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Pathophysiology and Pharmacology > COPD, Bronchitis, and Pneumonia > Flashcards

COPD, Bronchitis, and Pneumonia Flashcards

1
Q

one of the most common presentations in primary care

A

Acute Bronchitis

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2
Q

occurs across the lifespan; common reason for hospitalization; leading cause of death in older adults and chronically

A

Pneumonia

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3
Q

Acute Bronchitis

A

An inflammation of the bronchi in the lower respiratory tract usually caused by infection
•Usually occurs with an upper respiratory infection –persistent cough following rhinitis/pharyngitis
•Mostly viral (rhinovirus, influenza)
•Also bacterial

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4
Q

Clinical Manifestations of Acute Bronchitis

A
  • Cough with clear, mucoid sputum (sometime purulent)
  • Fever, headache, malaise, dyspnea on exertion
  • Mild increase temp, HR, RR
  • Normal breath sounds or expiratory breathing
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5
Q

How can you tell if your pt. has Pneumonia on a x-ray

A

Acute bronchitis -no radiologic findings Pneumonia –consolidation, infiltrates

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6
Q

Tx. of acute bronchitis

A
  • Supportive –fluids, rest
  • Nocturnal cough –cough suppressants
  • Wheezing –bronchodilators
  • Prolonged infection associated with constitutional symptoms and or smoker/COPD -antibiotics
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7
Q

Acute Exacerbation of COPD (AECOPD)

A

includes chronic bronchitis and emphysema
•Sustained (>48 hours) worsening dyspnea, cough, or sputum production causing need for ↑medications (↑use of PRNs, adding new medicine)
•Most frequent cause of medical visits, hospitalization, and death for people with COPD
•Average annual incidence 2-3 per year/person with COPD
•Results in decrease in lung function and life quality

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8
Q

what can cause AECOPD?

A

infections( viral, bacterial) and non-infections (allergens, irritants, CHF, PE).

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9
Q

how do you determine if Antibiotics are needed or not?

A

Purulent, requires Abx and non-purulent does not.

(Abx:7-10 days of therapy often able to self-initiate +/-PO steroids; Rx and instructions given as part of COPD action plan)

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10
Q

management of AECOPD

A

abx therapy prn, PO/IV corticosteroids, bronchodilators and oxygen for dyspnea, rest, fluids, nutrition

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11
Q

Nursing interventions for AECOPD

A

for dyspnea, cough, hypoxia, fatigue, dehydration•

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12
Q

Prevention of AECOPD

A

annual influenza vaccine; also ensuring pneumococcal vaccines up to date; smoking cessation

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13
Q

what is a common complication of AECOPD

A

Pneumonia

Purulent sputum +/-systemic manifestations: fever, chills, leukocytosis

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14
Q

Pneumonia

A

•Acute inflammation of lung parenchyma by a microbial agent
•bacteria, viruses, mycoplasma, fungi, parasites, chemicals
•Acquired by aspiration, inhalation, or hematogenous spread
•Leading cause of death in hospitalized older adults and people with chronic disease
•Failure of bodies natural defense mechanisms of the respiratory tract
For example:
•Lack of cough and epiglottal reflexes: endotracheal intubation, ↓ LOC
•Impaired mucocilliary elevator: air pollution, smoking, aging, URTI

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15
Q

Risk factors of Pneumonia

A
  • Advanced age, Air pollution, smoking, URTI, debilitating and chronic illness
  • altered LOC: drugs, ETOH, narcotics, sedatives, anaesthesia
  • intestinal gastric feeding, tracheal intubation, immunosuppressive drugs, bed rest/prolonged immobility.
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16
Q

types of pneumonia

A

Community-Acquired Pneumonia (CAP)
Hospital-Acquired Pneumonia (HAP)
Aspiration Pneumonia
Opportunistic Pneumonia

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17
Q

Community-Acquired Pneumonia (CAP)

A

Onset in the community of within 48 hours of hospitalization

Contributing Factors: winter months, smoking, COPD, recent abx use, factors r/t aspiration

18
Q

Hospital-Acquired Pneumonia (HAP)

A

Onset 48 hours or longer after hospitalization
•Accounts for 25% of all ICU infections Contributing Factors: aspiration, immunosuppressive therapy, general debility, ET intubation, contaminated respiratory equipment

19
Q

Aspiration Pneumonia

A

Caused by aspiration from stomach or mouth into lungs

Contributing Factors: ↓ LOC and loss of gag reflex; tube feed

20
Q

Opportunistic Pneumonic

A

•Caused by altered immune defense mechanism = highly susceptible to RTIs

Contributing Factors: post transplant drugs, chemotherapy, corticosteroids, radiation therapy, severe malnutrition, immune deficiency i.e. -HIV

21
Q

Pneumonia –Clinical Manifestation

A

Sudden onset fever, chills, productive cough with purulent sputum, pleuritic chest pain
•Pulmonary consolidation: dullness on percussion, inc tactile fremitus, bronchial breath sounds, crackles.
•Extrapulmonary: headache, myalgias, fatigue, sore throat N/V/D
•Atypical presentation: dry cough with more gradual onset, fever, chills + extrapulmonary signs –think viral

22
Q

Pleurisy

A

Inflammation of the pleura

23
Q

Pneumonia -Complications

A
  • Pleurisy -inflammation of the pleura; common•Pleural effusion
  • Atelectasis
  • Delayed resolution –esp. older adults, chronic illness
  • Lung abscess –uncommon
  • Empyema –accumulation of purulent exudate in pleural cavity
  • Pericarditis
  • Bacteremia
  • Meningitis
  • Endocarditis
24
Q

Diagnostics for pneumonia

A
  • History and physical•Sputum specimens, blood cultures, ABGs, CBC –↑ WBC with left shift
  • Chest x-ray:
25
Q

Pneumonia collaborative care

A
  • Prompt treatment
  • Physician, nursing, RT, PT
  • Oxygen therapy, DB & C, chest physio, rest
  • Diet minimum 1500 calories, small frequent meals d/t dyspnea, fluids 3 L/day
26
Q

Pharmacotherapy of pneumonia

A
  • Empirical antibiotic therapy -?no improved 48-72 hours –change agent
  • Antipyretics, analgesics, bronchodilators
  • Limited role for antivirals
27
Q

Pneumonia nursing assessment

A
  • PMHx
  • Medications
  • Symptoms
28
Q

PMHx of Pneumonia

A

lung diseases, smoking, ETOC, recent URTI, chronic illness, malnutrition, altered LOC, HIV, environmental/occupational exposures, travels, immobility, prolonged bed rest, surgery, intubation, tube feeding

29
Q

Medications for Pneumonia

A

: abx, corticosteroids, chemotherapy, immunosuppressive, chemotherapy, radiation therapy

30
Q

symptoms of Pneumonia

A

fatigue, anorexia, malaise, weakness, vomiting, fever, chills, cough, sputum, nasal congestion, pain with breathing, CP, sore throat, headache, abdominal pain, myalgias

31
Q

Pneumonia nursing diagnosis

A 
Activity intolerance
•Anxiety
•Imbalanced body temperature•Ineffective breathing pattern
•Impaired comfort
•Impaired communication
•Risk for confusion•Risk for falls
•Fatigue
•Impaired gas exchange
•Risk for fluid volume deficit
•Imbalanced nutrition
•Acute pain
•Self care deficits
32
Q

Nursing interventions: prevention of pnemonia

A

Preventing aspiration: positioning, dysphagia diet, SLP swallowing assessment
•Turn and reposition q2h to prevent pooling of secretions and ensure adequate lung expansion
•Position patients with ↓LOC side lying or upright to prevent aspiration ’good lung down’
•Avoid overmedication of narcotics, sedatives
•Strict medical asepsis, maintaining infection control precaution

33
Q

Atelectasis

A

collapsed airways in one or part of the lung. Often resolved with coughing or deep breathing

34
Q

Pleural effusion

A

Usually the effusion is sterile and is absorbed within 1-2 weeks. Occasionally necessitates aspiration by means of thoracentesis.

35
Q

delayed resolution

A

results from persistent infection seen as radiological consolidation.

36
Q

lung abcess

A

rare, occurs in negative pneumonia

37
Q

Pericarditis

A

results from the spread of infecting organism from pleura to pericardium

38
Q

bacterimia

A

can occur with pneumococcal pneumonia

39
Q

meningitis

A

can be caused by S. Pneumonia- if pt. is disoriented or confused do spinal tap.

40
Q

endocarditis

A

when organisms attach to endocardium and the valves of the heart.

Pathophysiology and Pharmacology (17 decks)

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