Chapter 23: Management of Patients w/chest & lower respiratory tract Disorders Flashcards
What are some strategies for the prevention of atelectasis?
Change patient’s position frequently, keep upright, encourage early mobilization, deep breathing, coughing, use Incentive Spirometry, pain control, chest percussion, postural drainage, suctioning.
What is the treatment of atelectasis?
Improve ventilation, remove secretions.
what are the interventions for atelectasis when the cause is bronchial obstruction?
coughing, suctioning, chest physiotherapy, nebulizer treatments, and bronchoscopy.
what are the interventions for atelectasis when the cause is lung compression?
Cough, deep breathe, ambulation, thoracentesis, or chest tube.
what are the classifications of Pneumonia?
Community Acquired, Hospital Acquired, Health Care Associated, and Ventilator Associated Pneumonias.
How often should one use IS?
10 times/hour
What are the classifications of Pneumonia
Community Acquired, Hospital Acquired, Health Care Associated, and Ventilator Associated.
When and where does CAP occur?
Within the community OR within 48hrs of hospital admission
HCAP criteria might include:
PNA occurring in a non-hosp. patient with extended health care contact.
Criteria might include:
Residing in a LTC facility, Antibx Rx, chemo, wound care within 30days of infections, hemodialysis, home infusion therapy, home wound care, OR family members who are infected due to multidrug-resistant bacteria.
what is HAP
Hospital Acquired PNA: occurs 48hrs OR longer after admission that did not appear to be incubating at time of admission.
what is VAP
Ventilator Associated PNA: a type of HAP that occurs 48hrs or longer after endotracheal intubation.
What are the risk factors for infection with Penicillin and Drug resistant pneumococci?
Age > 65, alcoholism, immunosuppression, beta-lactam rx w/in last 3 mos (Cephalosporins), multiple medical comorbidities, exposure to child(ren) in daycare.
what are the risk factors for CAP, HAP, HCAP, and VAP
CAP: older adults, patients with COPD, HF, alcoholism, asplenia, diabetes, pts. in LTC, children <5yo, smokers, immunosuppressed people,
HAP/HCAP: Patients with preexisting lung disease, cancer, COPD, homograft transplants, burns, antimicrobial therapy, debilitated people, tracheostomies, alcoholism, immunocompromise, and IV drug use.
How; is TB transmitted? What are the risk factors of TB transmission?
TB is a bacteria that is spread via the air and is airborne.
Risk factors for TB transmission include close contact with someone who has active TB, having an immunocompromised status, substance abuse (IV drug use and/or alcoholism), Pre-existing medical conditions or conditions requiring specialized treatments (DM, CRF, dialysis, organ transplant, gastrectomy), institutionalization, immigration from countries with high incidence of TB, Living in crowded, substandard housing.
What are the prevention strategies for TB?
- early identification and Rx of people with active TB: maintain a high index of suspicion, prompt initiation of effective multi anti TB RX.
- prevention of spread of infectious droplets: initiate AFB isolation, use private room w/neg. pressure, use of respirators.
- Surveillance for TB transmission: main. surv among health care workers, patients, promptly initiate contact investigations exposed to TB
How does TB present?
Insidious s/s: low-grade fever, weight loss, night sweats, anorexia, fatigue, cough: non-productive, productive, hemoptysis, lung sounds: crackles, diminished bronchial sounds, fremitus, epophony
How is TB diagnosed? When do you read the PPD
positive skin test, blood test, or sputum culture.
PPD results: 0-4mm not significant, 5+ may be significant in people at risk, 10mm+ is considered significant in people with normal or mildly impaired immunity.
PPD is read 48-72hrs after injection of PPD.
What are nursing interventions?
Promoting airway clearance: increase fluid intake, correct positioning.
Promote adherence to Rx regimen: teach med. schedule, S/E, take meds on empty stomach OR 1hr before meals, avoid tyramine and histamine foods:red wine, tuna, aged cheese, soy sauce, yeast extract, avoid alcohol.
Rifampin: makes these drugs LESS effective: beta blockers, OC. digoxin, Warfarin, corticosteroids, oral hypoglycemics, verapamil, theophylline, quinidine. DISCOLORS contact lenses.
Promote activity and adequate nutrition: small, frequent meals, liquid nut. supp., increase act. tol. identify food resources.
Prevent transmission: cover mouth/nose, proper disposal of tissues, hand hygiene
What is a delayed hypersensitivity reaction?
an inflammatory reaction that occurs 48-72hrs after exposure to an antigen. This is initiated by mononuclear leukocytes. Monocytes/macrophages and T-cells mediate these reactions, rather than antibodies.
What are the precautions for flu, TB, and PNA
Flu: droplet, TB: airborne, PNA: bacterial: droplet
What are the presentations and treatments of CAP
CAP: Strep PNA: abrupt onset, toxic appearance, pleuritic chest pain Rx: PCN, amox, cef drugs, macrolide, levofloxacin, vanc, linezolid.
Influenza: insidious onset, assoc. w/URI, fever, aches, chills, productive cough. Rx: doxycylcine, cephalosporin, flouroquinolone
Legionnaires: flu-like, high fever, LOC, h/a, pleuritic pain Rx: azithromycin or fluoroquinolone
Mycoplasma: insid. onset, sore throat, nasal congestion, ear pain, h/a, low grade fever, pleuritic pain, myalgia, diarrhea, rash, pharyngitis Rx: macrolide, doxycycline.
Viral: URI symptoms, GI symptoms Rx: tamiflu relenza
Chlamydial: hoarseness, fever, chills, pharyngitis, rhinitis, non-prod cough. Rx: macrolide or doxycycline
What are the presentations and treatments of HAP/HCAP?
Pseudomonas: toxic appearance, fever, chills, prod. cough, bradycardia, leukocytosis Rx: cef, cipro, pipercillin, aminoglycosides, imipenem
Staph PNA: severe hypoxemia, cyanosis, necrot. infect, bacteremia Rx: naficillin, oxacillin, vanc, linezolid
Kleb: rapid tissue necrosis, toxic appear, fever, cough, productive, broncho pna, lung abscess Rx:
what are the s/s and Rx for fungal PNA
S/S: cough, hemoptysis, Rx: voriconazole, amphotericin B
what are the classic s/s of PNA
sudden onset, shaking, chills, cough, stabbing chest pain, fever, tachycardia, sputum prod. cough, abn. breath sounds
