Quiz 3

What is dyspnea?

Shortness of breath, difficulty breathing

Whats the difference between dyspnea at rest vs at exertion?

Dypnea at rest is concerting

Dyspnea on exhertion is normal

What is the Borg scale used for

How much effort is takes for someone to function thier lungs properly

How is the borg scale measuured?

0-10

0=NO hardness to breathe

10= Maximal effort o breathe

What is a sleep disturnace?

The name of a category of conditions that cause poor sleep quality

Caused by helath or enviromental factors

What is a sleep disorder

A medical diagnosis that causes sleep disturbance

Is sleep apnea and sleep disorder or sleep disturnabce

Sleep disorder

What is sleep apnea?

Sleep Disorder

Interrupted breathing causing bad sleep due to upper airway obstruction

How does sleep issues affect the neurologic systems

Cognitive impairment

Behavioral changes

How does sleep issues afffect the immune system

Causes impaired immune function

How does sleep issues afffect the respiratory system

Exacerbates asthma

How does sleep issues affect the cardio system

Higher risk of heart disease

Hypertention

Strokes

How factors cause sleep disturbances in the hospital

Decrease sleep due to hospital factors like noises lights, overstim

Medication given at hospital can alter sleep (Opiods)

What is the definition of Sleep Disordered Breathing (SDB)

Different types of abnormal respiratory patterns assoicated with sleep

What are some types of Sleep Disordered Breathing (SDB)

Snoring

Apnea

Hypopnea

Obstructive sleep apnea

What is Obstructive Sleep Apnea (OSA)

Partial or complete upper airways obstruction during sleep

When does OSA usually occur?

REM cycle

throughout the night

What does Apnea mean?

Greater than 90% of airway cessation in respiratory airflow lasting longer than 10 seconds

Amost Complete sensation of breathing

What does Hypopnea mean?

30-90% decrease in airflow

What causes Obstructive Sleep Apnea

Muscle relaxation during sleep causes narrowing of airway passages due to tounge and soft palate falling backwards

What are some risk factors for OSA?

Obesity

Enlarged tounge, tonsils

Age greater than 65

Smokers

Men

Nasal Polyps

Neck Circumference

What are common clinical clinical manifestiations of OSA

Frequent arousal during sleep

Insominia

Daytime sleepiness

Loud snoring

Morning headache

What does the Polysomnography (PSG) test

Test invovlving elctrodes to measure sleep stages and wakefullness

What is the Apnea-Hypopnea Index

A measurable score a person can have based on the severaity of their apneic events.

How many apneic events do you have to have in an hour to be diagnoised with OSA?

more than 5

What are possibly complications that can happen if OSA goes untreated

HTN, Stroke, A Fib, Diabetes, Obesity, BAd memory , interpersonal difficulities

What are medical devices that can be used to help aleviate sleep apnea symtoms

CPAP

Nasal Mask

What do users of medical devises for OSA complain of that cause poor adherence?

Nasal Stuffiness

Why do sedatives and opoids worsen OSA?

They depress the CNS causing further upper airway muscle relaxation

Brain sensors to take a breath also are altered as well causing less incentive to breathe.

For mild OSA interventions, whats the best for sleep position?

Sleeping on side

Elevated HOB

Would losing weight be an effective intervention for mild sleep apnea

Yes

What are interventions for severe sleep apnea?

nCPAP or BiPAP

Surgery

What is a Uvulopalatopharyngoplatsy (UPPP, UP3)

Removal of obstructing tissues that black tonsillar pillars, uvula, and postieorir soft palate

Allows for winder opening of the pharnyx reudicn gthe risk of tissue collapse

What is a Genioglossal advancement and hyoid myotomy (GAHM)

Advancement of the tounge this allows the tounge from relaxing into the upper airway

What is Pneumonia?

Acute infection of lung parenchyma (functional parts of lung where gas exchange happens)

What are the common risk factors for Pneumonia?

Age > 65

Smoking

Immobility

Air Pollutions

Chornic DIsease

Immunocompromised

What causes Pneumonia to form

Aspiration

Tracheal intubation

Air polluion

Smoking

Aging

Can pneumonia be caused by aspiration of normal flora in nasopharynx

Yes

Can Pneumonia be caused by inhalation of microbes in the air

Yes

Can Pneumonia be caused by hematogenous spreads from primary infection elsewhere in the body (infection travels to teh lung)

Yes

What is Community-acquired pneumonia (CAP)

Pneumonia that got aquired not at a hospitla or healthcare facility

Can be treated or home or hosppital depends on paitents condiions

What is Hospital-acquired pneumonia (HAP)

Pneumonia that occurs 48 hrs or longer after hospitalization and wasnt there at time at admission.

Could be Ventilater assoicated pneumonia, happens after intubation

Why is it important to understand where the pneumonia is caught at?

Because it needs different types of treatment

Why is it important to give empiric antiotic therpapy for suspected pneumonia?

It serves as a broad spectrum antibiotc to help while waiting for culture to grow and be indentified.

What are the types of Pneumonia?

Viral (Most Common)

Bacterial

Mycoplasma

Aspiration

Necrotizing

Opportunistic

Is viral pneumonia treated with antibiotics?

No

What are risk factors for aspiration pneumonia?

Decreased LOC (causes depressed cough or gag reflex)

Difficulty swallowing

Insertion of foreign bodies (NG tubes)

If gastric juice is aspirated What happens?

1) stage stage causes chemical (no bacterial) pneumonitis

2) Eventually infection occurs in 24-72 hrs

What is Consolidation?

Alveoli becomes filled with water, fluid, imflammation fluids

Causes impaired lung function

What are some S/S for Pneumonia?

Cough: Can be Productive or Non productive

Sputum: Green, Yellow Rust

Fever, Chills

Dyspnea, Tachypnea

Pleuritic chest pain

What kind of colored sputum would a pneumonia paitent have?

Green, Yellow, Rust Color

In an older paitents what do S/S look of for Pneumonia?

Confused, Stupor

Hyperthermia, Diaphoreses

FAtique

Headache

Why do older paitents have differnt S/S for pneumonia compoared to the normal population

Their immune system is not as strong, delays stuff

During a physical assesment of a paitent fo pneumonia what can you expected to find

Fine or Corase Crackles over affected Region

Consolidation ]

• Bronchial Breath Sounds

• Egophone

• Increased Fremitus

When you percussion over an area affected by pneumonia what should you expect to feel?

Dullness due to liquid trapped in the lungs

When treating Pneumonia what are some major issues that block treatment?

MDR pathogens

Immunocompromised patients

History of antibiotic use

Prolonged Mechanical ventilation

As Pneumonia progresses what are some complications that can occur

Atelectasis

Pleurisy (Inflammation of pleura)

Pleural Effusion (Liquid pooling outside of lungs)

Bacteremia (bacterial INfection in blood)

Pneumothorax (Lung Collapse from air in pleural spce)

ARF

Sepsis

How is Pneumonia Diagnoised?

Physical examination

Chest X- Ray

Pulse Ox

ABGs

Sputum Sample and culutre

Blood Culutres

CBC with differential

When looking at an X Ray searching for pneumonia what would be seen?

White stuff this is actualy stuff that shows up

Black is air

Is there a clearn definitive treatment for viral pneumonia?

No, it is just supportive measures that aid in body’s natural antiviral stuff to kill it

After giving antibiotics when should you expect to se results

48-72 hrs

Giving antibiotics for pneumonia will see the paitent have

Decreased Temperature

Improved Breathing

Less Chest Discomfort

Compared to bacterial killing does the physical signs of pneuomnia lag after>?

Yes the absense of physical signs lags behind bc stuff needs to clear, even though theres no bacteria

What is the Pneumococcal vaccine used for?

To present S. pneumoniae infection

Why is it important to have adequet hydration for pneumonia paitetns?

-Prevents Dehydration
- Loosens Thick Mucous

Why is it important to keep the HOB elevated for Pnuemonia paitents?

So they dont have aspiration pneumonia

What population should have hydration adjusted for pnemonia

Older adults

Chornic Heart Failure

Renal Issues

Why are poeple on tube feeding at risk for pneumonia?

Because the tube feeding can accidently go into the lungs, throuhg reflux or dispalcement

Looking at objective data via assesemnt what signs point to pnemonia

Any signs that indicate hypoxia

• Restlessness

• Accessory muscle usage

• Nasal Flaring

• Decrease excursion

What state would the heart be at for someone with pneuonia?

Tachycardiac due to heart trying to get more oxygen from the impaired lung

What type of lab results would a paitent with pneumonia have?

Increased WBC

Abnormal ABGs

Positive Sputum

Abnormal Chest X ray

For a paitent with PNA how often should oral hygiene occur

2 times a day with Chlorhexidine swab

What is Atelectasis?

When Alveoli collapses, due to deflation and stickiness'

Secreations obstructing small airways causes alveoli not to be inflated with new air

What are some signs of Atelectasis?

Decreased/ Absent Breath sounds

Dullness on percussion

Who is at risk for Atelectasis?

Bedridden, Post op paitents

Anesthia

What are intervetions for Atelectasis?

Incentive Spirometer 10x and hour

What is the bacteria that causes TB

Mycobacterium tuberculosis

How is TB spread?

Through airborne particles

Why does TB usually happen in the lungs

The bacteria thrives in high oxygen enviorments

What are some risk factors for TB?

Living or working in institutions

Homeless

IV drug users & HIV+

Immunosuppression

What are some factors that relate to how transmissible TB is?

Number of organisms in air

Concentration of organisms

Length of exposure time

Immune syste of exposed person

What is the Microbiotic of M. tuberculosis?

Gram Positive Aerobic

Acid Fast

How is TB spread?

Airborn Droplet

1 to 5 micrometer

Can you usually get TB from short rapid exposure?

No

How long and proximety is needed in order to get TB?

It needs to be close, frequent, or prolonged

Is TB spread by touch, or physical contact?

No , not spread by

Touching, sharing food utensils, kissing, or other physical contact

How long does it take to develop symtoms for active TB?

2-3 weeks its slow

What are s/s of TB?

Typical Fever symtoms due to intense immune responses

Anorexia

Night Sweats

dry cough that becomes productive

Coughing up blood (Hemopytsis)

What are late s/s of TB, and why?

Dyspnea: Parts of Lung necrotoized, impairng lung fucntion

Hemoptysis: Coughing up blood and part of lung

What type of mask is used for TB and airborne precaution rooms?

N95

In an Immunosuppressed or older adult how would TB show up as?

No Classic fever symptoms

An older adult who has tb only defining sign due to immunocomprimsiion may be

Change in cognitive function

What is pleurisy, and why is it a symptom of TB?

Inflammation of Pleura Causing sharp pain on inhalation

When gathering history for a TB paitent what are important items to note?

Prior TB

Chronic illness

Immunosuppression

Socal and Occupational risk factors

For TB testing are TST, PPD, or Mantoux the same?

Yes thjey refer to the intradermal test for TB that you need to check in 48-72 hrs

How does a Tuberculin Skin Test (TST) work?

Purified protein Derivative is injected intradermly

Induration occurs if body fights recognized TB

Site INspected 48-72 hrs after

In a postiive Tuberculin Skin Test what should the characteritiscs of the INduration be

Palpable, Raised, Hardended, Swollen

REDNESS DOES NOT COUNT

For the general public what sized induration would suggest positive TB finding?

Induration > 15 mm

For individuals at risk (IV drug users, healthcare workers, nursing home residents, medically underserved populations) what induration number suggests positive TB finding

Induration > 10 mm

For immunocompirsed people (HIV, those close to TB paitents) what induration number suggests postiive TB

Induration > 5 mm