Exam 2 Flashcards
What symptoms raise a red flag for Tuberculosis?
Night sweats, unexpected weight loss, etc
Initially - a dry productive cough
How do you tell if a mantoux test is positive?
You palpate to feel for an induration.
In a regular low risk patient, how many mm of induration indicates a positive Mantoux test?
15mm or greater
If a client is a diabetic, immigrant, has end stage renal disease or an IV drug user (all high risk), how many mm of induration is considered a positive mantoux test?
10mm or greater
5mm or greater induration means a positive Mantoux test for what clients?
Immunocompromised people
- with HIV, recent contact with TB, TAKING PREDNISONE 15mg/day
What is the best way to confirm a diagnosis of TB?
Sputum sample
- looking for acid fast bacillus in the sputum
In starting treatment for TB, what does a patient need to be aware of before starting treatment?
Patients need to know that TB treatment is LENGTHY.
In the initial phase of TB treatment, rifampin is one of the meds used. What should a client be aware of while taking this med?
red-orange discoloration of bodily fluids
The history part of TB assessment is important because if a patient has received the BCG vaccine, they can test positive for TB
True
False
TRUE
- BCG can result in a false positive for TB
If a client is suspected or currently has TB, what precautions are they on?
Airborne Precautions
- single, negative air pressure room with 6-12 air exchanges/hr
- nurses must wear N95 masks
A client suspected of TB wants to go use the restroom, what mask should he wear?
The patient can wear a regular SURGICAL FACE MASK
What are the risk factors for Tuberculosis?
- poor underserved minorities
- homeless
- foreign-born persons
- living/working in institutions
- IV injection drug users
- immunosuppression
- overcrowded living
- poverty, poor access to healthcare
What are some nursing management methods for a patient with TB?
clients may go home if cultures positive
- teach patient how to minimize exposure to others
- notify public health department (public health nurse follow up)
- educate patient to take meds
- smoking cessation
What are the most common symptoms of pneumonia?
- productive or nonproductive cough
- yellow, green or rust-colored sputum
- fever, chills
- dyspnea, tachypnea
- pleuritic chest pain
In elderly patients that come in with an onset of confusion, what are our usual suspects?
UTI, Pneumonia, Hypoxia
What is a common symptom that can be seen in elderly patients with pneumonia?
Confusion or stupor, hypothermia
Pleural effusion is a complication in elderly patients with pneumonia. In this percussion, what is expected?
Dullness to percussion
- no breath sounds (due to fluid)
Atelectasis is the collapse of lungs (alveoli) which inhibits gas exchange. What are some interventions that can be done to prevent this?
- incentive spirometry
- early ambulation
- Turn, cough and deep breathe
same teachings for pneumonia or post op patients in pain,etc
This procedure is used to remove fluid from pleural effusion…
Thoracentesis
- if no improvement is seen, report to provider
What are some elderly complications of pneumonia?
- pleural effusion
- atelectasis
- sepsis
PAS
This test is ideally done before antibiotics are started for a client with pneumonia…
Culture and Sensitivity test
sometimes a broad-spectrum antibiotic is administered
Response to treatment for pneumonia is usually seen within…
2-3 days
-decreased temp and chest discomfort
-improved breathing
What is the usual inpatient med used to treat pneumonia?
Vancomycin, floxacin
What is an ADR of the pneumonia treatment floxacin (a fluroquinolone)?
Achilles Tendon Rupture
Nursing interventions for patients with pneumonia include…
- administer prescribed antibiotics first (for infection)
- auscultate breath sounds
- monitor for symptoms of hypoxemia
- position at semi-fowlers, HOB elevated
- monitor ability to cough effectively
- pulse ox should be 90% or greater
What does it look like when a patient with pneumonia is improving?
- effective RR, rhythm and depth
- clear lung sounds
- absence of infection
What are common things seen in a client with COPD?
- barrel chest
- tripod position
- pursed-lip breathing
- weight loss or anorexia
- prolonged expiratory phase
- fatigue, etc
What are potential complications in clients with COPD?
- cor pulmonae (right-sided heart failure)
- pulmonary hypertension
Spirometry confirms diagnosis of COPD. What other tests are used?
- chest xray
-pulse ox <88% at rest - serum antitrypsin levels
Treatment for COPD includes…
- bronchodilators like albuterol or ipratropium for acute symptoms
- LABA like salmeterol or formoterol or an anticholinergic like tiotropium are used for long term management
- keep o2 sat above 90% -humidification/nebulization for dryness
Since COPD can cause weight loss due to energy being exerted while eating, what are some interventions to help with that?
- rest at least 30 minutes before eating
- avoid exercise for 1 hr before and after eating
- used bronchodilator before meals
- encourage high calorie, high protein meals
- eat 5 to 6 small meals and water BETWEEN meals
- avoid foods that require a lot of chewing and fart forming foods
What are activity considerations for clients with COPD?
- walk 15 to 20 minutes 3 times a week
- modify ADLs to conserve energy
What are the symptom relief methods for a client with sinusitis?
-decongestants like pseudoephedrine
- corticosteroids like fluticasone
- saline spray
- antibiotics if worse symptoms or lasts greater than 1 week
What are some patient education for patients with sinusitis?
Rest, hydration, warm compresses, no smoking, take meds as prescribed, reduce exposure to allergens
Can a client with an egg allergy take the flu vaccine? If not, what can they use instead?
NO!!! A client with an egg allergy CANNOT take the flu vaccine.
- they can take a nasal spray instead*
What are some asthma triggers?
- cockroaches
- pet dander (hair)
- pollen
- smoke
- weather
- exercise
- mold
- strong smells
- beta blockers (metoprolol,etc) can cause brochospasms also ace inhibitors, etc
A peak flow meter or PEFR is commonly used as a test for…
Asthma
Wheezing is the most common symptom of an acute asthma attack. Does that mean the disease is severe?
NO! The client is still moving air.
- if they stop wheezing, that indicates a more severe problem
This IV corticosteroid is usually used for clients with asthma….
Hydrocortisone
This leukotriene modifier can be used for patients with asthma….
Montelukast
Montelukast is a medication that can be given to asthma patients. What are some important things to know about this medication?
- ADR can be suicidal ideations, depression
- given 2 hrs before activity
- usually taken once a day
The asthma action plan consists of a red, yellow and green zone. What is the peak flow of a client in the yellow zone?
50% - 79%
How do you administer an inhaler?
- I how deeply then exhale completely
- place lips firmly around mouthpiece
- breathe in deeply over 2-3 seconds while pushing down on the canister
- hold breath for 10 seconds
- exhale slowly through pursed lips
*wait 6 seconds between each puff
What is status asthmaticus?
A severe life threatening asthma attack that does not respond to standard treatments.
Intubation is a possible intervention for a client experiencing…
Status Asthmaticus
Rifampin is a med used to treat TB. What organ is this med hard on?
Rifampin is hard on the LIVER
- so check liver function tests!!!!
What is the general time frame for TB meds treatment??
6-9 months
What are our droplet precautions?
- PPE like mask
- private room if possible
- hand hygiene
- client should sneeze or cough into sleeve, etc
How do you educate a client on pursed lip breathing?
- relax neck and shoulders
- take a deep breath slowly through nostrils
- exhale slowly through pursed lips
What do you do if a client starts to experience a rash, chills etc when on an IV?
STOP IV!!!
