Chapter 30 & 31

Question 1

An inflammation of the bronchi in the lower respiratory tract usually caused by infection
Mostly viral
Bacterial infection is common in smokers and non-smokers
A persistent cough is the most common symptom.
Treatment is generally supportive.
Fluids, rest, anti-inflammatory agents

Answer 1

Acute bronchitis

Question 2

Acute inflammation of lung parenchyma caused by infection of lower respiratory tract – significant mortality and morbidity common.

Answer 2

Pneumonia

Question 3

Normal defense mechanisms become incompetent or overwhelmed.
Factors predisposing to pneumonia
Acquisition of organisms

Answer 3

Etiology of pneumonia

Question 4

Community-acquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)
Fungal pneumonia
Aspiration pneumonia
Opportunistic pneumonia

Answer 4

Types of pneumonia

Question 5

Organisms implicated with _________ include streptococcus pneumoniae, legionella, mycoplasma, chlamydia

Answer 5

Pneumonia

Question 6

Rick factors – poor mouth care, aspiration, intubation, contaminated equipment, debilitation, immunosuppressive therapy

Answer 6

Pneumonia

Question 7

can be viral, bacterial or fungal.
Onset is in the community or during first 2 days of hospitalization.

Answer 7

Community-acquired pneumonia (CAP)

Question 8

Risk factors – COPD, smoking, aspiration, recent use of antibiotics

Answer 8

Community-acquired pneumonia (CAP)

Question 9

develops at least 48 hours after admission

Answer 9

Hospital-acquired pneumonia (HAP)

Question 10

aspergillus

Answer 10

Fungal pneumonia

Question 11

usually with decreased consciousness (seizure, anesthesia, head injury, stroke substance abuse, tube feeds)
Gag and cough reflex is suppressed

Answer 11

Aspiration pneumonia

Question 12

usually with immune compromised immune system, with organisms that don’t usually cause a problem in healthy individuals)

Answer 12

Opportunistic pneumonia

Question 13

chemical, mechanical, bacterial

Answer 13

3 forms of aspirate pneumonia

Question 14

Bacterial and viral causative agents

Answer 14

Pneumocystis jiroveci (PCP)
Cytomegalovirus

Question 15

rarely causes pneumonia in healthy individuals but common in people with HIV

Answer 15

Pneumocystis jiroveci (PCP)

Question 16

a cause of viral pneumonia in the immune compromised client, particularly in transplant recipients.

Answer 16

Cytomegalovirus

Question 17

Lung abcess – not common
Empyema
Pericarditis
Meningitis
Endocarditis
Pleural effusion
pneumothorax

Answer 17

Pneumonia Complications

Question 18

requires drainage and antibiotics

Answer 18

Empyema

Question 19

spread of microorganisms to the heart.

Answer 19

Pericarditis

Question 20

diagnosed by lumbar puncture – individuals may appear confused, disoriented and drowsy

Answer 20

Meningitis

Question 21

endocardium and heart valves are affected by microorganisms

Answer 21

Endocarditis

Question 22

with chronic illness, 65 and older, individuals in long term care facilities

Answer 22

Pneumococcal vaccine

Question 23

Health promotion
Acute intervention
Ambulatory and home care

Answer 23

Nursing managment/implemntation: Pneumonia

Question 24

Determinants of health
Most at risk are the indigenous and immigration populations.
Males more then women
Higher rates in low socioeconomic groups, overcrowded living conditions, smoking and air pollution

Answer 24

Tuberculosis

Question 25

Etiology and pathophysiology:
Infectious disease caused by Mycobacterium tuberculosis
Spread via airborne droplets when infected person coughs, speaks, sneezes, sings
Organisms are dispersed in a room and then inhaled (rare for infection after brief exposure)
Inhaled bacilli pas into the bronchial system and implant on bronchioles or alveoli and multiply initially. Spreads via lymphatic system.
Favorable environments for growth include the upper lobes of the lungs, kidneys, epiphyses of bone, cerebral cortex and adrenal glands.
Tissue granuloma form which contains the bacteria then prevents replication and spread (Ghon complex is formed)
Latent TB infections (LTBI) organisms persist for years with few ever developing TB

Answer 25

Tuberculosis

Question 26

Clinical manifestations
early stages are usually free of symptoms
Cough (hemoptysis is associated with advanced disease, dyspnea is unusual)
May have chest pain characterized as dull or tight.
Acute symptoms (flulike)
High fever, chills, pleuritic pain, productive cough

Answer 26

Tuberculosis

Question 27

Miliary tuberculosis
Pleural effusion and empyema
Tuberculosis pneumonia
Other organ involvement:
CNS (meninges), Bone and joint tissue, kidneys adrenal glands, lymph nodes, genital tract

Answer 27

Tuberculosis complications

Question 28

large number of organisms travel through the bloodstream and spread to all organs

Answer 28

Miliary tuberculosis

Question 29

Caused by bacteria in pleural space.
Inflammatory reaction with plural exudates of protein rich fluid.
Can result from primary TB disease or reactivation of a latent infection.
Empyema is not as common as pleural effusion but may occur from large number of tubercular organisms in the pleural space.

Answer 29

Pleural effusion and empyema

Question 30

Large amounts of bacilli discharging from granulomas into lung or lymph nodes.
Clinical manifestations are similar to those of bacterial pneumonia.

Answer 30

Tuberculosis pneumonia

Question 31

Tuberculin skin testing
Chest radiographic study
Bacteriological studies
QuantiFERON-TB (QFT)

Answer 31

Diagnostic studies for TB

Question 32

Intradermal administration of tuberculin
Sensitivity remans for life and individual should not be tested again
Response decreases in immune compromised
Reactions > or equal to 5mm considered positive

Answer 32

Tuberculin skin testing

Question 33

Can not rely solely on x-ray to make diagnosis
Upper lob infiltrates, cavity infiltrates and lymph node involvement suggest TB

Answer 33

Chest radiographic study

Question 34

Stained sputum smears positive for acid fast bacilli are required for diagnosis
Require 3 consecutive sputum samples from different days
The culture can take up to 8 weeks to grow

Answer 34

Bacteriological studies

Question 35

Rapid blood test (few hours) but doesn’t replace cultures.

Answer 35

QuantiFERON-TB (QFT)

Question 36

4 drugs are used in the initial 2 month phase (INH, Rifampin, Pyrazinamide and ethambutal (sometimes discontinued)

Answer 36

Drugs for TB

Question 37

Individuals with LTBI have fewer bacteria, treatment is easier and only one drug is needed.
Treated with INH for 6 – 9 months or rifampin for 4 months

Answer 37

Latent tuberculosis infection

Question 38

BCG (bacilli Calmette-Guerin) is used to prevent TB
Can result in positive PPD reaction

Answer 38

TB Vaccine