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14 Cards in this Set

  • Front
  • Back
Respiratory structure:
_URT=Upper respiratory tract=NPET=nose, pharynx, epiglostis,tracheo
_LRT=Lower respiratory tract=bronchi,alveoli
*Anatomy: R.:3 lobes, straighter, shorter=>aspiration:food falling in, need to listen to lung sound in R.base when assess); L:2lobes
***Any condition of MENTAL staus/SWALLOWING ability may effect/impair funx of epiglostis and INCR RISK for aspiration/pneumoia(EX:DECR LOC, head injury, Tracheostomy tube, resuscitation efford(over breathing). CVA.
*Visceral pleura
*Compliance (distensibility, diffusion)
_Surfactant=DECR surface tension in alveoli=>If DECR pressure needed to inflate alveoli, help DECR tendency of alveoli to collapse.
_Chest wall:is shaped & support by Ribs & Sternum
_Visceral pleura & Lung:Lung are lined with membrance visceral Pleura.
_Intrapleural space & problem
_Diaphragm:major muscle of the respiratory sys.
+Inspiration:diaphragm contracts, thoracix cavity INCR, thoracix Pressure DECR=>AIR IN
+ Expiration=passive, telastic recoil of chest wall and lung allow chest to passively return to normal position=>AIR OUT
***PHRENIC NERVE innervate(stimulate to action) diaphragm.
Blood supply_2 types of circulation:
_Pulmonary circulation
_Bronchial circulation
_Pulmonary circulation: -O2 blood from R. ventrical thru Pulmonary artery is supplied for LUNG=>gas exchange at LUNG=>O2 blood fr.LUNG thru Pulmonary Vein is supply the Heart at L.Atrium.
_Bronchial circulation:Bronchial arteries , arrives form thoracic aorta, provide O2 to bronchi and other Lung tissues.
Intrapleural space:
Intrapleural space:
+Contain 20-25 cc fluid=lubricant=>help layers of pleural slide on each other during breathing.
+INCR cohesion between the layers that facilitate expansion during inspiration
+Too much fluid in the sac=Pleural Effusion=clear liquid
+Purulent fluid wict bacteria infection=Empyema

**Phrenic nerve ____ diaphragm
Major muscle of Resp.
_Inspiration: D contract,INCR cavity of the thoracix(lung anf chest wall)=>DECR the Pressure in the thoracix cavity =>AIR MOVE IN
_Expiration:passive, elastic recoil of chest wall and lung to noramal position.Thoracix pressure INCR=>AIR MOVE OUT
Compliance( Distensibility of Lung)
_Ability to stretch, measure of elasticity of the lung anf the Thorax.
_When compliance DECR, lung harder to inflate
EX: Pleuro Effusion, Pulmonary Fibrosis/sarcoidosis, Pul. edema.
_With Aging
* AP(anterioposterial) of the chest diameter INCR=>Barrel chest.
*Aveoli 's wall destruction
*DECR elastic recoil.
Diffusion process thru the Lung
O2 IN, CO2 Out over/cross capillary membrane.
Respiratory DEFENSE sys.
_Mucus:100ml/day_by mucociliary clearance sys.
_Cilia:Cover airway fr. trachea to bronchioles.Beat rhythmiclly to move mucus for the lung.What istrap in the area either cought OUT or Swallow.
_Cough reflex: Protective mechanism/reflex.Clear airway by high PRESSURE and VELOCITY. Remove effectively secretion Above large & main airway.
_Alveolar macrophages: eat , swallow bacteria. Debris move up by the cilia and cough out or Lymph sx carry out.
Aging and Respiratory Sys.
_DECR elastic recoil
_DECR chest wall compliance(distensibility)
_ INCR AP(anterioposterial) diameter =>barell chest.
_DECR number of Fnx alveoli
_DECR resp defense mechanis=>less effective
_Less forceful cough
_Less Fnx cilias.
P.561: Diagnostic Study& its purposes
_Chest X-Ray= screen, dx, evaluate changes
_CT scan=for Dx of lesions difficut to assess by conventional X-Ray study.Posteranterial/lateral
_MRI=Dx of lesions difficult to asscess by CT scan(lung apex near spine..)
_Pulmonary Angiogram=study to:*visulize Pulmonary vasculature*locate obstruction/pathologic condition_contrast medium,injected thru catheter into Pul arteries/right side of H.
_PET:distinguish benign & maglinant lung nodules, IV injection of radioisotope.
Endoscopic examination:
_Bronchoscopy:Dx, biopsy, specimen collection, take pic of changes, suction mucus, remove forgein objects...
_Thoracentesis:aspirate fluid
_Pulmonary Fnx test:Lung Volume and Air Flow
_Inflamation of LRT due to infection.frequent w/ COPD, but not always bcuz it can occur as sequela( abnormality following other disease) to URT=>acute bronchitis.
_Self limitting
_If acute bronchitis > 3mths( becuz exacerbation)=> pt get chronic bronchitis
2/ Causes: viral, strep, rhnovirus, influenza( bact could sit on top of chronic or standing on becuz you have URI)
3/S/S:cough, clear/purulent sputum, general malaise, T/P/R INCR, breath may be normal, X-Ray not consolidation or infiltrate.
4/ Tx: Fluid, Rest, cough suppresant, antibiotic(COPD), bronchodilator.
ATELECTASIS(can lead to pneumonia)
_Collapse of lung tissue at any structural level result with interference ith natural FORCES that promote lung expansion
_Common in POST-OP, especially with pt has CHEST, ADB surgery or fracture ribs, found in elderly at Bed rest.
_Detected by X-RAy 1st( bcuz: some pt mabe Asymptomatic)
_If postoperation, PT have INCR Temp.=>he has Atelectasis.
2/ S&S: dysapnea, tachypnea, tachycardia, cyanosis, DECR breath sound, Crackles, Fever(101 F)
3/ Prevention(Surgical Nurse)
_Frequent posioning
_Early ambulation
_ Deep Breathing
_Effective coughing
_Insetive spirometry
_Postural drainage
****Early S&S of INadequate Oxygen:
+CNS:unexplained apprehensive or unexplained restlessness(irritability)
+Resp:tachypnea ; dyspnea on exertion.
+Cardio:tachycardia, mild HTN
==> check VS, O2 SAT.
1/ Def:
2/Etiology Risk factors:
*Protective mechanism;
5/Clinical manifestation
6/Difinitive Diagnostic test
7/ Other types of Immunocompromised patient
1/ Def:inflammatory process in the lung structure a/s with increasing in interstitial & alveolar fluid, Decrese Gas Exchange
2/Etiology Risk factors:
_Virulence or quantity of infective agent
_Viral or bacteria
_Microplasm & fungi
*Protective mechanism: impaired by air polution, smoking, URI, aging, decrease filtration, decrease warming(cold), decrease humidication
With Pneumonia, inflamatory and pulmonary response to offending agent (body react to offending agent). It is happened in 3 ways:
+Aspiration of organism what in nasopharynx, oralpharynx into lung.
+Inhalation:of microbe in the air (mycoplasma pneumonia, fungi pneumonia, smoke, dust, gases, chemical)
+Hematogenous:spread fr. primary infection (staph.)=>staph. pneumonia)

_Community accquire:pt come to the hospital with it=> incubation. S/S in 2 days
_Hospital accquire:after 48h of admission.Pneumonia has highest motality and mobility of NOsocomial Infection. N.need to becareful with the Asepsic technique.
5/Clinical manifestation:
_Fever, chill, sweat.
_Cough, N/V
_Dyspnea, pleuritic chest pain
_Sputum production (green, bloody, rusty)
_Headache, sorethroat
_Crackling sound fr. fluid in interstitial area (tactile Femitus), INCR vibrating.
_Chest sound like bronchial breath sound over area of consolidation(tubular_loud sound)
_Unequal chest wall expansion(if large enough area)
_In elderly: can see mental confusion

6/Difinitive Diagnostic test:
_Blood test(WBC)
_Skin test
_ABG (arterial blood gas_O2)
_Chest X-Ray
_Sputum culture, graim stain, fungi, blood and urine culture
**Over the are of pneumonia, will see wjite opacification in the area consolidation(in one area instead all over the lung)

7/ Other types of Immunocompromised patient:
_PCP=pneumocystic carinii pneumonia=HIV/autoimmune Sx dod/on steroid/chemo, transplant taking the drug to block the reaction to the transplant depending on the drugs, sometimes we don't have drug to treat.
_CMV=cytomegalovirus=cause by viral pneumonia in immuno-compromised pt=>bacterial pneumonia
_Fungi:fungi pneumonia
8/Complication :
_Pleural effusion, Atelectasis, COnsolidation(localied infection), empyema, pericarditis, endocarditis, arthritis, pleurisy, lung abcesses, meningitis

9/Tx (asap)
_Antibiotic, Antiviral drugs(not work w/ bird flu)
_Specimen for sensitivity
_Fluid( 3L/day, check H. fnx)
_Oxygen therapy, med for fever/pain
_At least 1500 Kcal/day
_Flu, pneumonia vax (not cover 100%)
_Exercise habit=>keep natural resistance=>prevent aspiration
_Side lie, 30 degree, fowler position.
_Turn w/in 2h, mobility, oral care, coughing, deep breathing.
_Not over meds(pain), maintain sterial tech.
H=hob 30 degree
O=oral care(2X/day, swab in between, infuse fluid w/ syringe, brush & use suction PRN)
**Diffcult swallowing=>speech therapy=>liquid diet, start w/ thick one
2/Who at risk?
6/ Diagnosis Procedures
7/TB tests
8/Long term Tx:
9/ Prevention
_Bact. infected disease transmitted by Mycobacterium Tuberculosis.
_Incr since 1985 due to:
*HIV, immigrant student
*Deterioration of med
*Multi drugs resistance strains(MDR-TB)
*Resistance fr. not taking drugs as prescribed
*Using other substances, inadequate follow up
2/Who at risk?
*Immuno compromise
*Elderly, nursing homes
*CA pt.
*IV drug abuse
*Asia, Africa, Latin American Immigrants
*Health care worker

3/NEED? DOT= direct observation therapy=>to protect society
*TB=communicable disease
*Aerobic, gram positive Acid Fast Bacillus
*Airborne with inhalation
*Particle small enough to reach aveoli & penetrate lung tissue
*Spread by coughing, laughing, singing, talking and sneezing.
**Primary 1st in: lung(located apesis near the pleura of lower lobe), kidney, bone, cerebral cortex congenital, lymp node, adrenal gland (can be everywhere).
**Sequence of spread:
+ronchopneumonia develop in lung tissue by TB bacilla. Many Bacilla survive macrophages=>carry to regional bronchopulmonary lymph node via lymphatic Sx=>circulating blood.
+Bacilla may spread rapidly through the body b4 the cell madiated immune response available. Most primary TB heal over in monts (forming scar or lesions_these lesion containing living bacilli, can reactivate-even after many year and cause secondary infection.
+Host has lifelong relationship with TB

5/Reactivation occur:
_When resistance lower, advanced age, immuno suppression, malnutrition, ETOH & drugs, Diabetes, renal,genetic predisposition.
6/Sign & Symptom: Cough, fatigue, anoxeria, Wt. loss, high/low grade fever, chill, sweat, dyspnea, hemoplysis, chest, pain, tightness & crackles.

7/ Diagnosis Procedures:
_Monitor TB in Cow, diary products
_TB mimics other disease, X-Ray alone not a definitive test, can occur concurrently with other pulmonary disease.
_Assess pretest result and Hx of exposure:
+Skin Test:body immune response produce Hypersensitivity 3-10 wks after exposure and once acquired-sensitivity to Tubercullino tend to persist through LIFE.
**A (+) Rnx= present of TB infection(exposed). it is not indicate whether it is active, dorminate or causing illness.
**A (-) Rnx=not exposure, or depression of cell mediated immunity as in HIV.
**Testing & reading:not wheal=>not OK=>need to repead test.Read in 48-72h. Measure bump(inderation) report in mm(>=5 mm:normal person;>10 mm:health care provider)
**2 step plan( TB VAx):1st:get base line, prevent false(negative); 2nd:between 1-2 wks fr the 1st.
+The Calcification of lungs(upper lobe and lung lesions).
+Gastric washing:
+CSF, pus from abcess
+DNA finger printing
+Sputum specimen for Dx.(need enough amount to have productive smear, 10000ml of bacteria).
+Chest X-Ray:important but not definitive because other disease can mimic TB:multinodular lymp nodes, calcification of lung's lesion occurs after many years
+Anergy Pannel Testing:(APT):failure to response to any infection. DECR immune Sx, not response to TB skin test (symptom of TB, mump, candida and others).False(-):if APT not definitive=>X-Ray, Sputum, Isolation, Wait till result fr. 3 sputum in 3 separate days.

_INH (isoniazid)
_Enthambutol or Streptomycin
***Pt start all 4 meds to prevent resistance organism becuz bacilli is difficult to kill
***Tx continue long enough to eliminate dormant bacilla
9/Long term Tx:uninterupted, chemotherapy is important=>must complete all 4 meds.
_3 options:
+DOT required( daily/2-3X per week).Enthambutor d/c if susceptibility to INH/Rifapin.Pyrazinamid d/c after 8 wks.Tx duration=6M or at least 3M after sputum convert to negative.
+Daily INH, Rifampin and pyrazinamide.Enthambutol for 2wks=>DOT(2X/wk)=>duration:6wks. Isoniazid(INH) & Rifamine DOT_2X/wk wihtin 16 wks.

+DOT(3X/wk and all 4 meds for duration of 6 months
_weekly sputum test
_Therapy not working=> at least 2 meds added. After 1 year:liver fnx test
_Not treat=>pt can't go to society.
10/ Prevention:
_N95 mask.Known TB pt.=>use negative Pressure Room. Coughing use tissue & sleave(dispose properly). Staff waer well fitting mask(thicker). If exposed: INH 300 daily for 6-12M (kill dormant bacillar)
_INH 300 mg/daily/6-12 months recommended for: newly Dx infected, (+) skin test, no symptom. Live with Tb ppl. Skin test react(abnormal chest X-Ray, inactive TB.Possitive skin test plus Diabetes, Aids, Steroid.Less than 35 yrs old, skin test react, X-ray
***VAX: BCG( bacilli calmette Guerin). Live intinuated cacine. Does not prevent/reduce chance of natural infection. Does reduce seriousness clinical symptoms
***Other ways of spreading :irritating wound(splashes on mucus membrane)
Fungal Pulmonary Infection
2/2Types of fungal:
1/Regional in:
_Seriously ill
_On steroid
_Chemo. pt
_Most fungi pathogenis to human
_Found in skin
_Some fungal spore=>airborne=>lung=>mimic TB

2/2Types of fungal:
+Found in desert, construction ares, digging(N.Mexico)
+60% self limitting(asymptomatic)
+40% symptomatic
+Reginal fungus live in moist soil, mushroom, cellars chx house, bird dropping
+Dx by skin testing
+Disseminate in LUng, liver, CNS, Spleen, GI tract
+Tx:Amphotericin B
*fungalcidal antibiotic, Toxic
* Watch for fever, chills, vomitting, headache, DECR Renal Fnx, thrombophlebitis on site
*Premediate for N/V, histamine (DECR inflammation), antipyretic (Decr fever).