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68wm6 p2 L.A.D.

Lower Airway Disorders

Define bronchitis: Inflammation of the mucous membranes of the major bronchi and their branches
Bronchitis is usually secondary to what? Upper respiratory infections
List 3 clinical manifistations of bronchitis *Productive cough *Low grade fever *Diffuse rhonchi/wheezes, dyspnea *Chest pain *Generalized malaise, and headache
What do you question a PT about during an assessment if bronchitis is suspected? health, presence of headache, and/or aching chest pain
PTs with bronchitis are at increased risk of what, and why? Respiratory infections, Due to retained pulmonary secretions.
What causes legionnaires disease? Legionella Pneumophilia (Gram-negative)
Legionaires disease progresses on what two courses? *Influenza *Legionella disease (results in life threatening pneumonia)
List 3 clinical manifistations of legionaires disease *Significantly elevated temperature 102f - 105f (38.8c - 40.5c) *Headache *Diarrhea *General malaise *NONPRODUCTIVE cough with tachypnea *crackles and wheezing *Signs of shock *HEMATURIA indicating renal failure
Anthrax most commonly infects what? wild and domestic hoofed animals
How is anthrax spread? Through direct contact with bacteria and its spores.
True or False: A person infected with anthrax is at high risk for infecting others. False. It is not contagious by person-to-person
What is the most common form of anthrax? Cutaneous
What is the least common form of anthrax? GI
What do anthrax bacterial toxins cause? Hemorrhage, necrosis, and lymph edema
How does anthrax appear at first? It appears first like an insect bite (macule/papule), then black eschar formation and edema to site appears.
The initial symptoms of anthrax resembles what? Excluding what? The common cold or influenza, except infected persons will not develop nasal secretions
What does death usually result from in a PT with Anthrax? Blood loss and shock
How does an x-ray of inhaled anthrax differ from an x-ray of pneumonia? *Inhalation anthrax (widened mediastinum) *Pneumonia (infiltrates)
What is the most reliable screening for inhalation anthrax? Trick question. No single reliable screening is available.
What is the most reliable screening for cutaneous and GI anthrax? Culture
What antibiotic is the treatment of choice for anthrax, and how long should it be taken? Ciprofloxacin, 60 day course recommended.
What is the treatment of anthrax for soldiers? 30 days antibiotic and 3 doses of anthrax vaccine
How is tuberculosis aquired? Inhalation
What does tuberculosis result in? inflammatory infiltrations
True or False: tuberculosis has rapid onset. False. TB is usually latent in the early stages of infection and has potential for recurrence.
How does tuberculosis spread to susceptable organs? Via the blood and lymphatic system.
What precipitates tuberculosis disease, and what percentage results in disease? Tuberculosis infection. Only 10% of infections progress to disease.
What is the bacteria involved with tuberculosis? Mycobacteria
The rate of TB in foreign born americans increased how much since 1986? 65%
Approximately how many americans are infected with TB? 15 million
True of False: PTs with TB are easily identifiable by their symptoms. False. Many PTs with TB disply no s/s.
List 3 early signs of TB *Fatigue *Anorexia/weight loss *Productive cough *Fever *Weakness
What are the late signs of TB? *Daily reoccurring fever with chills *Night sweats *Hemoptysis (blood stained sputum)
What is done to confirm the Dx of active TB? Sputum culture
What kind of room do TB PTs require, and what is needed upon exiting room? Negative pressure room, must wear particulate matter mask when leaving room
True or False: Infants and children with TB dont usually require isolation. True.
What medications are used to treat TB? Isoniazid (INH), Streptomycin, and rifampin
Approximately how many PTs fail to complete their tuberculosis Tx? 50%
Why is rifampin used in TB PTs? prevention of meningococcal meningitis
What should you avoid while taking isoniazid for TB? food with tyramine and histamine... eg. Tuna, aged cheeze, red wine, soy sauce, yeast extracts
Why must foods with tyramine and histamine be avoided while on isoniazid? may cause lightheadedness, flushing, hypotension, headache and other symptoms
What can be taken to minimize the s/s when foods with tyramine/histamine are taken with isoniazid? 50-200mg of vitamin B6 daily
What happens when antiacids are taken with isoniazid? Decreased absorption of isoniazid
What happens when alchohol is taken with isoniazid? Toxicity
List three 2nd line anti-TB drugs *amikacin *Capreomycin *Cycloserine *Ethionamide *Levofloxacin *Ofloxacin *Para-aminosalicylic acid (PAS)
Rifampin and isoniazid are 1st or 2nd line drug? 1st line
Which anti-TB drug requires an opthalmologic follow up? Ethambutol
What is an expected adverse effect of rifampin? discoloration of all body fluids (red)
isoniazid inhimibts the metabolism of what? phenytoin
rifampin significantly decreases levels of what drug? saquinavir
How would you administer anti-TB drugs if GI upset/irritation occures Administer with food
What is pneumonia? An inflammatory process of the respiratory bronchioles and alveolar spaces that is caused by an infection
What times of the year are cases of pneumonia most common? Winter and spring
Who are cases of pneumonia most common in? Infants and elderly
List 3 causes of pneumonia *Bacterial pneumonia *Aspiration pneumonia *Viral pneumonia *Fungal *Chemical
list 3 clinical manifistations of pneumonia *Sudden onset of pleurisy *Severe chills *Elevated temperature and night sweats *Painful productive cough *Increased heart rate *Tachypnea with difficult expiration
What are manifistations of Streptoccocal /pneumococcal pneumonia? Rust colored sputum; possible friction rub
What are manifistations of staphylococcal pneumonia? *Rust colored sputum *possible friction rub *COPIOUS SALMON COLORED SPUTUM
What are manifistations of klebsiella pneumonia? Same as stRep + more of a gradual onset; more inflam of the terminal brochioles and alveoli (bronchopneumonia); if tx delayed beyond second day>>critically ill pt w/ increased risk of mortality rate
What are manifistations of Hemophilus pneumonia? *Croupy cough *Arthralgias (joint pain) *Yellow or green sputum
What form of pneumonia commonly follows a URI? Hemophilus
What are manifistations of mycoplasmal pneumonia? *Severe, non-productive cough *Crackles *Decreased breath sounds
What are the manifistations of viral pneumonia? *generally mild s/s *Cold symtoms *Irrating cough that produces mucopurulent or bloody sputm
List 2 antibiotics used to treat pneumonia *penicilin *e-mycin *cephalosporin *tetracycline
List 4 Tx in the medical management of pneumonia *Antibiotic therapy *O2 therapy *Analgesics/antipyretics *Expectorants *Bronchodilators *Vaccine *Physiotherapy *Humidification
True or False: Deep breathing exercises are discouraged for pneumonia PTs due to the inflammation to the lungs and pleural rub False. Deep breathing/coughing exercises are encouraged to open the airways and clear the lungs of mucous.
Pneumonia is a major cause of disease and death in who? Critically ill PTs
True or False: Pneumonia os the most common cause of death in North America True
What form of pneumonia carries a poor prognosis? Bacterial aspiration
How do the s/s of pneumonia differ in older adults? s/s of pneumonia often atypical (fever, sputum, cough often absent)
How do antitussives differ from expectorants? *Antitussives work by suppressing cough *Expectorants work by breaking down and thinning secretions, relying on coughs to expel mucus
What is the use of antitussives? To treat NON-PRODUCTIVE coughs occurring in pneumonia, bronchitis, TB, cystic fibrosis, and emphysema
What is the action of antitussives? Suppressing the cough reflex by direct action on the cough center in the medulla
What is the action of expectorants? Expectorants act by liquefying and reducing the viscosity of thick, tenacious secretions.
True or False: Antitussives and Expectorants fall under different categories False. They both fall under the 'antitussive' category.
What are the contraindications of antitussives? *Hypothyroidism *Pregnancy *Lactation
What are the precautions of antitussives? *Asthmatics *Geriatrics *Debilitated patients
True or False: Antitussives fall under Opioid and Non-opioid categories. True.
What are the most common adverse effects of antitussives? *Dizziness *Drowsiness *Nausea *Vomiting
Define Pleurisy: An inflammation of visceral and parietal pleura
List 3 causes of pleurisy *Bacterial *Tuberculosis *Pleural trauma *Pulmonary infarction *Lung cancer *Viral infections of intercostal muscles
What are the clinical manifistations of pleurisy? *SHARP PAIN ON ISNPIRATION *Fever and dry cough *Dyspnea *Elevated temperature
When does the pain of UNTREATED pleurisy subside? When pleural effusion developes
How should a PT with pleurisy lay in bed? On the affected side
Define pleural effusion: Fluid accumulation in the pleural space
Define pleural empyema: INFECTED fluid accumilation in the pleural space.
How does a fever associate with pleural empyema differ? Fever persists despite antibiotics.
What is the medical management of a pleural effusion/empyema? *Thoracentesis *Chest tube placement *Antibiotics
What is a chest tube inserted for (Tx, not disease) Continuous drainage and medication instillation
Is chest tube a closed or open system? Closed
True or False: A single chest tube is placed at the base of the affected plural space to drain accumilated fluids. False. A chest tube is place at the anterior and posterior of the affected pleural space and drains into 2 or 3 glass bottles or a 3 chamber drainage system.
How should a PT with chest tubes be placed, and why? On the unaffected side to prevent kinks.
List 3 potential causes of atelectasis *Hypoventilation *Shallow breathing post-op *Mucus accumulation *Compression from tumors *Stasis pneumonia *Aspiration
What is atelectasis? The collapse of alveoli, preventing respiratory exchange of CO2 and O2
What causes atelectasis? (mechanism, not diseases) Air blockage to a portion of the lung
What are the symptoms of atelectasis? *May cause few, if any, symptoms. *Fever, dyspnia, hypertension, TACHYPNEA if symptoms do occur.
Created by: Shanejqb