POM FINALS ASTHMA TO EPISTAXIS (josh copy)

What is the 3 characteristics of asthma?

Hyper-responsive airways

Inflammation

Excessive mucus production

What type of drugs is not given to px with asthma

Beta-blockers

decade of life asthma most common

1st decade

Second peak of asthma occurs during

3rd to 4th decade

gender risk of asthma occurs on?

both male and female

describe asthma

Atopic tendency with multiple allergic reactions

What are the 3 etiology of asthma

1. Extrinsic

2. Intrinsic

3. Lifestyle/environmental

Extrinsic etiology of asthma

Pollen, feces of house-dust mites, pet fur

Intrinsic etiology of asthma

Atopy w/ raised IgE levels, asthma gene (Chr. 11), bronchial hyper-reactivity

Lifestyle/environmental etiology of asthma

Exercise (>cold air), stress, smoking, drugs (NSAIDs, B-Blockers), pollution, viral infections (URTI)

What has a notorious allergic effect?

Protein

Triad of asthma

1. Edema

2. bronchoconstriction

3. mucous plugging affecting the bronchioles

Cause of asthma in pathogenesis

Mast cell degranulation

What is released during mast cell degranulation?

Histamine and prostaglandin

Symptoms of asthma

• Nocturnal cough

• Wheezing

• Inability to breath w/ cyanosis and coma

  (Status asthmaticus)

• Life threatening features: Cyanosis,

  apnea, confusion, exhaustion

Treatment in terms of medical for asthma

Beta2 Agonist - Salbutamol

Beta2 Agonist + Inhaled steroid ○ Add long-acting B2 Agonist
Add (Theophylline, leukotriene antagonist high-dose inhaled steroid)

Add oral steroids and nebulizers

What is monitored in patient with asthma

Peak expiratory flow

Device used to measure peak expiratory flow

Peak flow meter

Describe chronic obstructive pulmonary disease

Group of lung diseases leading to damage of lung tissue w/ persistent and progressive limitation of air flow

2 common cause of COPD

Chronic bronchitis

Emphysema

Other term for chronic bronchitis

Blue bloater

Other term for emphysema

Pink puffer

Other cause of COPD due to lifestyle

Smoking

Etiology of COPD

• Smoking (Active and Passive)

• Atmospheric Pollution

• Alpha 1 - Antitrypsin Deficiency (Pulmonary Protective Protease)

  • Congenital form

COPD due to chronic bronchitis

Damage to the respiratory epithelium with ulceration

COPD due to emphysema

Airspace dilation and loss of elastic tissue within the alveolar walls leading to gas trapping, over inflation, and limitation of expiratory airflow

SS of COPD

• Chronic cough

• Excessive sputum production

• Shortness of breath

• Expiratory wheeze

3 complications of copd

1. Respiratory failure

2. Right heat failure

3. Pneumothorax

T/F: Bronchodilators for COPD do offer the same degree of relief

F; do not offer; Temporal relief only

Treatment for COPD

1. Cessation of smoking

2. Antibiotics, bronchodilators, inhaled and oral steroids

3. Non-invasive ventilation

   1. Oxygen concentrator

4. Influenza and pneumococcal vaccination

5. Rely on low oxygen tension to drive their respiration and should not be given high-flow oxygen over long periods of time

Do we sedate COPD patients?

NO!

COPD has inflamed _

primary and secondary bronchi

Most common malignancy in western world

Lung Cancer

Incidence decreases on who and increases on who?

• Decreasing incidence in males

• Increasing incidence in females

What is the main cause of lung cancer?

smoking (90%)

Other causes of lung cancer

• Passive smoking

• Air pollution

• Coal and asbestos exposure

What are the 2 major groups of lung cancer?

1. Small Cell Lung Cancer

2. Non-small Cell Lung Cancer

Describe sclc

Centrally located, rapid growth rate, and metastasis early

describe nsclc

slow growth rate, metastasizes later

Horner’s syndrome is seen on patients with?

Lung cancer

Describe horner’s syndrome

miosis, partial ptosis, hemifacial anhidrosis

drooping eyelids

pstosis

miosis

constriction of pupil

hemifacial anhidrosis

loss of sweating of face (one side only)

Local signs and symptoms of lung cancer

1. Persistent cough

2. Prolonged chest infection

3. Chest pain increased by breathing and coughing

4. Hemoptysis

5. Progressive dyspnea

6. Hoarse voice

7. Horner’s Syndrome

8. Distended neck veins (superior vena caval obstruction)

Systemic signs and symptoms

1. Finger clubbing

2. Weight loss

3. Malaise

4. Anemia

5. Ectopic hormone production (e.g. ACTH)

Lung cancer spreads through (metastatic spread)

1. Bone pain

2. Neurological deficits

3. Jaundice

Treatment for patients with lung cancer

1. Curative surgery - 20%

2. Majority, palliative

   1. Radiotherapy

   2. Chemotherapy

   3. Supportive therapy

   4. Analgesia

3. Advice on how to stop smoking

These are evident/present on people with lung cancer

1. Chronic Lung Allograft Dysfunction (CLAD)

2. Distended neck veins

3. Horner’s syndrome

Color of lungs on patients with lung cancer

Charcoal

Inhaled foreign body percentage occurence

27%

IFB more common in?

Adults or lederly

Causes of inhaled foreign body

1. Close proximity to airway

2. Small instruments used

3. Supine position

4. Sedation-induced reduction in cough reflux

What part of the lung is affected during IFB

Right main bronchus to right lower lobe of the lung

IFB can develop risk for

1. Lung abscess

2. Pneumonia

When small object is inhaled, this affects?

Lungs

When larger object is inhaled, this affects?

Above the vocal cords

How to prevent iFB

1. Use of rubber dam

2. Placement of pharyngeal sponges

3. Restraining cords on instruments

4. Avoidance of over sedation

5. Training in instrument handling

TX for IFB

1. Removal

2. Antibiotics

Describe pulmonary embolism

Due to a blockage of a portion of the arterial system in the lungs

Cause of pulmonary embolism

Most commonly due to a blood clot shed from a deep vein thrombosis in the lower limb

• Prolonged immobilization

• Less common on fat, air, amniotic fluid

Pulmonary embolism is common in people that are?

Bedridden due to immobilization

Pathogenesis of pulmonary embolism

Embolus impacts and obstructs a portion of the pulmonary arterial circulation resulting in collapse of the alveoli in the area and decreasing the efficiency of gas exchange

Clinical features of pulmonary embolism

• Sudden onset of chest pain

• Acute shortness of breath

• Hemoptysis

• Collapse

• Sudden death

This clinical feature causes sudden death in pulmonary embolism (common)

Amniotic fluid embolism

Treatment for pulmonary embolism

Thrombolysis

Anticoagulation (Warfarin, coumadin)

Describe rhinitis

Inflammation of the lining of the nose

Causes of rhinitis

1. Allergies

2. Cigarette smoke

3. Changes in temperature

4. Exercise

5. Stress

Reaction by the body which happens in some people who are sensitive to chemical substances from various things present in the environment

Allergy

What are the 4 types of rhinits

1. Seasonal allergic rhinitis

2. Perennial allergic rhinitis

3. Non-allergic rhinitis

4. Allergic rhinitis

Caused by pollen in the air from plants, grasses or trees; Symptoms present during times of peak pollen levels

Seasonal allergic rhinitis

Chronic rhinitis, year-round problem; Caused by indoor allergens such

as dust and animal dander

Perennial allergic rhinitis

• Allergic cause cannot be

  identified

• Thought to occur because of

  abnormal regulation of nasal

  blood flow
  

Non-allergic rhinitis

• Symptoms are mostly in the nose

  and eyes

• Due to airborne particles of dust,

  dander, or plant pollens

Allergic rhinitis

When the cause is pollen, it is considered as?

Seasonal allergic rhinitis/hayfever

Over-sensitive immune response, reacts to substances (allergens) that are generally harmless and in most people do not cause an immune response

Allergy

Allergen example

Pollen or dust

1st exposure produces

Abs

2nd exposure produces

Ab-mediated release of histamine

Determination of Ige can be done through?

Blood test

Other determination test

Intradermal allergy test reactions

Best treatment for allergy

avoid what causes the allergic symptoms or reduce exposure

Medication options for allergies

1. Short-acting antihistamines

   1. Relieve mild to moderate symptoms, may cause drowsiness

   2. Loratadine (Claritin) - non-drowse

2. Long-acting antihistamines

   1. Less drowsiness e.g. Fexofenadine, and Citirizine

3. Nasal corticosteroid sprays

   1. If symptoms are not relieved by antihistamines alone

4. Decongestants

   1. Helpful in reducing nasal congestion (should not be used for long periods)

   2. Neozep, can cause hypertension (shoots up bp sa px with hypertension)

5. Cromolyn sodium

   1. Nasal spray (Nasalcrom) for treating hay fever

   2. Eye drop preparations are for itchy, bloodshot eyes

6. Leukotriene inhibitor

   1. Helps control asthma and relieve symptoms of seasonal allergies

Describe epistaxis

A nosebleed is a loss of blood from the tissue lining of the nose

Where is epistaxis occuring?

One nostril only!

If 2 nostril bleeding, this indicates?

High blood pressure

Season epistaxis prevalent

Winter

Air moving through the nose can also dry out the membranes and can form

Crust

T/F: These crusts bleed when irritated by rubbing, picking, or blowing the nose

T

Most nosebleeds occur on the front of the _

nasal septum

Rationale for front nasal septum

It contains many fragile, easily damaged blood vessels

Less commonly, nosebleeds may occur _

higher on the septum or deeper in the nose.

Higher septum or deeper in nose indicates _

Such nosebleeds may be harder to control

Frequent nosebleeds may also be a sign of _

hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu Syndrome)

T/F: Blood thinners do not worsen nosebleed

F; Blood thinners such as Coumadin or aspirin may cause or worsen nosebleeds

Causes of epistaxis

Allergic rhinitis, colds, sinusitis, deviated septum
An object stuck in the nose
Barotrauma

Blowing the nose very hard
Chemical irritants
Direct injury to nose, including a broken nose
Nose picking
Overuse of decongestant nasal sprays Repeated sneezing
Surgery on the face or nose
Taking large doses of aspirin or blood-thinning medicine
Upper respiratory infection
Very cold or very dry air, low humidity Prolonged use of decongestant Rebound rhinitis

Repeated nosebleeds may be a symptom of another disease such as

• high blood pressure, allergies, a bleeding disorder, or a tumor of the nose or sinuses.