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Older Adults Pt 2 > 7.1 Respiratory Part 2 > Flashcards

7.1 Respiratory Part 2 Flashcards

1
Q

Pulmonary TB

A
  • Airborne illness spread by droplet nuclei
  • Transmission occurs when droplets are inhaled and reach the alveoli
  • Most TB is caused by Myobacterium Tuberculosis
  • Small amount can be caused by Myobacterium Avium Complex (MAC)
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2
Q

Pathophysiology TB

A
  • Tubercle bacilli is inhaled and multiplies in the alveoli
  • Small amounts can enter the blood and spread to other areas of the body (brain, larynx, lymph nodes, lung, spine, bone, kidneys)
  • 2-8 weeks macrophages attempt to ingest the bacteria, causing the bacteria to create a shell called granuloma
  • When immune system cannot keep the bacteria under control, it multiplies and can travel to different areas such as the lungs, kidneys, brain and bones
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3
Q

Latent TB Infection

A
  • Granulomas is an inactive infection but when broken, becomes active TB
  • Can be detected by skin test or IFGA 2-8 weeks after infection
  • Immune system can usually stop multiplication of the bacteria
  • LTBI is not infectious
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4
Q

TB Disease

A
  • When granuloma break down it becomes active TB disease
  • This form is infectious
  • Confirmed by M. tb cultures
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5
Q

TB Sites of Disease

A
  • Lungs are most common site
    MILIARY TB - TB travels to different areas (Extrapulmonary TB)
  • Can cause meningitis in the CNS as well as brain/spinal cord
  • Extrapulmonary TB is not infectious unless the patient has some form of pulmonary disease already, or it occurs in the oral cavity/larynx.
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6
Q

Risk of Developing TB

A
  • 10% of people who are exposed will develop TB if not treated
  • Weakened immune system or HIV can heighten risk of developing TB after exposure
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7
Q

LTBI (Latent TB)

A
  • Bacteria that is alive but inactive (small amounts)
  • Non-infectious
  • Asymptomatic
  • TB skin tests and blood tests can detect LTBI
  • Sputum/Cultures show up as negative
  • Normal radiograph
  • Is not considered a TB case
  • Treatment should be considered to prevent TB
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8
Q

TB Disease

A
  • Active bacteria
  • Infectious
  • Cough/Fever/Chills/Weight loss
  • Positive TB Skin and Blood Test
  • Radiograph abnormal
  • Sputum/Cultures are positive
  • Needs treatment
  • Respiratory isolation
  • TB Case
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9
Q

MDR TB and XDR TB

A

MDR (Multi-Drug Resistant)
- Resistant to first line drugs such as isoniazid and rifampin

XDR (Extensive-Drug Resistant)
- Resistant to both first line drugs and second line drugs

Primary resistance - Individual contracted a drug resistant TB
Secondary resistance - Individual developed drug resistant TB during drug therapy

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10
Q

TB EVALUATION

A
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11
Q

TB Symptoms

A

Patient can either have no symptoms or the following symptoms below

  • Prolonged cough for 3+ weeks
  • Hemoptysis (spitting blood)
  • Chest pain
  • Loss of appetite, unexplained weight loss
  • Night sweats, fever, fatigue
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12
Q

Extrapulmonary TB Symptoms

A

Kidneys - Hematuria (blood in urine)
Meningitis - Headache/confusion
Spine - Back pain
Larynx - Hoarseness

  • Loss of appetite, unexplained weigh loss, night sweats, fever, fatigue
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13
Q

History/Physical

A
  • Ask about exposure and whether they have vaccine
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14
Q

Skin Test

A

Skin Test

  • Mantoux method (intradermal injection of tuberculin on forearm)
  • Assessed in 48-72 hours for size and induration (hardness)
  • Look for hardening not redness
  • Skin test cannot tell if disease is latent or active when positive result is shown
  • Negative means that they do not have latent or active TB

2-step-method

  • If first test is positive they are infected
  • If first test is negative, another test is given in 1-3 weeks and if positive they are infected, if negative they are not
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15
Q

X-Ray

A
  • Chest X-rays are used to confirm TB
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16
Q

Interferon Gamma Release Assay (IGRA) aka T-Spot Serum Test

A
  • Positive results show that you have TB but cannot distinguish between latent or active
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17
Q

Sputum Culture

A
  • Gold standard for TB screening

- Patient is cultured monthly until 2 consecutive negative cultures are seen

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18
Q

Medical Management TB

A
  • Always treated with 2 or more drugs with direct observation
  • Using 1 drug increases chances of bacteria developing resistance
  • Treatment is effective when no bacteria is observed in sputum
  • Requires long-term treatment and TB is resistant to many medications
  • Broad spectrum is not used, only drugs selective for TB
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19
Q

TB Induction Phase

A

2 months of 4 drugs

  • Isoniazid (INH)
  • Rifampin
  • Pyrazinamide
  • Ethambutol
  • Most important TB drugs to eliminate extracellular TB (sputum becomes non-infectious)
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20
Q

TB Continuation Phase

A
  • Consists of at least 2 drugs after susceptibility reports
  • Isoniazid and Rifampin if no drug resistant bacteria is found
  • 4 months for non-drug resistant strains
  • 4-7 months for non-drug resistant strains in HIV patients
  • Goal is to eliminate intracellular TB
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21
Q

TB Resistant Strains Treatment

A

Primary drugs

  • INH
  • Rifampin
  • Rifabutin
  • Ethambutol
  • Pyrazinamide

Secondary Drugs

  • Levofloxacin
  • Moxifloxacin
  • Kanamycin
  • Capreomycin
  • Amikacin
  • Cycloserine
  • Ethionamide
  • Para-aminosalicylic acid (PAS)
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22
Q

TB Nursing Management

A
  • Airway clearance
  • Advocating adherence to treatment
  • Promote activity/nutrition
  • Prevent transmission
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23
Q

Preventing TB Transmission

A
  • Promote Proper Ventilation
    (Primary Control includes opening doors and windows)
    (Mechanical Ventilation in hospitals with negative pressure rooms)
  • Isolation rooms with negative pressure (AII rooms)
  • Use N95 mask when entering rooms
  • OR should use the same ventilation during treatment
  • PPE
  • Testing for fitted masks for hospital workers
  • Respirators can be used for healthcare workers (not for patients)
  • Surgical masks can be worn by patient (not for healthcare workers)
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24
Q

TB Infection Control in Home

A
  • Can be sent home while still infectious
  • Make sure there are no young or immunocompromised people at home
  • Patient cannot travel unless it is for a healthcare appointment
  • Cover mouth when coughing/sneezing
  • Healthcare workers should wear respirators when visiting patient homes
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25
Q

Pneumonia (PNA)

A
  • Inflammation of parenchyma caused by bacteria, fungi, or viruses
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26
Q

Pneumonia Types

A 
Community acquired (CAP) 
- Occurring in community (48 hours or less after hospital admission)

Healthcare-associated (HCAP)
- Pneumonia occurring in non-hospitalized patient who comes in contract with healthcare frequently

Hospital-acquired (HAP)
- Occurs 48 hours or more after admission

Ventilator-associated (VAP)
- Develops 48 hours+ after endotracheal intubation or mechanical ventilation

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27
Q

Pneumonia Prevention

A
  • Pneumococcal vaccine
    Recommended for all adults 65+ and 19+ with weak immune systems
  • Smoking cessations
  • Reducing risk of aspiration
  • Hand hygiene
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28
Q

Pneumonia Risk Factors

A
  • Age
  • Comorbidities
  • Alcohol
  • Immunosuppression
  • Antibiotic therapy
  • Poor nutrition
  • Aspiration
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29
Q

Pneumonia Manifestations

A

Bacteria (Pneumococcal)

  • Chills/Fever
  • Pleuritic chest pain
  • Respiratory distress
  • Tachypnea

Viral/Mycoplasma/Legionella
- Bradycardia

  • Orthopnea
  • Crackles
  • Increased tactile fremitus
  • Purulent sputum
  • Respiratory tract infection
  • Headache
  • Low-grade fever
  • Myalgia (muscle aches)
  • Rash
  • Pharyngitis
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30
Q

Diagnosis of Pneumonia

A
  • Health history and physical exam
  • X-ray (in high fowler position
  • Sputum/Blood culture
  • Bronchoscopy for severe cases
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31
Q

Pneumonia Management

A
  • Antibiotics
  • Fluids
  • Oxygen (to prevent hypoxia)
  • Antipyretics
  • Antitussives (cough suppressant)
  • Decongestants
  • Antihistamines
32
Q

Nursing Process for Pneumonia

A
  • VS
  • Cough frequency/severity
  • Secretion odor, color and amount
  • Tachypnea, SOB
  • Auscultate lungs
  • Change in Mental Status
  • Fatigue, Edema, Dehydration
  • Heart Failure in Older Patients
33
Q

Pneumonia Complications

A

After initiation of therapy

  • Septic shock
  • Respiratory failure
  • Atelectasis
  • Pleural effusion
  • Delirium
34
Q

Pneumonia Interventions

A
  • O2 via face mask or nasal cannula with humidification (loosens secretions)
  • Coughing techniques
  • Physiotherapy
  • Position change/mobility
  • Antibiotics
  • Incentive Spirometry
  • Adequate hydration
  • Education on nutrition and etc
35
Q

Expected outcomes of Pneumonia

A
  • Improved airway patency
  • Conserves energy and slowly increases activity
  • Maintains adequate nutrition and hydration
36
Q

Lung Abscess

A
  • Pus/necrosis of pulmonary parenchyma (alveoli) caused by microbial infection
  • Most often caused by pneumonia
  • Symptoms include productive cough and febrile (fever) illness
  • Pleural friction rub on auscultation
  • IV antibiotic therapy for 3+ weeks and then oral antibiotics for 4-12 weeks

NURSING INTERVENTIONS

  • Administer IV antibiotic
  • Educate deep breathing and coughing
  • Encourage high protein diet
37
Q

Aspiration

A
  • Can cause pneumonia or be a complication of pneumonia
  • Risks include flat body position, swallowing disorders, seizures, stroke, LOC, cardiac arrest
    SYMPTOMS
  • Tachycardia, dyspnea, cyanosis, hyper/hypotension
    INTERVENTIONS
  • Elevate HOB, suction while avoiding gag reflex, check tube placement prior to feeding, thickened fluids for patients with trouble swallowing, speech therapy, education.
38
Q

Pleural Disorders

A
  • Membrane found in the thorax
  • Parietal covers inner and Visceral covers outer
  • Low protein pleura is usually found in between pleural spaces
39
Q

Pleural Disorders

A 
Pleurisy
- Infection of pleural cavity
Pleural Effusion
- Buildup of fluid in pleural cavity 
Empyema 
- Pus in pleural space
Pneumothorax
- Air/gas in pleural space 
Hemothorax
- Blood in pleural cavity
40
Q

Pleurisy

A
  • Inflammation of pleura (both layers)
  • Pleuritic pain (pain during respiration) is most common symptom
  • Friction rub can be heard on auscultation
  • X-ray, sputum analysis and thoracentesis can be used for diagnoses
  • Treatment includes analgesia, and splinting when coughing
41
Q

Pleural Effusion

A
  • Fluid in pleural space
  • Can be caused by heart failure, TB, pneumonia, or pulmonary infection
  • SYMPTOMS include fever, chills, pleuritic pain and dyspnea
  • ASESSMENT - decreased breath sounds and fremitus, dull percussion sound, tracheal deviation
  • Same diagnostic as pleurisy
42
Q

Empyema

A
  • Pus in pleural space from pneumonia or abscess
  • Similar manifestations to pneumonia
  • Noticeable decreased breath sounds upon auscultation
  • Fluid drainage is needed
43
Q

Pulmonary Emboli

A
  • Obstruction of pulmonary artery by thrombus usually from DVT
  • Can lead to ventricular failure and shock due to increased pulmonary arterial pressure and workload of right ventricle.
44
Q

Pulmonary Emboli Risk Factors

A
  • Trauma
  • Surgery
  • Pregnancy
  • Heart failure
  • Hypercoagulability
  • Cancer
  • Oral Contraceptives
  • Immobility
  • Venous stasis
    (Virchow triad - venous stasis, endothelial damage, hypercoagulability) for venous thrombosis
45
Q

PE Nursing Assessment

A
  • Dyspnea is the most common symptom
  • SOB, pleuritic chest pain during inspiration can also occur
  • Low o2, tachypnea, tachycardia, fever, diaphoresis, cough, syncope, and anxiety can also be seen
46
Q

Prevention of PE

A
  • Exercise to avoid venous stasis
  • Early ambulation
  • Anti-embolism stocking
  • Weight loss
47
Q

PE diagnosis

A
  • Chest x-ray or CT
48
Q

Treatment of PE

A
  • Improve respiratory/vascular status
  • Anticoagulation therapy (risk of bleeding)
  • Thrombolytic therapy
  • IVC Filter
  • Placed in inferior vena cava to prevent thrombi from reaching pulmonary circulation
49
Q

Pneumoconioses

A
  • Caused by inhalation of particles such as asbestosis, silicosis, and pneumoconiosis
  • Preventable but not treatable
  • Best way to counter this reducing exposure with protective gear
  • Assess where a patient works and level of exposure
  • Provide education on ways to prevent lung injuy
50
Q

COPD

A
  • Chronic Bronchitis
  • Emphysema
  • Bronchiectasis (airways widen and become more prone to mucus)
51
Q

COPD Pathophysiology

A
  • Airflow limitation due to abnormal inflammation response to particles/gas
  • Inflammation causes scar tissue which narrows airways and reduces elastic recoil (compliance) of lungs
  • Can cause pulmonary hypertension
52
Q

Chronic Bronchitis

A
  • Cough/Sputum production for 3+ months in 2 consecutive years
  • Cilia function is reduced
  • Bronchial walls thicken
  • Bronchial airways narrow
  • Mucus can plug the airways
  • Alveoli become fibrosed and damaged, macrophage function also diminishes in the alveoli leaving the patient more susceptible to respiratory infections
53
Q

Emphysema

A
  • Destruction of alveoli walls leading to decreased surface area (they combine)
  • There is increased dead space, air trapping, and impaired oxygen diffusion
  • Emphysema causes hypoxemia and increased CO2 buildup
  • Increased pulmonary pressure can also cause right-sided heart failure (cor pulmonale)
54
Q

COPD Risk Factors

A
  • Smoking
  • Aging
  • Occupational dust, chemicals, pollution
  • Infection
  • Hereditary (Alpha Antitrypsin Deficiency) can cause early-onset emphysema (20-40 y/o)
55
Q

COPD Clinical Manifestations

A
  • Chronic Cough
  • Sputum Production
  • Dyspnea

Can also include barrel chest, clubbed fingers, weight loss (due to dyspnea)

56
Q

Complications of COPD

A
  • Pneumonia
  • Chronic Atelectasis
  • Respiratory insufficiency/failure
  • Pneumothorax
  • Cor Pulmonale
57
Q

Management of COPD

A
  • Reduce risk factors (smoking cessations) is the most important
  • Manage exacerbations
  • Provide supplemental oxygen
  • Pulmonary rehabilitation
  • Pneumococcal vaccine and Influenza vaccine (primary prevention)
58
Q

Nursing Management of COPD

A
  • Begins with health history and review of diagnostic tests
  • Goal is to achieve airway clearance, improve breathing patterns through position, oxygen, medication, smoking cessation, improving activity tolerance, and education on medication such as inhalation mediations.
59
Q

Smoking Cessation the 5 A’s

A

Ask - Identify tobacco use at every visit for every patient
Advise - Urge them to quit
Assess - See if they are willing to quit
Assist - Use counseling and pharmacotherapy to help them quit
Arrange - Follow up within a week after they quit

60
Q

Home Oxygen for COPD Patients

A
  • Do not smoke near oxygen or flammable material
  • Caution signs should be placed in front of homes
  • Humidity is required during the therapy and must be provided
  • Falls is a risk due to length of tubes for oxygen
61
Q

Surgery for COPD

A

Bullectomy - Removal of bullae (air spaces in lung larger than 1cm alveoli) Allows improved function of lung tissue due to being less crowded)

Lung Volume Reduction (LVRS) - Remove diseased tissue and also reduces size of overinflated lung. Allows diaphragm to return to normal shape

Lung Transplant - Required for severe damage

62
Q

COPD Medications

A

Controlled Medication - Prevent exacerbations (long acting beta agonist, inhaled steroids, anti-cholinergics.

Quick acting - Rescue medication (Short acting beta agonist, short acting anti-cholinergics,

IM/IV/PO steroids, antibiotics when exacerbations are caused by bacterial infection

63
Q

Albuterol (Proventil, Ventolin, Salbutamol)

A
  • Beta 2 Adrenergic Agonist (Relaxes Bronchial Smooth Muscle)
  • Used for asthma, bronchospasm, bronchitis, COPD
  • Given either PO or Inhaled
  • Do not use in patients with cardiac disease or hypertension
    SIDE EFFECTS - Tremor, dizziness, nervousness, restlessness, tachycardia
  • Wash mouth after using inhaler, and advise them on proper inhaler use
64
Q

Anticholinergics

A
  • Blocks acetylcholine
  • Decreases secretions (respiratory, sweat, saliva)
  • Bronchodilation
  • Dilated pupils
  • Photophobia
  • Increases intraocular pressure
  • Increased heart rate
  • Used during pre-op to reduce secretions, emergency therapy for bradycardia/heart block, Parkinson’s disease, GI/GU disorders, dilate pupils
65
Q

Nebulizer Therapy

A
  • Aerosolizes medications allowing administration over minutes and smaller particles inhaled deeper into lungs
  • Used during difficulty clearing secretions, reduced vital capacity, and unsuccessful with other methods.

NURSING CARE

  • Take slow deep breaths through mouth and hold for a few seconds
  • Encourage coughing
  • Monitor effectiveness of therapy
66
Q

Bronchiectasis (NOT COPD)

A
  • Chronic irreversible dilation of bronchi and bronchioles

- Caused by airway obstruction, pulmonary infections, diffuse airway injury, genetics, abnormal host defenses.

67
Q

Bronchiectasis

A
  • Cough, sputum in copious amounts, and clubbing of finger nails
  • Management through drainage, physiotherapy, smoking cessations, antibiotics, bronchodilators, and mucolytics.
  • Nurses should alleviate and clear pulmonary secretions and teach patients about smoking cessations, drainage, respiratory infections, and conserving energy.
68
Q

Asthma

A
  • Hyperresponsiveness, edema, and mucus production of airways
  • Reversible with or without treatment
  • More common in males
  • Allergies is the strongest pre-dispositioning factor
69
Q

Risk Factors of Asthma

A
  • Allergies
  • Genetics
  • Air pollution, cigarettes, urban residence
  • Recurrent viral infections, other allergic diseases (allergic rhinitis)
  • House mites, cockroaches, mold, pollen, animal dander, food additives
  • Cold and dry air
  • Aspirin
  • Exercise
70
Q

Asthma Clinical Manifestations

A
  • Cough, Dyspnea, Wheezing
  • Absence of wheezing can mean there is no gas exchange
    ACUTE EXACERBATION
  • Chest tightness
  • Dyspnea
  • Diaphoresis
  • Tachycardia
  • Hypoxemia
  • Central cyanosis
71
Q

Asthma Care

A
  • Assess for severity
  • Assess how well patient controls their asthma
  • These assessments are assessed every encounter
72
Q

Asthma Treatment

A
  • First assess severity

- This tells us how severe of an intervention we need to use

73
Q

Asthma Medication

A

Rescue Medication
- SABA via nebulizer/inhaler or anticholinergics
Control Medication
- LABA, inhaled steroids, leukotriene modifiers
- Mast cell stabilizers

74
Q

Asthma Nursing Management

A
  • Manage ABC’s
  • Supplemental oxygen
  • All patients should have a rescue inhaler
  • Education on their medication, smoking cessations, triggers
  • Teach how to identify and avoid triggers
  • How to preform peak flow meter
  • How to complete asthma care plan
  • When to seek help
75
Q

Patient education for Asthma

A
  • How to identify/avoid triggers
  • Peak flow monitor to assess severity
  • How to implement asthma action care plan
76
Q

EXHALE

A
  • Helped to reduce asthma related hospitalizations

E - Education (Expand access to and delivery of education for asthma self-management) (AS-ME)
X - Xtinguish (Extinguish smoking/second hand smoke)
H - Home Visits (Used to reduce triggers and improve asthma self management)
A - Achievement (Strengthen support systems by improving access/adherence to asthma medications)
L - Linkage (Promoting coordinated care for people with asthma)
E - Environmental Policies
- Smoke free policies
- Clean diesel school buses
- Eliminate exposure to triggers in workplace

Older Adults Pt 2 (17 decks)

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