"Respiratory Disorders"

What is hemoptysis?

coughing up blood

What is Cheyne-Stokes breathing?

periods of deep breathing alternating with periods of apnea

What is hypercapnia?

too much CO2

What is hypocapnia?

Too little CO2 - respiratory alkalosis

What is hypoxemia?

low oxygen in the blood

What is hypoxia?

low oxygen in tissues

Which are respiratory infections?

-common cold

-rhinosinusitis

-influenza

-pneumonia

-tuberculosis

What is the common cold?

viral infection of the upper respiratory tract

What is the frequency of the common cold?

2-3 colds/year for adults

6-8 colds/year for children

Colds can be caused by:

a virus

• rhinovirus

• adenovirus and coronavirus

• RSV

• parainfluenza virus

What is Rhinovirus and when is it most common?

-The most common cause of colds

-most common in early fall and late spring

Parainfluenza is most common in:

children <3 yrs old

Adenoviruses and coronaviruses are most common in:

the winter and spring months

Respiratory Syncytial Virus (RSV) can:

increase the risk of asthma

Respiratory Syncytial Virus (RSV) is most common in:

-Winter an spring months

-Children <3 yrs old

What is true about viruses?

They cannot be treated with antibiotics

How is the common cold transmitted?

-droplet (eg: cough, sneeze), contact, fomites

-fingers are the greatest source of spread

What are the two common portals of entry for the common cold?

The nasal mucosa and conjunctival surface

What are clinical manifestations of a common cold?

-Rhinitis: inflammation of mucosal membrane

-clear and watery secretions

-Post nasal drip (can cause cough and sore throat)

-Headache

-Malaise

-Chills, fever

How is the common cold treated?

-Rest

-Antipyretic drugs

-Decongestants

Rhino-sinusitis is both:

Rhinitis and Sinusitis

What is Rhinitis? what mucus do you see?

inflammation of the nasal mucosa

clear watery discharge

What is sinusitis? what mucus do u see?

inflammation of the sinuses

purulent mucus

Where is the maxillary sinus located?

in each maxillary bone lateral to the nasal cavity (cheeks)

Where are the frontal sinuses located?

within the frontal bone (forehead)

Where is the sphenoid sinus located?

in the body of the sphenoid bone

(may extend into wing of sphenoid)

Where is the ethmoid sinus located?

between the eyes

6-12 small sinuses per side

What is acute rhinosinusitis?

-can be viral or bacterial or both

-symptoms last <1 month

What is subacute rhinosinusitis?

1-3 month

What is chronic rhinosinusitis?

Lasts beyond 12 weeks (>3 months)

symptoms/diagnosis of rhinosinusitis

CT scan

sx: facial pain, headache that worsens when coughing, sneezing, bending forward

What is the treatment for rhino-sinusitis?

-antibiotics if needed

-Antipyretics

-Viral will improve on its own (Rest, fluid intake)

What is influenza?

The most significant cause of upper respiratory tract infections

How is influenza transmitted?

via droplets generated when infected persons cough or sneeze

What virus has the highest mortality rate in children and elderly?

Influenza

What are the two types of influenza?

Type A and Type B

What is type A influenza?

-most common type

-can infect humans AND animals

-causes the most severe disease

What is Type B influenza?

-affects only humans

-less severe

What is the treatment for influenza?

-Fluids

-rest

-Antivirals (if less than 48 hrs with flu symptoms)

• Amantadine

• Rimantadine

• Zanamivir

• Oseltamivir 

What do antivirals do for influenza?

stop replication of the virus; they shorten the duration of it.

It is NOT a cure

What is acute bronchitis?

acute infection or inflammation of the airways or bronchi

-commonly follows a viral illness

What is the difference in symptoms between acute bronchitis and pneumonia?

The symptoms are similar except acute bronchitis does not present with pulmonary consolidation and chest infiltrates like pneumonia does

What is pneumonia?

infection of the lower respiratory tract (lungs, trachea, bronchi)

What is the leading cause of death in the elderly?

pneumonia

What causes pneumonia?

infectious causes: bacteria, viruses, or fungi

non infectious causes: aspiration pneumonia (aspirated gastric secretions)

Why must patients be NPO before surgery?

To reduce the risk of aspiration pneumonia

What are the classifications of pneumonia?

Classifications are according to:

-the source of infection

-immune status of the host

-type of agent causing the infection

-distribution of the infection

What pneumonia is according to the source of infection?

-hospital acquired

-community acquired

What pneumonia is according to the immune status of the host?

pneumonia in the immunocompromised person

What pneumonia is according to the type of agent causing the infection?

-Typical

-Atypical

What pneumonia is according to the distribution of the infection?

-Lobar pneumonia

-Bronchopneumonoa

What is community-acquired pneumonia (CAP)?

Infection acquired outside hospital

Symptoms begin <48 hours after hospital admission.

What is the most common bacteria that causes Community-acquired pneumonia?

Streptococcus pneumonia (Pneumococcus)

What is hospital acquired pneumonia (HAP)?

pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.

What is the 2nd most common cause of hospital acquired infection?

Hospital-acquired pneumonia

What is the mortality rate of hospital-acquired pneumonia?

much higher compared to CAP

20-50%

What is pneumonia in immunocompromised people?

Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection in HIV/AIDS patients

What is typical pneumonia and what does it cause?

• Pneumonia where the patient very ill and bedridden; aggressive, severe pneumonia

• patho:

  • exudation of fluid into the alveoli —> lung consolidation

What is atypical pneumonia? Cause? Patho?

• walking pneumonia

• Patient feels unwell but can continue daily activities.

• cause:

  • Mycoplasma pneumoniae.

• patho:

  • Infection mostly affects the alveolar walls and interstitial tissue, not the alveolar spaces themselves.

  • Lack of alveolar exudate and patchy involvement of the lungs causing lack of lung consolidation

What is the difference and imaging differences between typical and atypical pneumonia?

In typical pneumonia, there is fluid inside the alveoli —> large white patch on xray

In atypical pneumonia, there is clear alveoli and fluid in between them —> patchy x-ray

What are the symptoms of typical pneumonia?

• High fever

• Chills/shaking

• Malaise

• Productive cough (bc of mucus/exudate → lung consolidation)

• Pleuritic chest pain: sharp, stabbing pain when you breathe in or cough

What are the symptoms of atypical pneumonia?

• Mild malaise

• Dyspnea

• Dry cough

• Headache

• Patient remains functional

Typical pnuemonia caused by:

a bacteria

Atypical pneumonia is caused by:

nonbacterial

How do you assess for Typical pneumonia?

-Dullness on percussion

-Increased tactile fremitus

-Bronchophony, egophony, whispered pectoriloquy

normal lung sounds are:

resonant

The diagnosis of a client with exudation of fluid into alveoli and consolidation on a CXR will be:

typical pneumonia

general manifestations of pneumonia

• dysnpea

• tachypnea

• cyanosis

• fever

• headache

• elderly: confusion

How is typical pneumonia diagnosed?

sputum cultures to identify causative microorganism

cultures before antibiotics

What is tuberculosis?

infection caused by mycobacterium tuberculosis, acid-fast bacillus that infects the lungs

What is millary TB?

When TB bacteria migrates to other organs

precautions to take in TB pts

• place pts in negative pressure room

• door remains closed

• speak to nurse before entering room

• nurses wear N-95 mask

• patients wear surgical mask outside of room

What is primary TB?

• develops in someone not previously exposed

• -organism enters lungs and is attacked by macrophages which then become infected

• immune cells contain the infection by forming granulomas

• granulomas may heal or calcify —> healed dorant lesion

What is a granuloma?

• a mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance.

• these granulomas are permanent in the lungs

• bacteria remain dormant in the granuloma for years —> latent TB

Granuloma =

ghon focus

What is a Ghon focus?

A calcified granulomatous lesion in the lung

Ghon focus + lymph node infection =

ghon complex

What is a Ghon complex?

combination of tubercles in the lung and caseation in lymph nodes

What happens to granulomas?

They can remain their all our lives

Because of them, PPD test is (+)

Clinical Manifestations of Primary Tuberculosis

Not contagious

No S&S

positive PPD

What is Secondary Tuberculosis and what causes it?

• reactivation of dormant bacteria in granulomas

• caused by: immunosuppression, elderly, HIV

Reactivated TB can cause:

the person to develop S&S, and is contagious

What are symptoms of active TB (Secondary TB)?

-Low grade fever

-night sweats

-anorexia, weight loss

-hemoptysis

-dyspnea

What is measured in a PPD test ?

the size of the induration (bump) is measured by palpation

What are the three categories of positive TB reactions?

5-mm

10-mm

15-mm

How is TB diagnosed?

1. PPD skin test

2. CXR —> cavitations

3. Sputum culture and Blood culture

(Last two must be done to make sure it is TB)

An induration of >5mm on the Mantoux test indicates:

-HIV positive people

-Recent contact with TB positive individual

-organ transplant reciepients

An induration of >10mm on the Mantoux test indicates:

-Recent immigrant (<5 yrs)

-IV drug users

-Healthcare professional

-Resident or employee of high risk congregate setting: prison, ALFs, nursing homes, jails, homeless shelters

An induration of >15mm on the Mantoux test indicates:

-All persons with no risk factors

-children >4yrs old

How is TB treated?

Combination of 4 antibiotics to prevent resistance over a period of 6-9 months

• First ~2 months, take antibiotics (all 4):

  • Isoniazid (INH)

  • Rifampin (RIF)

  • PZA

  • EMB

• Then, follow with 4 months of only:

  • INH, Rifampin

T or F? Primary TB is asymptomatic, is not contagious and is a negative PPD.

False, PPD is still positive

What is ventilation?

movement of air in and out of the lungs

What is perfusion?

blood flow reaching alveoli via the capillaries

Oxygen bound to hemoglobin is:

oxyhemoglobin

Carbon dioxide bound to hemoglobin is:

Carbaminohemoglobin

Most CO2 travels through...

bicarb