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MedSurg 2 > Acute Respiratory Problems > Flashcards

Acute Respiratory Problems Flashcards

1
Q

What can we do for hospitalized smokers?

A

Welbutrin: antidepressant that helps ease nicotine withdrawal

Nicotine Patch
-SE = dizziness, sleeping problems, vivid dreams

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2
Q

Are cigarette quitting treatments more effective in men or women?

A

Men b/c women are less likely to quit b/c of weight gain that happens after quitting.

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3
Q

Traumatic Problems of the Respiratory System

A 
chest trauma - pneumothorax
epistaxis caused by:
-dry mucous membranes
-substance abuse
-infections (local or systemic)
-HTN
-bleeding disorders
-anticoagulant therapy
-trauma
-high flow O2
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4
Q

Tx for nosebleeds

A
  • calm the person
  • sit up with head slightly forward
  • apply pressure for 5-15min
  • seek medical attention if bleeding doesn’t stop
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5
Q

Vascular Problems of Respiratory System

A 
PE (leading cause is DVT)
Pulmonary HTN (increased pulmonary pressure d/t pulmonary vascular resistance to blood flow through arteries and arterioles) 
Cor Pulmonale (enlargement of R ventricle secondary to disease of lung, thorax or pulmonary HTN)
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6
Q

Pulmonary Edema

A

abnormal accumulation of fluid in alveoli and interstitial spaces

complication of heart and lung diseases

most common cause = left-sided HF

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7
Q

PE: Etiology and Pathophysiology

A
  • blockage of one or more pulmonary arteries by thrombus, fat, or air embolus or tumor tissue
  • clot in venous system into pulmonary circulation then lodges in small blood vessel and obstructs alveolar perfusion
  • most often affects lower lobes (cause vessels are smaller than in upper lungs)
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8
Q

Types of PEs

A

DVT: deep vein thrombosis
VTE: venous thromboembolism (originates in one place a piece breaks off and travels until it gets stuck)
Saddle Embolus: large thrombus at arterial bifurcation

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9
Q

Risk Factors for PE

A
  • immobility or reduced mobility
  • surgery w/in 3 months (esp. pelvic or lower extremity)
  • history of VTE
  • cancer
  • obesity
  • oral contraceptives/hormone therapy
  • smoking
  • prolonged air travel
  • heart failure
  • pregnancy
  • clotting disorders
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10
Q

Manifestations of PE

A

depends on type, size, and extent of emboli

  • dysnpea (most common manifestation)
  • mild-moderate hypoxemia

other symptoms include: tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, pulmonic heart sound

massive PE symptoms = change in mental status, hypotension, impending doom, death

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11
Q

PE Diagnostic Tools

A

D-Dimer (blood test): normal value <250ng/mL

  • elevated w/ clot degradation
  • could have false negatives with small PE as it may not be releasing enough to show up on blood work

Spiral (helical) CT scan/CT angiography or CTA:

  • most common, requires contrast
  • 3D pic of pulmonary vasculature

Ventilation Perfusion (V/Q) scan:

  • used if pt cannot have contrast
  • 2 components: perfusion scanning with radioisotope injection, ventilation scanning with radioactive gas inhaled
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12
Q

Additional tests to look at for PE (not diagnostic)

A 
arterial blood gas
chest x-ray
electrocardiogram (ruling out MI)
troponin levels
b-type natriuretic peptide
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13
Q

Drug Therapy for PE

A

Anticoagulation: stops clot from getting bigger

  • heparin: monitor PTT (antidote = protamine sulfate)
  • warfarin: monitor PT

Fibrinolytic agents: dissolve clot
-ex) tPA and Alteplase (activase)

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14
Q

Drug Therapy Monitoring for PE

A

monitor for bleeding in unusual places:

  • gums
  • stool
  • hematuria
  • hematemesis
  • bruising for no reasons
  • nose bleeds
  • tachycardia and hypotension
  • severe HA

monitor CBC (can show bleeding we can’t see)

avoid IM injections
use electric razor

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15
Q

Surgical Therapy for PE

A

Pulmonary embolectomy for massive PE
-when pt is unstable hemodynamically and thrombolytic therapy is contraindicated

Percutaneous catheter embolectomy or endovascular u/s delivered thrombolysis

Inferior vena cava (IVC) filter: prevents migration of clots in pulmonary system

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16
Q

Nursing Management of PE

A

prevention:

  • SCDs
  • ambulation
  • anticoagulation

immediate treatment:

  • bed rest in semi fowlers
  • assess cardiopulmonary status
  • O2
  • fluids
  • medication

pt support for anxiety, dyspnea, fear

education:

  • long term anticoagulation therapy
  • measures to prevent VTE
  • importance of follow ups
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17
Q

Acute Bronchitis

A

self-limiting inflammation of bronchi

most caused by viruses, but can be triggered by pollution, smoking, sinusitis, asthma

symptoms = cough, clear/purulent sputum, HA, fever, malaise, dyspnea, chest pain

18
Q

Acute Bronchitis: Diagnosis and Tx

A

Diagnosis: based on assessment of breath sounds (crackles or wheezes)

Tx: symptoms relief and prevention of pneumonia

  • cough suppressant, oral fluids, humidifier
  • beta 2 agonist inhaler
  • avoid irritants
  • if due to influenza, can take antiviral within 48 hours
  • see HCP sx last longer than 4 weeks
19
Q

Flu: Risk Factor

A
  • older than 50
  • younger than 3
  • chronic cardiac or pulmonary disease
  • long-term care facility residents
  • hospitalization in past year
  • immunocompromised
  • pregnant women in 2nd and 3rd trimester
  • heath care workers (transmit it to high risk groups)
20
Q

Flu: Subjective/Objective Data

A

abrupt onset of:

  • fever
  • HA
  • aches
  • cough
  • sore throat
  • fatigue

lung sounds are usually clear

symptoms last about a week (longer for elderly)

21
Q

Flu: Interventions

A

Prevention: vaccine and sneeze protection
Supportive measures: tx symptoms
Antiviral med (Tamiflu): decreases length and severity of sx by at least 1 day (need to take w/in first 48 hours)

22
Q

Flu: Complication

A

Secondary Bacterial Pneumonia

  • pt starts to improve but then worsens
  • tx w/ antibiotics is usually effective

also could get bronchitis, otitis media, sinusitis (can be treated)

23
Q

Pneumonia: Definition

A

Acute Inflammation of alveolar spaces causing consolidation of lung tissue as alveoli fill with exudate

Gas exchange difficult -> hypoxia and hypercapnia

Can be:
lobar = affects section of lung
bronchopneumonia = affects patches throughout lung

cause can be microbes, chemical (aspiration), fungal

24
Q

3 ways organisms can reach the lung:

A
  1. aspiration (normal flora lives in airway)
  2. inhalation: inhaling microbes like black mold
  3. hematogenous: spread from one place of the body to another
25
Q

CAP Risk factors

A

community acquired pneumonia
(not in hospital for 14 days of onset of symptoms)

  • smoking
  • COPD
  • flu
  • long term care facility
  • HIV
  • DM
26
Q

MCAP Risk Factors

A

HAP >48 hours post admission
VAP >48 hours after ET tube insertion
HCAP - 2 day hospitalization w/in 90 days - - long term care facility resident
- IV, chemo, or wound care w/in 30 days (even if it was in your home)
- received dialysis in hospital or clinic setting

-MDR (multi-drug resistance): huge issue for tx

27
Q

Pneumonia: S/O data

A

usually bacterial if there is abrupt onset

  • fever/chills
  • cough with purulent sputum
  • crackles or decreased breath sounds if consolidated
  • pleuritic chest pain (pain with inspiration or coughing, sharp or stabbing)
  • anorexia
  • cyanosis = late symptom

elderly present w/ lethargy, change in mental status, tachypnea, dehydration, hypothermia

28
Q

Pneumonia: Dx tools

A
  • CBC: leukocytosis with shift to left
  • chest xray: positive for infiltrate
  • sputum culture: positive (obtain before starting antibiotics
  • ABG: indicate hypoxemia
29
Q

Complications of Pneumonia

A 
Atelectasis
Pleurisy (inflammation of pleura)
Pleural effusion (fluid in pleural space)
bacteremia (blood infection)
pneumothorax
meningitis 
acute respiratory failure
sepsis/septic shock
30
Q

Pneumonia: Planning/Intervention

A

Prevention is best (stop smoking, vaccines):
In community - nutrition, rest, hygiene, avoid URI exposure, if URI seek medical care after 7 days of persistent sx

In hospital - frequent position changes, aseptic technique with suctioning, hand washing, assess for gag reflex to return after procedure where pt is sedated

31
Q

Pneumonia: Nursing Interventions

A
  • monitor VS 4h or as ordered
  • assess lung sounds, breathing patterns, sputum color and thickness each shift
  • O2 therapy (humidification when appropriate)
  • bedrest w/ BRP at first (allow for rest for hypoxia, semi to high fowlers in bed)
  • hand washing
  • mouth care
  • TC & DB
  • IS (hourly)
  • Respiratory Therapy (may need nebulizer)
  • Suctioning PRN
  • maintain IV access
  • assess mental status
32
Q

Pneumonia: Medications

A

Antibiotics (start broad then go narrow):

  • macrolides: azithromycin (Zithromax)
  • fluoroquinolones: levofloxacin (Levaquin)
  • beta-lactams: ceftriaxone (Rocephin)
  • Antipneumococcal, antipseudomonal beta-lactams: piperacillin/tazobactam (Zosyn)

Cough medications:

  • guaifenesis (robitussin, mucinex) - expectorant (stimulates cough)
  • antitussive (suppress cough at night so they can rest)
33
Q

TB: Definition and Risk Factors

A

infectious disease caused by mycobacterium tuberculosis

spread via airborne droplets (airborne precautions)

transmission requires close, frequent, prolonged exposure

  • poor, underserved, and minorities
  • immunosuppressed
  • foreign-born
  • living or working in institutions
34
Q

MDR-TB

A

resistant to 2 of the most potent first line anti-TB drugs

causes:
- incorrect prescribing (overprescribing)
- lack of public health case management
- non-adherence
- lack of funding for education and prevention

35
Q

TB: Manifestations

A

takes 2-3 weeks to develop symptoms
initial sx: dry cough that becomes productive, fever, malaise, anorexia, weight loss, low-grade fever, night sweats
late sx: dyspnea and hemoptysis

generalized flu like symptoms

*Immunosuppressed and older adults less likely to have fever and other signs of infection

36
Q

TB: Complications

A

When TB infects other organs, acute and long-term complications may occur

  • spinal issues
  • CNS (bacterial meningitis)
  • abdomen: peritonitis
  • other organs: kidneys, adrenal glands, lymph nodes and urogenital tract
37
Q

TB: DX tests

A

TST (tuberculin skin test)

  • injection in ventral forearm
  • site inspection for induration in 48-72 hours
  • induration= palpable, raised, hardened, swollen area (not red)
  • indicates development of antibodies following exposure to TB

Chest x-ray: cannot use alone to make dx

Bacteriologic studies: TB culture is gold standard (3 consecutive sputum samples at 8-24 hour intervals) - definitive dx takes up to 6 weeks

38
Q

TB: Drug Therapy

A

Active TB:
Initial drugs (8wk-3months): isoniazid, rifampin, pyrazinamide, ethambutol
Continuation (18wks): isoniazid and rifampin
*adverse SE = non-viral hepatitis (monitor liver function)

39
Q

MDR-TB: Drug Therapy

A

sensitivity test determines drugs
initial drugs: 5 different ones for at least 6 months
continuation: 4 drugs for 18-24 months

DOT: direct observation therapy

  • non-adherence is major factor in NDR-TB
  • watch pt take drugs
  • expensive but public health strategy to ensure adherence
40
Q

TB: Nursing Interventions for Acute Care

A

airborne isolation:

  • single room w/ 6-12 airflow exchanges/hour
  • healthcare workers wear HEPA masks (fit tested)
  • administer drug therapy
  • teach pt to prevent spread
  • pt wear mask outside of room
  • identify and screen close contact

Ambulatory care:
(may go home even if culture are positive)
do monthly sputum cultures
two consecutive negative cultures = noninfectious
notify public health nurse follow up and DOT

MedSurg 2 (18 decks)

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