Infectious Respiratory Disease In-Class Discussion Flashcards
Excess fluid in the lungs resulting from an inflammatory process
Inflammation triggered by many infectious organisms and by inhalation of irritating agents
Develops when the immune system cannot overcome the invading organisms
Fluid in lungs - physiological process in lung: infection causes inflammatory process - alveoli get inflamed and can have fluid buildup and makes hard breathe because cannot exchange gases
Pneumonia
What are some most common types of pneumonia? (Select all that apply)
A.community acquired
B.hospital acquired
C.ventilator associated
D.healthcare associated
E.dormant pneumonia
Answer: A, B, C, D
CAP, HAP, VAP, HCAP
HAP and HCAP - can get pneumonia from being exposed in hospital but also in any other healthcare environment - sim and antibiotics used to treat sim - bugs may be resistant bacteria in HAP and HCAP vs CAP; diff treatments for those
Which client would be at the highest risk for pneumonia?
A. Client 1
B. Client 2
C. Client 3
D. Client 4
Answer: D
Risk factor - more risk factors highest risk; grade risk factors in severity
16 years old not risk; older more risk; poor nutritional status is a little bit of risk factor; vaccine in last 3 months not risk factor
28 not risk; Tobacco - nicotine paralyzes cilia so cannot move bacteria or germs out body as well; 2 years ago for pneumococcal is fine because within normal range
45 not old; alcohol consumption regular risk factor because not good nutrition
Old - risk; chronic lung disease - is risk
Pneumococcoal vaccine: Depends provider and pat; depends on how at risk pat is and if have other immunosuppresant diseases - pats at risk good prevention strategy and covers only pneumococcal pneumonias
Rationale: Client 4 has the most risk factors: older client, chronic lung disease, has not had pneumococcal vaccine recently
Older adult - age
Chronic health problems - resp probs at highest risk
Recent exposure to respiratory viral or influenza infections - high risk developing a pneumonia
Limited mobility - not up and moving
Not taking deep breaths potentially secondary to pain
Uses tobacco or alcohol - smoking
Presence of gram-negative colonization of the mouth, throat, and stomach - colonization in upper airways
Altered LOC - along with aspiration
Aspiration - weak and at risk of aspirating get aspiration pneumonia
Presence of artificial tubes - VAP: even if have trach at high risk but if put on mechanical putting + pressure but is artifical and if sys not kept clean bacteria grow in tubing and pump into airways
Poor nutritional status
Immunocompromised status - high risk for infection
Mechanical ventilation (ventilator-associated pneumonia)
Imp talk about their risk factors with them
What are the risk factors for pneumonia?
Which clinical manifestations would the nurse most likely see in a client diagnosed with pneumonia? (Select all that apply)
A.Chest discomfort
B.Dyspnea
C.Fever
D.Cough
E.Myalgia
F.Increased respiratory rate
Answer: A, B, C, D, E, F
All SOB if prob with lungs see in every pat with resp prob
Chest discomfort - may also have side pain: pleurisy; pleural lining inflamed
Fever - not always; classic pneumonia prob have
Cough - productive or not; often times is productive
Myalgia - muscle ache; be fatigued
Increased respiratory rate or dyspnea
Hypoxemia - not uncommon be hypoxic - not exchange gases at alveolar level because all inflammator so lower O2 sats
Cough
Purulent, blood-tinged, or rust-colored sputum - secretions can be productive or not and if are can be purulent (infectious looking); yellow or green, foul smelling esp depending on type infection
Fever with or without chills
Pleuritic chest discomfort
Lungs: crackles, wheezing, diminished - number sounds depending on how bad pneumonia - consolidated and tons build up and bad and lot inflammation not hear much at all be really diminished because not moving air in and out or much at all; lung sounds vary
Myalgia
Headache - possibly
Rapid, weak pulse may indicate hypoxemia, dehydration, impending sepsis, or shock - getting close to becoming septic - sepsis in an infection: sepsis is a body’s rxn to an infection; happens is body starts getting huge inflammatory response, vasoconstriction, and organs shut down because reacting to infection in body; sepsis: IR in body
Hypotension
What are the clinical manifestations of pneumonia?
A result of vasodilation and dehydration
getting close to becoming septic - sepsis in an infection: sepsis is a body’s rxn to an infection; happens is body starts getting huge inflammatory response, vasoconstriction, and organs shut down because reacting to infection in body; sepsis: IR in body
Hypotension
Acute confusion from hypoxia - altered LOC - most common
Older adult
May not have fever - not have classic s/s; will present differently
More vague and weird symp - more generalized symp; body’s response to infection not infection as age not as good - response to infection not as strong not have classic s/s - present differently
What might be different in the older client?
most common manifestation in older patients rather than fever or cough – may be absent; response to hypoxia not as strong because even tho not exchanging as much gas at alveolar level with pneumonia not increasing RR as someone would if hypoxic because body diminishing
Acute confusion from hypoxia - altered LOC - most common
new onset of confusion, weakness, fatigue, lethargy, poor appetite, hypotension (secondary to dehydration)
Older adult
Which diagnostic tests does the nurse initially expect to be ordered for the client with pneumonia? (Select all that apply)
A.Pulse oximetry
B.Arterial blood gases
C.Chest X-ray
D.Chest CT
E.Sputum culture
F.Complete Blood Count (CBC)
G.Complete Metabolic Panel (CMP)
H.Coagulation panel
I.Pulmonary function test
Answer: A, B, C, E, F
CXR - diagnose pneumonia - big one to diagnose
ABG - know how breathing
Chest CT - not initially; see odd on CXR not fully diagnose may do CT scan but not initial
Sputum culture - culture and sensitivity to figure out specific antibiotic need
CBC - looking at WBC count - differential: % all diff types of WBCs
PFT - how exhaling - getting CO2 out - use on emphysema, chronic bronchitis, asthma: obstructive and restrictive diseases; not do on pneumia this - not prob exhaling and getting rid of CO2 lungs inflamed - not info with PFT; not done typ in acute care; often in outpat; not done when acutely ill because want baseline
When caring for a client with pneumonia, which nursing intervention is the highest priority?
A.Increase fluid intake
B.Encourage deep breathing exercises and controlled coughing
C. Ambulate as much as possible
D. Maintain a nothing-by-mouth (NPO)
Answer: B
All options okay for this; help keep airway cleared with controlled coughing; help keep alveoli open with deep breathing as much as possible to encourage to facilitate gas exchange - ABCs
Increase fluid intake - do want to to help thin secretions; not see immediate response
NPO - at risk for aspiration - not do for everyone but if think have aspiration pneumonia do this
A client is admitted to the hospital with a diagnosis of pneumonia. List the following nursing actions in the order they should be accomplished.
Insert an intravenous (IV) catheter to establish venous access.
Encourage increase in fluid intake
Administer prescribed antibiotic intravenous piggyback.
Collect a sputum sample for culture and sensitivity.
Obtain data about the client’s history and physical status
Answer:
Obtain data about the client’s history and physical status - want info: assessment
Insert an intravenous (IV) catheter to establish venous access. - always get sputum and blood cultures before start antibiotics - get after but let lab know
Collect a sputum sample for culture and sensitivity.
Administer prescribed antibiotic intravenous piggyback.
Encourage increase in fluid intake - imp action but not immediate
If not able to obtain we will not delay antibiotics
Sputum sample imp because want get before give antibiotics; we can get after admin antibiotics within 4-6 hrs but note for lab that given antibiotics; has much better outcomes for pat long-term quicker give antibiotics: not be IV; antibiotics crucial with pat and faster given are better; if waited for culture would wait 48 hrs not wait; obtain before but put on widespectrum until get culture back; sometimes not productive cough but never delay antibiotics until get sputum sample because need to still admin antibiotics; can do bronchoscopies and been fighting it for awhile and cannot figure out how treat it so do that; ideally like get sputum before but never delay antibiotics
Collect a sputum sample for culture and sensitivity.
Oxygen therapy - If hypoxic; if low O2 sat <95% put on O2
Monitor pulse oximetry
Cough and deep breath every 2 hours - Cough and deep breath to keep airway open
Incentive spirometry
Adequate hydration
Assess fluid status
Drug therapy
What interventions should be included when caring for a client with pneumonia
> 95% or in the patient’s normal range
Monitor pulse oximetry
5 to 10 breaths per session every hour while awake
IS - same thing as turn, cough, deep breath; don’t have do this; encourage take deep breaths and clearing airways
Incentive spirometry
Helps thin secretions
Adequate hydration
Monitor I & O
Assess oral mucous membranes and skin turgor
Assess fluid status
