Respiratory Disorders Flashcards
(49 cards)
1
Q
What is rhinosinusitis? What are some causes?
A
– rhinosinusitis (AKA sinusitis): inflammation of the mucous membranes of one or more of the sinuses
– causes
- after rhinitis
- Strep
- bacteria
- predisposing factors
- deviated septum
- nasal polyp
- nasal tumor
- facial trauma
- dental infection
2
Q
What are some signs and symptoms of rhinosinusitis? What are some interventions?
A
– s/s
- similar to cold
- facial pressure
- tenderness to touch
– interventions
- antibiotics
- antipyretics
- decongestants
- steam humidification
- hot/wet packs
- nasal saline irrigations
- functional endoscopic sinus surgery (FESS) – removes infected areas of mucosa
3
Q
What is pharyngitis? What are some causes? How is pharyngitis diagnosed? What are some signs and symptoms?
A
– pharyngitis: sore throat; inflammation of pharyngeal mucous membranes
– causes
- bacteria
- viruses
- irritants
- group A beta Strep –> acute glomerulonephritis
– diagnosed by rapid antigen test (RAT)
- screens group A beta hemolytic streptococcal antigen
– s/s
- odynophagia – pain during swallowing
- dysphagia
- fever
4
Q
What is pneumonia? What are the 5 types of pneumonia? Which population is especially at risk?
A
– pneumonia: inflammation of the air sacs of the lungs caused by
- excess fluid in lungs
- infectious agents
- inhaled irritants
– 5 types:
- community-acquired – easier to treat
- healthcare-associated – more difficult to treat (antibiotic resistance)
- bacterial – caused by Strep or Staph
- viral – most common
- atypical – caused by Chlamydophila
– elderly population is at higher risk – likely to experience confusion due to hypoxia
5
Q
What is bronchiolitis? How is it different than bronchitis?
A
– bronchiolitis: inflammation of terminal airways – common in younger kids
– bronchitis: inflammation of main airway
6
Q
What are some diagnostics tests for respiratory infections?
A
- sputum sample
- CBC
- blood labs
- BUN
- CXR
- pulse ox
- bronchoscopy
7
Q
What are some of the main interventions for respiratory infections?
A
- manage hypoxemia
- prevent airway obstruction
- CDB Q2H
- IV
- inhaled steroids
- manage sepsis by eradicating pathogens
- incentive spirometry
8
Q
What is severe acute respiratory syndrome (SARS)? What are interventions for SARS?
A
– SARS: virus infection of respiratory tract cells, triggering inflammatory response
– interventions:
- no known effective treatment
- prevent spread
- airborne iso
- handwashing
9
Q
Discuss TB?
A
- high communicable
- Mycobacterium TB pathogen
- airborne
- miliary/hematogenous TB: spread of TB throughout the body
- secondary TB: pt has TB but never presented, and then presents later
10
Q
What are some signs and symptoms of TB?
A
- persistent cough
- night sweats
- hemoptysis – coughing blood
- weight loss
- anorexia
- SOB
- fever, chills
11
Q
What are some diagnostic tests for TB?
A
- nucleic acid amplification test (NAAT) – detects nucleic acids for TB
- purified protein derivative (PPD) – 2 step
- induration of 10+ mm = positive
- tuberculin test (Mantoux) – intradermal PPD
- Quantiferon = gold standard
- sputum culture
12
Q
What are some interventions for TB?
A
- combined drug therapy
- isoniazid (INH) and rifampin used throughout
- pyrazinamide
- ethambutol
- 6 month therapy with strict adherence
- airborne precautions
13
Q
What is pulmonary empyema? What are some causes?
A
– pulmonary empyema: collection of pus in pleural space causing lung collapse
– causes:
- pulmonary infection
- pneumonia
- lung abscess
- chest surgery
- chest trauma
14
Q
What are some signs and symptoms of pulmonary empyema? Interventions?
A
– s/s:
- recent febrile illness
- chest pain
- cough
- dyspnea
- diminished breath sounds
- fever, chills, night sweats
- collapsed lung
- medial stinal deviation
– interventions:
- chest tube in pleural space
- thoracentesis
15
Q
What is thoracentesis? What is a potental complication?
A
– thoracentesis: removal of fluid by suction using a large needle into intrapleural space
– potential complication = rebound pulmonary edema
16
Q
What are 3 diseases that are classified as chronic air flow limitation diseases?
A
- asthma
- chronic bronchitis
- pulmonary emphysema
17
Q
What is COPD? What are some characteristic signs of COPD?
A
– chronic obstructive pulmonary disease: progressive disease that limits airflow due to abnormal inflammatory response to noxious particles
- includes
- emphysema – damaged alveoli – loss of tissue elasticity from hyperinflation of alveoli –> CO2 retention –> chronic acidic state
- bronchitis – inflammation of cronchi –> stimulates production of mucous
- tissue damage in COPD is irreversible and gradually increases in severity –> respiratory failure
– characterized by
- bronchospasms
- dyspnea
18
Q
What are characteristic signs and symptoms of bronchitis vs. emphysema?
A
– bronchitis:
- “blue bloaters” = cyanotic
- overweight
- elevated hemoglobin
- peripheral edema
- rhonchi
- wheezing
– emphysema:
- “pink puffers” = CO2 retention
- thin
- severe dyspnea
- quiet chest
- CXR shows hyperinflation with flattened diaphragm
19
Q
What is asthma? Which population experiences asthma most frequently?
A
– asthma: an intermittent, reversible airflow obstruction affecting only the bronchial airways – NOT the alveoli
– populations:
- adults – more common in women
- children – more common in boys
20
Q
How do the airways become obstructed in asthma?
A
- exposure to an irritant
- inflammation obstructs the lumen of the airway, causing swelling and mucous production
- airway hyperresponsiveness – constriction of the bronchial smooth muscle obstructs the airways
21
Q
Which antibody is involved in the inflammation associated with asthma? What chemicals become triggered by this antibody, causing inflammatory response?
A
– IgE
– chemicals triggered:
- histamine – immediate inflammatory response
- treat with Benadryl
- leukotriene and eotaxin – slower, prolonged inflammatory response
- treat with Singulair, Accolate, Zyflo
22
Q
What are some signs and symptoms of asthma?
A
- audible wheeze
- increased respiratory rate
- increased cough
- use of accessory muscles
- barrel chest
- long breathing cycle –> clipped speech
- cyanosis
- hypoexmia
23
Q
What are some diagnostic tests for asthma?
A
- ABG
- decreased O2 during asthma attack
- CO2
- decreased early in attack
- increased later
- eosinophil and IgE
- increased in allergic asthma
- sputum
- may contain eosinophils and shed epithelial cells
- pulmonary function test
- 15 - 20% decrease from predicted may indicate asthma
- 12% increase after bronchodilators indicates asthma
24
Q
What are the 3 measured components of pulmonary function tests?
A
- forced vital capacity (FVC): volume of air exhaled from full inhale to full exhale
- forced expiratory volume in first second (FEV1): volume of air blown out as hard and fast as possible during first second of most forceful inhale and exhale
- peak expiratory flow rate (PEFR): fastest airflow rate reached at any time during exhalation
25
What are the 3 zones for peak flow meters?
1. **green zone:** asthma is under good control; 80% of personal best
2. **yellow zone:** caution; airway narrowing present; administer rescue medication
3. **red zone:** medical alert; take rescue medication; seek medical attention
26
What are some interventions for asthma?
* peak flow meter used 2x/day
* drugs
* preventative -- change airway responsiveness to prevent asthma attacks; used every day
* rescue -- stop an attack once started
* exercise and activity -- promotes ventilation and perfusion
* oxygen therapy
* heliox -- mix of helium and oxygen
27
What are the drugs used for asthma?
* bronchodilators -- increase bronchial muscle relaxation
* short-acting beta 2 agonists -- rapid, short-term relief
* long-acting beta 2 agonists -- taken over a period of time; long-term relief
* anticholinergics -- blocks PSNS to increase bronchodilation
* methylxanthines -- last resort
* cardiac and CNS side effects
* anti-inflammatories
* corticosteroids
* NSAIDs
* leukotriene antagonists
28
What is status asthmaticus?
severe, life-threatening, acute episode of airway obstruction; intensifies once it begins; does not often respond to common therapies
if not reversed, pneumothorax and cardiac or respiratory arrest could result
29
What are some interventions for status asthmaticus?
* IV fluids
* systemic bronchodilator
* steroids
* epinephrine
* oxygen
* magnesium -- helps relax skeletal muscles
30
What are some risk factors of COPD?
* cigarette smoking -- biggest risk factor
* alpha 1-antitrypsin (AAT) deficiency -- enzyme made by the liver that is present in the lungs and regulate the breakdown of inhaled pollutants
* air pollution
31
What are some complications of COPD?
* hypoexmia
* acidosis
* respiratory infection
* cardiac failure -- cor pulmonale (R side heart failure with enlargement of R ventricle)
* cardiac dysrhythmias
32
How do you determine smoking pack years?
1. determine number of years smoked
2. determine packs per day
3. multiply values
33
What are some diagnostic tests for COPD?
* ABG
* hypoxia
* hypercarbia
* sputum
* CBC
* H&H
* electrolyte levels
* AAT levels
* CXR
* pulmonary function tests
34
What are some interventions for COPD?
* airway management
* breathing techniques
* positioning
* monitor respiratory changes Q2H
* effective coughing
* oxygen therapy
* pts with chronic hypercarbia require lower levels = 1 - 2 L/min
* drugs
* inhaled corticosteroids
* systemic
* mucolytics
* pulmonary rehab
* exercise to improve respiratory strength and endurance
* energy conservation
* avoid activites that arms raised
* pace activities
* gradually increase activity
* hydration -- at least 2 - 3 L/day
* beverages
* humidifiers
* nutrition
* monitor prealbumin
* prevent protein-calorie malnutrition
* many small meals per day
* manage anxiety
* can worsen symptoms
* manage risk for respiratory infection
* avoid large crowds
* flu and pneumonia vaccinations
* surgery
* lung transplant for end-stage pts
35
What is cystic fibrosis? Which populations most commonly experience cystic fibrosis? How is it diagnosed?
-- **cystic fibrosis:** error of chloride transport which produces a thick mucous with low water content; genetic disease that affects multiple organs and lethally impairs pulmonary function
* mucous plugs up glands, causing atrophy and organ dysfunction
* present from birth
* damages lungs, pancreas, liver
* caused usually by respiratory failure
-- mostly whites are affected
-- diagnosed by
* sweat chloride analysis
* normal = 35 mEq/L
* CF = 60 - 200 mEq/L
* genetic testing
* pulmonary function test
* may also see pancreatic problems, malnutrition, stunted growth, and cirrhosis
36
What are some signs and symptoms of cystic fibrosis?
* malnutrition
* smaller
* thinner
* vitamin deficiency
* abdominal distention
* GERD
* rectal prolapse
* foul-smelling stools
* steatorrhea
* DM -- due to pancreatic failure
* respiratory infection -- common
* chest congestion
* exercise intolerance
* cough and sputum production
* use of accessory muscles
37
What are some diagnostic tests for cystic fibrosis?
* pulmonary function tests
* CXR
* increased anteroposterior diameter
38
What are some interventions for cystic fibrosis?
-- mainly symptom management and weight management
* nutrition
* weight management -- space out meals
* vitamin supplement
* DM management
* pancreatic enzyme replacement
* chest physiotherapy
* exercise
* avoid mechanical ventilation -- difficult to wean pts off of this
* supplemental oxygen
* heliox
* airway clearance techniques
* drugs
* antibiotics for chronic infections
* avoid crowds to avoid infection
* organ transplant -- will not cure, but extends life 10 - 20 years
* lung
* pancreas
39
What is pulmonary arterial hypertension (PAH)?
-- **pulmonary arterial hypertention (PAH):** blood vessel constriction with increasing vascular resistance in lung; cor pulmonale
* unknown cause -- may be autoimmune
* death could result in 2 years without treatment
40
What are some interventions for PAH?
* drugs
* warfarin -- prevents clot formation due to stagnant blood
* aiming for INR = 1.5 - 2.0
* calcium channel blockers -- dilate pulmonary vessels to prevent clots
* diltiazem (Cardizem)
* nifedipine (Procardia)
* endothelin receptor antagonists -- promote BV relaxation, decrease pulmonary artery pressure
* bosentan (Tracleer)
* digoxin -- antiarrhythmic
* diuretics
* oxygen therapy
41
What is interstitial pulmonary disease?
-- **interstitial pulmonary disease:** AKA fibrotic lung disease; restrictive disease where lung tissue thickens, reducing gas exchange because lungs cannot expand (stiff lungs)
* affects
* alveoli
* BVs
* surrounding lung tissue
* slow onset
* dyspnea is most common symptom
42
What is sarcoidosis? Which population most commonly experiences sarcoidosis? What are some signs and symptoms? What is the main intervention?
-- **sarcoidosis:** granulomatous disorder (growth of granulomas -- lymphocytes, macrophages, epithelial cells, etc.) that most commonly affect the lungs
* autoimmune
* T lymphocytes damage lung tissue
-- affects younger population most commonly
-- s/s
* cough
* SOB
* abnormal CXR
-- main intervention = corticosteroids
43
What is idiopathic pulmonary fibrosis? Which population most commonly experiences? What are some interventions?
-- **idiopathic pulmonary fibrosis:** common restrictive lung disease with unknown etiology
* extensive fibrosis and scarring as a result of excessive inflammation
* poor prognosis -- 5 years even with proper interventions and treatment
-- population = older pts with hx of smoking or exposure to lung irritants
-- interventions seek to reduce inflammation:
* corticosteroids
* immunosuppressants
44
What is occupational pulmonary disease? How can it be prevented?
-- **occupational pulmonary disease:** disease caused by exposure to occupational or environmental hazards
* ranges from reversible effects to chronic lung disease
* dependent on amount of exposure
* worsened by cigarette smoke
-- prevented via special respirators and adequate ventilation
45
What is the main type of lung cancer?
bronchogenic carcinomas in bronchial epithelium
46
What are some interventions for lung cancer?
* chemotherapy
* targeted therapy
* targets specific phase of cancer cell division
* radiation therapy
* reduces size of tumor
* photodynamic therapy
* injected with an agent that sensitizes cancer cells to light
* medications administered -- leave normal cells more rapidly
* laser treatment causes irreversible damage to cancer cells
* lobectomy
* pneumonectomy
* removal of entire lung and severing bronchus
* segmentectomy
* removal of bronchus, pulmonary artery and vein, and tissues of involved segment of lung
* wedge resection
* removal of peripheral portion of lung
47
What is a chest tube?
drain placed in the pleural space to restore intrapleural pressure, allowing the lung to expand again
48
What are the 3 chambers of chest tubes?
1. chamber 1 = collects fluid draining from pt
2. chamber 2 = water seal that prevents air from entering pt's pleural space
* one-way valve allowing gas to escape but not to enter
3. chamber 3 = suction control
* gentle bubbling is normal
49
What are some postop care interventions for thoracotomy?
-- **thoracotomy:** incision into pleural space of chest cavity
-- postop care:
* pain management
* PCAs
* respiratory management
* assess Q2H
