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MED SURG 2 > Ch. 28 Concepts of Care for Patients with Infectious Respiratory Problems > Flashcards

Ch. 28 Concepts of Care for Patients with Infectious Respiratory Problems Flashcards

Exam 3

1
Q
  • highly contagious acute viral respiratory infection
  • RAPID ONSET of severe headache, muscle ache, fever, chills, fatigue, weakness, anorexia
  • preventable (or severity is reduced) with vaccination
  • handwashing is critical
  • antiviral agents may be effective if started within 24 to 48 hrs of symptoms
A

seasonal influenza

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2
Q

who are at risk for seasonal influenza

A
  • older adults
  • those with heart failure
  • chronic lung disorders
  • immunocompromised patients
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3
Q

different strains of influenza virus

A

Influenza A, B, C

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4
Q

when are adults with seasonal influenza contagious

A

24 hrs before symptoms occur and up to 5 days after symptoms begin

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5
Q

Influenza symptoms

A
  • rapid onset of severe headache, muscle aches, fever, chills, fatigue, and weakness
  • can also have sort throat, cough, and watery nasal discharge
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6
Q

influenza B symptoms

A
  • nausea, vomiting, and diarrhea
  • most patients feels fatigued for 1 to 2 wks after the acute episode has resolved
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7
Q

annual influenza vaccinations are important for whom to receive?

A
  • > 50 yrs of age
  • chronic illness or immune compromise
  • reside in institutions
  • live with or care for others with health problems that put them at risk for severe complications of influenza
  • are health care personnel providing direct care to patients (CDC, 2018a)
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8
Q

are annual influenza vaccinations 100% effective at preventing influenza?

A

no

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9
Q

what should you instruct your patient with influenza?

A
  • rest for several days
  • increase fluid intake unless another problem requires fluid restriction
  • saline gargles may ease sore throat pain
  • antihistamines may reduce the rhinorrhea
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10
Q
  • potential to spread globally
  • Avian flu, MERS, SARS
  • early recognition and quarantine
  • contact and airborne precautions (until specific type of pandemic influenza is identifed with routes of transmission known)
A

pandemic influenzs

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11
Q

part of adaptive immunity develops as a result of what?

A

generations of ancestral exposures to common viral families such as rhinoviruses, respiratory syncytial viruses (RSV), and coronaviruses, amoung others

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12
Q

Viral strains change how often and why do adults get several colds a year?

A

slightly every year so that the antibodies an adult makes against a specific strain one year are not completely effective against exposure to the other strains of that same viral family later that year or another year.

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13
Q

Why does a pandemic respiratory viral infection have the potential to spread globally?

A

the virus has previously infected only birds or other animals so no human ancestral immunity is present

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14
Q

Most bird and animal viruses cannot be transmitted to humans, but a few notable exceptions have occurred. Why is this? What are some examples?

A

these viruses mutated and became highly infectious to humans, causing pandemics
* 1918 Spanish influenza and the 2009 H1N1 influenza A

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15
Q

which virus family causes the common cold in humans but also includes bird and animal strains that have caused respiratory influenzas?

A

coronavirus family

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16
Q

What virus was responsible for jumping from species to another species in 2002 and 2003 causing SARS?

A

coronavirus

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17
Q

what does SARS stand for

A

severe acute respiratory syndrome

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18
Q

In 2012 another coronavirus mutation occurred causing a high but demographically confined mortality rate. What was this virus?

A

MERS-Cov
(Middle East respiratory syndrome)

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19
Q

December 2019 extending into 2020 coronavirus pandemic?

A

COVID-19
(CO= coronavirus; VI= virus; D= disease; 19= 2019)

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20
Q

Some patients that develop COVID-19 are asymptomatic or experience minimal symptoms, while others experience minor respiratory symptoms similar to a common cold and recover with no apparent long-term effects. What could particularly older adults and individuals with pre-existing chronic conditions develop?

A

a viral pneumonia that can lead to severe acute respiratory distress syndrome

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21
Q

COVID-19 symptoms

A
  • shortness of breath or difficulty breathing
  • new loss of taste or smell
  • fatigue
  • sore throat
  • muscle or body aches
  • n/v
  • headache
  • diarrhea
  • fever and chills
  • abdominal pain
  • cough
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22
Q

What drug class can be used for prevention or to shorten the duration the COVID-19?

A

antivirals

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23
Q

When must antivirals be started if a patient is suspected of having COVID-19?

A

within 48 hrs of symptoms onset

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24
Q

Infected patients of COVID-19 in the hospital setting should be placed in what for 7 days?

A

Droplet/ Airborne Precautions

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25
Q

Unique features in some patients infected with COVID-19

A
  • conjunctivitis
  • prothrombotic state (venous thromboembolic disease)
  • neurologic findings (encephalopathy with agitated delirium)
  • dermatologic findings (especially reddish nodules on distal digits- in young adults)
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26
Q

Indications for Emergency Interventions: COVID-19

A
  • trouble breathing
  • persistent pain or pressure in the chest
  • new confusion
  • inablility to wake or stay awake
  • bluish lips or face
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27
Q
  • excess fluid in lungs
  • can be lobar in nature
A

pneumonia

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28
Q

Pneumonia from respiratory infection is associated with the formation of what?

A

thick exudate

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29
Q

All pneumonias have excess fluid in the lungs from what?

A

an inflammatory process

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30
Q

What are used to dilate the bronchioles and move respiratory secretions for pneumonia patients?

A

respiratory treatments

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31
Q

If hypoxemia is not improved with oxygen therapy for a patient with pneumonia, what intervention will be done for them?

A

intubation and mechanical ventilation (may be done)

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32
Q

What is used to treat bacterial pneumonia that may occur with influenza?

A

antibiotics

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33
Q

Pneumonia may occur as what?

A
  • lobar pneumonia with consolidation in a segment or an entire lobe of the lung
  • bronchopneumonia with diffusely scattered patches around the bronci
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34
Q

Bacteria does what in a person whose immune system is compromised?

A

multiples quickly

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35
Q

what results when an abscess forms and perforates the bronchial wall?

A

tissue necrosis

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36
Q

Etiology of pneumonia

A
  • organisms such as bacteria, viruses, mycoplasmas, fungi, rickettsiae, protozoa, helminths
  • non-infectious causes (inhalation of toxic gases, chemical fumes, and smoke; and aspiration of water, food, fluid- including saliva, and vomitus)
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37
Q

Risk factors for Penumonia: Community- Acquired Pneumonia (CAP)

A
  • is an older adult
  • has never received the pneumococcal vaccination or received it more than 5 yrs ago
  • did not receive the influenza vaccine in the previous year
  • has a chronic health problem or other coexisting condition that reduces immunity
  • has recently been exposed to respiratory viral or influenza infection
  • used tobacco or alcohol or is exposed to high amounts of secondhand smoke
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38
Q

Risk factors for Pneumonia: Health Care- Acquired Pneumonia

A
  • is an older adult
  • has presence of gram-negative colonization of the mouth, throat, and stomach
  • has an altered level of consciousness
  • has had a recent aspiration event
  • has presence of endotracheal, tracheostomy, or nasogastric tube
  • has poor nutritional status
  • has reduced immunity (from disease or drug therapy)
  • uses drugs that increase gastric pH (histamine blockers- H2, antacids) or alkaline tube feedings
  • is currently receiving mechanical ventilation (ventilator-associated pneumonia- VAP)
39
Q

Incidence and prevalence of Pneumonia

A
  • 2 to 5 million cases annually in the US
  • higher among older adults, nursing home residents, hospitalized patients, patients with neurologic or swallowing problems, patients on ventilators
40
Q

Health Promotion and Maintenance for Pneumonia

A
  • vaccination
  • avoid crowded places during flu season
  • cough, turn, move, deep breathe
  • clean respiratory equipment
  • avoid pollutants
  • stop smoking
  • get rest and sleep
  • eat healthy diet
  • drink 3L of water daily (unless fluids are restricted)
41
Q

Assessment model for Pneumonia:
I PREPARE model

A
  • investigate
  • present work
  • residence
  • enviromental concerns
  • past work
  • activities
  • referrals and resources
  • educate
42
Q

HX portion of assessment of a pneumonia patient

A
  • risk factors
  • I PREPARE model
  • use of respiratory equipment
  • vaccination status
43
Q

Physical Assessment/ S/S portion of the Assessment of the Pneumonia Patient

A
  • general appearance
  • respiratory assessment
  • vital signs
  • dysrhythmias
44
Q

Psychosocial Assessment portion of the Assessment of a Pneumonia Patient

A
  • How do they feel?
  • Can they take care of themselves?
  • Do they have anyone to take care of them?
45
Q

Analyze the cues of a Pneumonia patient

A

potential for:
* decreased gas exchange
* airway obstruction
* sepsis
* pulmonary empyema

46
Q

Labs

A
  • BUN
  • Creatinine
  • electrolytes
  • kidney function
  • culture and sensitivity of sputum samples
    -when? first thing in the morning
    -may need to get a gram-stain
  • CBC- check for infection
  • blood cultures (pinpoint organism)
  • ABGs (if they are having poor gas exchange)
  • lactate level
47
Q

Imaging and other diagnostic assessments for a Pneumonia Patient

A
  • chest xray
  • CTA (cat scan of the chest, high resolution)
  • pulse ox
  • thoracentesis
48
Q

Goals for a Patient with Pneumonia

A
  • improving gas exchange
  • preventing airway obstruction
  • preventing sepsis
  • managing empyema
49
Q

Evaluate Outcomes for a Pneumonia Patient

A
  • attains or maintains adequate gas exchange
  • maintains patent airway
  • is free from infection
  • avoids empyema
  • returns to a pre-pneumonia health status
50
Q
  • highly communicable; caused by Mycobacterium tuberculosis
  • transmitted via aerosolization
  • secondary TB- reactivation of the disease in a previously infected person
A

Pulmonary TB

51
Q

How do you get TB?

A

close contact with an infectious person/ infected respiratory droplets become airborne and may be inhaled by others
* when a person with active TB coughs, laughs, sneezes, whistles, or sings

52
Q

Do all TB infections develop into active TB?

A

No, because the normal protection of immunity prevents full development of TB in the healthy person

53
Q

Recognizing risk factors for pneumonia

A
  • avoidance of people who are ill
  • good handwashing
  • screening (for those who work with people at high risk)

best managed on a societal level
* homelessness
* living in very crowded conditions
* substance use with malnutrition

54
Q

Treating pregnant woman with TB

A
  • the benefits outweigh the risks of treatment
  • women w/ untreated TB are at risk for passing the infection to the fetus; delivering a newborn with low birthweight
  • drugs used in initial treatment of TB DO CROSS the placenta but do not appear to harm the fetus
55
Q

treatment of LATENT TB infection in the pregnant woman

A
  • INH daily or 2x weekly for 9month with pyridoxine supplement
  • 3 month combo therapy of INH with rifapentinem referred to as 3HP- is not recommended for pregnant women or those planning to become pregnant within 3 months
56
Q

Treatment of a pregnant woman with ACTIVE TB

A
  • INH, rifampin and ethambutol daily for 2 months
    FOLLOWED by
  • INH and rifampin daily or 2x weekly for 7 months for a total of 9 months
57
Q

streptomycin & pregnancy

A

should not be used due to potential harmful effects on the fetus

58
Q

pyrazinamide and pregnancy

A

not recommended due to unknown effects on the fetus

59
Q

INH

A

isoniazid

60
Q

should not ever be stopped abruptly

A

frontline TB meds

61
Q

frontline TB medications

A
  • isoniazid (INH)
  • rifampin
  • pyrazinamide
  • ethambutol
62
Q

3HP

A

INH (isoniazid) + rifapentine
* 1x weekly for 3-month combo therapy

63
Q

Assessment: Recognize Cues-
HX/ Phy Ass/ Psychosocial

A

HX
* Past TB exposure?
* BCG vaccine?
* traveled recently?
Phy Ass
* progressive fatigue
* lethargy
* nausea, anorexia, & weight loss
* irregular menses
* low-grade fever
* cough w/ mucopurulent sputum, blood streaks
* dull aching chest pain
Psychosocial

64
Q

What is a BCG vaccine?

A

Bacillus Calmette-Guérin, a live attenuated tb strand vaccine
* children vax overseas
* may pop positive on a PPD/ skin test but does not mean they have the disease
* may pop positive for up to 10yrs

65
Q

onset of tb?

A

slow onset (patients are often unaware of problems until the disease is advanced)

66
Q

early detection of tb depends on what?

A

patient reports rather than observable indications

67
Q

DX TB: NAAT

A
  • nucleic acid amplification, used on respiratory secretions
  • RESULTS: <2hrs
68
Q

DX TB: PPD

A
  • purified protein derivative
  • intradermal skin test
  • READ in 48- 72hrs
    **induration (swelling, hardness) **
    >10mm = exposure/ dormant
    >5mm = + reduced immune
    false -occur more after 48hrs so reassessed at 72hrs
    no reaction & reduced immunity when infection present is anergy
  • positive reaction does not mean that active disease is present- but does indicate that there has been exposure to TB or dormant disease
69
Q

DX TB: IGRA

A

blood test, interferon gamma release assays
* shows how the patient’s immune system responds to the TB bacterium
* + result means that the person is infected with TB but does not indicate whether the infection is latent or active

70
Q

DX TB: sputum culture

A
  • confirms dx adn is also used to evaluate treatment effectiveness
  • take up to 4 wks for a valid result
  • AFTER drug therapy is started- sputum samples are obtained at specified intervals
  • cultures are usually - afte 3 months of effective treament
71
Q

who needs annual screening for TB?

A

anyone who comes into contact with people who may be infected with TB, including some health care workers

72
Q

How do we diagnose TB

A
  • chest xrays
  • sputum samples
  • NAAT
  • TST (Mantoux tuberculin skin test)
  • IGRA (Quanti-feron Gold plus) lab draw of 4 large tubes of blood
73
Q

to deem someone negative of TB

A

3 consecutive negative sputum samples from 3 different times of collection

74
Q

analyze cues

A
  • potential for airway obstruction
  • potential for dev of drug-resistant disease and spread of infecton (ed patient to complete meds- not to stop abruptly)
  • weight loss (significant weight loss in a short amount of time)
  • fatigued (tire easily)
75
Q

Planning/ Implementation for TB patient

A
  • promote airway clearance (coughing up sputum)
  • reduce drug-resistance and infection spread
  • improve nutrition (increase protein intake- protein shakes, protein-rich foods in diet)
  • managing fatigue- rest periods/ periodic breaks
76
Q

Care Coordination/ Transition Management

A
  • home care management
  • self-management education (smoking cessation, clean fresh air/ ventilation in their house)
  • health care resources (home oxygen services setup; home health nurses ensure patients are taking their TB meds- to prevent disease spread/ epidemic)
77
Q

Evaluate Outcomes: TB

A
  • effectively clears airways
  • is free of active TB and does not spread infection
  • demonstrates improved nutrition (gains weight)
  • reports decreased fatigue and increased energy
  • returns to pre-TB health status
78
Q

rhinosinusitis

A

inflammation; interferes with sinus drainage
s/s
* pain over cheek radiating to teeth
* sinus tenderness
* postnasal drip, sore throat, fever, erythema (redness)
interventions
* symptom relief
* drug therapy (antihistamines)
* humidification (steamy shower)
* nasal irrigation (neti pot)
* nutrition (adequate diet; plenty of fluids)

79
Q

peritonsillar abscess (PTA)

A

complication of acute bacterial tonsilitis
s/s
* pus behind tonsil; pushes uvula
* throat pain (raditating to the ear or teeth)
* spasms and pain of the muscles used in chewing (trismus)
* fever
* difficulty swallowing
* bad breath
* swollen lymph nodes
treatment
* antibiotics (ed pt to complete drug therapy)
* steroids to reduce swelling
* tonsilectomy may be needed
* abscess may need to be drained
EMERGENCY
* symptoms of obstruction- drooling & stridor

80
Q

inhalation anthrax

A

bacterial infection caused by Bacilius anthracis from contaminated soil
* fatality rate if infection occurs in lungs is 100% if left untreated
* A special feature of inhalation anthrax is that it is not accompanied by upper respiratory symptoms of sore throat or rhinitis
* occupational exposure- vets, farmers, and others who frequently contact animal wool, hides, bone meal, and skin
2 stages
* prodromal stage (flulike symptoms)
* fulminant stage (sudden onset of severe illness after feeling better from prodromal stage)

antibiotic therapy
bioterrorism

81
Q

endemic/ geographic respiratory infection

A

causative organism is common geographic location
* adults living in the area may have developed immunity over time
* treatment depends on specific organism

82
Q

failure to have a skin response to TB skin testing because of reduced immunity even when infection is present

A

anergy

83
Q

an abnormal solidification with lack of air spaces in a segment of area of the lung

A

consolidation

84
Q

a new coronavirus mutation that enabled this animal virus to infect humans and is responsible for the 2020 influenza pandemic

A

COVID-19

85
Q

a collection of pus in the pleural cavity

A

empyema

86
Q

respiratory infection caused by organisms that are much more common within a geographic location but the actual incidence of the infection is relatively low

A

endemic infection

87
Q

oxygen transport to the cells and carbon dioxide transport away from cells through ventilation and diffusion

A

gas exchange

88
Q

protection from illness or disease that is maintained by the body’s physiologic defense mechanisms

A

immunity

89
Q

localized swelling with hardness of soft tissue

A

induration

90
Q

invasion of pathogens into the body that multiply and cause disease or illness

A

infection

91
Q

a syndrome of normal tissue responses to cellular injury, allergy, or the invasion of pathogens

A

inflammation

92
Q

spread of TB throughout the body when a large number of organisms enter the blood

A

military (hematogenous) TB

93
Q

an infection with an organism to which most humans have no immunity and that has the potential to spread globally

A

pandemic infection

94
Q

a highly communicable disease caused by infection with Mycobacterium tuberculosis

A

tuberculosis (TB)

MED SURG 2 (13 decks)

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