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68 Cards in this Set
- Front
- Back
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define acute bronchitis
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inlammation of the bronchioles, bronchi, and trachea
usually follows an URI |
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most common etiology of acute bronchitis
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viral (90%)
adenovirus, rhinovirus, influenza, rsv, |
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of those with acute bronchitis, what populations are more likely to have a secondary bacterial infection?
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smokers, chronic illness (dm, lupus, immunocompromised because of steroids (asthma)
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ACUTE BRONCHITIS
pathogens comonly seen in those with secondary bacterial infections |
s pneumonia
h flu m catarrhalis |
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ACUTE BRONCHITIS
most prominent clinical feature |
cough - usually last < 3 weeks
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ACUTE BRONCHITIS
pharmacological management |
treat symptoms
abx if organism bacterial or risk factors indicate bacterial pathogen |
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ACUTE BRONCHITIS - differentials
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pneumonia
asthma pertussis tuberculosis |
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when is pertussis one of the differentials?
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adults who is couging more than 5-10 days
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rule of thumb about coughs?
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never suppress a wet cough except at night
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how is cough secondary to common cold treated?
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- 1st generation antihistamine/decongestant
- NSAIDs x 5 days |
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How is a cough assoc with acute bronchitis treated?
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SA bronchodilator (-terol) and
DM, codeine (antitussives at night so pt can get sleep) |
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What should you do if you palpate supraclavicular nodes?
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supraclavicular nodes drain the chest and breast so
follow up with cxr, ct, mammogram...anything to find out why those nodes are there |
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(3) Typical Sx of Pneumonia
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Fever; Cough w/ sputum; Pleurtic Chest pain
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A pt has chronic bronchitis. To prevent the development of an acute exacerbation of chronic bronchitis (AECB), the nurse teaches the pt to take provided antibiotics with the onset of: a. rhinitis and headache b. diffuse rhnonchi and wheezing c. fever and increased productive cough d. chest pain with a nonproductive cough
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c. Acute bronchitis is the greatest threat to those who have chronic bronchitis, and they often are provided with antibiotics to take at the first symptoms, which include fever, increased productive cough, and exertional dyspnea. Diffuse rhonchi and wheezing may be heard on auscultation but would not usually be noted by the pt. Pleuritic pain may also occur, but the cough is productive.
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define pneumonia
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infection or the lung parenchyma, alveolar spaces, and/or interstitial spaces. can be bacterial or viral
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why is it important to know difference b/w communit acquired pneumonia and nosocomial?
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different bugs
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define parenchyma
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functional unit of an organ
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pneumonia bug dx - the bug most likely to kill
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strep pneumoniae
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pneumonia bug dx - most likely to be infected with
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mycoplasma pneumonia
chlamydia pneumoniae |
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pneumonia bug dx - walking pneumonia (a mild form of pneumonia)
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mycoplasma pneumoniae
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what are the atypical pneumonias? and why called atypical
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mycoplasma pneumonia and chlamydia pneumonia
becasue of the appearance on xray |
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pneumonia bug dx - rust colored sputum
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strep pneumonia
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pneumonia bug dx - comon in smokers
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h. flu
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bug common in smokers with URI, bronchitis, sinusitis, pneumonia
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h. flu
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pneumonia bug dx - common in immunocompromised (dm, smokers, COPDers)
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legionella pneumophila
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pneumonia bug dx -
red currant jelly sputum, common in alcoholics |
klebsiella pneumoniae
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pneumonia - assessment findings
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cough (>90%)
Chest pain (>50%) fever, chills, increased rr and pulse, fever, malaise, fatigue |
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The cxr of one with bacterial pneumonia will likely show
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infiltrates
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what is the relationship between renal insufficiency and antibiotic use?
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kidneys are filtering poorly so less abx should be given because it will build up in the body causing toxicity. lower dose abx can lead to outpatient failure.
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CAP pneumonia tx - healthy and no abx in last 3 months
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macrolide (azitrhomycin or claruthromycin) or doxycycline (tetracycline)(cheaper)
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treatment of atypical pneumonia?
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macrolide (azitrhomycin or clarithromycin) or doxycycline (cheaper)
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pneumonia severity index - used to determine admission
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CURB65
confusion urea>7mm/l rr 30 or greater bp 90 or 60 65 yrs or greater outpt tx for 0 or 1 |
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Pneumococcal vaccination protects against ?
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step pneumoniae - the bug most likely to kill
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define COPD
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irreversilble, chromic airflow obstruction and inflammation on the airways with reduced expiratory flow that worsens as the disease progresses
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define chronic bronchitis
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sputum production for at least 3 months annually for 2 years
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pathophysiology of chronic bronchitis
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hyperplasia of the mucus membranes lining the bronchial walls causing chronic mucus production
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pathophysiology of emphysema
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enlargement of the alveolar dicts and air spaces distal to the terminal bronhioles resulting in air trapping and loss of elastic recoil of the lungs
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COPD commonly caused by
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cigarette smoke
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Cardinal sx of COPD and what usually brings the pt in?
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dyspnea
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discuss fev1/fvc
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- norm is 70-75% or greater
- < 70% indicates airflow obstruction (COPD, asthma) - calculated using age, ht, and gender |
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CXR findings of pt with emphysema
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flattened diaphragm
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beta receptors are found in the ____ and ____. B1 receptors ___ hr and b2 receptors in lungs cause __.
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heart
lungs increase bronchodilation |
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COPD treatment (both bronchitis and emphysema)
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-inhaled bet agonists
-anticholenergic agents -theophylline -inhaled/systemic corticosteroids |
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COPD TX-
when are inhaled/systemic corticosteroids used? |
acute eacerbations or severe disease
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Discuss the role of beta agonists in the tx of stable COPD
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short and long acting bronchodilators - (opens)
short actuing "rescue meds" immediate onset and work for about 4 hrs. (albuterol) long acting bronchodilators - onset @ 20 mins, duration 12 hrs. ex-salmeterol (serevent) |
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discuss the role of anticholenergics in the tx of stable COPD
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prevent closure (preventing bronchoconstriction, produce mild bronchodilation)
ex - ipratropium (atrovent) use 3-4 x per day tiotropium (spiriva) QD expensive |
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discuss the role of theophylline in the tx of stable COPD
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produces bronchodilation and also helps stop coughing.
causes nervousness. metabolized by liver, so watch out for drug-drug interactions |
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discuss the role of inhaled/systemic corticosteroids in the tx of stable COPD
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prevents/treats inflammation
most have suffix "one" or "ide" |
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What is the prescribing strategy for COPD
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4 steps - initiate or step up as sx develop or worsen
1. SA BD PRN (albuterol)% anticholenergics (Atrovent) 2. add LA BD when worse (serevent) 3. Add inhaled glucocorticosteroids (pulmocort) 4. add O2 (last resort) |
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define asthma
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CHRONIC airway disease characterized by REVERSIBLE airway OBSTRUCTION, INFLAMMATION, AND HYPERRESPONSIVENESS.
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earliest sx of of asthma
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cough esp nocturnal
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asthma expiration
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prolonged
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classifications of asthma (4)
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1. mild intermittent
2. mild persistent 3. moderate persistent 4. severe persistent |
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most pts with asthma are classified as
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mild persistent or moderate persistent
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management of mild intermittent asthma
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bronchodilator prn
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management of mild persitent asthma
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low dose inhaled steroid prn
bronchodilator prn consider leukotriene blocker |
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what is a leukotriene?
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chemical mediator of inflammation
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management of persistent asthma
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low dose inhaled steroids
long acting bronchodilator (advair = fluticisone + salmeterol) |
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Why is a spacer used with inhaled steroids?
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improve med delivery
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Important teching point when usine inhaled steroids?
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rinse mouth after use to prevent thrush
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health promotion and asthma
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pneumococcal vaccine
influenza vaccine annually encourage regular exercise |
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Primary screening tool for TB
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mantoux test (aka PPD)
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primary dx tool in TB
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sputum specimen (takes a long time for results)
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why is a cxr obtained on someone after they have a positive mantoux?
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shows if disease is active or not
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What is the BCG vaccine?
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TB immunization
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what is a resp side effect of ace inhibitors?
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cough
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a 60 y/o male has localized wheezing. what is the most likely dx and why?
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a lung tumor - the growing tumor has narrowed one spot
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long term use of steroids may cause?
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osteoporosis and cataracts
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