| Question | Answer |
| What is pneumonia? | The result of an inflammatory process that primary affect the gas exchange area of the lungs. In response to inflammation; fluid and RBCs from the pulmonary capillaries leaks into the alveoli. |
| What would be found in the alveolar effusion fluid of a pneumonia patient? | RBCs, fluid, leukocytes (WBCs), macrophages |
| What types of microorganism(s) cause pneumonia? | Bacteria (Gram + or Gram -), Fungal Viruses, TB, Anaerobic organisms |
| What are the classifications of pneumonia? | Community Acquired Pneumonia (CAP), Hospital Acquired Pneumonia (HAP), and Ventilator Acquired Pneumonia (VAP) |
| How lost does it take to develop hospital acquired pneumonia (HAP)? | Develops 48 hours or long after admission |
| How long does it take to develop ventilator acquired pneumonia (VAP)? | Develops 48-72 hours after intubation |
| What type of pneumonia is most common in AIDS patients? | Pneumocystis carinii pneumonia |
| What drug is used to treat pneumocystis carinii pneumonia? | Aerosolized pentamidine (Nebupent) - via Respigard Nebulizer |
| What are the chest assessment findings for a patient with pneumonia? | Increased tactile and vocal fremitus, dull percussion note, bronchial breath sounds, crackles and rhonchi, pleural friction rub (if process extended to the pleural space), whispered pectoriloquy |
| What is pulmonary edema? | Results from excessive movement of fluid from the pulmonary vascuary system to the extravascular and air spaces of the lungs |
| What are the anatomical alterations found in Pulmonary Edema? | Atelectasis, pink or frothy white sputum |
| What are the signs and symptoms associated with pulmonary edema? | Increased HR, RR, and BP (BP can be low if cardiac output i low), Cyanosis, Peripheral Edema, Cheyne Stokes Respirations (in patients with severe left sided heart failure), Sudden Paroxysmal Nocturnal Dyspnea, Orthopnea, Cough with frothy pink sputum |
| What is the most common cause of Cardiogenic Pulmonary Edema? | Congestive Heart Failure |
| What is the fluid movement associated with Pulmonary Edema? | Fluid moves from the perivascular and peribronchial interstitial spaces, alveolar walls and interstitial spaces swell, progressively fluid moves into alveoli, bronchioles, and bronchi |
| What is the normal hydrostatic pressure in the pulmonary capillaries? | 10-15 mmHg |
| What is the normal oncotic (Osmotic) pressure in the pulmonary capillaries? | 25-30 mmHg |
| What is Paroxysmal Nocturnal Dyspnea? | Sudden difficulty breathing at night |
| What are the ABG results for early stage pulmonary edema? | Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis) |
| What are the ABG results for late stage pulmonary edema? | Acute Ventilatory Failure with Hypoxemia (Acute Respiratory Acidosis) |
| What treatments are used to treat pulmonary edema? | O2 therapy, bronchopulmonary hygiene, hyperinflation with CPAP (first line of treatment), diuretics, inotropic agents, mechanical ventilation |
| What drugs are used to treat pulmonary edema? | Diuretics (Lasix/ Furosemide) and Inotropic Agents (Digitalis/ Digoxin: increase myocardial contractility) |
| What is a pleural effusion? | Excessive accumulation of fluid in the pleural space that separates the visceral and parietal pleura and compresses the lungs |
| What is a thoracentesis? | A procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest |
| How would you treat a Pleura Effusion? | Treat underlying cause, possible thoracentesis or chest tube depending on severity, pleurodesis, oxygen therapy, lung expansion therapy, mechanical ventilation |
| What PFT results would be found in patient with a pleural effusion? | Restrictive |
| What is the most common cause of transudative fluid? | Congestive heart failure |
| What is a pulmonary embolism? | A blockage to the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism) |
| How will the deadspace ratio be affected by a pulmonary embolism? | The deadspace ration will increase due to ventilation without perfusion at the embolus site |
| How will ventilation and perfusion be affected by a pulmonary embolism? | Areas of deadspace will be found in the lungs where blood flow is blocked stopping perfusion; ventilation will not be affected |
| What are the primary symptoms of a pulmonary embolism? | Increased HR and RR, pulmonary hypertension, sudden onset dyspnea (classic sign), severe chest pain (angina), anxiety, diaphoresis, cyanosis, cough/ hemoptysis, crackles at emboli site |
| What is a pulmonary infarction? | Embolus significantly disrupts blood flow causing the lung tissue to die |
| What is the treatment for a pulmonary embolism? | O2 therapy at 100%, anti-coagulants (Heparin, Warfarin, Coumadin), thrombocytes, preventative measures, pulmonary embolectomy (last resort) |
| What causes fungal diseases? | Inhalation of spores |
| What is the main anti-fungal drug? | Amphotericin B (Fungizone) |
| What is Coccidioidmycosis? Where are the spores found and in what part of the country? | Endemic in hot, dry regions (CA, AZ, NV, NM, UT, TX); after inhalation of coccidioides immitis spores, spores settle into the lung, begin to germinate, and form round, thin walled calls called spherules |
| What is Blastomycosis? | Spores are found in areas of high organic matter; forest soil, decaying wood, animal manure, and abandoned buildings |
| What part of the country is Blastmycosis found? | Occurs in people living in the south central and midwestern United States and Canada |
| What is Histoplasmosis? | Spores found in soils rich in bird excrement, most common fungal disease in the US |
| What part of the country is Histoplasmosis found? | Prevalence is especially high along the major river valleys of the Midwest |
| What is another name for Coccidioidmycosis? | Valley fever |
| What is another name for Blastomycosis? | Chicago disease |
| What is an alternate name for Histoplasmosis? | Ohio Valley Fever |
| Which fungal disease produces purulent sputum? | Blastomycosis |
| What is disseminated TB? | aka Extrapulmonary TB; bacilli escape from the lungs and travel to other parts of the body |
| What are the major pathological changes found in TB? | Alveolar consolidation, A/C membrane destruction, caseous tubercule or granulomas, cavity formation, fibrosis and secondary calcification of lung parenchyma, distortion of bronchi, increased bronchial secretions |
| What is the most effective drug used to treat TB? | Isoniazid (INH) |
| What is a closed pneumothorax? | Gas in the pleural space is not in direct contact with the atmosphere |
| What is an open pneumothorax? | Pleural space is in direct contact with the atmosphere; gas can move in and out |
| What is a tension pneumothorax? | One-way valve-like action of ruptured parietal pleaur; gas enters during inspiration, but cannot leave during expiration (most serious) |
| What is the visceral pleura? | Inner layer of the pleura |
| What is the parietal pleura? | Outer layer of the pleura? |
| How are PFT volumes effected by a pneumothorax? | Decreased |
| What are the symptoms of a tension pneumothorax? | Increased HR, RR, and BP, hypoxemia, pain, anxiety, and cyanosis |
| What is a secondary spontaneous pneumothorax? | Occurs suddenly without an underlying cause; can be secondary to pneumonia, TB, and COPD (bleb and bullae on surface of lung pop); also often occurs in tall, thin persons ages 15-35 |
| What are the causes of an iatrogenic pneumothorax? | Occurs during diagnostic or therapeutic procedures such as; pleural or liver biopsy, thoracentesis, intercostal nerve block, cannulation of a subclavian vein, tracheostomy |
| What is the treatment of a pneumothorax with a lung collapse of <15% to 20%? | Bed rest or limited physical activity; reabsorption of intrapleural gas occurs usually within 30 days |
| What is the treatment of a pneumothorax with >20% lung collapse? | Chest tube insertion to evacuate air |
| What is flail chest? | Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax |
| What is the most common cause of Flail Chest? | Trauma |
| What anatomic alterations are found in the lungs of a patient with Flail Chest? | Double fracture of numerous adjacent ribs, rib instability, lung restriction, atelectasis, lung collapse (pneumthorax), lung contusion, and secondary pneumonia |
| What is Kyphoscoliosis? | A combination of two thoracic deformities that commonly appear together |
| What anatomic alterations are found in the lungs of a patient with Kyphoscoliosis? | Lung restriction and compression as a result of the thoracic deformity, mediastinal shift, mucous accumulation, and atelectasis |
