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1

What is pulse oximetry?

non invasive methoid to measure O2 saturation (SaO2

2

What are the diagnostic uses of bronchoscopy?

-direct visualization (tracheobronchial tree, larynx,
-biopsy of tissue
-aspiration of deep sputum

3

What are the therapeutic uses of bronchoscopy?

-aspiration
-control of bleeding
-removal of foreign bodies
-brachytherapy (endobronchial radiation therapy)
-palliative laser obliteration of bronchial neoplastic obstruction

4

What do you do before a bronchoscopy?

-verify informed consent
-NPO 4-8 hours before to reduce aspiration
-reassure patient that he will be able to breathe
-tell patient not to swallow local anesthetic sprayed in throat
-provide basin for expectoration of anesthetic
-remove dentures or prostheses

5

What do you do during a bronchoscopy?

-local anesthesia or moderate sedation
-patient in sitting or supine position
-scope inserted in nose or mouth and into pharynx
-monitor oxygen saturation because these patients commonly have pulmonary diseases

6

What do you do post bronchoscopy?

-NPO until anesthesia has worn off and gag reflex has returned
-postop fever is common within 24 hours, a lowgrade fever is normal
-warm saline gargle and lozenges if throat is sore

7

What complications should be assesed after bronchoscopy?

-coughing or expectoration of blood (hemoptysis) which may indicate trauma to the lung
-evaluate for S and S of pneumothorax, tension pneumothorax, subcutaneous emphysema, and pyogenic infection (tachypnea, dyspnea, diminished breath sounds, anxiety, restlessness, fever.)

8

What are the most important things to assess for after bronchoscopy?

-coughing or expectorations of blood (hemoptysis)
-tachypnea
-dyspnea
-diminshed breath sounds
-anxiety
-restlessness
-fever
-diminished breath sounds (sign of pneumothorax)
-reflex bradychardia and hypotension
-pulmonary edema

9

What is pneumonia?

-acute infection of the lung parenchyma
-inflammation or infection of the bronchioles and alveolar spaces of the lungs

10

What is the etiology of pneumonia?

-results when defense mechanisms become incompetent or overwhelmed (smoking or epiglottis issue, mucociliary escalator)
-decreased cough and epiglottal reflexes may allow aspiration
-decreased consciousness weakens the cough and epiglottal reflexes

11

How does the mucociliary mechanism become impaired?

pollution
cigarettes
viral URI
tracheal infection
aging
chronic diseases supressing the immune systems ability to inhibit bacterial growth

12

What are the 3 methods that cause organisms to reach the lungs (causing pneumonia)?

1. aspiration from naso/oropharynx
2. inhalation of microbes present in air (mycoplasma pneumonia and fungal pneumonias)
3. hematogenous psread from primary infection elsewhere in body (EX: streptococci and staph from infective endocarditis

13

Risk factors of pneumonia?

-condition that produce mucous or bronchial obstruction
-immunocompromised (heart failure, diabetes, alcoholism, COPD, and AIDS)
-smoking
-prolonged immobility
-depressed cough relflex

14

How is pneumonia classified and what are the types?

-according to causative organism
-clinical classification: community acquired, health care associated, immunocompromised, aspiration, hospital acquired, ventilator associated
-bacteria, viruses, mycoplasma, fungi, parasites, chemicals

15

What type of pneumonia has an increased risk for multidrug resistant pathogens?

health care associated HCAP

16

This infetion occurs in patients who have not been hospitalized or in long term care for 14 days after onset.

CAP: community acquired

17

With CAP where is it treated and what antibiotic and when is it started?

-treated at home or hospilatized depending on patient
-empiric antibiotic therapy started ASAP even before a definitive diagnosis or causative agent is confirmed

18

What commonly causes CAP in outpatients?

strep
mycoplasm
haemophilus influenza
C. pneumonia
respiratory viruses

19

This occurs 48 hours or longer after hospitalizationand not present at time of admission?

HAP: hospital acquired

20

This occurs 48 hours after endotracheal intubation.

VAP: ventilator acquired

21

What is VAP and HAP associated with?

longer hospital stays, increased costs, sicker patients, increased risk of morbidity and mortality

22

What is a major problem in treating HCAP (health care associated) pneumonia?

-the development of multidrug-resistant (MDR) organisms.
-What are the primary culprits: S.aureus and gram negative bacilli

23

What can identify the MDR organisms for HCAP? What do these MDR organisms do to the morbidity and mortality of risks?

-antibiotic suseptibility tests
-MRD organisms limit appropriate therapy and increase the risks of pneumonia

24

What is health care associated pneumonia?

occuring in nonhospitalized patient with extensive health care contact with one or more of the following:
-hospitalization for > or equal to 2 days in acute care within 90 days of infection
-residence in nursing home/long-term care facility
-antibiotic therapy, chemotherapy, or wound care within 30 days of infection
-hemodialysis in hospital or clinic
-home infusion or wound care therapy
-family member with infection due to multi-drug resistance bacteria

25

Explain aspiration pneumonia? What are the major risk factors?

-abnormal entry of secretions into lower airway
-decreased level of consciousness
-difficulty swallowing
-insertion of nasogastric tube with or without feeding

26

Why is aspiration pneumonia common with loss of consciousness?

the gag/cough reflex is depressed

27

Explain pathophysiology of aspiration pneumonia?

-aspirated materials trigger inflammatory response
-primary bacterial infection most common
-Empiric therapy based on severity, where acquired, and causative organsim

28

What is tghe most common form of aspiration pneumonia?

-primary bacterial infection (more than one organism is identified on sputum culture
-normally broad spectrum antibiotics are given

29

What causes chemical (noninfectious) pneumonitis?

aspiration of acidic gastric contents
-this may not require antibiotic therapy, but secondary bacterial infection can occur 48 to 72 hours later

30

What is necrotizing pneumonia?

-liquefaction and in some situations cavitation of lung tissue
-rare complication of bacterial lung infection
-often results from CAP
-causative organisms: Staph, Klebsiella, Strep
-Tx: long term antibiotic therapy and possible surgery