Ch.28 concepts of care for pt. with infectious respiratory problems Flashcards
seasonal influenza
- highly contagious acute viral respiratory infection
- preventable with vaccination
- hand washing is critical
- antiviral agents may be effective if started within 24 to 48 hours
seasonal flu rapid onset of…
severe headache muscle ache fever chills fatigue weakness anorexia
pandemic influenza
- potential to spread globally
- avian flu, MERS, SARS
- early recognition and quarentine
- contact and airborne precautions
- antiviral drugs can be used for prevention or to shorten the duration of the infection
pneumonia (PNA)
- an infection that inflames the air sacs in one or both lungs
- airsacs may fill with fluid or pus
- causing cough with phlegm pus fever chills and difficulty breathing
what is inflammation pneumonia triggered by
infectious organisms and by inhaling irritating agents
gas exchange concept for pneumonia
- excess fluid in lungs
- can be lobar in nature
pneumonia health promotion and maintenance
- vaccination: 65 or older, immunocompromised, chronic health issues
- advoid crowded places during flu season
- cough, turn, move, deep breathe every 2 hr- helps with gas exchange and gets mucous up
- clean respiratory equipment- reduced infection
- avoid pollutants
- stop smoking
- get rest and sleep
- eat healthy diet
- drink 3l of water daily
pneumonia assessment recognize cues: risk factors
risk factors:
- AGE
- no vaccination
- chronic health problems
- use of respiratory equipment
- vaccination status
pneumonia assessment recognize cues: physical assessment and s/s: general appearance
- FLUSHED CHEEKS
- anxious look
- chest pain
- MYALGIA- pain in muscles
- headache
- chills
- fever
- cough
- tachycardia
- dyspna
- hemoptysis (blood sputum)
- SPUTUM- may have blood. color:yellow, green, brown, rusty, thick
pneumonia assessment recognize cues: physical assessment and s/s: respiraotry assessment
- breathing pattern
- use of accessory muscles
- positioning
- cough
- sputum assessment
- lung sounds (crackles)
pneumonia assessment recognize cues: physical assessment and s/s: vital signs
- increased respiration rate
- hypotension
- tachycardia
- dysrhythmias
pneumonia assessment recognize cues: psychosocial
- assess for signs of anxiety
- approach the pt. calm
- if experience dyspnea, keep interview short
pneumonia assessment recognize cues: lab assessment
- gram stain, culture and sensitivity of sputum- gram positive
- CBC: elevated wbc
- blood cultures: infection gone to blood stream
- ABGs: impaired gas exchange
- serum electrolytes, BUN, creatinine
- lactate level: sepsis
chest x ray
pulse ox
thoracentesis- removes fluid or air from lungs
pneumonia: why is there a decrease gas exchange
due to decreased diffusion at the alveolar capillary membrane
pneumonia: why is the a potential for airway obstruction
PRIORITY
- due to inflammation with excessive pulmonary secretions, fatigue, muscle weakness
pneumonia: why is there a potential for sepsis
due to the presence of microorganisms in a very vascular area and reduced immunity
pneumonia: why is there a potential for pulmonary empyema
- due to a spread of infectious organisms from the lung into the pleaural space
pneumonia improving gas exchange
- oxygen therapy
- incentive spirometer
pneumonia preventing airway obstruction
- cough and deep breath at least every 2 hr
- use incentive spirometer
- drink at least 2l of water
- monitor i&O, oral mucus membranes, skin turgor
- bronchodilators prescribed for bronchospasm
- iv steroids used to decrease inflammation and airway swelling
pneumonia: preventing sepsis
- use of anti-infectices for 5-7 days for ucomplicated CAP and up to 21 days with severely impaired immunity or with HAP
- PNA caused by aspiration involves interventions that prevent lung damage and treat infection
pneumonia: managing empyema
- treatment involves draining empysema cavity, re-expanding the lung and controlling infection
- antibiotics prescribed and chest tube placed, chest surgery is a possibility
pneumonia: home care management
- pt. level of fatigue, dyspnea, and social support
- one level for bathroom needs and sleeping
- home nursing assessment
pneumonia: self management education
- use of anti-infective therapy
- notify provider of the following symtoms: chills, fever, persistent cough, dyspnea, wheezing, hemoptysis, increased sputum production, chest discomfort, increasing fatugue
- rest is important= slowly increase activity
health care resources
- smoking cessation
- immunization of appropriate persons
pneumonia evaluating outcomes
- attains or maintains adequate gas exchange
- maintains patent airway
- free from infection
- avoids empyema
- returns to pre-pneumonia health status
tuberculosis
secondary tb
where does bacillus multiply
- highly communicable caused by myocobacterium tuberculosis
- transmitted via aerosolization- airborn precautions
- secondary TB- reactivation of the disease in a previously infected person
- bacillus multiples when it reaches areas like the bronchi or alveoli
- tb consists of an inflammation and exudative response, which causes pneuomonitis
- only small amount of adults infected with bacillus develip active tb
TB health promotion and maintenance & risk factors
risk factors:
- homelessness
- living in crowded conditions
- substance use with malnutrtion
- avoidance of people who are ill
- good handwashing
- screening
TB history
- past tb exposure
- BCG vaccine- may show a false postive= chest xray or bloodwork
tb physical assessment s/s
- progrssive fatigue
- lethargy
- nausea
- ANOREXIA
- WEIGHT LOSS
- irrgular meses
- LOW GRADE FEVER
- COUGH WITH BLOOD STREAKS
- sptum
- chest pain
- night sweats with fever
psychosocial
- alleviate fear
- help not feel isolated
- direct contact should get tested
- assist with getting time off of work
tb diagnostic test
- chest xray
- sputum culture
- NAAT
- TST
- IGRA (quantiferon-tb, gold in tube)
PPD skin test
postive reaction of skin test does not mean that active disease is present, but does indicate that there has been exposure to tuberculosis or dormant disease
TB: why is there a potential for airway obstruction
- due to thick secretions and weak cough effort
TB: why is there a potential for developing drug resistance
spread of infection due to inadequate adherence to therapy regime
TB: why is there weight loss
due to inadequate intake and nausea from therapy regimen
TB: why is there fatigue
due to lengthy illness
poor gas exchange
increased energy demands
TB: promoting airway clearance
- drink plenty of fluids
- take a deep breath before coughing
- use incentive spirometer
TB reducing dry resistance and infection spread
- antimicrobial therapy
- Rifampin: red ting to skin and pee, advoid alc, & extra contraceptives
- pyrazinamide- pt. has gout advoid, drink with 8oz of water, look for s/s of dark urine
all for 8 weeks
combination drug therapy last another 18 weeks - airborne precautions
- sputim specimens every 4 weeks once drug therapy has started
- 3 consecutive negative sputum cultures means pt. no longer infectious
tb improving nutrition
- tb drugs may cayse nausea
- take once a day meds at night and order antiemetics
- take with small snack
- advoid alc
- lack of phosphorus= lack of energy
tb managing fatigue
- pt. should resume activties and get plenty of rest
- reassure pt. that fatigue will resolve with continued treatment
tb homecare management
- managed outside hospital
- collab with interprofessional team
tb self management
& how long not contangious
- follows medication regimen
- no longer contagious after 2 to 3 weeks of drug therapy
TB health care resources: what should they do after treatment?
- pt. should follow up with primary care at least 1 year after active treatment
Tb evaluating outcomes
- effective clears airways
- free of active tb and does not spread infection
- demonstrates improved nutrition
- reports decreased fatigue and increased energy
- returns to pre-tuberculosis health status
