronchiectasis?
diagnose - physical exam, history of symptoms, chest radiography, high-resolution CT, bronchoscopy, sputum culture, pulmonary function
treat - antibiotics, bronchodilators, postural drainage, sputum removal management, vibratory devices, avoiding environmental irritants (such as smoke, fumes, large amounts of dusts), removal of affected part of lung if lots of hemoptysis
112
What is pneumoconiosis?
- any disease of lung caused by long-term mineral dust inhalation
forms:
- Asbestosis (exposure to asbestos fibers, slow and progressive diffuse fibrosis of lngs, most common)
- anthracosis (black lung or coal miner's lung, accumulation fo carbon deposits in lung from inhaling smoke or coal dust)
- silicosis (inhaling silica (quartz) dust and causes dense fibrosis of lungs and empysema)
113
s/s of pneumoconiosis?
- dyspnea on exertion
- dry cough (later turns productive, similar to cough of chronic bronchitis)
- pulmonary hypertension
- tachypnea
- general malaise
- recurrent repiratory tract infections
114
how to diagnose and treat pneumoconiosis?
diagnose - pt history, physical exam chest radiographic studes, pulmonary function test, ABg
treat - relieving symptoms, bronchodilatior, oxygen therapy, chest physical terhapy, corticosteroids, lung transplant, treat TB aggressively, stop smoking
115
What is hemothorax + s/s, etiology, diagnose and treat?
accumulation of blood and fluid in pleural cavity
- s/s r pale and clammy skin, weak and thready pulse, falling bp, chest pain, labored and shallow/ gasping respirations
- cause is trauma, erosion of pulmonary vessel or hematologic disordes
- diagnose with diminished or breath on affected side, radiographs, blood tests, ABG
- treat which horacostomy
116
What is flail chest +s/s, etiology, diagnose and treat?
- condition of instability in chest wall caused by multiple rib fracture, sternum also may be fractured
- s/s r double fracture of 2 or more adjacent ribs, severe pain, dyspnea, cyanotic, extremely anxious, paradoxical breathing
- caused by direct trauma from direct compression by heavy object, MVA, hard fall onto solid object or industrial accident
- diagnose with chest truama and paradoxical movement, chest radiography
- treat with stabilizing chest wall, allowing rib fractures to heal while maintaining respiratory integrity, mechanical ventilation and sedation of pt w/ endotracheal tube, pain meds, supplemental oxygen, rib fixation
117
What is infectious mononucleosis + s/s?
- epstein-barr virus infection (aka glandular fever)
- acute herpesvirus infection
- ss r cervical and generalized lyphadenopathy, tnsil appear coated with debris, mild transient hepatitis, atypical lymphocytosis, general maliase, anorexia, chills, sore throat, fevere, headache, fatigue,
118
how to diagnose and treat infctious mononucleosis?
- diagnose with history and physical exam to rule out hepatitis, leukemia, Hodgkins lyphoma, lymphosarcoma, blood smear exam, immunologic study of blood serum, infectious mononucleosis blood screening test, antinuclear antibody (ANA), total serum bilirubin, liver function tests, EBV serology
- treat based on symtpoms: bed rest, fluid intake, IV fluids, antipyretic meds,
119
What is adult respiratory distress syndrome (ARDS)
- type of acte lung injury, characterized by severe pulmonary congestion, acutre respiratory distress, hypoxemia
120
What is adult respiratory distress syndrome (ARDS)
- type of acte lung injury, characterized by severe pulmonary congestion, acutre respiratory distress, hypoxemia
- secondary to some agent of insult that precipitates increased capillary permeabiltiy in lungs, pulmonary edema, resulting respiratory failure, injury to cells activates leukocytes and platelets to release additional injury = albeoli fill with exudate = collapse at end of expiration
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s/s of ARDS?
- severe hypoxemia
- progressive hypercapnia
- acidosis
- intercosta and suprasternal retraction w/ cyanosis or mottled skin
- septicemia
- shock or insult to lungs
- hemorrhagic, wet, boggy, congested, unable to diffuse oxygen lungs
- atelectasis
- sudden and severe dyspnea w/ rapid and shallow respiration
122
diagnose and treat ARDS?
diagnose - have underlying cause: pneumonia, fulminating sepsis, asapiration of gastric contents, hypovolemic shock, near-drowning episode, fat embolism, cardiopulmonary bypass, chest radiograph,s, ABG
treat - no cure, only supportive, oxygenation by establishing an airway, administered humidfied oxygen, suction the air passage, protective lung ventilation strategy, mechanical ventilation w/ addition positive end-expiratory pressure (PEEP), nutritional status, cautious hydration, renal failure, superinfection
123
What is sarcoidosis +s/s, etiology, diagnose and treat?
- multisystem granulomatous (small lesions of inflamed cells) most common in lungs
- s/s r dry cough, SOB, mild chest pain from loss of lung volume and abn lung stiffness, fatigue, fever, wt loss, swollen ankles, joint pain
- cause is unknown, thought to be malfunction of immune system or caused by virus, exposure to toxins in environment or other insults
- diagnose w/ complete medical eval, history, physical exam, chest radiography, labh tests, pulmonary function studies, biopsy
- treat: most resolve spontaneously, may need corticosteroid therapy, immunosuppressant drug methotrexate
