chapter 28 med surg
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| acute bronchitis | inflammation of the bronchi in the lower resp tract, usually occurs with or after a viral upper resp tract infection
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| community acquired pneumonia | lower resp trach infection with onset in the community or during the first 2 days of hospitalization
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| cor pulmonale | enlargement of the right ventricle secondary to disease of the lung, thorax or pulmonary circulation
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| empyema | collection of purulent fluid in the pleural space
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| flail chest | results from the fracture of 2 or more ribs in 2 or more separate locations causing an unstable segment
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| hemothorax | accumulation of blood in the pleural space
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| hospital acquired pneumonia (HAP) | pneumonia occurring 48 hrs or longer after hospital admission and not including the time of hospitalization
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| lung abcess | a cavity in the lung parenchyma containing purulent material. it is formed by necrosis of lung tissue
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| pertussis | highly contagious infection of the lower resp tract with a gram-negative bacillus, Bordella pertussis
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| pleural effusion | abnormal collection of fluid in the parietal pleura (chest wall) and the visceral pleura (the lung)
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| pleurisy | inflammation of the pleura, most common cause is pneumonia
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| pneumoconiosis | general term for a group of lung diseases caused by inhalation and retention of dust particles
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| pneumonia | acute inflammation of the lung parenchyma that is most frequently caused by a microorganism
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| pneumothorax | air in the pleural space as a result of the air in the pleural space
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| pulmonary edema | abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs, it is a complication of various heart and lung diseases, it is considered a medical emergency and life threatening
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| pulmonary embolism (PE) | the blockage of pulmonary arteries by a thrombus, fat or air embolus or tumor tissue
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| pulmonary hypertension | elevated pulmonary pressures resulting from an increase in pulmonary vascular resistance to blood flow
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| tension pneumonthorax | air in pleural space that does not escape, continued increase in amt of air shifts intrathoracic organs and increases intrathoracic pressures
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| thoracenthesis | aspiration of intrapleural fluid for diagnostic and therapeutic purposes
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| thoracotomy | surgical opening into the thoracic cavity
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| tuberculosis | an infectious disease caused by Mycobacterium tuberculosis
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| Prevention of resp diseases | avoid cigarette smoking, avoid exposure to environmental smoke, avoid exposure to allergens, indoor pollutants and ambient air pollutants, wear proper protection when working in an occupation with prolonged exposure to dust, fumes or gases
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| acute bronchitis- | Definitionon: inflammation of the bronchi in the lower resp tract
s/s: cough, mucoid/purulent sputum, HA, malaise, SOB, low grade fever, wheezes
tx: fluids, rest, anti-inflammatory agents, antiviral meds (zanamivir, useltamivir) must start 1st 48hrs
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| pertussis | contagious infection of lower resp tract, dangerous to child under 6m, s/s: cough followed by gasps "whooping" cough, may last 6-10 wks, tx: abx usually macrolides (erythromycin, azythromycin
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| pneumonia | acute inflammation of the lung parenchyma. Organism that cause pneumonia reach the lung by (1) aspiration (2) inhalation, (3) hematogenous
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| types of pneumonia | community acquired pneumonia (CAP)- caused by Streptococcus pneumoniae (penicillin-sensitive and -resistant strains), Haemophilus influenzae (ampicillin-sensitive and -resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant
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| types of pneumonia | hospital acquired pneumonia (HAP)- pneumonia that occurs more than 48 hours after hospital admission but that was not incubating at the time of admission, caused by P aeruginosa, Acinetobacter species, Escherichia coli
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| types of pneumonia | ventilator associated pneumonia (VAP)-occurs more than 48hrs after intubation
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| types of pneumonia | health care associated pneumonia (HCAP)dx made <48h after,(1)adm in an acute care hospital for >48h within 90d of the dx,(2)nursing home or long-term care,(3) received IV abx, chemo, or wound care within the 30d after(4) attended hospital/dialysis clini
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| aspiration pneumonia | occurs from abnormal entry of secretions or substances into the lower airway
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| opportunistic pneumonia | individuals @ risk include; altered immune responses, severe protein calorie malnutrition, HIV, radiation, chemo, long term corticosteroid therapy, s/s: fever, tachycardia, dyspnea, non-productive cough, hypoxemia, tx: Bactrim/Septra
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| tuberculosis | infectious disease caused by mycobacterium tuberculosis, s/s: early stages no s/s: fatigue, malaise, anorexia, unexplained wt loss, low grade fever, night sweats, cough, mucoid or mucopurulent sputum, dyspnea is unusual, hemoptysis in advanced cases
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| tuberculosis | dx tests: PPD skin test, CXR, tx: 4 drugs necessary for initial phase for 6months. INH, Rifadin, PZA and ethambutol for latent TB INH qd for 6-9months
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| atypical mycobacteria | closely resembles TB, may be caused by atypical acid fast mycobacteria, only differentiates from TB by bacterilogic
culture, not airborne tx: similar to TB
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| pulmonary fungal infection | caused by inhalation of spores, exposure is common but most are asymptomatic, activation or infection occurs mostly in severely ill patients, s/s: similar to bacterial pneumonia, tx: amphotericin B given IV, less serious infection; Nizoral, Diflucan
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| lung abcess | cavity in lung parenchyma containing purulent material, it is formed by necrosis of lung tissue, s/s: cough with purulent sputum that is foul smelling/tasting, hemoptysis, fever, chills, prostration, pleuritic chest pain, dyspnea, wt loss,
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| lung abcess | dx: CXR, CT, sputum collection, bronchoscopy, tx: broad-spectrum abx, postural drainage
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| blunt trauma | the chest strikes or is struck by an object ex. steering wheel hits chest
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| penetrating trauma | gun/stab wound
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| pneumothorax | air in the pleural space resulting in partial or complete collapse of the lung, as volume of air trapped in the pleural space increases, the lung volume decreases, suspect pneumothorax in blunt traumas
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| types of pneumothorax-closed | closed-not associated with external wound, most common form is a spontaneous pneumothorax it is caused by rupture of small blebs on the visceral pleura. Blebs are the result of airway inflammation. Commonly due to smoking,other cause broken ribs,
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| types of pneumothorax-open | open- occurs when air enters the pleural space through an opening in the chest wall. ex. stab/gunshot wounds or surgical thoracotomy
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| types of pneumothorax-tension | rapid accumulation of air in the pleural space cause high intrapleural pressure.s/s: cyanosis, air hunger, violent agitation, tracheal deviation away from affected side, neck vein distention, hyperresonance,
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| con't types of pneumothorax-tension | tx: med emergency, needle decompression, chest tube
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| hemothorax | blood in the pleural space, may or may not occur in conjunction with pneumothorax. s/s:dyspnea, dullness to percussion, absent breath sound, hgb shock, tx:chest tube with drainage, bld transfusion to tx hypovolemic shock
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| chylothorax | presence of lymphatic fld in the pleural space. The thoracic duct is disrupted either traumatically or from malignancy. s/s:tachycardia, dyspnea
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| rib fracture | most common are 5 & 10 because they are least protected by chest muscles. s/s: pain @ site, shallow breathing due to pain, atelectasis, pneumonia
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| flail chest | results from fracture of 2 or more ribs in 2 or more separate location. The affected area will move paradoxically with respect to the intact portion of the chest during respiration. s/s: rapid, shallow resp, tachycardia, tx: oxygen, fx will heal with time
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| Thoracotomye | sx opening into the thoracic cavity. 2 types median sternotomy (splitting the sternum) for surgery of the heart and lateral thoracotomy (posterior/anterior) for the lungs
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| pleural effusion | pleural space usually contains 5-15ml of fld that acts as lubricant btw the chest wall (parietal pleura) & the lung (viscera pleura) it is an abnormal collection of fld in this space
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| empyema | purulent fld in the pleural space. s/s: pleural effusion, progressive dyspnea & decreased movement of the chest wall on the affected side. tx: chest tube with drainage and antibiotics
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| sarcoidosis | chronic multisystem granulomatous disease of unknown cause, primary affects lungs/liver. May also involve the skin, eyes, kidney, heart & lymph nodes. s/s: dyspnea, cough, chest pain, tx: aimed @ suppression of inflammatory response. followed for 3-6m
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| pulmonary edema | abnormal accumulation of fld in the alveoli & interstitial spaces of the lungs (med emergency). interferes with gas exchange by causing an alteration in the diffusion pathway btw the alveoli & pulmo capillaries
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| pulmonary embolism (PE) | blockage of pulmonary arteries by a thrombus, fat or air embolus or tissue tumor. The embolus travels with the bld flow through small-bld vessels until it lodges and obstructs perfusion of the alveoli.
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| pulmonary embolism (PE) con't | s/s: dyspnea, chest pain, hemoptysis, low PaCO2, cough, crackles, fever, accentuation of pulmonic heart sound,change in mental status from hypoxemia. dx: CT scan,VQ scan, D-dimer, pulmoangiography. tx: O2, alteplase, Coumadin heparin, IVC filter
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| pulmonary HTN | elevated pulmo pressures resulting from an increase in pulmonary vascular resistance to bld flow. It increases workload of the right ventricle & causes right ventricle hypertrophy & eventually heart failure
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| pulmonary HTN con't | s/s: SOB, fatigue, exertinal chest pain & syncope. Tx: NO CURE, diuretics, anticoagulants, oxygen, calcium channel blockers,
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| secondary pulmonary HTN | occurs when primary disease causes a chronic elevation in pulmoartery pressures. s/s: dyspnea, fatigue, lethargy, chest pain. tx: treat underlying disease
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| Cor pulmonale | enalargement of right ventricle secondary to diseases of the lung, thorax or pulmonary circulation. Present with or without overt cardiac failure most common cause is COPD. s/s: dyspnea, fatigue. tx: low-flow O2, bronchodilators, diuretics, low Na diet,
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| lung transplant | indicated for end stage lung disease, COPD, idiopathic fibrosis, cystic fibrosis, a1-antitrypsin deficiency, pulmo HTN. requirements: no renal/liver/HIV, no malignancy for 2 yrs, 4 types: single, bilateral, heart-lung & lobe transplant from living family
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