Chapter 30 & 31 Flashcards
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
Acute bronchitis
Acute inflammation of lung parenchyma caused by infection of lower respiratory tract – significant mortality and morbidity common.
Pneumonia
Normal defense mechanisms become incompetent or overwhelmed.
Factors predisposing to pneumonia
Acquisition of organisms
Etiology of pneumonia
Community-acquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)
Fungal pneumonia
Aspiration pneumonia
Opportunistic pneumonia
Types of pneumonia
Organisms implicated with _________ include streptococcus pneumoniae, legionella, mycoplasma, chlamydia
Pneumonia
Rick factors – poor mouth care, aspiration, intubation, contaminated equipment, debilitation, immunosuppressive therapy
Pneumonia
can be viral, bacterial or fungal.
Onset is in the community or during first 2 days of hospitalization.
Community-acquired pneumonia (CAP)
Risk factors – COPD, smoking, aspiration, recent use of antibiotics
Community-acquired pneumonia (CAP)
develops at least 48 hours after admission
Hospital-acquired pneumonia (HAP)
aspergillus
Fungal pneumonia
usually with decreased consciousness (seizure, anesthesia, head injury, stroke substance abuse, tube feeds)
Gag and cough reflex is suppressed
Aspiration pneumonia
usually with immune compromised immune system, with organisms that don’t usually cause a problem in healthy individuals)
Opportunistic pneumonia
chemical, mechanical, bacterial
3 forms of aspirate pneumonia
Bacterial and viral causative agents
Pneumocystis jiroveci (PCP)
Cytomegalovirus
rarely causes pneumonia in healthy individuals but common in people with HIV
Pneumocystis jiroveci (PCP)
a cause of viral pneumonia in the immune compromised client, particularly in transplant recipients.
Cytomegalovirus
Lung abcess – not common
Empyema
Pericarditis
Meningitis
Endocarditis
Pleural effusion
pneumothorax
Pneumonia Complications
requires drainage and antibiotics
Empyema
spread of microorganisms to the heart.
Pericarditis
diagnosed by lumbar puncture – individuals may appear confused, disoriented and drowsy
Meningitis
endocardium and heart valves are affected by microorganisms
Endocarditis
with chronic illness, 65 and older, individuals in long term care facilities
Pneumococcal vaccine
Health promotion
Acute intervention
Ambulatory and home care
Nursing managment/implemntation: Pneumonia
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
Tuberculosis
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
Tuberculosis
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
Tuberculosis
Miliary tuberculosis
Pleural effusion and empyema
Tuberculosis pneumonia
Other organ involvement:
CNS (meninges), Bone and joint tissue, kidneys adrenal glands, lymph nodes, genital tract
Tuberculosis complications
large number of organisms travel through the bloodstream and spread to all organs
Miliary tuberculosis
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.
Pleural effusion and empyema
Large amounts of bacilli discharging from granulomas into lung or lymph nodes.
Clinical manifestations are similar to those of bacterial pneumonia.
Tuberculosis pneumonia
Tuberculin skin testing
Chest radiographic study
Bacteriological studies
QuantiFERON-TB (QFT)
Diagnostic studies for TB
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
Tuberculin skin testing
Can not rely solely on x-ray to make diagnosis
Upper lob infiltrates, cavity infiltrates and lymph node involvement suggest TB
Chest radiographic study
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
Bacteriological studies
Rapid blood test (few hours) but doesn’t replace cultures.
QuantiFERON-TB (QFT)
4 drugs are used in the initial 2 month phase (INH, Rifampin, Pyrazinamide and ethambutal (sometimes discontinued)
Drugs for TB
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
Latent tuberculosis infection
BCG (bacilli Calmette-Guerin) is used to prevent TB
Can result in positive PPD reaction
TB Vaccine
