lower respiratory problems (TB, pneumothorax, pulmonary edema, IPAH)

TB precaution:

Airborne droplet

T or F?

TB can spread though physical contact such as kissing

F

_______ TB

infection without disease (+ tst, - bacteriological studies, no xray findings)

2 Latent

TB: primary manifestation

Dry cough becomes productive

TB: manifestations

• Fatigue

• Malaise

• Anorexia

• Unexplained _________

• Low grade fever

• ____________

Weight loss, Night sweats

TB: LATE manifestations

• ___________

• ____________

Dyspnea, hemoptysis

Acute, sudden Tuberculosis (TB)

• high fever

• Chills

• Flu-like symptoms

• ___________

• Productive cough

• ________

• ___________

• Hypoxemia

• normal or adventitious breath sounds like crackles

Pleuritic pain, ARF, hypotension

Symptoms of TB usually do not develop until ______ after infection or deactivation

2-3 weeks

More evaluation needed for TB evaluation in patients with ______ d/t not showing classic manifestations

HIV

Widespread dissemination of mycobacterium through the bloodstream to several distant organs

• occurs with primary or reactivation of LTBI

• fatal if untreated

• Fever, cough, lymphadenopathy, hepatomegaly, splenomegaly

Miliary TB

TB : complication : ______

• unilateral pleural effusion

• Chest pain, fever, cough

Pleural TB

TB complications miliary and pleural TB

Diagnostics:

AFB cultures, pleural biopsy

TB in the spine (__________)

Destruction of intervertebral disc and adjacent vertebrae

Pott disease

Central nervous system TB:

Bacterial meningitis

Abdominal TB can lead to

Peritonitis

Gold standard for diagnosing TB

Sputum culture

TB- sputum culture

__consecutive sputum specimens, each collected at a 8- to 24-hour intervals, with at least 1 early morning specimen

Growth may take up to _______

3, 6

Active TB drug therapy

Rifampin, isoniazid, pyrazinamide, ethambutol

Rifampin

S/E: __________, liver toxicity, thrombocytopenia

Orange discoloration of bodily fluids

Isoniazid

S/E: ___________, asymptomatic elevation of aminotransferases (ALT, AST)

AVOID ALCOHOL

Liver toxicity

Pyrazinamide

Exclusions

Pregnancy, hepatitis

Ethambutol

S/E: ____________ ,headache, blurred vision

Ocular toxicity

TB: _________ stopped if other three first line drugs show bacteria is susceptible to it

Ethambutol

MDR-TB: initial phase drugs (5 drugs)

• 1 or 2 first-line agents, _____________, ____________ and 1 or more second-line agents

• For at least ________ after sputum culture is negative

Fluoroquinolone, injectable antibiotic, 6 months

MDR-TB : continuations

4 drugs for ___-_____

18-24 months

TB:

Major side effect of Isoniazid, Rifampin, Pyrazinamide is:

_______________

nonviral hepatitis

TB: Isoniazid, Rifampin, Pyrazinamide

___________ are done at the start of treatment and monitored closely ( every _______- _______)

LFTs, 2-4 weeks

Fluoroquinolones (levofloxacin, moxifloxacin)

S/E:______, _____________, rash

GI problems, neurologic effects like dizziness

Injectable antibiotics

S/E:

Hepatitis, GI toxicity

LTBI: isoniazid given for _________

9 months

TB room

Neg pressure

TB: airborne precautions fit

Gown, gloves, n95

Small pneumothorax s/sx

Mild tachycardia, dyspnea

Large pneumothorax s/sx:

• respiratory distress (_____________, Dyspnea, Low O2 sat)

• Breath sounds absent over affect area

Shallow rapid respirations

Pneumothorax diagnostic study

CXR

Pneumothorax intervention

Chest tube insertion

Tension pneumothorax s/sx:

• cyanosis

• _________

• Extreme ________

• _________

• Neck vein distention

• ____________

• Late sign - ______________

Air hunger, agitation, subcutaneous emphysema, profuse Diaphoresis, trachial deviation

Tension pneumothorax interventions

Needle decompression, chest tube insertion

Hemothorax s/sx

• dyspnea

• Decreased or absent breath sounds

• ____________

• Decreased Hgb

• __________

Dullness to percussion, shock

Hemothorax interventions:

Chest tube insertion, blood transfusion, hypovolemia treatment

Pneumothorax prehospital emergency care

Cover wound on three sides

Pulmonary Edema most common cause

Left HF

Severe Pulmonary Edema:

• dyspnea, ________, _________

• 3rd ♥ sound may be present

• _________________

Diaphoresis, wheezing, hemoptysis

Pulmonary edema diagnosis

CXR

Pulmonary Edema

• Position: ___________

• Keep SpO2 greater than ___%

• IV diuretics or nitroglycerin

• Monitor VS, WOB, breath sounds, output, electrolyte balance, response to treatment

Semifowlers or high, 90

Mean pulmonary artery pressure

12-16 mmHg

Idiopathic Pulmonary Arterial Hypertension (IPAH) can result in _______ and death if untreated

Right HF

Idiopathic Pulmonary Arterial Hypertension (IPAH)

classic: ___________ and _________

• other: exertional chest pain , dizziness, syncope, abnormal ♥ sounds (S3)

Dyspnea on exertion, fatigue

Idiopathic Pulmonary Arterial Hypertension (IPAH)

Progressive signs:

Dyspnea at rest, cor pulmonale, HF

Idiopathic Pulmonary Arterial Hypertension (IPAH)

Diagnostics: ___________

• Others: ECG, CXR, PFTs, ECHO, CT scan

Right side heart cath

Idiopathic Pulmonary Arterial Hypertension (IPAH): drug therapy:

• Pulmonary vasodilation, reduce R ventricular overload, reverse modeling

• Manage ______

• Prevent _______

• Prevent hypoxia : keep O2 90% or higher

do _______

Edema, thrombi, low flow O2

Idiopathic Pulmonary Arterial Hypertension (IPAH): drugs for pulmonary vasodilation

• iloprost, treprostini, ___________

Epoprostenol (Flolan)

Idiopathic Pulmonary Arterial Hypertension (IPAH) Surgical interventions

• thromboendarectomy (PTE)

• Atrial septostomy

• ____________

Lung transplant

Cor Pulmonale:

• exertional dyspnea, Tachypnea, cough, fatigue

• RV hypertrophy

• Intensity of ___

• _________

• May have HF

S2, polycythemia

Cor Pulmonale care

• long term ______

• Fluid, electrolytes acid base imbalances corrected

• ______

• ___________

• CCB, vasodilators, anticoagulants, digitalis, phlebotomy

O2 therapy, diuretics, bronchodilators

Idiopathic Pulmonary Arterial Hypertension (IPAH)

Phosphodiesterase type 5 enzyme inhibitors

• promotes smooth muscle relaxation in lung vasculature

• Don’t take with NO

Sildenafil

Idiopathic Pulmonary Arterial Hypertension (IPAH)

Pulmonary vasodilator

Epoprostenol, low oxygen

Cor Pulmonale diagnostic

Echo, BNP, CXR