Diseases Day 3

Front 1

Asthma medications: bronchodilator continued

Back 1

Anticholinergic: ipratropium and tiotropium bromide

:blocks neurotransmitter acetylcholine

:ATROVENT OK WHEN FIRST LINE BRONCHODILATORS ARE INEFFECTIVE, OR THE PATIENT HAS AN ADVERSE REACTION TO B2 AGONIST (INCREASE HR)

:MAY ALSO BE USED IN COMBINATION W/BETA ADRENERGICS

:ipratropium + albuterol (combivent MDI, Duoneb: svn) called a synergistic relationship cause the two meds work together to help the patient.

Front 2

Asthma medications: Bronchodilators Cont

Back 2

Methylxanthines/Xanthines

:Less effective than beta adrenergics

:naturally occurring in body

:phosphodiesterease inhibitors

:Backdoor bronchodilator

:Oral, injection, suppository form

NOT FOR USE IN EMERGENCY/ ACUTE ATTACK

theophylline is a methylxanthine,

methylxanthines/Xanthines are found in coffee, cocoa, anything with caffeine.

Front 3

miscellaneous asthma factoids

Back 3

People who use too many bronchodilators (wear out the key/lock mechanism, B2 agonist/receptor)

Status asthmaticus refractory to bronchodilators: emergency

Use aggressive bronchodilators and early use of corticosteroids possibly IV

May need (positive airway pressure)PAP or Heliox(helium and oxygen mixed) to force medication(controvery cause denser gases to deliver medications works better, meaning how far down the drops get in airway depends on density of gas, helium is less dense, might not get far)

Bronchial thermoplasty: heat via radio lessen ability to constrict smooth muscle.

Dilates airways 5 years, nearly 80% success.

Not for emergency

Front 4

Endotracheal intubation if nothing else works

Homework pages 200 to 208 Jardins

Page 535 and 953 Egan

Back 4

Trachea is distal to the esophagus. trachea is on the outside for breathing.

Front 5

Bronchiectasis

Back 5

bronchiectasis is destruction and widening of the large airways

:may be congenital or acquired (not hereditary per say)

Bronchiectasis is often caused by recurrent inflammation or infection of the airways

Cystic fibrosis causes about a third of all bronchiectasis cases in the united states

Would want antibiotics and mucolytics

Front 6

Bronchiectasis

Back 6

May be caused by congenital DZ named Kartagener's syndrome, autosomal recessive, dyskinesia of cilia

Influenza and other pulmonary infections can lead to acquired bronchiectasis

Possible but not typically associated with COPD

Often PT has right sided heart failure due to hypoxemia and PHT pulmonary hypertension

Front 7

Bronchiectasis definition

Back 7

A chronic necrotizing infection proximal to bronchi and bronchioles leading to , or associated with, abnormal dilation and destruction of the larger airways.

Front 8

Bronchiectasis

Back 8

3 major types

1. varicose: twisted, distorted bronchi resembling varicose veins

2. cylindrical: bronchi are twisted and resembles tubes

3. Saccular (cystic) bronchi end in large cyst like sacs

Front 9

Radiologic findings

Back 9

Chest radiograph

:translucent (dark) lung fields

:Depressed or flattened diaphragm

:Hyperinflation: mucous plugs

:long and narrow heart

Air bronchograms (air filled sacs)

Front 10

Pathological changes

Back 10

Hallmark is chronic production of large quantities of purulent fetid sputum

Depending on extent, restrictive or obstructive

:dyspnea

:Hemoptysis

:dull or tympanic percussion

:wheezing, rhonchi, crackles

:Atelectasis, consolidation

Front 11

Abnormal laboratory tests and procedures

Back 11

Polycythemia

Sputum examination

:Streptococcus pneumoniae

:Haemophilus influenzae

:Pseudomonas aeruginosa

:Anaerobic organisms

:DZ less occurrence today due to antibiotic therapy advancements.

Front 12

General management of bronchiectasis

Back 12

Respiratory care treatment protocols

:#1 antibiotics and expectorants

:Immunizations against infectives

:Bronchopulmonary hygiene therapy protocol

:Bronchodilator protocol

:Hyperinflation therapy protocol

:Mechanical ventilation protocol

:Surgery, lung resection.

Quiz on asthma and bronchiectasis

Front 13

Cystic fibrosis

Back 13

Chapter 34 page 705 to 797 EgansChapter 14 page 213 des jardins

Front 14

CF Case study

Back 14

Answer self assessment questions 1 to 10 in Jardins page 249.

Front 15

Cystic fibrosis

Back 15

Etiology

Cystic fibrosis is an inherited childhood disease that causes thick, sticky mucous to build up in the lungs and digestive tract

It is a multi system involving disease

Front 16

Etiology

Back 16

CF is a genetic DZ

2 defective genes to be passed down

(autosomal recessive) : one from each parent

Over 1000 different mutations

1:1000 births caucasians americans have the CF gene

Approx 30000 in the use 1000 new each year

Average of survival today is 37 to 40 years old

Front 17

Facts

Back 17

Most children are diagnosed with CF by their 2nd birthday. A small number, however are not diagnosed until age 18 or older. These patients usually have a milder form of CF.

Front 18

Anatomical alterations

Back 18

Thick viscid secretions inrespiratory tract

Clogs pancreatic ducts

Clogs bile ducts in liver

Mucosal inflammation

Mucosal hypertrophy

Recurrent LRTI (lower respiratory tract infection)

Bronchiectasis

Obstructive DZ

Front 19

Cllinical manifestations

Back 19

Excessive mucous production

Reoccuring infections (pseudomonas aeruginosa)

Hemoptysis (bronchiectasis)

Pulmonary hypertension(hypoxia and pressure against capillary beds)

Respiratory failure

Stunted growth (inability to properly digest food)

Front 20

CF clinical testing

Back 20

#1 increased chloride content in sweat (sweat test)

Salty taste when kissed

Increased salt wasting

Dehydration in hot weather

Salt craving

Newborn genetic testing

:sweat test to verify

Front 21

CF radiology

Back 21

Chest X ray

:hyperinflation

:peribronchial thickening

:Lung collapse: atelectasis

Chest CT (computed tomography)

:Bronchiectasis

:mucoid impaction

:Areas of centrilobular opacities

:sub pleural bullae (fluid filled sacs like blisters, develop on the lung parenchyma under the visceral plueral)