Management of Patients with Lower Respiratory Tract Disorders

Pneumonia
Pharmacologic Management: S. pneumonia: - azithromycin (Zithromax) - doxycycline (Vibramycin) With cardiopulmonary disease - Cefpodoxime (Vantin) - Cefuroxime (Zinacef) - Co-amoxiclav (Augmentin) - Doxycycline (Vibramycin) ? Bacteria produces Betalactamases ? Penicillins Cephalosporins Carbapenems Monobactams 3. Pneumonia in immunocompromised host 4. Aspiration Pneumonia Community Acquired P. 1. The most common cause of CAP in people younger than 60 without comorbidity abd older than 60 with comorbidity: a. S. pneumonia (Answer) b. H. influenza c. Legionella d. Pseudomonas aeruginosa 2. Another type of CAP, occurs most often in older children and young adult is spread by infected respi. Droplets through person to person contact: a. S. pneumonia b. Mycoplasma pneumonia (Answer) c. Cytomegalovirus 3. CAP occurs either in the community setting or within: (Answer)The First 2 days of hospitalization 4. To reduce or prevent serious complications of CAP, vaccination of pneumococcal infection is advised for the ff.: a. 65 years and older b. Immunocompetent but with chronic illness c. Asplenia d. Living in high risk areas e. Immunocompromised f. All of the above (Answer) Hospital Acquired Pneumonia

contains beta-lactams ring

Nursing Management: Improving Airway Patency - Hydration - Humidification - Use of incentive spirometer - Chest physiotherapy - Suctioning - Administer O2 Promoting rest and conserving energy - Promoting fluid intake - Maintain nutrition - Promoting patients knowledge Major Categories: 1. Community Acquired Pneumonia 2. Hospital Acquired Pneumonia

5. Which of the ff. predispose a patient to HAP: a. Patient on reverse isolation status b. Presence of lowly virulent organism c. Impaired host defenses (Answer) d. Intact host defenses 6. The ff. are interventions that may pay a role in the development of HAP EXCEPT: a. ET intubation b. Appropriate use of antibiotics (Answer) c. Use of NGT d. Prolonged chest tube e. Impaired removal of secretions 7. Staphylococcal pneumonia is responsible for 30% cases of HAP. Its mortality rate is high due to specific resistant strains reffered as: a. Enterobacter b. Klebseilla c. E. coli d. MRSA (Methicillin Resistant Staphyloccocus Aureus >Flesh eater, resistant to ->penicillin) )(Answer) 8. To prevent MRSA spread, the ff. should be done to the patient EXCEPT: a. Should be placed on a regular ward (Answer) b. Placed in contact precaution c. Minimized contact of visitors d. Treated with Vancomycin 9. CDC indentified 3 specific strategies of preventing HAP. These are the ff.: a. Staff education and infection surveillance b. Interruption of the cycle of infection c. Modification of host risk infection d. All of the above (Answer) Pneumonia in the Immunocompromised Host

10. The ff. are risk factors, EXCEPT: a. AIDS b. Genetic immune disorders c. Chemotherapy d. Limited use of corticosteroids (Answer) e. Use of broad spectrum antibiotics f. Long term uses of mechanical ventilators Aspiration Pneumonia Pulmonary Tuberculosis - Presence of lesions or Granulomas from Mycobacterium TB.

11. TB is associated with the ff., EXCEPT: a. Poverty b. Malnutrition c. Standards of living (Answer) 12. TB is spread from person to person by: (Answer) Airborne Transmission and Droplet Nuclei Pathophysiology (see copy)

Assessment & Dx Findings 13. Which of the ff. is a conclusive diagnostic test for TB: a. Mantoux test b. AFB test (Answer) c. Chest X-ray d. Serological test Prevention: Vaccination Proper nutrition Identify and treat people with TB

Strengthen immunity Manage stress

Pharmacologic Management: Latent TB - INH for 9 months Active TB (1st line) - Isoniazid (INH) *peripheral neuropathy , prevents absorption of vitamin B6 *management; give Pyrodixine *Bacterocidal - Rifampi (RIF) * normal to have orange-red urine, sweat, tear drops - Esthambutol (EMB) *optic neuritis *nephrotoxicity *ototoxicity - Pyrazinamide (PZA) - -Myrin P Active TB (2nd line) - Aminoglycosides: amikacin (AMK) kanamycin (KM) - Fluroquinolones: ciproxfloxacin (CIP), levofloxacin 14. Defines as resistance to the two most first-line TB drugs: (Answer) Multi-drug-resistant tuberculosis (MDR-TB) Chronic Obstructive Pulmonary Disease (COPD) ? Bronchiectasis collapse of the bronchi ? Emphysema collapse of the alveoli (loss of elasticity) ? Bronchitis inflammation of the bronchi *chronic Chronic Bronchitis

Presence of cough and sputum for at least 3 months in each of 2 consecutive years 15. Defining characteristics of chronic bronchitis: a. Increase in size and number o goblet cells (Answer) b. Dilation of bronchial lumen c. Enhanced function of the alveolar macrophages. Emphysema - Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli.