Med Surg Exam 2- Pulmonary PPT

Dyspnea

• Subjective sensation of uncomfortable breathing

• Orthopnea

  • Dyspnea when a person is lying down

• Paroxysmal nocturnal dyspnea (PSD) 

signs and symptoms of pulmonary disease

dyspnea, cough, abnormal sputum, hemoptysis, abnormal breathing patterns, hypoventilation, hyperventilation, cyanosis, hypoxia, clubbing, pain

cough

• Acute cough

• Chronic cough

hemoptysis

coughing up blood

abnormal breathing pattern

kussmaul respirations (hyperpnea) + cheyne-stokes respiration

hypoventilation

leads to hypercapnia

hyperventilation

leads to hypocapnia

acute bronchitis summary

• Self-limiting inflammation of bronchi; most caused by viruses 

  • Other triggers: pollution, chemical inhalation, smoking, chronic sinusitis and asthma 

  • With the seasons changing comes an increase in viral respiratory illnesses like bronchitis 

    • Patients that are more susceptible to get viral respiratory illnesses will be more likely to get bronchitis 

acute bronchitis symptoms

• *cough, clear/purulent sputum, headache, fever, malaise, dyspnea, chest pain

  • Cough is most common symptom; lasting up to 3 weeks; more frequent at night 

  • Clear mucus cough/ green sputum

    • The green sputum does not always indicate that it has now evolved to a bacterial infection

    • Coughing can lead to chest pain

acute bronchitis diagnosis + tx

• Breath sounds: crackles or wheezes

• Treatment goal–symptoms relief and prevent pneumonia; supportive

  • Cough suppressants, oral fluids, humidifier 

  • Beta 2-agonist inhaler –wheezing or underlying pulmonary condition 

  • Avoid irritants

  • See HCP: fever, dyspnea, or duration greater than 4 weeks 

  • Chest x-ray can be used for dx to look for consolidation

    • To look for patchy white areas in the lungs → pneumonia 

    • Cough suppressants can be prescribed and used/ stronger than OTC 

    • Encourage patients to drink more fluids 

    • Pts with underlying conditions (asthma, COPD) have more intense symptoms → we need albuterol to open up the airways due to the inflammation 

      • AVOID IRRITANTS (like smoking)

    • Can be due to the flu –pts should get prescription for antivirals within 48 hours 

    • Can be persistent –need to encourage patients to see HCP as it might turn into bacterial and they will need antibiotics

Pneumonia

• Acute infection of lung parenchyma 

• Associated with significant morbidity and mortality rates

• Pneumonia and lower respiratory tract infections such as influenza 

  • 4th leading cause of death worldwide in 2019 

• VERY CONCERNING 

Aspiration of normal flora from nasopharynx or oropharynx:

1. something going down the wrong pipe

   1. Unlikely to lead to pneumonia as we usually cough it out

      1. Think about patients who cannot cough: patients with bad gag reflex, neurological problems (stroke, brain injury), patients with problems eating or drinking

      2. Seen often in older patients living in tertiary care facilities (rehab, nursing homes). 

         1. These older patients have comorbidities → high mortality rate

      3. We can also aspirate GI acids (gastric reflux can travel to respiratory tract) 

Inhalation of microbes present in the air

1. coughing, laughing, talking coming from infected patient

   1. TB, covid, flu –droplet/airborne precautions 

Hematogenous spread from primary infection elsewhere in the body

1. comes from another site of infection 

   1. I.e. UTI going into the blood stream and travels to the lungs

Long-term smokers:

1. cilia loses ability to sweep away debris over time the longer that the person smokes

Cough reflex

1. patients who had a stroke lose ability to swallow → lack of cough reflex

Community-acquired pneumonia (CAP)

• Acute infection in patients who have NOT been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms 

• Can be treated at home or hospitalized dependent on the patient’s age, VS, mental status, comorbidities, and condition

• MRSA, legionella (populates within water source)

• Particularly connected with elderly patients 

  • Assessment CURB 65

  • Confusion, BUN greater than 20, RR greater than 30, age greater than 65 

    • Every time you tick yes to each criteria, outcome is not looking great 

Hospital-acquired pneumonia (HAP) or nosocomial pneumonia

• HAP: occurs 48 hours or longer after hospitalization and not present at time of admission 

  • E.coli, assinabacter, clebisella ammonia 

• Ventilator-associated pneumonia (VAP): occurs more than 48 hours after endotracheal intubation 

  • These patients tend to be much more sick → increased mortality rate 

• These are the most common bacterial organisms but pneumonia is MOST commonly caused by the influenza VIRUS

• We must figure out if its viral or bacterial so we can plan proper tx 

  • Also, we must note the comorbidities of the patient

manifestations of pneumonia

Most common

• Cough: productive or non-productive

• Green, yellow, or rust-colored sputum 

• Fever, chills

• Dyspnea, tachypnea 

• Pleuritic chest pain 

Older or debilitated patients: confusion or stupor, hypothermia