Unit 2 221 exam

hemoptysis

blood-tinged frothy sputum

usually associated with pulmonary edema

eupnea

normal breathing

kussmaul respirations

deep rapid respirations typically for acidosis

may follow strenuous activity

more related to abnormal metabolic activity

wheezing

whistling sounds

asthma patients, COPD

indicate obstruction in small airways

wheezing response

need bronchodilators

stridor

high pitched crowing noise

sign of blockage/object, usually upper airway

dyspnea

difficulty breathing often with exertion

using accessory respiratory muscles

increased CO2 / hypoxemia

orthopnea

discomfort breathing when lying down

usually caused by pulmonary congestion

congestive heart failure

congestive heart failure of the right side

peripheral edema

congestive heart failure of the left side

lung

rales

light bubbly crackling sounds with serous mucus

ronchi

pneumonia or chest infection

deeper or harsher sounds from thicker mucus

most dangerous lung sounds

none

absence of lung sounds

no air movement or collapse of lungs

hypoxia

low oxygen levels in body tissue

hypoxemia

low oxygen levels in the blood

hypercapnia

increased carbon dioxide in the blood

reasons for clubbing

chronic hypoxia with respiratory or cardiovascular disease

congenital heart disease

obstructive lung disease (cystic fibrosis, pulmonary fibrosis, COPD)

yellowish-green, cloudy, thick mucus

bacterial infection

rusty or dark colored sputum

pneumococcal pneumonia

very large amounts of purulent sputum with odor

bronchiectasis

bronchiectasis

__abnormal__ __widening__ of the __bronchi__ or their branches, causing a risk of infection

thick tenacious mucus

asthma or cystic fibrosis

blood tinged sputum

chronic cough, tumor, tuberculosis

rhinorrhea

runny nose, thin/clear

pruritus

itching

common cold treatment

2 or more of the following:

nasal decongestant

antitussive

analgesic

antihistamine

caffeine (offset antihistamine)

what causes allergic rhinitis

inflammation of upper airways, lower airways, and eyes

allergic rhinitis treatment

antihistamines (don’t reduce congestion, but reduce inflammation)

intranasal glucocorticoids

sympathomimetics (oral and intranasal)

common cold

viral infection spread through respiratory droplets

focus of common cold treatment

symptomatic

background of common cold

infection and inflammation lead to pharyngitis, laryngitis, acute bronchitis

sinusitis treatment

decongestants

analgesics

antibiotics (amoxicillin)

side effects of amoxicillin

nausea, vomiting, diarrhea and rash

what should you take with amoxicillin

milk/food

upper respiratory tract infections

common cold

allergic rhinitis

sinusitis

flu

croup

croup (laryngotiacheobronchitis)

viral infection common among children

kids with wheezing when breathing in

lower respiratory infections

pneumonia

tuberculosis

severe acute respiratory syndrome (SARS)

adult respiratory distress syndrome (ARDS)

types of pneumonia

lobar pneumonia

bronchopneumonia

ventilator associated pneumonia (VAP)

lobar pneumonia

bacterial

community based

inflammation and vascular congestion

exudate with fibrin, rusty sputum

sudden, systemic, rales, confusion

lobar pneumonia treatment

amoxicillin, doxycycline, azithromycin

bronchopneumonia

can be several microorganisms

gradual: fever, cough, rales, purulent sputum

bronchopneumonia treatment focus

antibacterial

ventilator associated pneumonia (VAP)

bacteria pooling in back colonizing around “cuff”

VAP treatment

30-45º elevation

thorough oral care every 2-4 hours

remove ET tube as soon as possible (less than 48 hours)

tuberculosis associations

crowded living

immunodeficiency

malnutrition

alcoholism

conditions of war

chronic disease

HIV infection

tuberculosis

infection transmitted by oral droplets from person with active infection

primary tb infection

when organisms first in lungs

asymptomatic

contagious -- need N-95

secondary tb infection

cell mediated immunity impaired by stress, malnutrition, HIV infection, age

ACTIVE TB

TB treatment

isoniazid

rifampin

isoniazid for TB

latent TB

common resistant

PO or IM

inactivated by liver, excreted by kidney

adverse effects of isoniazid

hepatotoxicity

peripheral neuropathy

seizures, dizziness, ataxia

ataxia

poor muscle control

rifampin for TB

broad-spectrum antibiotic

PO empty stomach

TURNS BODY FLUIDS ORANGE

adverse effects of rifampin

hepatotoxicity, GI distress

severe acute respiratory syndrome (SARS)

acute respiratory infection

initial: fever, headache, myalgia, chills, anorexia, diarrhea

later: long effects (dry cough, dyspnea, interstitial congestion, hypoxia), might require mechanical ventilation

transmission of SARS

respiratory droplets (watch close contact)

adult respiratory distress syndrome (ARDS)

injury to alveolar wall and capillary membrane leading to release of chemical mediators

signs/symptoms of ARDS

dyspnea, restless, rapid/shallow respiration, increased HR, acidosis

associated with multiple organ dysfunction or failure

upper respiratory meds

antihistamines

nasal decongestants

intranasal glucocorticoids

antitussives

expectorants

corticosteroids

empyema

pockets of puss collected in body cavity

steatorrhea

bulky, fatty, foul stools that can occur with cystic fibrosis

pulsus paradoxus

exaggerated drop in systemic blood pressure during inspiration

symptom of asthma

antihistamine mechanism of action

block h1 receptor sites (h1 agonist)

lower inflammation

first generation antihistamine

diphenhydramine (benadryl)

diphenhydramine treatment use

allergic rhinitis, pruritus, uticaria

common cold, sneezing, cough

motion sickness prevention

pruritus

itch

uticaria

hives

contraindications for diphenhydramine

closed angle glaucoma (increased pressure), urinary retention, sever liver disease (metabolized in liver)

diphenhydramine interactions

CNS depressants

second generation antihistamine

loratadine, cetirizine

second generation antihistamine treatment

seasonal allergies (allergic rhinitis)

nonsedating (operating heavy machinery)

fewer anticholinergic symptoms

nasal congestion

dilation of nasal blood vessels and swelling of nasal cavity

rebound congestion

at certain point after prolonged use med causes dilation rather than vasoconstriction → more severe systems

nasal decongestants mechanisms of action

stimulate alpha adrenergic receptors → nasal vascular constriction

nasal decongestant use

allergic rhinitis, inflammation, infection

safe for children 6-11 if for less than 5 days

NOT under 6, pregnant, or breastfeeding

side effects of nasal decongestants

nervous/restless

rebound nasal congestion (>5 days)

nasal decongestants interactions

caffeine, MAOIs, beta blockers

nasal decongestant drug

phenylephrine (pseudoephedrine)

phenylephrine

systemic decongestants tracked at pharmacy

complications of phenylephrine

rebound congestion, vasoconstriction, CNS stimulation

how much phenylephrine can you get?

9 g within 30 days

3\.6 g/day

intranasal glucocorticoids

anti-inflammatory (allergic rhinitis prevention and treatment)

intranasal glucocorticoids meds

becelomethasone and intranasal fluticasone (Flonase)

side effects of intranasal glucocorticoids

headache, blurred vision

irritated/dry nasal mucosa, pharyngitis

hoarseness, nausea, vomiting

candidiasis, insomnia

prevention for oral candidiasis

rinse/oral care to prevent oral thrush

antitussives mechanisms of action

suppress cough reflex

types of antitussives

non-opioid

opioid

combination preparations

non-opioid antitussives

less CNS effect, not sedating (dextromethorphan)

opioid

if patient already has pain, can do cough too (codeine)

expectorants

loosens bronchial secretions allowing elimination by cough

expectorant use

common cold

side effects of expectorant use

drowsiness, dizziness, headache, n/v/d

what should you not take with expectorants

antitussives (want to cough it out of you)

corticosteroids

principal anti-inflammatory drugs by suppressing the immune system

corticosteroids uses

long term for monitoring or short term for acute asthma

for inflammation and edema, decrease airway mucus builds up

corticosteroids

budesonide, fluticasone, prednisone

budesonide and fluticasone use

first line asthma inflammation

inhaled

persistent - use drugs daily

adverse effects of budesonide and fluticasone

oral thrush, dysphonia (difficulty speaking)

prednisone

oral med for moderate/severe persistent asthma or manage acute exacerbations of asthma or COPD

use as brief as possible