COPD, Bronchitis, and Pneumonia Flashcards
one of the most common presentations in primary care
Acute Bronchitis
occurs across the lifespan; common reason for hospitalization; leading cause of death in older adults and chronically
Pneumonia
Acute Bronchitis
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
Clinical Manifestations of Acute Bronchitis
- Cough with clear, mucoid sputum (sometime purulent)
- Fever, headache, malaise, dyspnea on exertion
- Mild increase temp, HR, RR
- Normal breath sounds or expiratory breathing
How can you tell if your pt. has Pneumonia on a x-ray
Acute bronchitis -no radiologic findings Pneumonia –consolidation, infiltrates
Tx. of acute bronchitis
- Supportive –fluids, rest
- Nocturnal cough –cough suppressants
- Wheezing –bronchodilators
- Prolonged infection associated with constitutional symptoms and or smoker/COPD -antibiotics
Acute Exacerbation of COPD (AECOPD)
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
what can cause AECOPD?
infections( viral, bacterial) and non-infections (allergens, irritants, CHF, PE).
how do you determine if Antibiotics are needed or not?
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)
management of AECOPD
abx therapy prn, PO/IV corticosteroids, bronchodilators and oxygen for dyspnea, rest, fluids, nutrition
Nursing interventions for AECOPD
for dyspnea, cough, hypoxia, fatigue, dehydration•
Prevention of AECOPD
annual influenza vaccine; also ensuring pneumococcal vaccines up to date; smoking cessation
what is a common complication of AECOPD
Pneumonia
Purulent sputum +/-systemic manifestations: fever, chills, leukocytosis
Pneumonia
•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
Risk factors of Pneumonia
- 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.
types of pneumonia
Community-Acquired Pneumonia (CAP)
Hospital-Acquired Pneumonia (HAP)
Aspiration Pneumonia
Opportunistic Pneumonia
Community-Acquired Pneumonia (CAP)
Onset in the community of within 48 hours of hospitalization
Contributing Factors: winter months, smoking, COPD, recent abx use, factors r/t aspiration
Hospital-Acquired Pneumonia (HAP)
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
Aspiration Pneumonia
Caused by aspiration from stomach or mouth into lungs
Contributing Factors: ↓ LOC and loss of gag reflex; tube feed
Opportunistic Pneumonic
•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
Pneumonia –Clinical Manifestation
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
Pleurisy
Inflammation of the pleura
Pneumonia -Complications
- 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
Diagnostics for pneumonia
- History and physical•Sputum specimens, blood cultures, ABGs, CBC –↑ WBC with left shift
- Chest x-ray:
Pneumonia collaborative care
- 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
Pharmacotherapy of pneumonia
- Empirical antibiotic therapy -?no improved 48-72 hours –change agent
- Antipyretics, analgesics, bronchodilators
- Limited role for antivirals
Pneumonia nursing assessment
- PMHx
- Medications
- Symptoms
PMHx of Pneumonia
lung diseases, smoking, ETOC, recent URTI, chronic illness, malnutrition, altered LOC, HIV, environmental/occupational exposures, travels, immobility, prolonged bed rest, surgery, intubation, tube feeding
Medications for Pneumonia
: abx, corticosteroids, chemotherapy, immunosuppressive, chemotherapy, radiation therapy
symptoms of Pneumonia
fatigue, anorexia, malaise, weakness, vomiting, fever, chills, cough, sputum, nasal congestion, pain with breathing, CP, sore throat, headache, abdominal pain, myalgias
Pneumonia nursing diagnosis
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
Nursing interventions: prevention of pnemonia
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
Atelectasis
collapsed airways in one or part of the lung. Often resolved with coughing or deep breathing
Pleural effusion
Usually the effusion is sterile and is absorbed within 1-2 weeks. Occasionally necessitates aspiration by means of thoracentesis.
delayed resolution
results from persistent infection seen as radiological consolidation.
lung abcess
rare, occurs in negative pneumonia
Pericarditis
results from the spread of infecting organism from pleura to pericardium
bacterimia
can occur with pneumococcal pneumonia
meningitis
can be caused by S. Pneumonia- if pt. is disoriented or confused do spinal tap.
endocarditis
when organisms attach to endocardium and the valves of the heart.
