Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
131 Cards in this Set
- Front
- Back
|
What are the stats on Pneumoinia?
|
6th leading cause of death in amer. 3 mill suffer from it.
600,000 require hospitalization 40,000 die from it. |
|
|
Noosocomial pneumonia ?
|
Occurs in hospitalized pt. & is the most common nosocomial infection causing death.
|
|
|
What happemes in response to inflammation w/ alveoli?
|
fluid, serum, and RBC's pour into them.
|
|
|
what happens in pertaining to the leukocyte's?
|
move into the affected area to engulf and kill invading bacteria.
|
|
|
What do the macrophages do?
|
move in to remove debris
|
|
|
when the infection is over whelming what happens?
|
Alveoli become ingulfed with fluid, RBC's, polymorphonuclear leukocytes, & macro become consolidated
|
|
|
What gets sabotaged in the lungs?
|
all protevtive mechanisms: sneezing, gag reflex, cough, ciliary movement.
|
|
|
During the early stages of a lung abscess the pathology is indistinguishable from what other disease
|
pneumonia
|
|
|
In a lung absecss what moves in and engulfs the invading organisms
|
polymorphonuclear leukocytes and macrophages
|
|
|
What are the marjor pathological or structural changes of a lung abscess?
|
Alveolar consiolidation: Alveolar capillary & bronchial wall destruction;tissue necrosis;cavity fomration;fibrosis & calcification of the lung parenchyma; bronchopleural fistula & empyema; ateletasis;excessive airway secertions
|
|
|
A lung Abscess is most commonly formed by what type of organism
|
anaerobic
|
|
|
How do anaerobic organisms enter the lungs?
|
when an pt aspirates gastrointestinal fluids containing the organism
|
|
|
What does iatrogenic mean?
|
treatment
|
|
|
What does VAP STAND FOR?
|
Ventilator associated pneumonia
|
|
|
What are some factors that predispose pt's to pneumonia?
|
Pulmonary factors, systemic factors, chronic factors, and iatrogenic procedures.
|
|
|
What pulmonary factors?
|
Airway disease, poor cough, and reduce gag reflex & aspiration.
|
|
|
What systemic factors?
|
Immunosuppression- AIDS, chemo, leukemia, and transplantation
|
|
|
What are the two most common causes of abscess formation
|
pneumonia caused by aspiration (klebstellia or Staphylococcal)
|
|
|
When a lung absecss is present what happens to the pt.'s vitals
|
the RR, HR, CO, BP all increase
|
|
|
When a lung absecss is present what happens to the pt.'s PFT
|
decrased expiratory maneuvers, lung volume & capacity restrictive disease
|
|
|
When a lung absecss is present what happens to the pt.'s ABG's Mild and Severe?
|
Mild- alveloar hyperventilation with hypoexmia
Severe- acute ventilatory failure with hypoxemia |
|
|
When a lung absecss is present what happens to the pt.'s Breath sounds?
|
increase tactile and voal fremitus; crackles/rhonchi, dull percussion note over abscess
|
|
|
What would be some chronic systemic diseases?
|
Diabetes, renel failure, and cirrhosis
|
|
|
What are the iatrogenic procedures?
|
Intubation, mechanical ventilation, use of humidifers & aersol generators, lack of handwashing & sterile technique
|
|
|
What accounts for more than 80% of all bacterial pneumonias?
|
Streptococcal pneumonia/ Streptococcus pneumoniae-formly diplococcus pneumonia
|
|
|
If a person has a lung abscess what would their cough be like?
|
at first dry non-productive barking cough; then foul-smelling brown/grey (anaerobic + other organism); oldorless green or yellow, blodd streaked or hemoptysis occasionally
|
|
|
What would the CXR look like for a pt with an absecss
|
increased opacity cavity formation of the lobes; gravity dependt position at the time of aspiration; fibrosis & calcification; pleural effusion; permanant lung
|
|
|
What is the treatment of a lung abscess
|
CPT & BD several time a day or flutter device/ Antiobiotic (Pencillin or Clindamycin)/ Surgery/ Hyperinfaltion Techniques/Supplemental O2
|
|
|
Tell me a little about streptococcal pneumonia?
|
Transmitted by aersol from a cough,sneeze, or infected person. rust colored sputum&sensitive to penicillian A derivatives
|
|
|
Explain the stages of primary TB
|
primary stage infection; begins when inhaled bacilli implant in the alveloi/ Baciili multi in about 3-4 weeks/lung tissue surrounds the infected area (tubercele or granuloma)
|
|
|
What happens to the bacilli in Tb when treated with antibiotics or one's own immune system
|
fiibrosis & clacification replace the tubercele during the healing process = fibrosis & Calicification -lung tissue retracts and becomes scarred
|
|
|
When TB is reactiated months to years after inital infection has been resolved is known as what
|
Secondary TB
|
|
|
What type of TB does the Bacilli escape form a tubercele & rapidly disseminate to sites other than the lungvia pulmonary lympathic system or blood stream
|
Disseminated TB or extrapulmonary TB
|
|
|
What is aome anatomic alteration of the lungs with TB
|
Alveloar consolidation*Alveloar capillary destruction*Caseous tubercles or granulomas*Fibrosis of lung parenchyma* Distortion & Dilation of the bronchi * increased bronchial secretions
|
|
|
TB is primarily caused by what
|
Mycobacterium tuberculosis
|
|
|
TB is a highly aerobic organism so where would you expected it to thrive in a human
|
in areas of high O2 apex of the lung
|
|
|
How is Tubercle bacillus transmitted
|
by aersol droplets, coughing, sneezing or laughing
|
|
|
What is the most common diagnosis for Tb
|
Intradermal Tuberculin skin test - Mantoux
Injection of PPD wheal< 5 mm "-" wheal 10mm or more "+" |
|
|
What are the acid-fast stains for sputum cultures of TB
|
Ziehl-Neelsen Stain (reveals bright red acid fast bacilli againist a blue background)
Fluorscent acid-fast stain (reveals luminescent yellow-green bacilli againist dark brown background) |
|
|
What is the quick ID method of Mycobacterium Species
|
Deoxyribonucleic Acid (DNA probe)
|
|
|
What is Nontuberculosis Mycobacterium
|
Its a atyicla mycobacterial infection found in soil and water
|
|
|
If a Pt has Tb what are their vital signs like
|
increased RR, HR, CO, and BP
|
|
|
What are some general Clincial manifestions of Tb
|
Chest pain/ Cyanosis/ Peripherial edema- JVD- pitting edema- enlarged and tender liver
|
|
|
If a pt has TB what would a chest assesment tell you
|
increased tactile and vocal fremitus, dull percussion note, bronchial breath sounds, crackles, rhochi, wheezing, pleural friction rub, whispered pectoriloquy
|
|
|
What would the CXR look like of a TB Patient
|
increased opacity, cavity formation, pleural effusion, calcification and fibrosis, retraction of lung segments or lobes, right ventricular enlargement
|
|
|
How long is Pharmacologic agents used in Tb
|
Consist of 2-4 drugs for 6-12 months
|
|
|
What drugs are used to amnage Tb
|
First line (9 months)
isoniazid and Rifampin supplemented with Ethambutol, stretomycin, pyrazinamide |
|
|
What is the respiratory care tx of Tb
|
oxygen therapy, brochopulmonary hygiene therapy, hyperinfaltion therpay, Mechanical Vent
|
|
|
what is the most common fungal infection in the USA
|
Histoplasmosis
|
|
|
What fungal disease is common in soil when enriched by large quanities of droppings from pigeons, starlings, blackbirds, chickens and bats
|
Histoplasma Capsulatum
|
|
|
What fungus is primarily found in Ohio, Mississippe, & St Lawerence River Valleys
|
Histoplasmosis
|
|
|
If a pt has acute histoplasmosis what does do you expect to find
|
implation of the organism in the lung, with regional lymph node involvment. Siginificant spread of the fungi via blood stream. Infected tissues react with necrosis or a granuloma
|
|
|
How does Histoplasmosis present itself in a human
|
*Asymtomatic or subside within a few days without therpay*heavy exposure-flu like symptoms chills, fever, headache, general aches and pains, non-productive cough, substernal chest discomfort
|
|
|
What does the CXR look like of a pt with Hitoplasmosis
|
pneumonia infiltarte, Miliary pattern, nectrozing pneumonia, nodule=histroplamona
|
|
|
How is Histoplamosis treated
|
Amphotericin B -most effective
Ketoconazole -acute cases, less toxic Surgicial resection |
|
|
What is the prognosis for a pt with Histoplasmosis
|
primary infection- excellent for older children and adults
Disseminated - grave Chronic -cavitation with pulmonary function impairemnt & respirtaory insufficiency |
|
|
What is Coccidiodomycosis caused by?
|
spherical fungi carried by wind dust particles that have been isolated in the soil, plants, and vertebraes of animals in arid regions
|
|
|
Where is Coccididomycosis most prevalent?
|
Western hemisphere, South West USA (CA, AZ,NV,NM,TX,UT)
|
|
|
What type of fungus may occur following the earth- moving for construction & therefore can be kept to a min by dust control...Mining for copper
|
Coccidiodomycosis
|
|
|
How is Coccidiomycosis transmitted into the body
|
spores are inhaled from contaiminated soil and settled in the lung. Tissue reacts by forming granulomas and the infection is brought under control
|
|
|
What are the clinical manifestations of Coccidiodomycosis
|
60% are asymptomatic
mild flu-like symptoms such as desert fever, valley fever, & San Joaquin Valley Fever |
|
|
How does Coccidiomycosis look like on an CXR
|
thin- walled cavity, pneumonia type infiltare nodule = coccidioidoma
|
|
|
How is Coccidiodomycosis managed and treated
|
Observe, Ampotericin B, Ketoconazole, Surgical resection in perisitent localized lesions
|
|
|
What are the 4 types pf Aspergillosis
|
Allergic bronchopulmonary aspergillosis* Fungus ball or aspergilloma, Chronoc nectrozing Aspergillosis* Invasive or disseminated Aspergillious
|
|
|
What are some characteristics of Allergic brochopulmonary Aspergillosis
|
*occurs in a background of long stabding asthma* frequent mucus plugging of the bronchi* atelectasis, bllod eosinophils & antibiodies
|
|
|
How is Allergic brochopulmonary Aspergillosis
|
steriods are effective, CPT, Humdification and bronchodilators
|
|
|
How is a fungus ball or aspergilloma created
|
by a colonization of aspergillus in a performed pulmonary capillary cavity or cyst often due to TB or Sarcoidosis. The ball os formed by tighly matted funagl mycelia with fibrin mucus and cellular debris
|
|
|
Asperillosis follows another disease what is this known as
|
a secondary disease
|
|
|
Chronic necrotizing pulmonary aspergillosis mimcs what other disease
|
TB
|
|
|
Out of the fungal diseases which one is the most serious and often fatal diease
|
Invasive or Disseminated Asperigilloisis
|
|
|
What is used to treat Chronic necrotizing pulmonary aspergillosis
|
Amphotericin B and Flucytosine
|
|
|
What type of fungus normall resides in the gingival crevices & tonsils, and responds to antibiotics so the organism is closer to a bacteria than to a fungus
|
Acintomycosis
|
|
|
What is the treatment for Acintomycosis
|
Pencillin, surgery, and postural drainage
|
|
|
What is Rheumatic fever?
|
Starts with strep throat, 1-4wks attacks cns,joints.
***mostly attacks mitral valve*** tx w/ antibiotics |
|
|
What is staphylococcal pneumonia?
Gram positive****** |
pneumonia following a virus infection. seen in children and immunosuppressed adults. Transmitted by aerosol from cough sneeze and contaminated articles.
|
|
|
What is Hemaphilus influenza?
*** Gram Negative***** worse than gram + |
2 dary pneumonia after primary viral infection. affects children 1 mth to 6yrs. always cause of epiglottis.transmitted via aersol or contact
|
|
|
What is Klebsiella Pneumonia?
***gram negative**** |
common nosocomial infection. Necrotizing with pleural rxn. lobar pneumonia.
|
|
|
What are the clinical features of klebsiella pneumonia?
|
reddish-brown, brick mucus. Sudden onset, resulte as aspirationof vomitusfollowing intoxication,seizer, or some unconscious state
|
|
|
What is Rheumatic fever?
|
Starts with strep throat, 1-4wks attacks cns,joints.
***mostly attacks mitral valve*** tx w/ antibiotics |
|
|
What is staphylococcal pneumonia?
Gram positive****** |
pneumonia following a virus infection. seen in children and immunosuppressed adults. Transmitted by aerosol from cough sneeze and contaminated articles.
|
|
|
What is Hemaphilus influenza?
*** Gram Negative***** worse than gram + |
2 dary pneumonia after primary viral infection. affects children 1 mth to 6yrs. always cause of epiglottis.transmitted via aersol or contact
|
|
|
What is Klebsiella Pneumonia?
***gram negative**** |
common nosocomial infection. Necrotizing with pleural rxn. lobar pneumonia.
|
|
|
What are the clinical features of klebsiella pneumonia?
|
reddish-brown, brick mucus. Sudden onset, resulte as aspirationof vomitusfollowing intoxication,seizer, or some unconscious state.
|
|
|
where can the opportunistic organism be seen?
|
In alcholics, chronic COPD, diabetics, nusing home pt's, men>40yrs old. Also seen in homeless people.
|
|
|
How can the bacterical cause of pneumonia be transmitted?
|
by transmition of clotting IV solutions, food and hands.
|
|
|
What would be the tx for bacterical pnuemonia?
|
Tobramycin &Cephalospin.
Tobbramycin also tx for C.F. Septicemia - toxins are in the bloodstream |
|
|
What can you tell me about legionaire's disease?
**pontiac disease** TX=ERYTHROMYCIN |
pneumonia, sources-cooling towers air conditioning units,lakes & pools.
pnuemonia like disease took months to isolate causative agent. NOT SPREAD PERSON TO PERSON |
|
|
what is Pneumonas aeruginous?
|
gram negitive. copious amounts of green mucus smells sweet like grapes. temp peaks in the morning.
tx-vancomycin |
|
|
What is Chlamydia pneumonia?
|
id'd as cause in adults. schools military institutions an families. assoc. with meningoencephalities myocarditis,CAD, and guilian Barre syndrome.
|
|
|
What does Guilain Barre do?
|
paralysis you from the feet up. Causes death.
|
|
|
Mycoplasma pneumonia? what is it?
|
atypical seen in young adults and adolescemts."walking pneumonia"
Tx= erythromycin & Tetracycline |
|
|
What happens with Chlamydia pneumonia?
|
acute pulmonary infection. transmission from birds. pigeon breeders and poultry workers get it
|
|
|
Tell me about Respiratory Syncytial Virus
(RVS) |
seen in children under 6 months & elderly with lung disease.
tx= SPAG, Virazole-Ribsvirin, anti viral drug ddeliveried for 12 to 18 hrs for 3 to 7 days |
|
|
Broncho pneumonia
|
type of bacterial pneumonia that has *segmental distribution*
|
|
|
Community acquired
|
got pneuomo outside of hospital
|
|
|
lobar pneumonia
|
in the lobes.
|
|
|
Necrotizing pneomonia
|
pnuemo that causes perment damage to the tissues
|
|
|
Muscominal pnuemonia
|
acquired in the hospital
|
|
|
pneumonia
|
inflammation of parnychema & AIR SPACE while consolidation
|
|
|
Viral pneumonia
|
threw out lung fields, bilateral interstitial infiltrates caused by a virus. Very Serious (chickenpox pneumonia
|
|
|
Chickenpox pneumonia
|
life threating complication from varicella virus
spreads to lungs. Can cause a secondary infection |
|
|
Rubella - measles
|
Respiratory complications are often encounteredwith involment of the mucosa of the resp tract.
|
|
|
North American Blastomycosis is a chronic fungal infection that orginated in the respiratory tract then spreads to the skin what part of the US is this common
|
S Carolina ( central and southeastern US)
|
|
|
With Blastomycosis what part of the lung in affected
|
upper lobes are more involved
|
|
|
What is the Tx for Blastomycosis
|
Amphotericin B and Ketoconazole
|
|
|
What typer of disease is Nocardiosis
|
Oppotunistic supprative disease
suppurative = pus |
|
|
What disease reults form exposure to contaminated soil not man to man
|
Nocardiosis
|
|
|
What is the Tx for Nocardiosis
|
Sulfa drugs or antibiotics for several months
|
|
|
What is the name for the eupropean Blastomycosis
|
cryptococcosis
|
|
|
What organisms causes Cryptococcosis
|
Crptopcpccus neoformans- a fungus that exist in yeast, soil, animals and humans
|
|
|
What is the most common underlying disease of pts with Cryptococcosis
|
COPD
|
|
|
What is the Tx for Cryptococcosis
|
Symptoms are like meningitis therofore when treated with Amphotericin B there is only a 60% surivival rate
|
|
|
Another forma viral pneumonia is the adnovirus what is it caused by and what symptoms does it present?
|
etiologic agent ARDSS, fever, s ore throat, horeness, conjuctivitis with upper resp. symptoms
|
|
|
What does SARS stand for and where is it common & what is it
|
severe Acute Respirtaory Syndrome- 2002 china* highly cntagiuos- tranismission spread through droplets* incubation 2-7 days Tx Broad Spectrum Antibiotic
|
|
|
How does a pt get Rickettsia
|
Transmission is by arthropods, lice, fleas, ticks, mice
|
|
|
With SARS is death likely
|
no its rare
|
|
|
What Pneumonia is most common in pt's with AIDS
|
Pneumocystis Carinii
|
|
|
what form of pneumonia do some say its a protozoa and others idenitfy it as a fungi
|
Pneumocystis Carinii
|
|
|
What is the Tx for Pneumocysytis Carinii
|
Pentamidine adminstered as an inhaled aerosol
|
|
|
What typer of pneumonia is now for its blood red pigmeny and leaves necrotizing oatche of bronchopneumonia
|
Serratia Pneumonia
|
|
|
What is VAP
How quickly does it develop |
Ventilator Acquired Pneumonia
it devlops after 48 hrs of mechiancial ventilitaion |
|
|
What typer of Pneumonia is cauded my mineral oil aspiration, laxative oil for elderly, oily nose drops ofr babies
|
Lipoid Pneumonia
|
|
|
Medical history of pneumonia?
|
Fever--increases the metabolic rate which increases the demand on the heart & lungs to provide extra o2, cough sputum production SOB, chest pain. increased RR, HR, CO, BP
|
|
|
ABG w/ pneumonia
|
shunt perfusion w/no ventilation. Mild- acutealveolar hyperventilation w/ hypoxemia. Sever- acute ventilatory failure w/ hypoxemia.
|
|
|
Chest assessments:
Lobar pneumonia? |
Gives unilateral chest expansion.
|
|
|
Chest assessments:
|
Increased tactile & vocal fremitus
|
|
|
Chest assessments:
|
Dull percussion note, bronchial breath sounds & course crackles, Crackles/ rhonchi,
|
|
|
Chest assessments:
Pleural friction rub |
If pleural inflammation is present. whispered pectoriloquy, pleural effusion, cough. CXR:-increased density from consolidation & atelectasis.
|
|
|
Treatment of pneumonia
|
Bronchodilators- when pneumonia breaks up excessive secretions.
|
|
|
Treatment of pneumonia
|
CPT- moblilzes secretions, suction for ineffective cough. Thoracentesis- for large pleural effusions.
|
|
|
Criteria for sever pneumonia
|
RR> 30/min
PaO2<60mmhg on Fio2>30% CXR- multiple lobe environment Evidence of shock=Bp<90/60 Low urine output<20ml/hr |
