CSE patho 3

what is the past medical history of a pt with myasthenia gravis? general appearance?

past medical history: gradual onset weakness, may have previous admissions for myasthenia gravis

general appearance: weakness that improves with rest, drooping eyelids (pytosis), double vision (diplopia), difficulty swallowing (dysphagia)

what is the respiratory pattern for a pt with MG? breath sounds?

resp. pattern: shallow breathing

breath sounds: diminished with crackles

what special test are done on pt with MG?

edrophonium test (tensilon challenge test)

electromyogrpahy

blood test for ach receptor antibodies

ice pack test- ice packs on eye lids, considered positive if ptosis iproves

during tensilon test if VT, VC, MIP and weakness improves with tensilon what is it reffered to as? what should you do?

reffered to as a myasthenic crisis, indicating more of this type of drug needs to be given

maintenance drug therapy (anticholinesterase therapy, cholinesterase inhibitors) including

• pyridostigmine

• prostigime

during tensilon test if VT, VT, MIP, muscle weakness worsens what is it referred to as? what should you do?

referred to as a cholinergic crisis which is an overdose of anticholinerstrase drug

administer atropine to reverse tensilon, will relieve symptoms of crisis

what treatment should be given to a pt with MG?

• closely monitor VT, VC, MIP (intubate when indicated)

• bed rest restriction and soft diet to reduce symptoms

• oxygen therapy for hypoxemia

• hyperinflation therapy

• pulmonary hygiene

what is the past medical history of a pt with guillian barre? physical appearance?

past medical history: febrile illness, often viral in nature

physical appearance: acute weakness, especially in the legs, cyanosis

what is the respiratory pattern of a pt with GB? breath sounds?

resp. pattern: shallow breathing

breath sounds: diminished with crackles

what special test are given to pt with GB?

• lumbar puncture- high protein level in CSF (>500 mg/dL)

• abnormal electromyograph

• elevated (IgM) immunoglobin levels

what is tx and management directed at for GB pt? where are pt initially managed? what should closely be monitored?

directed at stabilization of vital signs and supportive care

initially pt should be managed in the ICU

monitor VT, VC, MIP - intubate when indicated

what tx is given to pt with GB?

• oxygen therapy for hypoxemia

• hyperinflation therapy (IS/SMI, IPPB)

• pulmonary hygiene

• mechanical ventilation for impending or acute ventilatory failure

• IVIG therapy and plasmapheresis therapy

what is the past medical history of a pt with a drug overdose? respiratory pattern? general appearance?

past medical history: previous admissions for overdose, found by family, friends, etc.

resp pattern: slow, shallow respirations

physical appearance: altered level of consciousness, euphoria

what is the diagnostic testing done for drug overdose? what are reversal agents that are given for overdose what is each for?

drug toxicology

reversal agents:

• narcan: narcotic overdose

• romaxicon: benzodiazepine overdose

• acetylecystiene: acetaminophen overdose

what can cause ARDS?

• sepsis (most common)

• aspiration pnumonia

• massive blood transfusion

• drug abuse

• severe trauma

what is the general appearance of a pt with ARDS? resp pattern?

general apperance: cyanotic

resp pattern: tachypnea, substernal or intercostal retractions

what are the breath sounds for a pt with ARDS? chest percussion? vital signs?

breath sounds: bronchial crackles

percussion: flat/ dull

vital signs: tachycardia, hypertension

what does the chest x-ray look like for ARDS pt?

x-ray: increased opacity, diffuse alveolar infiltrates with ground glass appearace

what is the pulmonary function of a pt with ARDS? what special test is done?

pulmonary function: decreased volumes and capacities (VT, RV, FRC, and TLC)

special test:

hemodynamic monitoring shows elevated PAP with normal PCWP

what are the vent settings of a for ARDS?

• tv 4-6 mL/kg

• maintain pplat <30

• initiate recuitment maneuvers

• inverse ration

• APRV

• pressure regulated volume control

• high frequency ventilation

• permissive hypercapnia

what is tx and management of ARDS?

• treat underlying conditions

• oxygen therapy

• hyperinflation therapy

• prone position

• INO therapy

• CPAP/PEEP

what causes pneumonia?

causes include bacteria, viruses and aspiration

what is the past medical history for a pt with pneumonia?

past medical history: initially mimics cold or flu, signs and symptoms may develop quickly, may have chest pain

SOB may be present

what is the cough of a pt with pneumonia? chest finding? respiratory pattern?

cough: productive, green/ yellow

chest findings: decreased expansion, increased tactile and vocal fremitus

resp. pattern: tachypnea

what is the chest percussion of a pt with pneumonia? breath sounds?

percussion: flat or dull

breath sounds: crackles bronchial, whispered pectoriloquy

what is the physical appearance of a pt with pneumonia?

appearance: diaphoretic, cyanosis

vitals: increased HR, BP, QT, Temp

what does the chest x ray look like for a pt with pneumonia?

x-ray: increased density from consolidation and atelectasis, air bronchograms, possible pleural effusion

what is the sputum culture of a pt with pneumonia? what special test are done?

sputum: gram positive or negative organism

special test: CT scan, acid fast stain for tuberculosis, ELISA test for HIV

what drug therapy is given to pt with pneumonia?

• antibiotics determined by history, sputum culture

• antipyretics to control fever

• analgesic for pain

• cough suppressants if necessary

what is the tx/ management for pneumonia?

• oxygen therapy

• pulmonary hygiene therapy

• hyperinflation therapy

• VAP protocols

• bed rest

• addequate fluid intake

• thoracentesis for large plerual effusion

what are the causes of head trauma/ surgery?

TBI, tumors, aneurysms, cerebrovascular accidents (CVA), seizures

what is the respairatory pattern of a pt with head trauma? LOC? pupillary response?

resp. pattern: irregular rhythm, cheyene- stokes or biots breathing

LOC: altered level (risk of aspiration)

pupillary response: abnormal

what special test are done for pt with head trauma?

CT, MRI, PET scans

intracranial pressure monitoring

what is given to tx acute elevation of ICP?

hyperventilatio

keep head of bed elevated

mannitol

what medication is given for sedation in pt with head trauma? what medication is for sezuires?

sedation: benzodiazepine or propofol

sezuires: dilantin

what other tx is given for pt with head trauma?

• airway protection

• O2 therapy to maintain PaO2 near 100 torr

• mechanical ventilation

• maintain PaCO2 at normal levels

• minimize mean airway pressure with low PEEP and peak inspiratory pressures

what can be the cause of neck or spinal injury?

traumatic injury, tumors, spinal deformities

what is the apperance of the neck in spinal/ neck injury? resp pattern? LOC?

neck appearance: bruised over affected area

resp. pattern: may be apneic with severe damage to spine

LOC: altered

what special test are given to pt with neck/ spinal injury?

CT, MRI scans

what is the tx for neck/ spinal injury?

• oxygen therapy to prevent hypoxemia

• maintain patent airway: use modified jaw thrust and flexible bronchoscope for intubation

• support ventilation, oxygenation, circulation and perfusion as indicated by bedside assessment