Ch. 28 Concepts of Care for Patients with Infectious Respiratory Problems Flashcards
Exam 3
- 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
seasonal influenza
who are at risk for seasonal influenza
- older adults
- those with heart failure
- chronic lung disorders
- immunocompromised patients
different strains of influenza virus
Influenza A, B, C
when are adults with seasonal influenza contagious
24 hrs before symptoms occur and up to 5 days after symptoms begin
Influenza symptoms
- rapid onset of severe headache, muscle aches, fever, chills, fatigue, and weakness
- can also have sort throat, cough, and watery nasal discharge
influenza B symptoms
- nausea, vomiting, and diarrhea
- most patients feels fatigued for 1 to 2 wks after the acute episode has resolved
annual influenza vaccinations are important for whom to receive?
- > 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)
are annual influenza vaccinations 100% effective at preventing influenza?
no
what should you instruct your patient with influenza?
- 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
- 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)
pandemic influenzs
part of adaptive immunity develops as a result of what?
generations of ancestral exposures to common viral families such as rhinoviruses, respiratory syncytial viruses (RSV), and coronaviruses, amoung others
Viral strains change how often and why do adults get several colds a year?
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.
Why does a pandemic respiratory viral infection have the potential to spread globally?
the virus has previously infected only birds or other animals so no human ancestral immunity is present
Most bird and animal viruses cannot be transmitted to humans, but a few notable exceptions have occurred. Why is this? What are some examples?
these viruses mutated and became highly infectious to humans, causing pandemics
* 1918 Spanish influenza and the 2009 H1N1 influenza A
which virus family causes the common cold in humans but also includes bird and animal strains that have caused respiratory influenzas?
coronavirus family
What virus was responsible for jumping from species to another species in 2002 and 2003 causing SARS?
coronavirus
what does SARS stand for
severe acute respiratory syndrome
In 2012 another coronavirus mutation occurred causing a high but demographically confined mortality rate. What was this virus?
MERS-Cov
(Middle East respiratory syndrome)
December 2019 extending into 2020 coronavirus pandemic?
COVID-19
(CO= coronavirus; VI= virus; D= disease; 19= 2019)
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 viral pneumonia that can lead to severe acute respiratory distress syndrome
COVID-19 symptoms
- 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
What drug class can be used for prevention or to shorten the duration the COVID-19?
antivirals
When must antivirals be started if a patient is suspected of having COVID-19?
within 48 hrs of symptoms onset
Infected patients of COVID-19 in the hospital setting should be placed in what for 7 days?
Droplet/ Airborne Precautions
Unique features in some patients infected with COVID-19
- conjunctivitis
- prothrombotic state (venous thromboembolic disease)
- neurologic findings (encephalopathy with agitated delirium)
- dermatologic findings (especially reddish nodules on distal digits- in young adults)
Indications for Emergency Interventions: COVID-19
- trouble breathing
- persistent pain or pressure in the chest
- new confusion
- inablility to wake or stay awake
- bluish lips or face
- excess fluid in lungs
- can be lobar in nature
pneumonia
Pneumonia from respiratory infection is associated with the formation of what?
thick exudate
All pneumonias have excess fluid in the lungs from what?
an inflammatory process
What are used to dilate the bronchioles and move respiratory secretions for pneumonia patients?
respiratory treatments
If hypoxemia is not improved with oxygen therapy for a patient with pneumonia, what intervention will be done for them?
intubation and mechanical ventilation (may be done)
What is used to treat bacterial pneumonia that may occur with influenza?
antibiotics
Pneumonia may occur as what?
- lobar pneumonia with consolidation in a segment or an entire lobe of the lung
- bronchopneumonia with diffusely scattered patches around the bronci
Bacteria does what in a person whose immune system is compromised?
multiples quickly
what results when an abscess forms and perforates the bronchial wall?
tissue necrosis
Etiology of pneumonia
- 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)
Risk factors for Penumonia: Community- Acquired Pneumonia (CAP)
- 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
Risk factors for Pneumonia: Health Care- Acquired Pneumonia
- 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)
Incidence and prevalence of Pneumonia
- 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
Health Promotion and Maintenance for Pneumonia
- 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)
Assessment model for Pneumonia:
I PREPARE model
- investigate
- present work
- residence
- enviromental concerns
- past work
- activities
- referrals and resources
- educate
HX portion of assessment of a pneumonia patient
- risk factors
- I PREPARE model
- use of respiratory equipment
- vaccination status
Physical Assessment/ S/S portion of the Assessment of the Pneumonia Patient
- general appearance
- respiratory assessment
- vital signs
- dysrhythmias
Psychosocial Assessment portion of the Assessment of a Pneumonia Patient
- How do they feel?
- Can they take care of themselves?
- Do they have anyone to take care of them?
Analyze the cues of a Pneumonia patient
potential for:
* decreased gas exchange
* airway obstruction
* sepsis
* pulmonary empyema
Labs
- 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
Imaging and other diagnostic assessments for a Pneumonia Patient
- chest xray
- CTA (cat scan of the chest, high resolution)
- pulse ox
- thoracentesis
Goals for a Patient with Pneumonia
- improving gas exchange
- preventing airway obstruction
- preventing sepsis
- managing empyema
Evaluate Outcomes for a Pneumonia Patient
- attains or maintains adequate gas exchange
- maintains patent airway
- is free from infection
- avoids empyema
- returns to a pre-pneumonia health status
- highly communicable; caused by Mycobacterium tuberculosis
- transmitted via aerosolization
- secondary TB- reactivation of the disease in a previously infected person
Pulmonary TB
How do you get TB?
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
Do all TB infections develop into active TB?
No, because the normal protection of immunity prevents full development of TB in the healthy person
Recognizing risk factors for pneumonia
- 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
Treating pregnant woman with TB
- 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
treatment of LATENT TB infection in the pregnant woman
- 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
Treatment of a pregnant woman with ACTIVE TB
-
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
streptomycin & pregnancy
should not be used due to potential harmful effects on the fetus
pyrazinamide and pregnancy
not recommended due to unknown effects on the fetus
INH
isoniazid
should not ever be stopped abruptly
frontline TB meds
frontline TB medications
- isoniazid (INH)
- rifampin
- pyrazinamide
- ethambutol
3HP
INH (isoniazid) + rifapentine
* 1x weekly for 3-month combo therapy
Assessment: Recognize Cues-
HX/ Phy Ass/ Psychosocial
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
What is a BCG vaccine?
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
onset of tb?
slow onset (patients are often unaware of problems until the disease is advanced)
early detection of tb depends on what?
patient reports rather than observable indications
DX TB: NAAT
- nucleic acid amplification, used on respiratory secretions
- RESULTS: <2hrs
DX TB: PPD
- 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
DX TB: IGRA
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
DX TB: sputum culture
- 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
who needs annual screening for TB?
anyone who comes into contact with people who may be infected with TB, including some health care workers
How do we diagnose TB
- chest xrays
- sputum samples
- NAAT
- TST (Mantoux tuberculin skin test)
- IGRA (Quanti-feron Gold plus) lab draw of 4 large tubes of blood
to deem someone negative of TB
3 consecutive negative sputum samples from 3 different times of collection
analyze cues
- 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)
Planning/ Implementation for TB patient
- 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
Care Coordination/ Transition Management
- 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)
Evaluate Outcomes: TB
- 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
rhinosinusitis
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)
peritonsillar abscess (PTA)
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
inhalation anthrax
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
endemic/ geographic respiratory infection
causative organism is common geographic location
* adults living in the area may have developed immunity over time
* treatment depends on specific organism
failure to have a skin response to TB skin testing because of reduced immunity even when infection is present
anergy
an abnormal solidification with lack of air spaces in a segment of area of the lung
consolidation
a new coronavirus mutation that enabled this animal virus to infect humans and is responsible for the 2020 influenza pandemic
COVID-19
a collection of pus in the pleural cavity
empyema
respiratory infection caused by organisms that are much more common within a geographic location but the actual incidence of the infection is relatively low
endemic infection
oxygen transport to the cells and carbon dioxide transport away from cells through ventilation and diffusion
gas exchange
protection from illness or disease that is maintained by the body’s physiologic defense mechanisms
immunity
localized swelling with hardness of soft tissue
induration
invasion of pathogens into the body that multiply and cause disease or illness
infection
a syndrome of normal tissue responses to cellular injury, allergy, or the invasion of pathogens
inflammation
spread of TB throughout the body when a large number of organisms enter the blood
military (hematogenous) TB
an infection with an organism to which most humans have no immunity and that has the potential to spread globally
pandemic infection
a highly communicable disease caused by infection with Mycobacterium tuberculosis
tuberculosis (TB)
