Exemplars for CHs 20 & 21, Respiratory

acute rhinitis

Inflammation and irritation of nasal mucosa

what are the two possible causes of acute rhinitis?

allergic or viral causes

viral causes of acute rhinitis include…

mainly rhinovirus, also coronavirus and adenovirus

S&S of viral acute rhinitis include…

red nasal mucosa & turbinates
yellow or green nasal discharge
High lymphocyte levels

S&S of allergic acute rhinitis include…

grey nasal mucosa & turbinates
clear nasal discharge
Eosinophil levels increase

how is allergic rhinitis treated?

antihistamines, acetaminophen, may need steroid nasal spray

acute pharyngitis

Inflammation of the pharynx, usually viral cause

S&S of acute pharyngitis

Red, swollen pharyngeal membranes and tonsils

Fever

malaise

sore throat, but typically no cough

“Strep throat” may be present (need a culture to diagnose)

how is acute pharyngitis treated?

Antibiotics, antipyretics, analgesic, & salt water gargles

acute sinusitis

infection of the sinuses

can be acute, subacute, or chronic

how long does acute sinusitis last?

viral is 5-7 days

bacterial is up to 4 weeks

how long does chronic sinusitis last?

more than 12 weeks

S&S of sinusitis include…

Headache, pain over sinus areas, fatigue, nasal obstruction,
purulent nasal discharge

how is sinusitis treated?

Antimicrobial agents, decongestants, saline spray

epiglottitis

inflammation of the epiglottis, often caused by infection, leading to difficulty breathing and swallowing.

can have bacterial and viral causes

how is epiglottitis best diagnosed?

with x ray and laryngoscopic exam

tell tale sign is “steeple sign”

why could epiglottitis become a medical emergency?

because inflammation could obstruct the trachea, which obstructs breathing

trachea equipment should be ready at hospital

S&S of epiglottitis include…

anxiety

stridor (when air goes against a compressed area)

trouble breathing sitting up

how is epiglottitis treated?

antibiotics

bronchitis

inflammation of the bronchi and bronchioles resulting in diminished bronchial mucociliary function and edematous mucous membrane

causes of bronchitis include…

Viral, bacterial, or inhalation of toxic substance

risk factors for bronchitis include…

smoking, common cold, sinusitis, pharyngitis

S&S of bronchitis include…

muscles ache all over

fever

persistent cough

common cold

sputum (could be clear, yellow, green, blood tinged)

maybe slight cyanosis or greyish skin

blue mucous membranes

what color of sputum with bronchitis means viral? what color means bacterial?

color doesn’t determine viral or bacterial cause

what lung sounds are heard with bronchitis?

ronchi and wheezing

how is bronchitis diagnosed?

with a culture and sensitivity of sputum

how is bronchitis treated?

broadspectrum antibiotics

Expectorants (meds that’ll help cough up bronchial secretions)

Mucolytic agents (to thin tenacious secretions)

Bronchodilator (to open up air passages)

prescription cough suppressant (for coughing at night)

pneumonia

when mucus and exudative edema accumulate between
the alveoli and capillaries to cause reduced gas exchange

what trademark lung sounds are heard with pneumonia?

crackles

why are crackles heard with pneumonia?

because alveoli are opening and closing against the purulent exudate

S&S of pneumonia include…

SUDDEN onset of symptoms

cough (may be non/productive)

fever

chills

pleuritic chest pain (pain when breathing in/out)

fremitus

dullness with percussion

dyspnea

hemoptysis

tachypnea

use of accessory muscles to breathe

low SaO2

how is pneumonia diagnosed?

with chest x ray to diagnose and sputum culture

how is pneumonia treated?

antibiotic (for bacterial)

Put them in fowler’s position

Give supplemental o2 through nasal cannula

Give analgesia for pain

Give antipyretic for fever

Give bronchodilator to help breathing

Recommend pneumococcal vaccine

Asthma

hyperreactive airway disease of the bronchioles that cause (reversible) airway constriction

-each attack leads to bronchiole remodeling

S&S of asthma include…

Prolonged expiration (takes longer to breathe out) (early sign of airway obstruction)

Wheezing (because air goes against very narrow opening) 

Cough

Dyspnea

Report tight chest feeling

use of accessory muscles to breathe

↑ BP & HR

Anxiety (cause they can’t breathe properly)

Fear of dying

how is asthma diagnosed?

PFT/FEV (↓ during acute attack)

history/physical

Draw labs (allergy, eosinophils, CBC)

what is a stepwise approach to asthma treatment?

approach used before trying drugs

may start with something simple like breathing exercise, then move on to inhaled meds

drug treatments for asthma include…

maintenance drugs (salmeterol) as preventative measures

rescue drugs (albuterol) for acute attacks

inhaled corticosteroids (budesonide)

status asthmaticus

a potentially fatal, asthmatic, medical emergency where pt has trouble breathing after med team has intervened

-May need to be intubated

-person will be cyanotic and have CO2 retention

COPD

condition where the bronchioles are very narrow and produce a lot of mucous and alveoli clusters have a problem with recoil (opening; can be caused by smoking)

combo of emphysema and bronchitis

bronchitis in COPD

pt has trouble getting air INTO lungs (inspiratory problem) due to being unable to get around hypersecretion of mucous = hypoxia

low SaO2

some cyanosis

emphysema in COPD

pt has trouble getting air OUT OF lungs (expiratory problem) due to overdistention of alveoli

results in ↑ Co2 in lungs = hypercapnia

why are people with emphysema in COPD called “pink puffers”?

because they still have good O2 levels are still good, so their lips keep a pink color, but they breathe through pursed (puffed) lips

why are people with bronchitis in COPD called “blue bloaters”?

because they tend to have low oxygen levels, leading to cyanosis and a bloated appearance due to fluid retention

how is COPD diagnosed?

assessment test (questionnaire)

PFT

CBC

Chest x ray

ABGs

ECG

what is a stepwise approach to COPD treatment?

O2 therapy, cessation of smoking, pulmonary rehabilitation, vaccinations)

drug treatments for COPD?

SABAs

LABAs

LAMAs

ICs

Leukotriene agonists