Unit 6 and Unit 7 Part 1 Flashcards Preview

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Flashcards in Unit 6 and Unit 7 Part 1 Deck (139):
1

influenza

acute viral infc in URT

2

when does influenza increase

seasonal infc

3

which types of influenza have inc prevelance

types A, B,C

4

incubation period for influenza

1-4 days

5

what strain of influenza usually causes epidemics

A

6

who has inc risk for influenza

HCP
peds pts
geri pts

7

why do HCP have inc risk for influenza

personally compromised rt repeat exposure

8

why do peds pts have inc risk for influ

defenses arent fully established yet

9

why do geri pts have inc risk for influ

dec defenses rt to age

10

patho influenza

viral injury to epithelial cells in URT, inflm/tissue damage

11

why may abx be perscribed in influ

prophylaxis ONLY, to dec risk of 2ndary infc rt compromised IR in pts w inc susceptibility

12

2 complications assoc with influ

2ndary bact infc
bronchitis/pnumonia

13

what are complications of influ rt to

movement of virus to LRT lt bronchial/alveolar damage

14

mnfts

cough
fever
malaise

15

characteristics of cough in influ

beneficial unless the URT is irritated, then it inc irritation/infc -> damage

16

course of influenza

self limiting

17

tx of influenza

prevent spread
vaccine for prophylaxis
symptomatic mgmt
limit infc to urt
antivirals??

18

egs of antivirals

amantadine
rienza

19

amantadine

1st gen antiviral that inhibits RNA coating of virus

20

what strains is amantadine most effective against

A and B

21

rienza

2nd gen antiviral that inhibits replication of virus, prevents virus rls from host

22

pnuemonia

inflm of bronchioles and alveoli

23

what forms does pnuemonia come in

infectous
non infectous

24

what is pnuemonia classifed by

agent
location

25

et of pnuemonia

usually dt bact, or virus, fuingu
aspiration
inhalation of fumes

26

how does inflm occur in pnuemonia

agent enters RT and proceeds into lungs

27

why is it abn for an infectous agent to proceed into the lungs

pulmonary defense is impaired and cant filter out pathogens

28

what happens when there is inflm in the lungs in pnuemonia

pulm edema -> impaired gas exch -> Co2 build up -> systemic hypoxia

29

typical pnuemonai

bacterial pnuemonia that occurs where there is empty spaces

30

atypical pnuemonia

dt any other agent, virus? things proliferating using cells around tissues

31

lobar pnuemonia

lung inflm specific to an entire lobe

32

broncho pnuemonia

inflm throughout alveoli in entire lung

33

area of consolodation

area with solidification of 3 components

34

what 3 components make up areas of consolodation when solidified

exudate
inflm debris
inflm cells

35

how are areas of consolidation seen

on cxr

36

mnfts of pnuemonia

fever/chills
dyspnea rt dec gas exchnage
sputum
headace
chest pain

37

what mnft makes pnuemonia different the flu

chest pain

38

sputum

combination of mucous and exudate

39

dx for pnuemonia

hx, px
cxr
sputum c and s

40

why are sputum c and s's done in pnuemonia

to determine if abx are needed

41

tx of pnuemonia

abx with typical pnuemonia
symptomatic mgmt

42

COPD

persistant inflm causing aw, vasculature and parenchyma inflm

43

what episodic problem is prominent in copd

acute, recurrent, chronic obstr of aw

44

what disorder are included in copd

chronic bronchitis
emphysema

45

what may copd coexist with

aasthma

46

et/risks for copd

smoking (80-90%)
recurrent resp infc (not chronic)
aging
genetic def of alpha one antitrypsin

47

why does aging inc risk for copd

lt dec lung compliance rt age of aw and l/o elasticity

48

what does smoking do to mucous prod? what does it lead to

inc mucous in RT, lumenal obstr

49

how does smoking compromise the mucociliary blanket

destroys cilia that lines the RT

50

how does inc mucous in RT affect cilia

overwhelms them by mucous logging them

51

what does smoking do to the airway

inflames it

52

what effect does smoking produce? (mnft)

coughing

53

what does coughing do to the airway of the copd pt

inc damage to inflamed area

54

what structures of the RT does smoking destroy

aw
alveoli wall

55

3 mechanisms of airflow in chronic bronchitis (CB)

hypertrophy of bronchial wall
inflm and mucous sec
damage to elastic tissue

56

hypertrophy of bronchial wall in CB

lt dec lumen size dt inc inflm

57

inflm and mucous sec in CB

lt up to 50 percent lumen obstr. dt inflm causing inc exudate and smoking lt inc mucous

58

damage to elastic tissue in CB

lt dec compliace, airway is no longer held open

59

what is CB dt

smoking, reccurent infc

60

where do changes in CB appear first

large aw

61

characteristics of affected large aw in CB

hypertrophy of submucousal glands rt inc gland workload

62

why do submucosal glands of inc workload in CB

dt inc sec of mucous dt smoking

63

where do changes appear second in CB

smaller airway

64

what changes occur in the smaller aw in CB

inc in goblet cells

65

what does inc/excess mucous in CB lt

impaired mucociliary defense

66

what happens when mucociliary defenses are compromised in CB

infc and bronchial wall inflm

67

why does aw collapse occur in the patho of CB

lumen obstr rt inflm leads to collapse caused by trapping of air in terminal aw. air slowly diffuses out into circulation lt collapse

68

what happens do alveolar ventilation in CB, why

decreases, dt air trapped in parts of lung

69

what happens when there is a V:P imbal

hypoxemia

70

hypoxemia

dec O2 in ABG

71

V in V:P

air moving in and out lungs

72

P in V:P

gaseous exchange

73

normal V:P

0.8

74

normal V

4L air in and out/min

75

normal P

5.5L blood thru PC /min

76

what is important to remember about VP ratio

it could be the same number even if V and P are smaller, abn numbers

77

what variable changes in CB
why

V
dt abn obstr. even though aw may collapse, its still a ventilation problem, not perfusion

78

dx CB

chronic cough (cant use coughing alone)

79

chronic cough

presence of cough for 3 consec mo for 2 years

80

main mfnt of CB

impaired resp fx

81

how is impaired resp evidenced by

hypoxemia
hypercapnia

82

resp fx

composed of gas exch and ventilation

83

other mnfts of CB (7)

activity intol
inc mucous prod
sputum
dyspnea
wheezing w/o auscultation
wet crackles
inc expiratory length

84

what is dyspnea in CB dt

lumen obstr

85

what is wheezing dt in CB

thinning aw

86

why are wet crackles heard in auscultation in CB

air moving over and thru mucous

87

why is expiration length inc in CB

rt dec elastic recoil of lungs -> trouble compressing TC to exhale quickly

88

complication of CB

secondary bact infc rt mucous accum

89

emphysema

destr of alveolar tissue and capilarry beds

90

what are of lung has inc incidence for emphysema

terminal airway

91

what does emphysema lt

l/o compliance

92

compliance

ease of lung filling/emptying with inc difficulty breathing

93

what happens to distal airspace in alveoli in emphysema

increases dt loss of wall integerity

94

what causes enlarged distal airspaces in emphysema

alveolar merging

95

why is alveolar merging not beneficial

inc alveolar size -> inc SA -> dec surface for gas exchange

96

et emphysema

smoking (classic)
genetic def of alpha1 antitrypsin (A1A)

97

fx of A1A

protease, ez inhibitor, allows break down of old protein in an organized and controlled fashion

98

what is A1A responsible for

regulating protein breakdown in lungs

99

what does smoking do to A1A in classic emphysema

inhibits it

100

what happens when a1a is inhibited

inflm and protein break down in lungs

101

what does cigarette smoke attract to the lungs

inflm cells

102

what do inflm cells bring to lungs

inc proteases

103

what do proteases do to the lungs

alveolar damage

104

how is smoking with classic emphysema a triple wammy in terms of patho and lung damage

inhibits inhibitor
increases inflm cells
inflm cells bring inc protease

105

why is ventilation impaired in emphysema

permanent distended air spaces

106

what VP variable does emphysema change

Both

107

why is WoB inc in emphysema

air is trapped in spaces between alveoli

108

what does trapped air result in

increased amount of dead space

109

dead space

areas not involved in gas exchange

110

why is ventilatory effort in emphysema increased

rt dec/compromised lung capacity

111

what 3 things mean increased work of breathing

nasal flaring
pursed lip breathing
accessory m use

112

why does the P variable change in emphysema

capillary walls are destroyed by proteases -> impaired perfusion

113

another name for air pocket inbetween alveoli

bleb

114

bullae

when a bleb inc in size and is visible bc it presses on plueral memb

115

what does smoking lt (fig flowcart)

attraction of inflm cells
dec a1a activity

116

what is released when inflm cells are attracted (fig flowchart)

elastase

117

what inhibits the action of elastase (fig flowchart)

a1a

118

what causes destruction of elastic fibers in lungs (fig flowchart)

dec a1a dt smoking
inherited a1a def
inhibited elastase action

119

what does destruction of elastic fibers lead to in lungs (fig flowchart)

emphysema

120

2 types of emphysema

centraacinar
panacinar

121

centriacinar emphysema

destruction is confied to terminal and respiratory bronchi.

122

alveoli condition in centriacinar emphysema

currently have little damange

123

which type of emphysema is most common

centraacinar

124

panacinar

damage to aw and peripheral alveoli
inc severity

125

mfnts of emphysema

dyspnea
inc ventilatory effor
barrel chest

126

what makes something a barrel chest

when chests transverse diameter and anterioposterior diameter are equal (2:2)

127

what is a normal chest diamter ration

2:1 transverse to anterioposterior

128

dx for COPD

hx, px
labs
cxr
pulm fx tests

129

what do pulm fx tests measure

lung vol

130

tx for COPD

limit progression
lifestyle mod
vaccine
drugs

131

what lifestyle mods have to be made to tx copd

NO smoking
avoid aw irritants

132

why do we encourage COPD pts to get vaccianted

for prophylaxis rt dec IR and inc susceptibility

133

what vaccinations should copd pts receive

flu q1 year
pnuemonial q5year

134

first line drugs for COPD

short acting b receptor agonist
anticholinergics

135

what happens if first line drugs arent working for COPD

add inhaled steroids

136

what do we do if a short acting b receptor agoinst isnt working COPD

long acting b receptor agonist

137

thcophyline (COPD)

bronchodilator with some anti inflm properties

138

how do beta receptors work

cause bronchodilation in bronchiols (smaller aw)

139

how do anticholinergics work

cause bronchodilation in larger aw (bronchi)