chest and lower resp problems

Question 1

types of pneumonia ***

Answer 1

CAP: community acquired (most common)

HAP: hospital acquired (48hrs or more after admission

VAP: ventilator assosiated (preventable)

oppotunistic infections (immunocompromised host)

viral (rare in adults)

aspiration pneumonia

Question 2

pnemonia vaccinations ***

Answer 2

prevnar 13
PCV15
PCV20
PPSV23

Question 3

pnemonia s/s
sub
obj
older pts ***

Answer 3

subjective:
fever/chills
pleuritic chest pain
cough/dyspnea

objective:
crackles/rhonchi
dullness on percussion
tachypnea

older pts:
confusion, hypotension (sepsis)

Question 4

pneumonia diagnositic test ***

Answer 4

CXR
blood cultures
sputum culture
↑WBC
ABG

Question 5

pnemonia medical management ***

Answer 5

ABX (empiric therapy/broad specturm)
get blood culture first

O2 therapy
hydrate
mobilize secretions, HOB elevated
OOB to chair
Chest PT
IS
balace activity and rest

Question 6

pneumonia nursing management
what to promote and monitor
monitor for what complications***

Answer 6

rest
airway clearance
prevent hypoveolemia
nutrition
pt educagion

monitor for complications:
worseing
shock
pleural effusion
delirium

Question 7

tuberculosis ***

Answer 7

m. tuberculosis

leading COD from infectious disease in the world

airborne transmission (negative pressure, respirator)

Question 8

TB s/s ***

Answer 8

fever
cogh
night sweats
fatigue
weight loss
crackles
deminished breath sounds

extra pulmonary symptoms (bones, kidneys, LN, meninges)

Question 9

TB diagnostic test ***

Answer 9

tuberculin skin test (PPD)
*positive: induration and erythemia, 5mm or greater
*15mm is postive automatically
*the other ones if positive you get a further tests

TB blood tests

Sputum culture

Question 10

TB tx***

Answer 10

Anti-TB drugs for 6-12 months

First line meds:
*isoniazid (risk for neuropathy/take B6 to prevent)
*Rifampin (orange secretions)
*Pyrazinamide
*Ethambutol (optic neuritis)

Question 11

TB nursing management ***

Answer 11

Promote airway clearance

Medication adherence (direct observe therapy DOT)

Nutrition

Prevent transmission

Monitor for spread of disease (signs of infection or spread to organs)

Question 12

TB vaccine***

Answer 12

Live vaccine

Will affect PPD not blood test

Question 13

Pulmonary embolism***

Answer 13

Occlusion of pulmonary blood vessels

DVT
Fat
Air
Tumors
Vegetative heart valves
Amniotic fluid

Will have ventilation but decreased/absent perfusion

Question 14

PE s/s***

Answer 14

Classic:
Dyspnea
Chest pain
Tachycardia

Cough hemoptysis
Resp distress
Hypoxia

Question 15

What can massive PE do***

Answer 15

Right sided HF/shock

Hypotension
Tachycardia
AMS

Question 16

Pulmonary embolism diagnostic test
***

Answer 16

CTA (CT angiogram) dye in vein

VQ scan

D-dimer (measures fibrin/clots in body)

CXR (rule out other diagnoses)

Venous US lower extremities

ABG (hypoxemia, hypocapnia, alakosis)

Question 17

PE medical management
Goal
Med types
Other tx***

Answer 17

Goal of therapy: dissolve the embolus

Anticoagulants:
LMWH (enoxaparin)
Heparin
DOAC (ribaroxaban)
Warfarin

Thrombolytics

Surgery

IVC filter placed (catches PE)

Question 18

PE medical management: anticoagulation ***

Answer 18

SQ: LMWH (enoxaparin)

IV: heparin (monitor PTT 20-35sec)
*antidote: protamine sulfate

PO: warfarin (monitor INR 2-3)
*antidote: VIT K

PO: DOACs (direct oral anticoagulant)
*rivaroxaban

Question 19

Surgical management of PE***

Answer 19

Vena cava filter (IVC filter)

Pulmonary embolectomy

Question 20

Nursing management of PE***

Answer 20

Promotre oxygenation

Monitor for imporve or worsen

Monitor Side effects of meds

Treat pain/anxiety