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Nursing Semester 3 > Cyndi - Week 10 - Exam 5 > Flashcards

Cyndi - Week 10 - Exam 5 Flashcards

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1
Q

what is pneumonia?

A

the inflammation of lung tissue, where alveolar spaces fill with bacteria, virus, fungus, or food

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2
Q

what are the the 4 types of pneumonia?

A
  • community acquired pneumonia (CAP)
  • hospital acquired infection (postop pneu, ventilator associated pneu)
  • opportunistic
  • aspiration d/t stroke, altered LOC, etc
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3
Q

what are the clinical manifestations of pneumonia?

A
  • fever
  • tachypnea
  • tachycardia
  • dyspnea
  • adventitious lung sounds (crackles, wheezes)
  • productive or non-productive cough
  • hypoxemia
  • pleuritic chest painj
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4
Q

what are the complications of pneumonia?

A
  • pleural effusion
  • atelectasis
  • bacteremia/sepsis
  • lung abcess/empyema
  • acute respiratory failure
  • pneumonthorax
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5
Q

what are the diagnostic tests used for pneumonia?

A
  • CXR
  • labs
  • sputum gram stain, C+S
  • oxygenation studies (ABGs, O2 sats)
  • CT, MRI of chest
  • bronchoscopy
  • CURB 65 or pneumonia severity index
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6
Q

what labs are used for pneumonia?

A

WBC
CRP
Blood cultures
procalcitonin (PCT) r/o sepsis

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7
Q

what is the tx for pneumonia?

A
  • oxygenation (bronchodilators/resp tx; oxygenation prn)
  • ATBs
  • antipyretics
  • ↑ fluids as tolerated
  • encourage nutrition
  • meds (take whole prescription, drug-drug interactions)
  • when to return to med (consider vax)
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8
Q

what are the 5 other respiratory disorders?

A
  • fungal infections (coccidioidomycosis “valley fever”; histoplasmosis)
  • lung abscess
  • asbestosis
  • sarcoidosis
  • SARS
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9
Q

what is tuberculosis?

A

infectious disease caused by bacteria Mycobacterium Tuberculosis

  • usually involves in lungs in US, but can infect abdomen, kidneys, bones, adrenal glands, lymph nodes, and meninges
  • **drug resistant strains found world wide
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10
Q

how is TB transmitted?

A
  • airborne transmission via droplets with cough, sputum, sneezes, singing
  • *not spread by hands or objects
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11
Q

what is needed for an airborne transmission??

A

N95 mask and negative air pressure

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12
Q

what are the risk factors for TB?

A
  • Health care workers
  • IV drug users
  • Close proximity to person with active TB
  • Lack of or underserved medical care
  • Country of origin
  • Homeless
  • Substance abuse
  • Lowered immunity
  • Age
  • Malnutrition
  • Institutional or inner city residents
  • Racial or ethnic minorities
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13
Q

what are the diagnostics used for TB?

A
  • intradermal placed TB skin test (TBST)
  • CXR
  • AFB sputum (x 3 am specimens)
  • QuantiFERON - TB (QFT)
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14
Q

what are the characteristics of the TB skin test??

A
  • interpreted 48-72 hrs after placement
  • INDURATED area measured in mm
  • positive test > 5-15 mm
  • immune compromised > 5 mm
  • if +, should never have TBST again
  • 2 step process for health care
  • should not use TBST if had BCG vaccine
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15
Q

what are the characteristics of quantiFERON-TB?

A
  • rapid blood test (few hrs)

- doesn’t replace sputum cultures

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16
Q

TEST: what is important about the sputum collection for TB?

A

must have THREE am specimens

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17
Q

what is the BCG vaccine?

A

Bacille Calmette-Guerin used in areas with high TB rates to prevent and ↓ severity of TB in places like Phlippines and Mexico

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18
Q

In the US BCG is not used because… (3)

A
  • low rates of infection
  • unpredictable PPD result
  • confuses the T-B exposure issue
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19
Q

what are the characteristics of latent TB?

A

have been exposed to bacteria

  • TB germs asleep
  • don’t look or feel sick
  • CXR normal
  • can’t spread TB to others
  • tx by taking one med for 9 months
  • “conversion” - immune system contains
  • 5-10% will develop active TB someday
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20
Q

what are the characteristics of active TB?

A

contagious with TB

  • feel sick, tests +
  • germs in lungs, spreads to other people
  • tx for taking 3-4 meds for 6 mo
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21
Q

what are the sxs of latent TB?

A
  • no sxs
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22
Q

what are the sxs of early stages of TB?

A
  • can be free of symptoms

- thus two step testing

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23
Q

what are the acute sxs of TB?

A

Flu symptoms

  • high fever
  • chills
  • pleuritic pain
  • productive cough
  • malaise
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24
Q

what are the sxs of advanced TB?

A
  • weight loss
  • anorexia
  • night sweats
  • hemoptysis, rarely dyspnea
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25
Q

what is the tx for TB?

A

If hospitalized, as soon as suspected, needs:
Airborne isolation room
- anteroom
- 6-12 exchanges per hour
- either negative pressure vented outside or Hepa filtration

26
Q

What must staff wear if there is a patient with TB?

A
  • N95 mask
  • perform hand hygiene
  • use other PPE as needed
27
Q

what is the tx for latent TB?

A

tx with INH for 6-9 months

- HIV patients should take INH for at least 9 months

28
Q

what is the drug tx for active TB?

A
  • Initial phase 4 drugs for 2 months:
  • INH
  • Rifampin
  • Pyrazinamide
  • Ethambutol
  • Then INH + Rifampin for additional 18 wks
  • If drug resistant, add a fluoroquinolone and second‐line drug regimen
29
Q

what is the pt education for drug tx for active TB?

A
  • Medication side effects – know them
  • When to seek medical care
  • Importance of compliance
  • Liver function, vision monitored
30
Q

what are the side effects for INH for active TB?

A

elevated ALT AST, sxs of hepatitis

31
Q

what are the side effects of Rifampin?

A

orange discoloration of body fluid: tears, sweat

32
Q

what are the side effects of Pyrazinamide?

A

hepatitis, joint pain, hyperuricemia

33
Q

what are the side effects of Ethambutol?

A

lowered ability to discriminate bt red and green - monitor visual acuity

34
Q

what is Directly Observed Therapy?

A

Public health department ensures adherence with treatment plan

35
Q

what are the characteristics of directly observed therapy?

A 
• Noncompliance ‐ major problem in
development of multidrug resistance
• Obtains sputum specimens
• Nurse watches patient swallow the meds
• Identifies people at risk/informs contacts
• Communicates statewide with other PHD
• Coordinates care with local agencies
• Takes appropriate measures to prevent
spread of disease
36
Q

what are the goals for TB tx?

A
  • comply with therapeutic regimen

- have no recurrence of disease

37
Q

what are the expected outcomes for TB tx?

A
  • complete resolution of disease
  • normal pulmonary function
  • absence of any complications
  • no transmission of TB
38
Q

what are the complications of TB?

A
  • miliary TB (spread throughout the body0
  • pleural effusion
  • pneumonia
  • other organ involvement
39
Q

what is pulmonary embolism?

A

blockage of pulmonary artery by thrombus

40
Q

what are the causes of PE?

A
  • afib
  • DVT
  • fat emboli
41
Q

what are the risk factors of PE?

A
  • immobility
  • surgery
  • stroke
  • hx of DVT
  • HTN
  • obesity
42
Q

what are the sxs of PE?

A
  • dyspnea
  • chest pain
  • hemoptysis
  • may begin suddenly
  • if large PE obstructing > 50%. R heart failure d/t pulmonary HTN, severe hypoxemia, and low BP
43
Q

what are the diagnostic tests for PE?

A
  • spiral CT with IV contrast
  • VQ scan
  • D Dimer
  • pulmonary angiogram
  • ABGs
44
Q

what is the tx for PE?

A
  • anticoags (tPA, heparin, Lovenox, Coumadin)
  • supportive (SCDs)
  • **prevention is key
45
Q

what is pulmonary HTN?

A

↑ pulmonary artery pressure

46
Q

what is primary pulmonary HTN?

A

idiopathic

- genetic or cause unknown

47
Q

what is secondary pulmonary HTN?

A

as a result of another disease

- COPD, atherosclerosis, PE, etc.

48
Q

what are the sxs of pulmonary HTN?

A
  • dyspnea on exertion

- fatigue

49
Q

what is the tx for pulmonary HTN?

A

can extend life, but not cure:

  • diuretics, anticoags, CCB, O2
  • new drugs promote PA vasodilation via a continuous infusion pump
  • lung transplant
  • **without tx, cor pulmonale (R sided HR) and death can result
50
Q

what is pulmonary edema?

A

abnormal accumulation of fluid in lung tissues as a result of other disease
• interferes with gas exchange in lung
• interstitial vs alveolar edema

51
Q

what is the most common cause of pulmonary edema?

A

heart failure

- other causes COPD, near drowning, etc.

52
Q

what are the key sxs of pulmonary edema?

A
  • pink frothy sputum refractory hypoxia with sudden, sever dyspnea
53
Q

what is flash pulmonary edema?

A

refers to sudden onset

54
Q

what is the tx for pulmonary edema?

A

tx related to cause

- oxygenation support, diuretics, cardiac meds if indicated

55
Q

what is pulmonary fibrosis?

A

scarring of the lung connective tissue

56
Q

what are the causes of pulmonary fibrosis?

A
  • inflammation, smoking, occupational, environmental

* **prevention when possible

57
Q

what are the sxs of pulmonary fibrosis?

A

severe dyspnea, dry cough

58
Q

what is the tx of pulmonary fibrosis?

A

steroids, resp meds, cytotoxic drugs

59
Q

what is the prognosis of pulmonary fibrosis?

A

very poor

60
Q

what is sarcoidosis?

A

granulomas - clusters of immune cells that scars lungs

**causes, tx, prognosis varies, sxs, complication

61
Q

what is pneumothorax?

A

complete or partial collapse lung

  • spontaneous (closed)
  • iatrogenic
  • traumatic (open or closed)
  • tension

Nursing Semester 3 (29 decks)

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