Term
| Aspiration pna refers to pulmonary consequences resulting from the entry of the following 3 things into the airways |
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Definition
| 1) Abnormal fluid 2) Particulate exogenous secretions 3) endogenous secretions |
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Term
| What are the 2 requirements to produce aspiration pna? |
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Definition
| 1) Compromise in the usual defense that protect the upper airways 2) Inoculum deleterious to lower airways by toxic effect, inflammation, or obstruction |
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Term
| What does true aspiration pna refer to? |
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Definition
| an infection caused by less virulent bacteria (primarily anaerobes) |
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Term
| What does "true" aspiration pna usually refer to? |
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Definition
| infection caused by less virulent bacteria (primarily anaerobes) |
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Term
| Name 9 predisposing conditions to developing aspiration pna |
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Definition
| ALOC, dysphagia, upper GI d/o, mechanical disruption of glottic closure, pharyngeal anesthesia, protracted vomiting, large volume TF, fdg GT, recumbent position |
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Term
| What are the most common risk factors in the community and in LTC facility? |
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Definition
| Community - ALOC d/t etoh and drugs and LTC - dysphagia d/t neurologic dz |
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Term
| define chemical (acid) pneumonitis. What is best example of aspirated substance? |
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Definition
| Aspiration of substances that are toxic to lower airways independent of bacterial infxn. Ex: gastric acid |
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Term
| What sx occur /p the chemical is aspirated? How long is the onset? |
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Definition
| Dyspnea and cyanosis w/i 2 hrs |
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Term
| What shows on CXR in a pt w/ chemical aspiration pna? |
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Definition
| infiltrates in one or more lower lobes |
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Term
| what is the prognosis of chemical aspiration? |
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Definition
| rapid clinical recovery in 24-36hrs, CXR resolution in 4-6 days |
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Term
| What pulmonary consequences occur w/i 3 min of chemical aspiration? |
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Definition
| atelectasis, peribronchial homorrhage, pulmonary edema, and degeneration of bronchial epithelial cells |
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Term
| What occurs pathologically in the lungs /p 4 hrs of chemical aspiration? |
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Definition
| Alveolar spaces filled neutrophils and fibrin |
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Term
| What occurs in the lungs /p 48 hrs? |
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Definition
| hyaline membranes are seen, lung is grossly edematous and hemmorhagic with alveolar consolidation |
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Term
| What is the presumed pathologic mechanism in chemical aspiration? |
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Definition
| release of pro-inflammatory cytokines |
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Term
| What is the pulmonary consequence of recurrent chemical aspiration? |
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Definition
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Term
| What is the clinical presentation of chemical aspiration? |
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Definition
| abrupt prominent dyspnea, low-grade fever, cyanosis, diffuse crackles, severe hypoxemia |
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Term
| What is seen on bronchoscopy in chemical aspiration? |
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Definition
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Term
| What should be done for observed aspiration? |
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Definition
| Immediate tracheal suction |
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Term
| what is the major therapeutic approach to treat chemical aspiration? |
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Definition
| ventilation to support pulmonary function |
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Term
| Are abx typically used in a pt w/ chemical aspiration? |
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Definition
| Yes for probable secondary bacterial infxn |
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Term
| What is the most common form of aspiration pna? |
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Definition
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Term
| What are the describe the indolent sx and course of bacterial aspiration pna? |
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Definition
| Productive cough, fever, dyspnea evolving over several days or wks |
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Term
| Are rigors present in bacterial aspiration pna? |
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Definition
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Term
| Describe sputum in bacterial aspiration pna. |
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Definition
| Purulent - diagnostic of anaerobic bacteria |
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Term
| Evidence of what other type of disease is seen in pts w/ bacterial aspiration pna? |
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Definition
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Term
| What is the first line drug of choice for bacterial aspiration pna? |
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Definition
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Term
| what are alternative drugs used to tx bacterial aspiration pna? |
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Definition
| Augmentin (amoxicillin-clavulanate) OR Flagyl (metronidazole) PLUS amoxicillin OR penicillin |
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Term
| What is aspiration pna d/t mechanical obstruction? |
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Definition
| involves fluid or particulate matter that can cause airway obstruction or reflux airway closure - not toxic to lungs |
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Term
| Name 4 common aspirated fluids that are non-toxic? |
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Definition
| Saline, barium, most ingested fluids containing water, gastric contents w/ pH > 2.5 |
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Term
| What is the most common cause of aspirated fluid/mechanical obstruction |
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Definition
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Term
| Examples of solid particles that can be aspirated. |
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Definition
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Term
| What are presenting s/sx if a large object is lodged in the larynx or trachea? |
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Definition
| Sudden respiratory distress, cyanosis, aphonia |
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Term
| What are the presenting signs/sx if the aspirated material is from smaller particles with less severe obstruction? |
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Definition
| Irritant cough and wheezing |
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Term
| What is seen on CXR in mechanical obstruction? |
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Definition
| atelectasis or obstructive emphysema with cardiac shift and elevated diaphragm |
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Term
| What is seen on bronchoscopy in mechanical obstruction? |
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Definition
| visualization of solid particle |
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Term
| what is considered the critical clinical intervention for mechanical obstruction? |
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Definition
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Term
| What do you do if a solid object is lodged? |
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Definition
| heimlich maneuver (if in larynx and trachea), bronchoscopy |
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Term
| what is a frequent complication of mechanical obstruction? What is the usual pathogen? |
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Definition
| bacterial superinfection - anaerobic bacteria |
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Term
| Name 5 prevention measures for aspiration pneumonia? |
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Definition
| positioning, dietary consistency changes, oral hygiene, TF, medications |
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Term
| What are the most common risk factors for aspiration pna? |
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Definition
| impaired consciousness and dysphagia |
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