Lower Resp Tract Disorders
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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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