Lower Respiratory Flashcards
atelectasis:
collapse of the (lungs) alveoli caused by hypoventilation, obstruction or compression
hemothorax:
partial or complete collapse of the lung due to blood accumulating in the pleural space; may occur after surgery or trauma
induration:
an abnormally hard lesion or reaction, as in a positive tuberculin skin test
orthopnea:
shortness of breath when reclining or in the supine position
pleural effusion:
abnormal accumulation of fluid in the pleural space
pneumothorax:
partial or complete collapse of the lung due to positive pressure in the pleural space
respiratory weaning:
process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen
thoracentesis:
insertion of a needle or catheter into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of a pleural effusion
thoracotomy:
surgical opening into the chest cavity
Acute Tracheobronchitis Pathophysiology
- Acute inflammation of the mucous membranes of the trachea and bronchial tree.
- Produces mucopurulent sputum
- Occurs In response to Streptococcus pneumonia, Haemophilus influenza, or Mycoplasma pneumonia
- Can also come from a fungal infection.
what is important for diagnosis of Acute Tracheobronchitis
Sputum culture
Acute Tracheobronchitis of Clinical Manifestations
Dry irritating cough Mucoid to purulent sputum Fever, chills, Night sweats Headache & malaise Shortness of breath inspiratory stridor and expiratory wheeze
Mucoid Sputum
clear or white
Malaise:
general discomfort
explain dry cough
its unproductive cough, pt still has sputum but its sitting in their lungs.
Acute Tracheobronchitis Medical Management
- Treat symptoms
- Antibiotic treatment if bacterial
- Increase fluid intake
- Suctioning may be needed
- Steam inhalations
- Moist heat to chest
antihistamines for Acute Tracheobronchitis Medical Management
are not prescribed, because they can cause excessive drying and make secretions more difficult to expectorate
Acute Tracheobronchitis Nursing Management
- Encourage bronchial hygiene
- Use analgesics
- Effective coughing techniques
- Prevention of overexertion
- Promote rest/semi or high fowlers position
Encourage bronchial hygiene
(bronchial hygiene consists of increased fluids and coughing to remove secretions)
Acute Tracheobronchitis Nursing Assessment
1. Health history* (Smoking Vaccinations Surgeries Injuries Hospitalizations)
Current health problems Date of last x-ray, PFT* Diagnostic results Recent weight loss* Night sweats* Sleep disturbances*
why is recent weight loss important when assessing Tracheobronchitis
overexertion and SOB can lead to weightless
PFT
pulmonary function test
Its good to ask about x-rays and PFTs
to compare old imaging to current imaging results.
So if a patient is experiencing a new onset of night sweats
it could potentially be because of tracheobronchitis
goals for acute tracheobronchitis
Patient will:
Have no difficulty with breathing.
Remain over 92% oxygen saturation.
Sustain adequate respiratory function.
Free of symptoms of respiratory distress.
Demonstrate an effective productive cough to clear secretions.`
nursing interventions for acute tracheobronchitis
Prevent complications by: (Monitoring vital signs, respiratory status.) Elevate the head of the bed. Encourage pursed lip breathing and clearing of sputum. (Suction when necessary) Evaluate level of activity tolerance. Note presence and degree of dyspnea. Increase fluid intake.
Pneumonia patho
Inflammation of the lung caused by various microorganisms
causes of Pneumonia
Bacteria, mycobacteria, fungi, viruses
statistics about pnemonia
- Most common cause of death from infectious disease in the US
- Viruses are most common cause in infants and children.
- 8th leading cause of death in the US in 2012.
pnemonia patho
Inflammation in the alveoli producing exudate (sticky substance) that interferes with diffusion of O2 and CO2
WBCs fill the normally air-filled alveoli causing bronchospasms.
Poorly oxygenated blood eventually results in arterial hypoxemia.
Bronchospasm occurs when
the airways (bronchial tubes) go into spasm and contract. This makes it hard to breathe and causes wheezing
V./Q. refers to
the ratio between ventilation and perfusion in the lung, which is normally approximately 4 to 5
lobar pneumonia is defined
If a substantial portion of one or more lobes is involved, the disease is referred to as
classifications of pnemonia
Community-acquired pneumonia (CAP)
Health care-associated pneumonia (HCAP)
Hospital-acquired pneumonia (HAP)
Ventilator-associated Pneumonia (VAP)
Community-acquired pneumonia (CAP)
Occurring in the community or <48 hours after hospital admission.
Health care-associated pneumonia (HCAP)
Non-hospitalized patient with contact with one or more of: hospitalization for >2 days, nursing home, antibiotic therapy, hemodialysis, wound care, infected family member
Hospital-acquired pneumonia (HAP)
Occurring >48 hours after hospitalization
Ventilator-associated Pneumonia (VAP)
Occurring >48 hours after endotracheal intubation
An important distinction of HCAP
is that the causative pathogens are often MDROs
A multidrug resistant organism (MDRO)
isa germ that is resistant to many antibiotics
HCAP is often difficult to treat, thats why ____
initial antibiotic treatment must not be delayed
HAP is associated with a high mortality rate, in part because
of the severity of the organisms, the resistance to antibiotics, and the patient’s underlying disorder
preventative measure for: Patients who are immunosuppressed or neutropenic (low neutrophil count)
Initiate special precautions against infection
preventative measure for: Prolonged immobility and shallow breathing pattern
Reposition frequently and promote lung expansion exercises
preventative measure for: Depressed cough reflex (due to medications, a debilitated state, or weak respiratory muscles)
Reposition frequently to prevent aspiration
preventative measure for: placement of nasogastric, orogastric, or endotracheal tube
Minimize risk for aspiration by checking placement of tube
preventative measure for: Supine positioning in patients unable to protect their airway
Elevate head of bed at least 30 degrees
Pnemonia Risk Factors
>65 years old Comorbidities: COPD, Heart failure, Diabetes, AIDs (they are immunosuppressed) Prolonged immobility Long-term care residence Prolonged NPO Aspiration (of bacteria/infection) Use of tobacco or alcohol
Pnemonia Clinical Manifestations
Nasal Congestion Cough Sore throat tachypnea Flushed cheeks Headache fever Orthopnea Pleuritic Pain Myalgia Purulent Sputum
Consolidation of lung, a sign of pnemonia
is density of lungs due to fluids filling characterized by:
- Tactile fremitus (vocal vibration detected on palpation)
- Dull percussions
Pnemonia diagnostic studies
History and physical Chest X-ray Pulse oximetry and ABGs Blood culture Sputum culture Bronchoscopy (may be completed in severe cases)
Chest X-ray in Pnemonia patients is used for (
to detect anatomical abnormalities
Bronchoscopy
is a procedure to look directly at the airways in the lungs using a thin, lighted tube (bronchoscope)
complications of pnemonia
Lung abscess
Pleurisy
Pleural Effusion
Atelectasis
Lung abscess
Localized collection of pus caused by microbial infection.
Lung abscess patho
Caused by aspiration of anaerobic bacteria
Lung abscess symptoms
foul smelling sputum Fever Productive cough Dyspnea Weakness Weight loss
Lung abscess assessment findings
Pleural friction rub (grating or creaking sound)
Crackles
Percussion dullness
Lung abscess prevention
Dental and oral hygiene
Lung abscess treatment
These pts will need strong IV antibiotics or surgical resection in rare cases.
Pleurisy
Inflammation of both layers of pleurae
Pleurisy patho
Surfaces rub together with respirations, causes sharp pain that worsens with inspiration
Pleurisy patient education
The nurse educates the pt to turn and splint frequently onto the affected side to splint the chest wall.
Pleural Effusion
Collection of fluid in pleural space.
Usually secondary to another disease process.
Thoracentesis may be performed
what is a sign of Pleural Effusion
Empyema: Accumulation of thick, purulent fluid in pleural space
Thoracentesis
(aspiration of fluid and air from the pleural space)
Nurse’s job is to record the output and report findings to doctor
Atelectasis
Collapsed or airless condition of the alveoli.
Atelectasis patho
Caused by hypoventilation, obstruction to airways, or compression
Atelectasis signs
Increased dyspnea Cough Sputum production Pleural pain Central cyanosis
Atelectasis is one of the most commonly encountered abnormalities seen on _________
a chest x-ray
Nursing measures to prevent atelectasis include
frequent turning, early mobilization, and strategies to expand the lungs and to manage secretions
Medical management for pnemonia
- Antibiotic therapy based on culture and sensitivity.
- Bronchodilators (albuterol)
- Supportive treatment
“Supportive treatment” for Medical management for pnemonia includes:
Hydration Oxygen for hypoxemia Antipyretics Antitussives (cough) Nasal decongestant Antihistomines
_______ are ineffective in viral upper respiratory tract infections and pneumonias,
Antibiotics
Antibiotics are indicated with a viral respiratory infection only if a secondary _____ pneumonia, bronchitis, or rhinosinusitis is present
bacterial
Nursing Management for pnemonia
Patient positioning Oxygen supplementation Monitor intake and output Activity grouping Administer medications as ordered Education about symptoms to report
Prevention for pnemonia
Vaccines if older than 65 or w/ chronic health issues:
(PCV 13) Pneumococcal conjugate vaccine
(PPSV23) Pneumococcal polysaccharide vaccine
& Seasonal influenza vaccination yearly
PPSV23
is a newer vaccine and protects against 23 types of pneumococcal bacteria
adults age 65 or older who have not received PCV13
a dose of PCV13 should be given followed by PPSV23 one year later
renewal of PPSV23 vaccines
after 5 years of previous dose
Nursing Assessment for pnemonia
History and physical Signs and symptoms of illness Vital signs Respiratory assessment Peripheral pulses Skin color
nursing interventions for pnemonia
Provide humidification Suction as needed Promote fluid intake and coughing Encourage rest and activity grouping Administer oxygen as necessary Education Medication administration Monitor for complications
why is removing secretions is important
because retained secretions interfere with gas exchange and may slow recovery.
(CPT) Chest Physiotherapy
is postural drainage, important in loosening and mobilizing secretions
Pneumonia symptoms the nurse must educate the pt to report to Physician
difficulty breathing,
worsening cough,
recurrent/increasing fever,
and medication intolerance
for Bacterial Pnemonia, patients usually begin to respond to treatment within
24 to 48 hours after antibiotic therapy is initiated.
Tuberculosis
An infectious disease that affects the lung parenchyma (functioning portion of the lung tissue)
the infectious agent of Tuberculosis
“M. tuberculosis” is the infectious agent
Tuberculosis infects
one third of the world’s population
Tuberculosis is associated
with poverty, malnutrition, substandard housing, and inadequate healthcare
Pathophysiology of TB
- Bacteria are transmitted through the airway to the alveoli
- Immune response occurs to lyse (destroy) the bacilli and normal tissue
3, Accumulation of exudate occurs in the alveoli which can cause pneumonia
TB’s Initial infection usually occurs
2 to 10 weeks after exposure
TB Could be dormant. Becomes Active disease
due to Immunosuppressed patients or reinfections
TB spreads from person to person by
airborne transmission
Risk Factors for TB
Inadequate healthcare
Preexisting medical conditions
Travel to countries with high prevalence
Health care workers providing high risk activities
countries with a high prevalence of TB
(southeastern Asia, Africa, Latin America, Caribbean).
preventing the transmission of TB
Early identification
Initiate isolation precautions for any patient with suspected TB
Surveillance for TB transmission via tuberculin skin testing
Isolation for TB includes:
negative pressure private room and use of ultraviolet lamps
TB symptoms
Progresses gradually Low grade fever Cough Night sweats (common) Fatigue Weight loss (common) Cough Nonproductive or mucopurulent Hemoptysis (coughing blood)
TB assessments and diagnostics
- Complete history (traveled to countries?)
- Physical examination
- Thorough respiratory assessment
- Tuberculin skin test
- Chest X-ray
Thorough respiratory assessment for TB includes:
assessing the lungs for consolidation by evaluating breath sounds (diminished, bronchial sounds; crackles), fremitus, and egophony.)
If the patient is infected with TB, the chest x-ray usually
reveals lesions in the upper lobes.
The Mantoux method is used to determine
whether a person has been infected with the TB bacillus
what are the steps for injecting TB skin test?
- purified protein derivative (PPD), is injected into the intradermal layer of the inner aspect of the forearm, approximately 4 inches below the elbow.
- The needle, with the bevel facing up, is inserted beneath the skin.
- Then, 0.1 mL of PPD is injected,
A significant (positive) PPD reaction does
not necessarily mean that active disease is present in the body.
Mantoux test readings
(Negative) = redness only
(Positive) = Wheel greater than 6-10 mm
(positive) = “immunosuppressed” wheel is 5+ mm diameter
A significant (positive) reaction indicates
past exposure to M. tuberculosis or vaccination with bacille Calmette-Guérin (BCG) vaccine
QuantiFERON-TB Gold In-Tube and T-SPOT
TB blood tests.
Preferred test for patients who have received the vaccine.
Available within 24 to 36 hours.
A positive test indicates a possible infection.
Sputum culture is completed to confirm positive diagnosis.
TB Can cause atypical manifestations in geriatrics such as
Unusual behavior
Altered mental status
in geriatrics, TB skin test reaction is
delayed by 1 week, and a second TB skin test should be performed 1-2 weeks after
Geriatrics are at a higher risk when
living at a long term care facility
TB medical management
Anti-TB agents for 6 to 12 months to eradicate organisms and prevent relapse
Four anti-TB medications given at beginning of treatment (given as a cocktail)
Isoniazid (INH)
Rifampin (Rifadin)
Pyrazinamide (PZA)
Ethambutol (Myambutol)
those 35 years or younger who have PPD test results with 10 mm of induration or more and who are foreign-born from countries with a high prevalence of TB are suggested to take
Prophylactic isoniazid (INH) treatment involves taking daily doses for 6 to 12 months.
pulmonary TB medications regimen
Take the 4 Medication cocktail once a day for 2 months and are oral medications then continues a 4-7 months PO depending on culture result
Common side effects of TB medications:
Hepatitis
Neuritis
(nausea + vomiting)
Nursing Management for TB patients
Promoting airway clearance
Advocating adherence to treatment regiment
Promoting activity and nutrition
Preventing transmission
Promoting Airway Clearance for TB
Increase fluid intake to promote systemic hydration
Positioning for breathing comfort
lower and middle lobe bronchi drain more effectively when
the head is down
the upper lobe bronchi drain more effectively when
the head is up.
Rifampin lowers the effectiveness of these medications.
beta blockers,
anticoagulants
or contraceptives
rifampin, it can cause an
orange tint to their urine.
TB is a communicable disease and that taking medications
is the most effective means of preventing transmission
The nurse educates the patient to take the medication either
on an empty stomach or at least 1 hour before meals,
Patients taking isoniazid should avoid foods that contain
tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), to avoid headaches and hypotension
Patients should also avoid alcohol because
of the high potential for hepatoxic effects.
Promoting Activity and Adequate Nutrition for TB
Goal: To increase activity tolerance and muscle strength
Willingness to eat may be altered
Identify facilities that provide meals to patients with limited resources
Small frequent meal planning
Liquid nutritional supplements
Preventing Transmission patient teachings include:
Covering mouth and nose while sneezing and coughing.
Hand hygiene.
Proper disposal of tissues.
Watch for transmission signs to other organs in the body.
Watch for transmission signs to other organs in the body by:
Frequent vital signs
Spikes in temperature
Changes in renal or cognitive function
miliary TB
Spread of TB infection to nonpulmonary sites of the body
