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Lower Resp Tract Disorders

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Question
Answer
Atelectasis? How it develops?   At: closure or collapse of alveoli Dev: acute in postop/immobile/decr ventilation/blockage/xtra pressure on lung  
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Diff b/n pleural effusion? pneumothorax? hemothorax?   eff: fluid in pleural space(bn parietal and visceral pleurae) pneu: air in space hemo: blood in space  
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s/s of atelectasis?   dyspnea, cough, sputnum acute: resp distress showing tachyc/tachyp/pleural pain/central cyanosis(late sign of hypoxia)  
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Nsg preventions for atelectasis   turn, mobilization, deep breathing(q2h), incentive spir. Mgmt secretions: cough/suction/nebulizer/CPT  
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Other nsg mgmt when first line measures fail   PEEP(+ end-expiratory pressure)- mask that provides exp resistance CPPB(continuous pos press breathing)  
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Tx for pleural effusion?   thoracentesis - needle aspiration of fluid, or chest tube  
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what is acute tracheobronchitis?   inflammation of mucous membranes of trachea/bronchial tree.  
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Manifestations of tracheobronchitis? TX?   scanty sputum at first, fever, chills, insp stridor, exp wheeze, purulent sputum tx: fluids to thin secretions, moisture  
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Two classifications of pneumonia   CAP-community-acquired: w/in 1st 48h after hospitalization. HAP- hospital-acquired/nosocomial: More than 48h after admission  
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CAP types Steptococcal pneumonia 14% mortality rate   winter/Af Am/elderly/COPD, heart failure, alcoholism, asplenia, DM s/s: pain, quick onset tx: penicillin  
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Haemophilus influenza 30% mortality rate   alcoholics/elderly/DM/COPD/child<5y s/s: assoc with URI tx: amoxicillin  
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Legionnaires' Disease 15-50% mortality rate   summer/fall, older men/smokers/excavation sites s/s: flu like tx: fluoroquinolone,azithromycin  
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Mycoplasma pneumonia Viral Chlamydial   tx: macrolie, tetracycline oseltamivir/zanamivir fluoroquinolone  
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HAP Pseudomonas Pn 40-60% mortality   cancer/burns/lung disease s/s: productive cough, fever, chill tx: betalactam + cipro, levofloxin, aminoglycoside  
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Staphylococcal pn 25-60% mortality   drug users/hiv/MRSA s/s: hypoxemia, cyanosis, necrotizing inf tx: vancomycin, linezolid  
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Klebsiella pn 40-50% mortality   alcoholic/COPD/elderly s/s: tissue necrosis, cough, fever tx: levofloxacin, piperacillin/tazobactam + amikacin  
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Pneumonia in Immunocompromised PCP, fungal, mycobacterium(TB)   from corticosteroids, chemo, AIDS  
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Aspiration Pn   aspirate GI contents, gases, chemical contents  
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Who should get pnue vaccine?   >65, immunocompetent, asplenia(w/o spleen)  
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Complications of pneumonia   hypotension, shock, resp failure, heart failure, dysrhythmias, pericarditis, pleural effusion  
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what is silent aspiration   non-fx nasogastric tube allows gastric contents to accumulate in stomach Placement is key to prevention  
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When is residual volume checked in tube feedings?   q4h and if >200-250ml residual volume, then pt shows intolerance to feedings  
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what is SARS   viral resp illness caused by coronavirus. s/s: fever >100.4, coughing, trouble breathing tx: droplet/contact/airborne  
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TB preventions   negative pressure private room, fitted respirators, standard precautions  
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What is the Mantuox test for TB   Dx of TB How: deposit purified protein PPD subq w/ bevel of needle facing up to create bleb/wheal. Results in 48/72h Reaction pos: induration(hardening) and erythema  
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Induratino measurements for pos TB   0-4mm- not signuficant >5mm- sig for at risk(HIV+, contact, + chest xray) >10mm- sig with impaired immunity Pos not mean active TB, immunocompromised may be + and not show = anergy  
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What may be diff for elderly wtih TB tests   s/s of confusion, fever, anorexia, wt. loss. TB test can show no reaction or delay up to wk(recall phenomenon), need 2nd test  
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TB tx?   antifubercolosis agents 6-12mos with 3-4 or more meds INH, Rifampin, pyrazinamidem, ethambutol Nsg Intv: compliance  
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contraindications for IHH and rifampin   INH avoid tyramine(tuna, aged cheese) (Vit B given with INH) Rifampin: alter metabolism and make less effecitve of BB, warfarin, dig, corticosteroids, oral contraceptives  
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Lung abscess s/s? tx?   necrosis of pulmonary parenchyma by inf s/s: pleural friction rub, crackles tx: clindamycin(Cleocin)  
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Peurisy s/s? tx? nsg mgmt?   inflamm both layers of pleurae s/s: knifelike pain, maybe one side s/s effusion: sob, pain, decr chest wall excursion tx: indomethacin(anti-inflamm) nsg: splinting, thoracentesis  
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Empyema s/s? tx? nsg?   thick, purulent fluid in space w/ walled off area s/s: like pneumonia dx: chest CT tx: drainage, abx nsg: breathing excercises  
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Pulmonary Edema s/s? tx?   fluid in alveolar space/lung tissue from heart prob(LV), pneumonectomy, pneumothorax dx: crackles, frothy secretion tx: fix problem  
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Acute Resp Failure vs chronic   acute: ventilation/perfusion impaired..PaO2<50, PaCO2>50, pH<7.35 chronic: long period, by COPD, neuromuscular diseases  
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ARDS Acute Resp Distress Syndrome   from acute lung injury 4-48h leading to hypoxemia tx: PEEP, nutritional support 35-45kcal/kg/day nsg: turning(prone), decr anxiety, sedate(ativan/versed/propofol/precedex), paralytics(pavulon/norcuron/tracrium/zemuron  
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pulmonary arterial hypertension two types?   MAP>25, wedge press <15mmHg 1.idiopathic,primary from known cause: women, 20-40y, death in 5y 2.From known cause  
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Pulmonary arterial htn s/s? tx?   s/s: dyspnea(exertion/rest), chest pain, weakness, fatigue, syncope, Rside heart failure tx: viagra/tracleer/thelin/letairis  
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Pulmonary Heart Disease-Cor Pulmmonale   RV enlarges of heart from diseases(COPD, pulmonary htn) tx: treat cause  
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Pulmonary Embolism   obstruction of pulmonary art or branch by thrombus from venous sys or Rside of heart.  
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risk factors for PE   venous stasis, injury, tumor, polycythemia, splenectomy, vascular dis, DM, COPD, HF, obesity, preg, elderly, oral contraceptives  
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Emergency mgmt for PE   O2, ABGs, CT, ECG, catheter if suffered embolism, stockings  
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anticoagulation therapy for PE   heparin continued til INR is 2.0-2.5 then need to take same kind of warfarin PO  
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Thrombolytic therapy for PE   urokinase, streptokinase, alteplase  
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Sarcoidosis   mostly of lung w/ s/s dyspnea, cough, hemoptysis, congestion  
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Lung Cancer Staging and types   1.sm cell cancer 2. non-sm cell cancer sqaumous cell, lg cell, adenocarcinoma Stage 1 to IV(metastatic) Cough that changes can mean cancer  
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Rib fractures 1-3 means? 5-9? lower?   1-3: high mortality bc subcl aa/vv 5-9: most common lower: spleen/liver injury tx: control pain  
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Flail chest?   3 or more adjacent ribs fractured at 2 or more sites..free floating rib segments tx: airway/secretions/pain  
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what is a contrecoup contusion   contused lung occurs on other side of pt of body impact  
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Gunshot wounds classified by 3 types of velocity? Factors to determine?   low, med, high factor: distance from which gun was fired, caliber of gun, size of bullet  
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Nsg intv to mgmt gunshot wound to chest   maintain cardiopulmonary fx, assess further injuries, type blood for transfusion, peripheral pulses, lg bore IV line, catheter, NG tube, chest tube  
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What causes a pneumothorax?   pleural space exposed to pos atmospheric pressure. Normal is neg or subatmospheric simple/traumatic  
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tension pneumothorax?   air pulled into pleural space from lacerated lung or chest wall wound and gets trapped, not expelled. Lung collapse, heart/trachea shift to unaffected side(mediastinal shift). Incr press so decr circulation. tx: chest tube in 2nd intercostal space  
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When is a thoracotomy needed in open pneumothorax?   If >1500ml blood aspirated by thoracentesis or >200ml/h from chest tube  
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