Respiratory Disorders Overview
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Questions and Answers

What is the primary organism responsible for Tuberculosis (TB)?

  • Escherichia coli
  • Mycobacterium tuberculosis (correct)
  • Staphylococcus aureus
  • Streptococcus pneumoniae

    • Tuberculosis is primarily transmitted through contaminated food.

    False

    Name one risk factor for contracting Tuberculosis.

    Being in close contact with an infected person

    Tuberculosis is characterized by a local inflammatory reaction and the development of a __________.

    <p>granuloma</p> Signup and view all the answers

    What is one of the methods to conduct a comprehensive nursing assessment?

    <p>Conducting a systematic primary and secondary survey.</p> Signup and view all the answers

    Polypharmacy can complicate nursing care for patients with complex respiratory conditions.

    <p>True</p> Signup and view all the answers

    What is the importance of recognizing clinical cues for patient deterioration?

    <p>It enables timely intervention to prevent further decline.</p> Signup and view all the answers

    After inhalation, TB particles lodge in the __________ and alveolus.

    <p>bronchiole</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Granuloma = Local inflammatory response to infection Polypharmacy = Use of multiple medications Deterioration = Worsening of patient’s condition Assessment = Systematic evaluation of patient health</p> Signup and view all the answers

    Which of the following is a component of a therapeutic plan of care?

    <p>Collaborative management strategies</p> Signup and view all the answers

    What is the most common life-limiting genetic condition affecting Australians?

    <p>Cystic Fibrosis</p> Signup and view all the answers

    Hospitalization is necessary for most patients with tuberculosis.

    <p>False</p> Signup and view all the answers

    What is the primary cause of morbidity and death in cystic fibrosis?

    <p>Respiratory manifestations</p> Signup and view all the answers

    A pulmonary embolism occurs due to a blockage of pulmonary arteries by a __________.

    <p>thrombus, fat or air embolism, or tumor tissue</p> Signup and view all the answers

    What is the percentage of pulmonary embolisms that arise from a deep vein thrombosis (DVT)?

    <p>70%</p> Signup and view all the answers

    Patients with tuberculosis are infectious for the first two weeks after starting treatment if their sputum is positive.

    <p>True</p> Signup and view all the answers

    What type of disorder is cystic fibrosis?

    <p>Autosomal recessive disorder</p> Signup and view all the answers

    The effective management of symptoms of cystic fibrosis includes medications and __________.

    <p>physiotherapy</p> Signup and view all the answers

    Match the following conditions with their characteristics:

    <p>Tuberculosis = Infectious disease requiring early detection Cystic Fibrosis = Autosomal recessive disorder affecting lungs Pulmonary Embolism = Blockage of pulmonary arteries Pulmonary Oedema = Fluid accumulation in the lungs</p> Signup and view all the answers

    Which of the following is NOT a characteristic of pulmonary embolism?

    <p>Is a non-emergency condition</p> Signup and view all the answers

    What is the most common cause of acute bronchitis?

    <p>Viral infections</p> Signup and view all the answers

    Cough is the most common symptom of acute bronchitis and can last for up to 3 weeks.

    <p>True</p> Signup and view all the answers

    Name one preventive measure to reduce the risk of respiratory diseases.

    <p>Avoid cigarette smoking</p> Signup and view all the answers

    Acute bronchitis is usually triggered by infections in the ______ or ______.

    <p>nose, throat</p> Signup and view all the answers

    Match the following symptoms with their possible occurrences in acute bronchitis:

    <p>Cough = Common symptom Green sputum = Possible but not reliable for infection Chest pain = Associated symptom Normal breath sounds = Assessment finding</p> Signup and view all the answers

    Which of the following vaccines is recommended for the prevention of respiratory diseases?

    <p>Pneumococcal vaccine</p> Signup and view all the answers

    Which of the following is a primary preventive measure against influenza?

    <p>Flu vaccine</p> Signup and view all the answers

    Only influenza A viruses can cause significant illness in humans.

    <p>False</p> Signup and view all the answers

    What is a common viral cause of bronchiolitis in infants?

    <p>Respiratory syncytial virus (RSV)</p> Signup and view all the answers

    The flu season typically begins in the _______ and continues through the spring.

    <p>autumn</p> Signup and view all the answers

    What is the incubation period for influenza?

    <p>1–4 days</p> Signup and view all the answers

    Match the following types of influenza viruses to their characteristics:

    <p>Influenza A = Can infect various animals and humans Influenza B = Primarily infects humans and causes regional epidemics Influenza C = Causes mild illness and does not cause epidemics or pandemics</p> Signup and view all the answers

    What antiviral medications are effective for treating influenza?

    <p>Zanamivir and Oseltamivir</p> Signup and view all the answers

    Antibiotics should be used to treat viral infections like influenza.

    <p>False</p> Signup and view all the answers

    What is a key characteristic of the second (paroxysmal) stage of pertussis?

    <p>Paroxysms of cough with a whooping sound</p> Signup and view all the answers

    Cough suppressants are effective in treating pertussis.

    <p>False</p> Signup and view all the answers

    Name one risk factor for developing pneumonia.

    <p>Age over 65 years</p> Signup and view all the answers

    Pneumonia can be classified into ___________ and hospital-acquired pneumonia.

    <p>community-acquired</p> Signup and view all the answers

    Match the following organisms with their associated type of pneumonia:

    <p>Streptococcus pneumoniae = Community-acquired pneumonia Staphylococcus aureus = Hospital-acquired pneumonia Mycoplasma pneumoniae = Community-acquired pneumonia Klebsiella pneumoniae = Hospital-acquired pneumonia</p> Signup and view all the answers

    Which of the following mechanisms does NOT protect the airway from infection?

    <p>Fever response</p> Signup and view all the answers

    What is the primary reason for receiving the flu vaccine in autumn?

    <p>To ensure full protection by the time flu season peaks</p> Signup and view all the answers

    Children under 6 months of age are recommended to receive the trivalent inactivated influenza vaccine (TIV).

    <p>False</p> Signup and view all the answers

    What are two common side effects of the live attenuated influenza vaccine (LAIV)?

    <p>Runny nose, nasal congestion</p> Signup and view all the answers

    The presence of __________ is often a symptom of pertussis.

    <p>uncontrollable, violent coughing</p> Signup and view all the answers

    Match the vaccine types with their delivery method:

    <p>Trivalent inactivated influenza vaccine (TIV) = Injection Live attenuated influenza vaccine (LAIV) = Nasal spray</p> Signup and view all the answers

    Which group is most vulnerable and particularly encouraged to receive the flu vaccine?

    <p>Healthcare workers and residents of long-term care facilities</p> Signup and view all the answers

    People who have known immunodeficiency can receive the live attenuated influenza vaccine (LAIV).

    <p>False</p> Signup and view all the answers

    What is the maximum benefit timing for antiviral therapy after the onset of influenza symptoms?

    <p>24-48 hours</p> Signup and view all the answers

    COVID-19 is primarily transmitted through infectious __________ aerosols and droplets.

    <p>respiratory</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with COVID-19?

    <p>Rash</p> Signup and view all the answers

    Which of the following symptoms is most commonly associated with pneumonia?

    <p>Cough</p> Signup and view all the answers

    Older patients may exhibit classic symptoms of pneumonia.

    <p>False</p> Signup and view all the answers

    What is a potential complication of pneumonia that involves inflammation of the pleura?

    <p>Pleurisy</p> Signup and view all the answers

    In pneumonia, neutrophils are activated to engulf and kill the offending __________.

    <p>organisms</p> Signup and view all the answers

    Match the symptoms of pneumonia with their descriptions:

    <p>Cough = May or may not be productive Tachypnea = Rapid breathing Dyspnea = Shortness of breath Pleuritic chest pain = Pain during breathing, often sharp</p> Signup and view all the answers

    What is a common diagnostic measure for pneumonia that can provide sufficient information for management decisions?

    <p>Chest X-ray</p> Signup and view all the answers

    Acute respiratory failure is a rare outcome in patients with severe pneumonia.

    <p>False</p> Signup and view all the answers

    What is empyema?

    <p>Accumulation of purulent exudate in the pleural cavity</p> Signup and view all the answers

    The recommended daily fluid intake for a patient with pneumonia is at least _______ liters.

    <p>2</p> Signup and view all the answers

    Match the following complications of pneumonia with their descriptions:

    <p>Atelectasis = Collapsed, airless alveoli Lung abscess = Rare complication associated with S. aureus and Gram-negative organisms Bacteraemia = Bacterial infection in the blood Pneumothorax = Air collects in the pleural space causing lung collapse</p> Signup and view all the answers

    Which of the following is a major factor influencing the transmission of tuberculosis?

    <p>Length of exposure</p> Signup and view all the answers

    Tuberculosis is highly infectious and can be easily spread through casual contact.

    <p>False</p> Signup and view all the answers

    What is the disease process that forms the hallmark of tuberculosis?

    <p>granuloma</p> Signup and view all the answers

    People with HIV are __________ times more likely to develop active tuberculosis.

    <p>18</p> Signup and view all the answers

    Match the following classifications of tuberculosis with their descriptions:

    <p>Primary TB = Initial infection leading to active disease Latent TB = Infection without symptoms that can become active later Reactivated TB = Previous TB infection that has returned Extrapulmonary TB = TB that occurs outside of the lungs</p> Signup and view all the answers

    Which of the following treatment options should be prescribed for a previously healthy outpatient with no recent antibiotic therapy and no risk for DRSP?

    <p>Doxycycline or macrolide class of antibiotic</p> Signup and view all the answers

    Patients with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) should receive vancomycin or linezolid.

    <p>True</p> Signup and view all the answers

    What is the recommended total treatment time for patients with community-acquired pneumonia (CAP)?

    <p>A minimum of 5 days</p> Signup and view all the answers

    Hydration is important to prevent __________ in patients with pneumonia.

    <p>dehydration</p> Signup and view all the answers

    Match the following antibiotic types with their examples:

    <p>Macrolides = Azithromycin β-lactams = Ceftriaxone Antipneumococcal, antipseudomonal β-lactams = Piperacillin/tazobactam Aminoglycosides = Gentamicin</p> Signup and view all the answers

    For patients with pneumonia and a penicillin allergy, which substitute should be used for the β-lactam?

    <p>Aztreonam</p> Signup and view all the answers

    Clinical improvement in pneumonia patients typically occurs within 7-10 days.

    <p>False</p> Signup and view all the answers

    Which of the following is a priority care problem for a patient with pneumonia?

    <p>Impaired gas exchange related to fluid accumulation</p> Signup and view all the answers

    Patients with pneumonia should practice good health habits to reduce their risk of complications.

    <p>True</p> Signup and view all the answers

    Name one method to prevent aspiration pneumonia in patients with feeding tubes.

    <p>Elevate the head of the bed 30–45 degrees during meals.</p> Signup and view all the answers

    The overall goals for a patient with pneumonia include clear breath sounds and __________ breathing patterns.

    <p>normal</p> Signup and view all the answers

    Match the following nursing interventions with their purpose:

    <p>Oxygen therapy = To improve oxygen saturation levels Hydration = To thin secretions Incentive spirometer = To encourage deep breathing Early ambulation = To prevent complications like pneumonia</p> Signup and view all the answers

    Which of the following is recommended for individuals at risk of pneumonia?

    <p>Pneumococcal vaccines</p> Signup and view all the answers

    Patients recovering from pneumonia should limit their fluid intake.

    <p>False</p> Signup and view all the answers

    What is one important nursing action to facilitate lung expansion in immobile patients?

    <p>Turn and reposition the patient at least every 2 hours.</p> Signup and view all the answers

    It is important to maintain strict __________ to reduce the incidence of healthcare-associated infections.

    <p>medical asepsis</p> Signup and view all the answers

    Match the following complications with their associated preventive measures:

    <p>Aspiration pneumonia = Proper positioning during feeding Healthcare-associated pneumonia = Hand hygiene and infection control Postoperative pneumonia = Early mobilization and use of incentive spirometer Hypoxia = Oxygen therapy and monitoring</p> Signup and view all the answers

    What percentage of lung cancer cases is attributed to smoking?

    <p>80–90%</p> Signup and view all the answers

    The 5-year survival rate for lung cancer has decreased from 22% to 10% between 1989 and 2014.

    <p>False</p> Signup and view all the answers

    Name one risk factor for developing lung cancer aside from smoking.

    <p>High levels of pollution, radiation, or asbestos.</p> Signup and view all the answers

    The risk of lung cancer decreases to that of non-smokers within ___ to ___ years of quitting smoking.

    <p>10 to 15</p> Signup and view all the answers

    Match the following lung cancer risk factors with their descriptions:

    <p>Smoking = Accounts for 80–90% of lung cancers Passive smoking = Health risk from smoke inhaled by non-smokers Asbestos exposure = Long-term exposure increases lung cancer risk Pollution = Environmental factor linked to respiratory issues</p> Signup and view all the answers

    Which of the following is the most common symptom reported first by patients with lung cancer?

    <p>Persistent cough</p> Signup and view all the answers

    A chest X-ray is the definitive diagnostic test for lung cancer.

    <p>False</p> Signup and view all the answers

    What are two types of lung cancer staging mentioned?

    <p>Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)</p> Signup and view all the answers

    A patient with lung cancer may experience __________ due to laryngeal nerve involvement.

    <p>hoarseness</p> Signup and view all the answers

    Match the following diagnostic methods with their appropriate use in lung cancer assessment:

    <p>Chest X-ray = Initial diagnostic test CT scan = Evaluate lung mass extent Biopsy = Definitive diagnosis Sputum cytology = Identify malignant cells</p> Signup and view all the answers

    What percentage of sputum cytological studies yield positive results for malignant cells?

    <p>20-30%</p> Signup and view all the answers

    Name one surgical intervention used in the interprofessional therapy for lung cancer.

    <p>Surgery</p> Signup and view all the answers

    What is the primary cause of the higher incidence of lung cancer in Māori populations in New Zealand compared to the general population?

    <p>All of the above</p> Signup and view all the answers

    Women with lung cancer live, on average, 12 months longer than men with lung cancer.

    <p>True</p> Signup and view all the answers

    What is the average chance of a non-smoking woman developing lung cancer?

    <p>1 in 17</p> Signup and view all the answers

    The two broad sub-types of primary lung cancer are _____ and _____ lung cancer.

    <p>non-small cell, small cell</p> Signup and view all the answers

    Match the types of lung cancer with their characteristics:

    <p>Squamous cell carcinoma = Slow growth, accounts for 20-30% of lung cancers Adenocarcinoma = Moderate growth, most common in non-smokers Large cell carcinoma = Rapid growth, highly metastatic Small cell carcinoma = Very rapid growth, associated with poor prognosis</p> Signup and view all the answers

    Which of the following is a characteristic of small cell lung cancer (SCLC)?

    <p>Spreads early via lymphatics and bloodstream</p> Signup and view all the answers

    Non-smoking men are at a greater risk of developing lung cancer than non-smoking women.

    <p>False</p> Signup and view all the answers

    What is the main treatment approach for small cell lung cancer?

    <p>Chemotherapy</p> Signup and view all the answers

    Study Notes

    Tuberculosis (TB)

    • Caused by Mycobacterium tuberculosis
    • Transmission: airborne droplets (suspended in air mins-hours)
    • Symptoms:
      • Pathophysiology: Once inhaled, particles lodge in bronchiole and alveolus

      • local inflammatory reaction and granuloma developed

      • Scar tissue develops & calcifies

    Interprofessional care—Tuberculosis

    • Early detection
    • Accurate diagnosis
    • Effective disease treatment
    • Prevention of spread
    • Hospitalisation not necessary for most patients
    • Infectious for first 2 weeks after starting treatment if sputum +ve
    • Need to monitor adherence

    Cystic fibrosis

    • Autosomal recessive disorder affecting Lungs and digestive system
    • Abnormal exocrine gland secretions causing excessive thick mucous
    • Most common life-limiting genetic condition affecting Australians
    • No cure
    • Respiratory manifestations usual cause morbidity and death
    • Treatment: management of symptoms through medications and physiotherapy

    Pulmonary Oedema

    • Pathophysiology:
      • Occurs when fluid leaks from the blood vessels in the lungs into the air sacs
      • This prevents oxygen from passing into the bloodstream
      • Causes shortness of breath, coughing up blood, and swelling in the legs and ankles

    Pulmonary Embolus (PE)

    • Pathophysiology:
      • Blockage of pulmonary arteries by thrombus, fat or air embolism, or tumour tissue
      • Obstructs alveolar perfusion
      • Medical emergency
    • Clinical manifestations:
      • Shortness of breath
      • Chest pain
      • Coughing up blood
      • Rapid heart rate
      • What percentage of PE’s arise from a DVT?
        • 90%

    Respiratory Disease Prevention

    • Avoid smoking and exposure to secondhand smoke.
    • Wash hands frequently to prevent the spread of infections.
    • Limit exposure to allergens, indoor pollutants, and outdoor air pollution.
    • Get a pneumococcal vaccine and yearly flu vaccine as directed by a healthcare provider.
    • Wear appropriate protection when working in environments with prolonged exposure to dust, fumes, or gases.

    Lower Respiratory Tract Infections (LRTIs)

    • LRTIs are a common and serious health concern.
    • They can be caused by viruses or bacteria.
    • Acute LRTIs are the primary cause of morbidity and mortality in both children and adults.

    Acute Bronchitis

    • Acute bronchitis is inflammation of the bronchi in the lower respiratory tract.
    • It is primarily caused by viruses.
    • Air pollution, dust, chemical inhalation, smoking, chronic sinusitis, and asthma are potential triggers.
    • Most cases resolve on their own.
    • The most common symptom is coughing, which can last up to 3 weeks.
    • Clear or mucoid sputum is often present, but the color of the sputum is not a reliable indicator of bacterial infection.
    • Other symptoms include headache, fever, malaise, hoarseness, muscle aches, shortness of breath, and chest pain.
    • Diagnosis is based on clinical assessment and patient history.
    • Chest X-rays are not typically used unless pneumonia is suspected.
    • Treatment focuses on supportive measures, such as cough suppressants, expectorants, bronchodilators, and analgesics.
    • Antibiotics are usually not prescribed unless a prolonged infection with systemic symptoms is present.
    • Complementary and alternative therapies, like honey, may help with symptom relief.
    • If influenza is the cause, antiviral medications such as zanamivir or oseltamivir can be used within 48 hours of symptom onset.

    Influenza (Flu)

    • Highly contagious respiratory illness that causes significant morbidity and mortality.
    • Seasonal epidemics occur worldwide.
    • In Australia and New Zealand, the flu season runs from autumn through spring, peaking in winter.
    • Vaccination of high-risk groups, such as those with chronic health conditions and the elderly, can reduce morbidity and mortality.

    Influenza Aetiology and Pathophysiology

    • Influenza viruses are classified into three types – A, B, and C - but only types A and B typically cause significant illness in humans.
    • Influenza A is further categorized based on surface proteins (haemagglutinin [H] and neuraminidase [N]) - H antigens allow the virus to enter cells, and N antigens facilitate cell-to-cell transmission.
    • Influenza A viruses can infect a variety of animals, including humans, birds, pigs, horses, seals, and dogs.
    • Virus mutations often lead to new strains capable of infecting different species.
    • When humans are exposed to a new strain for which they have no immunity, global spread of the virus can occur, leading to a pandemic.
    • Pandemics can also occur if a previously circulating strain re-emerges after several years.
    • Epidemics are more localized outbreaks that often occur yearly, usually caused by variants of existing strains.
    • Influenza A is the most common and virulent flu virus.
    • Influenza B and C only infect humans and do not have subtypes.
    • Influenza B can cause regional epidemics, but is generally milder than influenza A.
    • Influenza C causes mild illness and does not cause epidemics or pandemics.
    • The ability of influenza viruses to evolve over time accounts for their widespread impact and highlights the need for annual vaccination against emerging strains.
    • Direct contact with infected animals or exposure to contaminated water and surfaces are common transmission routes.
    • Human-to-human transmission occurs through droplet contact and inhalation of aerosolized particles.
    • The virus has an incubation period of 1-4 days, with peak transmission risk occurring approximately one day before symptom onset, which can persist for 5-7 days.

    Influenza Signs and Symptoms

    • The onset of flu is often sudden, with systemic symptoms like chills, fever, loss of appetite, malaise, muscle aches, headache, cough, runny nose, and sore throat.
    • Physical findings are usually minimal, with normal breath sounds during chest auscultation.
    • Dyspnea and crackles indicate secondary pulmonary complications.
    • In uncomplicated cases, symptoms subside within 7 days.
    • Weakness or fatigue can last for weeks, especially in older adults.
    • Hyperactive airways and chronic cough can occur during recovery.
    • Pneumonia is the most common influenza complication, which can be either viral (primary influenza pneumonia) or bacterial (secondary bacterial pneumonia).
    • Secondary bacterial pneumonia is often marked by initial improvement of influenza symptoms followed by worsening cough and purulent sputum, requiring antibiotic treatment if initiated early.

    Influenza Diagnostic Studies

    • Patient history, comorbidities, clinical findings, and community influenza patterns are crucial information for confirming influenza.
    • Rapid flu tests can detect the virus in nasal secretions, although their efficacy is variable.
    • Viral cultures are considered the gold standard for diagnosing influenza, but can take 3-10 days to provide results.
    • Viral cultures are beneficial for identifying the specific viral strain, which is used in the formulation of the upcoming flu season's vaccine.

    Nursing and Interprofessional Management of Influenza

    • Primary prevention is the most effective strategy for managing influenza.
    • Two types of flu vaccines are available: inactivated and live attenuated.
    • The influenza vaccine is typically updated annually based on the circulating virus strains.
    • Autumn is the ideal time to receive the vaccine, allowing for the two weeks needed to develop full protection.
    • Vaccination and health promotion strategies decrease the incidence and transmission of influenza to vulnerable populations.
    • Although benefits are clear, many people remain hesitant to get vaccinated.
    • Current vaccines are highly purified, and severe reactions are extremely rare.

    Influenza Vaccination Safety Alert

    • Advocate for influenza vaccination for all people over 6 months of age, particularly for individuals at high risk, including healthcare workers, long-term care facility residents, and those with chronic health conditions.
    • Prioritize vaccination for healthcare workers to prevent transmission to high-risk individuals.

    Nursing Management of Influenza

    • The primary nursing goals for influenza are symptom relief and secondary infection prevention.
    • Unless the patient is high-risk or develops complications, only supportive therapy is necessary.
    • Rest, hydration, analgesics, and antipyretics can provide symptom relief.
    • Hospitalization may be required for older adults and those with chronic illness.
    • Antiviral medications (neuraminidase inhibitors), such as oseltamivir, zanamivir, and peramivir, are available to prevent and treat influenza A and B.
    • These medications prevent the virus from budding and spreading to other cells, potentially shortening symptom duration and reducing complication risk.
    • Treatment should be initiated as soon as possible for hospitalized patients, severely ill individuals, and those at high risk for complications.
    • For maximum benefit, treatment should begin within 24-48 hours of symptom onset, although it may be initiated later if clinically appropriate.

    COVID-19

    • The recent COVID-19 pandemic has resulted in over six million deaths worldwide.
    • In Australia and New Zealand, the pandemic saw over 10 million cases and roughly 15,000 deaths.
    • First identified in Wuhan, China, in late 2019, COVID-19 is caused by the SARS-CoV-2 virus, a type of coronavirus.
    • Most infections are mild; however, COVID-19 can cause severe illness, especially in at-risk groups such as the elderly and those with underlying health conditions.
    • Symptoms may include fever, cough, fatigue, and/or a loss of taste or smell.
    • Other symptoms might include sore throat, headache, or gastrointestinal issues.
    • Patients with severe symptoms, such as shortness of breath or chest pain, may require hospitalization.
    • Transmission occurs through infectious respiratory aerosols and/or droplets released when an infected person sneezes, coughs, breathes, or speaks.
    • Vaccination, maintaining a distance of 1-2 meters from others, wearing masks in poorly ventilated settings or when in close proximity to others, hand hygiene, respiratory etiquette (covering the mouth and nose when sneezing or coughing), and self-isolation when unwell are all important for preventing transmission.
    • The virus can survive on plastic surfaces for up to two days, making regular surface cleaning and frequent hand washing or alcohol-based hand rub use crucial.

    Pertussis (Whooping Cough)

    • Highly contagious respiratory tract infection caused by the bacterium Bordetella pertussis.
    • Characterized by uncontrollable, violent coughing.
    • Despite improved childhood vaccination rates in developed countries, pertussis incidence has been steadily rising since the 1980s, with the most significant increase seen in adults.
    • Immunity from childhood DTPa vaccination may wane over time, leading to milder infections that are still distressing and contagious.
    • Pneumonia or brain damage from pertussis can be fatal, with a mortality rate of approximately 1 in 125 for infants under six months old in Australia.
    • DTPa vaccines are recommended for vulnerable groups, including pregnant women, children, and adults who will be around infants and children.

    Pertussis Signs and Symptoms

    • Occur in stages:
      • Catarrhal stage: mild upper respiratory tract infection (URTI) with low-grade fever or no fever, runny nose, watery eyes, and a mild non-productive cough.
      • Paroxysmal stage: characterized by paroxysms (episodes) of coughing. Inspiration after each cough produces the characteristic "whooping" sound as the patient tries to breathe in against an obstructed glottis. Vomiting may also occur. Coughing is more frequent at night.
    • Coughing can last for 6 to 10 weeks.

    Pertussis Treatment

    • Includes a course of antibiotics, usually macrolides (erythromycin, azithromycin).
    • Cough suppressants and antihistamines are not recommended, as they are ineffective and can induce coughing episodes.
    • Corticosteroids and bronchodilators are also not useful for reducing symptoms.

    Pneumonia

    • An acute infection of the lung parenchyma.
    • Continues to pose significant risks of morbidity and mortality.

    Pneumonia Aetiology

    • The airway distal to the larynx is protected from infection by various defense mechanisms, including:
      • Mechanical barriers: air filtration, epiglottis closure over the trachea, cough reflex, mucociliary escalator mechanism, reflex bronchoconstriction.
      • Immune defenses: secretion of immunoglobulins A and G, and alveolar macrophages.
    • Pneumonia is more likely to occur when these defense mechanisms are weakened or overwhelmed by the virulence or quantity of infectious agents.
    • Factors that can impair the mucociliary mechanism include:
      • Decreased consciousness (depresses cough and epiglottic reflexes, potentially leading to aspiration)
      • Tracheal intubation (interferes with the normal cough reflex and bypasses the mucociliary escalator mechanism)
      • Air pollution
      • Some medications
      • Cigarette smoking
      • Normal age-related changes
    • Chronic diseases can weaken the immune system's ability to prevent bacterial growth.

    Pneumonia Risk Factors

    • Abdominal or thoracic surgery
    • Age over 65
    • Air pollution
    • Altered consciousness (alcoholism, head injury, seizures, anesthesia, medication overdose, stroke)
    • Bed rest and prolonged immobility
    • Chronic diseases (chronic lung or liver disease, diabetes mellitus, heart disease, cancer, chronic kidney disease)
    • Debilitating illness
    • Exposure to bats, birds, rabbits, or farm animals
    • Immunosuppressive disease and/or therapy (corticosteroids, cancer chemotherapy, human immunodeficiency virus [HIV] infection, immunosuppressive therapy after organ transplant)
    • Inhalation or aspiration of noxious substances
    • Intestinal and gastric feedings via nasogastric or nasointestinal tubes
    • IV medication use
    • Malnutrition
    • Recent antibiotic therapy
    • Residence in a long-term care facility
    • Smoking
    • Tracheal intubation (endotracheal intubation, tracheostomy)
    • Upper respiratory tract infections

    Pathways of Pneumonia Development

    • Aspiration of normal flora from the nasopharynx or oropharynx
    • Inhalation of airborne microbes
    • Haematogenous spread from a primary infection elsewhere in the body (e.g., Staphylococcus aureus)

    Pneumonia Classifications

    • No universally accepted classification system exists.
    • Pneumonia can be classified based on the causative pathogens, disease characteristics, or appearance on chest X-ray.
    • The most widely recognized and useful classification is based on whether the pneumonia is community-acquired or hospital-acquired.
    • This classification aids in identifying the most likely cause and selecting appropriate antimicrobial therapy.

    Community-Acquired Pneumonia (CAP)

    • An acute lung infection in patients who haven't been hospitalized or resided in a long-term care facility within 14 days of symptom onset.
    • The decision to treat at home or admit to a hospital involves various factors, including patient age, vital signs, mental status, presence of comorbid conditions, and overall condition.
    • Standardized tools can assist clinical judgment in making these decisions.

    CURB65 Scale

    • The CURB65 scale is used to assess pneumonia severity and hospitalization need.
    • Each of the following indicators receives 1 point:
      • Confusion (compared to baseline)
      • BUN > 20 mg/dL
      • Respiratory rate ≥ 30 breaths/minute
      • Blood pressure < 90 mmHg systolic
      • Age 65 years or older
    • Scoring determines the level of care:
      • 0 points: Treat at home
      • 1-2 points: Consider hospital admission
      • 3 or more points: Hospital admission
      • 4-5 points: Consider admission to intensive care unit

    Hospital-Acquired Pneumonia (HAP)

    • HAP develops in non-intubated patients at least 48 hours after hospital admission, and was not present at admission.
    • Ventilator-associated pneumonia (VAP) is a type of HAP that occurs more than 48 hours after endotracheal intubation.
    • HAP and VAP are associated with longer hospital stays, increased costs, sicker patients, and higher mortality rates.

    Types of Pneumonia

    • Viral pneumonia is the most common type, occurring in one-third of cases. It can range from mild to life-threatening (e.g., acute respiratory failure in influenza).
    • Bacterial pneumonia can be severe and require hospitalization.
    • Mycoplasma pneumoniae, known as "atypical" pneumonia, shares characteristics of bacteria and viruses. It's typically mild and affects those under 40 years old.

    Aspiration Pneumonia

    • Aspiration pneumonia occurs when material from the mouth or stomach enters the trachea and lungs.
    • Risk factors include:
      • Decreased consciousness (seizure, anaesthesia, head injury, stroke, alcohol)
      • Difficulty swallowing
      • Nasogastric intubation
    • The aspirated material (food, water, vomit, secretions) triggers inflammation.
    • The most common type is a primary bacterial infection involving multiple organisms (aerobes and anaerobes).
    • Antibiotic treatment is chosen based on illness severity, acquisition location (community vs. medical), and likely causative organism.
    • Acidic gastric content aspiration leads to chemical pneumonitis, which may not require antibiotics.
    • Secondary bacterial infection can occur 48-72 hours after chemical pneumonitis.

    Opportunistic Pneumonia

    • Individuals with impaired immune responses are at risk. This includes those with:
      • Severe protein-calorie malnutrition
      • Immunodeficiencies (e.g., HIV)
      • Radiation or chemotherapy treatment
      • Immunosuppressive therapy (long-term corticosteroids)
    • Besides bacterial and viral pneumonia, immunocompromised individuals can develop infections from microorganisms that don't typically cause disease, such as:
      • Pneumocystis jiroveci (PJP)
      • Cytomegalovirus (CMV)
    • PJP is rare in healthy individuals but common in people with HIV.
    • PJP symptoms include:
      • Fever
      • Tachypnea
      • Tachycardia
      • Dyspnea
      • Non-productive cough
      • Hypoxia
    • Chest X-rays show diffuse bilateral infiltrates, and widespread disease leads to massive lung consolidation.
    • PJP can be life-threatening, causing acute respiratory failure and death.
    • The infection can spread to other organs (liver, bone marrow, lymph nodes, spleen, thyroid).
    • Before treating PJP, bacterial and viral pneumonias must be ruled out.
    • Treatment involves trimethoprim/sulfamethoxazole (Bactrim) IV or orally, depending on severity and response.
    • CMV, a herpes virus, can cause viral pneumonia.
    • Most CMV infections are asymptomatic or mild, but severe disease can occur in immunocompromised individuals.
    • CMV is a major complication after hematopoietic stem cell transplantation.
    • Treatment includes antiviral medications and high-dose immunoglobulins.

    Pneumonia Pathophysiology

    • Pneumonia is an inflammatory response in the lungs triggered by various organisms, including bacteria, viruses, and fungi.
    • Some viruses directly damage lung cells, while most trigger an inflammatory response.
    • Increased blood flow and vascular permeability occur in the lungs during pneumonia.
    • Neutrophils are activated to fight off invading organisms.
    • Accumulation of neutrophils, organisms, and fluids in the alveoli disrupts gas exchange, leading to hypoxia.
    • Increased mucus production can further obstruct airflow and reduce gas exchange.
    • Consolidation occurs in bacterial pneumonia when alveoli fill with fluid and debris.
    • Resolution and healing occur with macrophage lysis and processing of debris, restoring lung tissue and normal gas exchange.

    Pneumonia Signs and Symptoms

    • Common symptoms include cough, fever, chills, dyspnea, tachypnea, and pleuritic chest pain.
    • Sputum may be present and can vary in color, from green and yellow to bloody.
    • Viral pneumonia may initially resemble influenza, with respiratory symptoms worsening 12-36 hours after onset.
    • Older or debilitated patients may present with atypical symptoms like confusion, stupor, or hypothermia instead of fever.

    Pneumonia Complications

    • Complications are more common in older individuals and those with underlying chronic diseases.
    • Pleurisy (inflammation of the pleura) and pleural effusion (fluid in the pleural space) are relatively common complications that usually resolve within 1-2 weeks.
    • Atelectasis (collapsed alveoli) may occur and typically resolves with effective coughing and deep breathing.
    • Bacteremia (bacterial infection in the blood) is more likely with infections caused by Streptococcus pneumoniae and Haemophilus influenzae.
    • Lung abscess, a rare complication, can occur with pneumonia caused by Staphylococcus aureus or Gram-negative organisms.
    • Empyema, an accumulation of pus in the pleural cavity, requires antibiotic therapy and drainage.
    • Pericarditis can result from the spread of infection from the pleura to the pericardium.
    • Meningitis caused by S. pneumoniae may be possible, especially in disoriented or confused patients.
    • Sepsis can occur when bacteria from the alveoli enter the bloodstream, potentially leading to shock and multiple organ dysfunction syndrome (MODS).
    • Acute respiratory failure, a leading cause of death in severe pneumonia, occurs when the lungs are unable to exchange oxygen and carbon dioxide effectively.
    • Pneumothorax, a collection of air in the pleural space causing lung collapse, is another potential complication.

    Pneumonia Diagnostic Studies

    • History, physical examination, and chest X-ray often provide enough information for treatment decisions.
    • Chest X-ray reveals patterns characteristic of the infecting organism.
    • Sputum specimens for culture and Gram stain are helpful in identifying the causative organism.
    • Blood cultures are important for seriously ill patients.
    • Arterial blood gases (ABGs) assess for hypoxemia, hypercapnia, and acidosis.
    • Leucocytosis with increased immature neutrophils (bands) is common in bacterial pneumonia.

    Pneumonia Interprofessional Care

    • Pneumococcal vaccine is recommended for individuals aged 65 years and older and for younger patients at high risk.
    • Prompt treatment with appropriate antibiotics is crucial for bacterial and mycoplasmal pneumonia.
    • Supportive measures include oxygen therapy for hypoxemia, analgesics for chest pain, and antipyretics for fever.
    • Antiviral therapy may be used for influenza and other select viral pneumonias.

    Pneumonia Medication Therapy

    • Empirical antibiotic therapy based on the likely infecting organism is used initially.
    • Treatment options for bacterial community-acquired pneumonia (CAP) vary based on patient factors like health status, comorbidities, and location.
    • Treatment regimens for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and CAP usually include antibiotics effective against resistant Gram-negative and Gram-positive organisms.
    • IV antibiotics are switched to oral therapy once the patient is stable and clinically improving.
    • Treatment duration for CAP is typically at least 5 days with afebrile status for 48-72 hours before discontinuation.

    Pneumonia Nutritional Therapy

    • Adequate hydration is essential to help loosen secretions and prevent dehydration.
    • Weight loss is common due to increased metabolic demands and difficulty eating.
    • Small, frequent meals and high-energy oral supplements may be helpful for dyspneic patients.

    Pneumonia Nursing Management

    • Nursing assessment includes reviewing medical history, medication use, functional health patterns, and physical examination findings.
    • Priority care problems include impaired gas exchange, ineffective breathing pattern, and acute pain.
    • Overall goals include clear breath sounds, normal breathing patterns, absence of hypoxia, normal chest X-ray, and prevention of complications.

    Pneumonia Nursing Implementation

    • Health promotion measures emphasize good health habits like hand washing, proper nutrition, rest, exercise, and avoiding cigarette smoke.
    • Preventing aspiration is crucial, especially in patients with altered consciousness or difficulty swallowing.
    • Maintaining oral and respiratory hygiene helps reduce the risk of healthcare-associated infections.
    • Strict medical asepsis and infection control measures are essential to prevent the spread of microorganisms.

    Pneumonia Acute Interventions

    • Monitoring physical assessment parameters, providing treatment, and assessing response to treatment are essential.
    • Prompt specimen collection and initiation of antibiotics are crucial.
    • Oxygen therapy, hydration, nutritional support, breathing exercises, early ambulation, therapeutic positioning, and physiotherapy interventions are integral to patient care.

    Pneumonia Ambulatory and Home Care

    • Patient education includes taking antibiotics as prescribed, monitoring symptoms for improvement, managing medication interactions, getting adequate rest, staying hydrated, and abstaining from alcohol and smoking.
    • A follow-up chest X-ray is usually recommended in 6-8 weeks to evaluate resolution.
    • Older adults and chronically ill patients may require a longer convalescence period.

    Lung Cancer Overview

    • Lung cancer is the fifth most common cancer in Australia, accounting for 9% of all cancers diagnosed.
    • Despite advancements in treatment, lung cancer has the highest death rate of any cancer, responsible for 17% of cancer-related deaths.
    • For Aboriginal and Torres Strait Islander peoples in Australia, lung cancer is the most commonly diagnosed cancer and the leading cause of death.
    • Five-year survival rates have improved from 10% in 1989 to 22% in 2014, indicating advancements in medical treatment.

    Aetiology

    • Smoking is responsible for 80–90% of all lung cancers.
    • Tobacco smoke contains over 60 carcinogens and substances that interfere with normal cell development.
    • Exposure to tobacco smoke affects the bronchial epithelium, which usually recovers with smoking cessation.
    • The risk of lung cancer gradually decreases after quitting smoking, reaching non-smoker levels within 10-15 years.
    • Risk assessment is categorized into smokers, former smokers, and never smokers.
    • The risk of developing lung cancer is directly related to lifetime tobacco exposure:
      • Total cigarettes smoked
      • Age of smoking onset
      • Inhalation depth
      • Tar and nicotine content
      • Filtered/unfiltered cigarettes
    • Passive smoking contains the same carcinogens found in mainstream smoke, posing health risks to non-smokers and children.
    • Other risk factors include high levels of pollution, radiation (especially radon exposure), asbestos, and heavy or prolonged exposure to industrial agents such as:
      • Ionizing radiation
      • Coal dust
      • Nickel
      • Uranium
      • Chromium
      • Formaldehyde
      • Arsenic
    • Gender differences exist in lung cancer incidence, risk factors, and survival.
      • Men have a 1 in 15 chance of developing lung cancer, compared to 1 in 17 for women.
      • Men are diagnosed and die from lung cancer more frequently than women.
      • Male smokers are 10 times more likely to develop lung cancer than non-smokers.
      • Lung cancer incidence and deaths are decreasing in men, but increasing in women.
      • Women develop lung cancer after fewer years of smoking than men and at a younger age.
      • Non-smoking women are at greater risk than non-smoking men.
      • Women with lung cancer, on average, live 12 months longer than men.
    • Racial and ethnic populations also show variability in lung cancer incidence and survivability.

    Pathophysiology

    • Most primary lung tumours originate from mutated epithelial cells.
    • Carcinogen-induced mutations are influenced by genetic factors.
    • Tumour development is promoted by epidermal growth factor.
    • Tumours grow slowly, taking 8-10 years to reach 1 cm in size, detectable by X-ray.
    • Lung cancers primarily occur in the segmental bronchi or beyond, favoring the upper lobes.
    • Primary lung cancers are broadly categorized into:
      • Non-small cell lung cancer (NSCLC) - most prevalent
      • Small cell lung cancer (SCLC)
    • Lung cancer metastasizes predominantly through direct extension, blood, and lymph systems.
    • Common sites for metastasis:
      • Liver
      • Brain
      • Bone
      • Lymph nodes
      • Adrenal glands

    Non-small Cell Lung Cancer Types

    • Squamous Cell Carcinoma:
      • Accounts for 20-30% of lung cancers.
      • More common in men.
      • Centrally located, producing early symptoms like non-productive cough and hemoptysis.
      • Less prone to metastasis.
      • Surgical resection may be attempted.
      • Adjuvant chemotherapy and radiation are used.
      • Life expectancy is generally better than SCLC.
    • Adenocarcinoma:
      • Accounts for 30-40% of lung cancers.
      • Most common in non-smokers, more common in women.
      • Peripherally located.
      • Often asymptomatic until widespread metastasis.
      • Surgical resection may be attempted depending on staging.
      • Does not respond well to chemotherapy.
    • Large Cell (Undifferentiated) Carcinoma:
      • Accounts for 10% of lung cancers.
      • Composed of large, anaplastic cells, often arising in the bronchi.
      • Highly metastatic via lymphatics and blood.
      • Surgery is rarely attempted due to high metastasis rates.
      • Tumour may be radiosensitive, but often recurs.

    Small Cell Lung Cancer (SCLC)

    • Accounts for about 20% of lung cancers.
    • The most malignant form of lung cancer.
    • Spreads rapidly via lymphatics and bloodstream, with frequent brain metastasis.
    • Associated with endocrine disturbances.
    • Chemotherapy is the mainstay of treatment, but prognosis is poor.
    • Radiation therapy is used as adjuvant therapy and palliatively.

    Other Lung Tumours

    • Hamartomas:
      • Most common benign tumour.
      • Slow-growing congenital tumour composed of fibrous tissue, fat, and blood vessels.
    • Mucous Gland Adenoma:
      • Benign tumour arising in the bronchi.
      • Consists of columnar cystic spaces.
    • Mesotheliomas:
      • Can be malignant or benign.
      • Begin in the visceral pleura.
      • Malignant mesotheliomas are linked to asbestos exposure.
      • Benign lesions are localized.
    • Secondary Metastases:
      • Cancer cells from other parts of the body spread to the lungs through pulmonary capillaries or lymphatic networks.
      • Common primary sources: breast, gastrointestinal tract, and genitourinary tract.

    Paraneoplastic Syndrome

    • Caused by hormonal or cytokine factors excreted by tumour cells or an immune response against the tumour.
    • Symptoms can manifest before malignancy diagnosis.
    • Examples include:
      • Hyperkalemia
      • Syndrome of Inappropriate ADH Secretion (SIADH)
      • Adrenal hypersecretion
      • Hematological disorders
      • Neurological syndromes
    • SCLC is most often associated with paraneoplastic syndrome.
    • These conditions may improve with treatment of the underlying neoplasm.

    Signs and Symptoms

    • Typically non-specific and appear late in the disease process.
    • Symptoms may be obscured by a chronic cough attributed to smoking or smoking-related lung disease.
    • Symptoms vary based on cancer type, location, and metastasis.
    • Common symptoms include:
      • Persistent cough
      • Blood-tinged sputum
      • Dyspnea or wheezing
      • Chest pain (localized or unilateral, mild to severe)
    • Later symptoms:
      • Non-specific systemic symptoms (anorexia, fatigue, weight loss, nausea, vomiting)
      • Hoarseness due to laryngeal nerve involvement
      • Unilateral diaphragm paralysis
      • Dysphagia
      • Superior vena cava obstruction (due to intrathoracic spread)
      • Palpable lymph nodes in the neck or axillae
      • Mediastinal involvement (pericardial effusion, cardiac tamponade, arrhythmias)

    Diagnostic Studies

    • Chest X-ray:
      • Initial diagnostic test.
      • May identify a lung mass, infiltrate, metastasis to ribs or vertebrae, or pleural effusion.
    • CT Scanning:
      • Used to further evaluate a lung mass.
      • Identifies location and extent of masses in the chest, mediastinal involvement, and lymph node enlargement.
    • Sputum Cytological Studies:
      • Identifies malignant cells.
      • Results are positive in only 20-30% of specimens.
    • Biopsy:
      • Necessary for definitive diagnosis.
      • Obtained through:
        • CT-guided needle aspiration
        • Bronchoscopy
        • Mediastinoscopy
        • Video-assisted thoracoscopic surgery (VATS)
      • Thoracentesis fluid analysis can also identify malignant cells.
    • Staging Studies:
      • Bone scans, CT scans of the brain, pelvis, and abdomen.
    • Other Diagnostic Tests:
      • Complete history and physical examination.
      • FBC with differential.
      • Chemistry panel.
      • Liver function tests (LFTs).
      • Renal function tests.
      • Pulmonary function tests.
      • Magnetic resonance imaging (MRI)
      • Positron emission tomography (PET)

    Staging

    • Non-small Cell Lung Cancer (NSCLC) Staging - TNM System:
      • Stage I, IIA, IIB, IIIA: May be surgical candidates.
      • Stage IIIB and IV: Usually inoperable, poor prognosis.
    • Small Cell Lung Cancer (SCLC):
      • TNM staging is not useful due to aggressive nature.
      • Limited stage: Confined to one side of the chest and regional lymph nodes.
      • Extensive stage: Extends beyond the limited stage.
      • Two-thirds of patients have extensive disease.

    Screening for Lung Cancer

    • Recommended for early diagnosis
    • Annual low-dose CT screening should be considered for:
      • Individuals aged 50-80 with a history of smoking (20 pack-year history or current smokers).
      • Those who quit smoking less than 15 years ago.
    • Australia and New Zealand do not have active national screening programs, but they are likely to be implemented in the future.

    Interprofessional Care

    • Treatment decisions consider:
      • Survival
      • Symptom control
      • Quality of life
      • Response rates

    Surgical Therapy

    • Treatment of choice for NSCLC stages I-IIIA without mediastinal involvement.
    • Offers the best chance for a cure.
    • 5-year survival rate in stage I and II ranges from 30% to 50%.
    • Survival is influenced by the primary tumour size and comorbidities.
    • Surgery may be combined with radiation therapy and/or chemotherapy for other NSCLC stages.
    • 50% of NSCLCs are not resectable at diagnosis.
    • Surgical procedures:
      • Pneumonectomy (removal of one entire lung)
      • Lobectomy (removal of one or more lobes of the lung)
      • Segmental or wedge resection
      • VATS may be used for cancers near the lung surface.
    • Surgery is generally not used for SCLC due to its rapid growth and dissemination.
    • Cardiopulmonary status evaluation is essential for determining operability.
    • Pulmonary function studies and ABGs are used to assess cardiopulmonary status.

    Radiation Therapy

    • Used for treatment of both NSCLC and SCLC.
    • Modes of administration:
      • Curative therapy
      • Palliative therapy (symptom relief)
      • Adjuvant therapy (in combination with surgery or chemotherapy)
    • Primary therapy for individuals who cannot tolerate surgery.
    • Relieves symptoms like dyspnea, hemoptysis, and superior vena cava syndrome.
    • Treats pain from metastatic bone lesions or cerebral metastasis.
    • Preoperative radiation can reduce tumour size.
    • Complications:
      • Esophagitis
      • Skin irritation
      • Nausea and vomiting
      • Anorexia
      • Radiation pneumonitis

    Stereotactic Body Radiotherapy (SBRT)

    • A newer lung cancer treatment.
    • Also known as stereotactic surgery or radiosurgery.
    • Delivers high-dose radiation accurately to the tumour.
    • Offers an option for early-stage lung cancer patients who are not surgical candidates.
    • Outpatient procedure using specialized positioning and radiology techniques.
    • Higher radiation dose to the tumour with minimal exposure of healthy lung tissue.
    • Therapy is given over 1-3 days.

    Chemotherapy

    • Primary treatment for SCLC.
    • Used for NSCLC in non-resectable tumours or as adjuvant therapy.
    • Various chemotherapy medications and regimens are utilized.
    • Common drug combinations:
      • Etoposide
      • Carboplatin
      • Cisplatin
      • Paclitaxel
      • Vinorelbine
      • Docetaxel
      • Gemcitabine
      • Pemetrexed (Alimta)
    • Chemotherapy administration methods:
      • Oral (tablets, capsules, liquids)
      • Intravenous (IV)
      • Catheter
      • Intramuscular
      • Intra-arterial
      • Intraperitoneal
      • Intrathecal
      • Subcutaneous

    Targeted Therapy

    • Uses drugs that target and block specific molecules involved in tumour growth.
    • May be less toxic than chemotherapy.
    • Examples:
      • Tyrosine kinase inhibitors for NSCLC, targeting the epidermal growth factor receptor.
      • Bavacizumab for NSCLC with abnormal ALK gene.
      • Drugs that inhibit angiogenesis by targeting vascular endothelial growth factor.

    Immunotherapy

    • Drugs targeting PD-1 (protein on T cells) to boost the immune response against cancer cells.
    • Examples:
      • Nivolumab (Opdivo)
      • Atezolizumab (Tecentriq)
      • Pembrolizumab (Keytruda)
    • Used for metastatic NSCLC that has progressed after other treatments and expresses PD-1.
    • May shrink tumours or slow their growth.

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