Lower Respiratory Flashcards
What is pneumonia and how deadly is it?
- Infection of lung parenchyma
- Significantly high morbidity and mortality rate
What occurs with fluid in the lugns in terms of gas exchange?
What do you do if a patient has fluid?
- Fluid makes O2 getting into the lungs and CO2 getting out less effecient
- Cough
What occurs in pneumonia?
- Decreased cough
- Decreased epiglotal reflexes
- Mucociliary mechanism impaired
What things are you at risk for wen you have pneumonia?
- Aspiration
- Infections (ex. Influenza)
Define…
- Community-Acquired Pneumonia (CAP)
- Hospital-Acquired Pneumonia (HAP)
- Ventilator Acquired Pneumonia (VAP)
CAP- Not hospitalized or in long term care facility 14 days of the onset of symptoms
HAP- 48 hours or longer after hospitlization and not present at time of admission
VAP- type of HAP that occurs more than 48 hours after endotracheal intubation
What blood test is a good measure for inflammation?
ESR- Erythrocyte Sedimentation Rate
—> How quickly erythrocytes settle at the bottom of the test tube
What are the goals/outcomes and treating Pneumonia?
- Clear breath sounds
- Normal breathing patterns
- No signs of hypoxia
- Normal Chest X-Ray
- Normal WBC count
- Absence of complications related to pneumonia
What is empyma?
Pus
What test do you do to know if someone has cystic fibrosis?
Sweat Chloride Test
What are the risk factors for aspiration pneumonia?
- Decrease LOC
- Decreased Gag Reflex
- Dysphagia
- NG Tube
What does necrotizing pneumonia cause?
-IMMEDIATE respiratory insufficiency or failure
What are some signs and symptoms of pneumonia?
- Cough, Fever, Chills
- Dyspnea, Tachypnea
- Pleuritic, Chest Pain
- Green, Yellow, Or Rus-Colored Sputum
What would you find in a physical examination with someone who has pneumonia?
- Fine or course crackles
- Bronchial breath sounds
- Egophony - Increase resonance of voice when auscultating lungs due to something in lungs
- Increased Fremitus- put hands on the patient’s back and percuss so if you feel vibrations, it indicates fluids or a tumor
- Dullness to percussion if pleural effusion present
- Tachycardia
- Confusion to Delirium
What is thoracentesis?
Thoracentesis- Temporary relief if pleuritic effusion is compromising; Needle is put between ribs into the pleural space between the lungs and the chest wall and drain fluid out
What’s one way to decrease the risk of pneumonia?
What’s one way to treat bacterial pneumonia and how does the patient improve?
-Pneumococcal Vaccine (To Prevent Streptococcus Pneumoniae)
- Antibiotics
- –> Decreased Temperature
- –> Improved Breathing
- –> Chest Discomfort
What are some supportive care interventions a nurse can do for a patient with pneumonia and what do they improve?
- O2 for hypoxemia
- Analgesics for chest pain
- Antipyretics for fever
- Individualize rest vs activity
What is a treatment for viral pneumonias?
No definitive treatment
What is the treatment for Influenza Pneumonia?
Antiviral Drugs
What should you do in terms of drug therapy with a patient with pneumonia?
- Start with IV and then switch to oral therapy as soon as patient stable
- Should see improvements in 3-5 days
What should you do in terms of nutritional therapy with a patient with pneumonia?
- Adequate hydration (may have to be IV initially)
- Thin and loosen secretions
How should a patient with pneumonia eat and why?
-High calorie, small, frequent meals
Because it is easier for dyspneic patients to breath because they can’t eat and breath at the same time
Should you monitor for weight loss in patients with penumonia?
Monitor for weight loss for patients with pneumonia?
What are some nursing diagnosis you can make with a person with pneumonia and related to what?
- Impaired gas exchange- related to fluid and exudate accumulation within the alveoli and surrounding lung tissue
- Ineffective breathing pattern- related to inflammation and chest discomfort
- Acute pain- related to inflammation and ineffective pain management
- Activity Intolerance -related to chest discomfort, Inflammation, SOB, and personalized weakness
What are some nursing implementations that can help AT RISK patients from developing pneumonia?
- Reposition every 2 hours
- Strict medical asepsis
- Strict Ventilator bundle to theirs only
- Elevate HOB 30 degrees and have them sit up for all meals
- Assess for Gag Reflex
- Incentive Spirometry
- Mobilize Secretions
- Skin Checks Frequently
- Oral Hygiene and Suctioning
- Avoid unecessary antibiotic use
-Perform Swallow Study for Elderly Patients (ultrasound After Swallowing)
What are some important/urgent nursing implementations that can be done during pneumonia acute care (they already have it)
- Frequent assessment with Oximetry
- PROMPT initiation of antibiotics (unless viral)
- O2 as needed
What are some people you can work with in an interprofessional collaboration and what do they do?
- Respiratory Therapists- Oxygen Therapy
- Physical Therapists- Postural Drainage and Chest Percussion
What do humidifiers do?
What don’t they do?
- Facilitates the ease of breathing
- Doesn’t mobilize and/or get rid of secretions
What should you see during an evaluation for someone cleared of pneumonia?
- SpO2 Greater than or equal to 95%
- Clear of Sputum inAirway
- Effective Respiratory Rate, HR, and Depth of Respirations
- No Adventitious Breath Sounds
- Lungs Clear to Ausculatation
What should you see and hear if you auscultate and percuss someone with pleural effusion?
- Localized Decreased Breath Sounds
- Dullness to Percussion
What is used for outpatient treatment of penumonia?
Erythromycin
What does TB create in your lungs, when do they occur, and what do they do when they occur?
- Creates craters called Ghon complexes in your lungs
- Eats Alveoli
- When Ghon Complexes are Released
What are some populations that are vulnerable to TB?
- Homeless
- Living or Working In Institutions (includes health care workers)
- IV Drug Users
- Foreign Born Persons
- Povery
- Immunosurpressed
What are some diagnostic tests that can be done to determine TB?
- Tuberculin Skin Test
- Sputum Culture and Sensitivity
- Sputum for AFB
- Chest X-Ray
How long does it take to clear TB?
6-9 months
What criteria does TB need in order to be considered Multidrug-Resistant Tuberculosis (MDR-TB)?
Resistance to at least 2 potent first line anti-TB drugs
-Specifically Rifampin and Isoniazid
What criteria does TB need in order to be considered Extensively Drug Resistant TB (XDR-TB)?
Resistant to any Fluoroquinolone + Any Injectable Antibiotic
Most Resistant to Treatment
Describe Primary, Latent, and Active TB infections?
Primary- Initial Infection and Inflammation begins
Latent TB- No signs or symptoms but infected
Active TB- Reactivation post Primary; Signs and symptoms show
What is a somewhat unique symptom of TB?
Night Sweats
What are the classes of TB Infections?
Classes
0 = No exposure or History
1 = Exposure and No History (-PPD)
2 = Latent TB and no Symptoms (+PPD skin test)
3 = TB Clinically Active (+ bacteriological studies or both a +PPD and X-Ray Evidence)
4 = History of TB but not clinically active (+PPD)
5 = TB suspect (diagnoasis pending and stay in this category for 3 months)
What does a +PPD skin test indicate?
What doesn’t it indicate?
What constitutes as a +PpD test?
- Indicates Infection
- Doesn’t indicate whether it’s latent or active causing illness
- Reactions greater than or equal to 15 mm considered positive in normal patients
What is considered a +PPD test in an immunocompromised patient?
Reactions greater than or equal to 5mm
