LOWER RESPI Flashcards
An acute inflammation of the mucous membranes of the trachea and the bronchial tree
Acute Tracheobronchitis
Host of Acute Tracheobronchitis
History of URTI, specifically of viral etiology
Agent of Acute Tracheobronchitis
S.pneumoniae
Haemophilus pneumoniae
Mycoplasma pneumoniae
Aspergillus (fungus)
Environmental factors of Acute Tracheobronchitis
-Inhalation of physical and chemical irritants
-Inhalation of gases or other air contaminants
Acute Trancheobronchitis Clinical Manifestations (Early)
-Dry, irritating cough with scan mucoid sputum (initial sign)
-Sternal soreness
-Fever or chills
-Night sweats
-Headache
-Generalized malaise
Acute Trancheobronchitis Clinical Manifestations (Late)
-SOB
-Stridor and Wheeze
-Purulent sputum
-Blood streaked sputum in severe cases
Acute Tracheobronchitis Medical Management
-Antibiotic treatment, as ordered
-Analgesic, as ordered
-Suctioning, as ordered
-Bronchoscopy
Nursing Management of Acute Tracheobronchitis
-Encourage oral fluid intake
-Encourage coughing exercise
-Emphasize to complete full course of antibiotics
-Steam inhalation
-Apply moist heat to chest to relieve soreness and pain
-Advise to rest in in between activities
Is the inflammation of the lung parenchyma
Pneumonia
Classification of Pneumonia
-Community Acquired Pneumonia
-Health care-Associated Pnemunonia
-Hospital Acquired Pneumonia
-Ventilator Associated Pneumonia
Most common cause of Community Acquired Pneumonia
S. Pneumoniae
Causative agent of CAP
-S.pneumoniae
-Gram-positive
-Haemophilus influenzae
-Mycoplasma pneumoniae
-Viruses
Mode of Transmission of CAP
Droplet Spread
Transmission precaution of CAP
-Droplet precaution
-Cough etiquette
Risk Factors of CAP
-Immunosupression
-Smoking
-Prolong immobility and shallow breathing pattern
-Depressed cough reflex
-Aspiration
-NPO
-Presence of NGT, OGT, or ETT
-Supine positioning in patient unable to protect airway
-Antibiotic Therapy
-Alcohol intoxication-supresses reflexes
-Advanced age
-Respiratory therapy with improperly cleaned equipment
Patchy areas of consolidation and more common form of pneumonia
Bronchopneumonia
Entire lobe (1 or more is consolidated)
Lobar Pneumonia
Classification of Pneumonia that occurs at community level or within 48 hours after admission
Community- Acquired Pneumonia (CAP)
Classification of Pneumonia that occurs in non-hospitalized patients with extensive health care contact
Health care-Associated Pneumonia (HCAP)
Classification of Pneumonia that occurs 48 hours or more after hospital admission
Hospital-Acquired Pneumonia (HAP)
Classification of Pneumonia that occurs 48 hours or more after intubation
Ventilator- Associated Pneumonia (VAP)
May cause CAP in immunocompromised adults
-Cytomegalovirus (most common)
-Herpes simplex virus
-Adenovirus
-Respiratory syncytial virus
Clinical Manifestation of CAP
-Sudden onset of chills
-Rapidly rising fever (38.5C to 40.5C)
-Pleuritic chest pain
-Tachypnea (RR=25 to 45 cpm)
-Shortness of breath
-Use of accessory muscles
-Cough
-Sputum Production
-Orthopnea
-Poor appetite
-Crackles
Shortness of breath when reclining or supine
Orthopnea
Manifestations of CAP where vocal vibrations detected on palpation
Tactile fremitus
Manifestations of CAP where spoken “E” sound becomes a loud, nasal-sounding “A” upon auscultation
Egophony
Manifestations of CAP where whispered sounds are easily auscultated through the chest wall
Whispered pectoriloquy
Diagnostic of CAP
-CXR
-CBC= +leukocytosis
Reveals areas of consolidation/infiltration
CXR
Required vaccine for CAP prevention
Pneumococcal Conjugate Vaccine (PCV 13)
Recommended for all older adult aged 65 years and up, as well as adults 19 years or older with conditions that weaken the immune system
PCV 13
Medical Management of CAP
Antibiotic therapy as determined by C&S result
Clinical features of S.pneumoniae
Abrupt onset, toxic appearance, pleuritic chest pain, usually involves 1 or more lobes
Clinical features of haemophilus influenzae
Insidious onset associated with URTI 2-6 weeks before onset of symptoms, usually involves greater than 1 lobes
Clinical features of Mycoplasma pneumoniae
-Insidious onset
-sore throat
-nasal congestion
-ear pain, headache
-low- grade fever
-pleuritic pain
-myalgias
-diarrhea
-erythematous rash
-pharyngitis
-interstitial infiltrates on CXR
Medical Management of CAP
-Hydration
-Antipyretics
-Warm, moist inhalation
-Supplemental oxygen, as ordered if with hypoxemia
-For viral pneumonia, same management, except for antibiotics
Nursing Management of CAP
-Encourage increased oral fluid intake (2-3L/day), unless contraindicated
-Facilitate chest physiotherapy, as ordered
-Instruct patient to assume a comfortable position to promote rest and breathing (Semi Fowler’s)
-Instruct to avoid overexertion
-Advise small, frequent meals
-Encourage intake of fluids with electrolytes (Gatorade, Pocari Sweat)
Is an infectious disease that primarily affects the lung parenchyma
Tuberculosis
Causative Agent of PTB
Mycobacterium tuberculosis
Mycobacterium TB is:
-Acid- Fast aerobic rod
-Sensitive to heat and UV light
PTB mode of transmission
Airborne
Precaution of PTB
Airbone Precautions
4 cardinal signs of PTB
-Cough
-Unexplained fever
-Unexplained weight loss
-Night sweats
Other manifestations of PTB
-Sputum Production
-Hemoptysis
Diagnostics for PTB
-CXR-PA view
-Sputum GenXpert
-Direct Sputum Smear Microscopy (DSSM)
-Mantoux Test
Screening test for all presumptive cases
CXR- PA view
Primary diagnostic test for PTB
Sputum GenXpert
Serve as alternative dx tool IF Xpert is not available
Direct Sputum Smear Microscopy (DSSM)
Shall only serve as adjuvant when there is doubt in making clinical diagnosis in children
Mantoux Test
4 cardinal signs of PTB
-Cough
-Unexplained fever
-Unexplained weight loss
-Night sweats
How many ml for sputum collection of GenXpert
1 ml
Sputum collection for DSSM is
3-5 ml, 2 specimens 1 hour apart or early morning specimen on the next day
Notation T interpretation
MTBI detected, RR not detected
Notation RR interpretation
MTB detected, RR detected
Notation TI interpretation
MTB detected, RR indeterminate
Notation N interpretation
Normal/ MTB not detected
Notation I interpretation
Invalid/ no result/ error
What are the Anti-TB medications?
RIPE
Rifampicin (R)
Isoniazid (H)
Pyrazinamide (Z)
Ethambutol (E)
Regimen 1 Intensive is
2 months (HRZE)
Regimen 1 Maintenance is
4 months (HR)
Regimen 2 Intensive is
2 months (HRZE)
Regimen 2 Maintenance is
10 months (HR)
