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Exam 7 > Lower Respiratory Tract Disorders > Flashcards

Lower Respiratory Tract Disorders Flashcards

1
Q

Acute bronchitis

A 
Inflammation of bronchial tree
Secondary to URI
Viral 
Exposure to inhaled irritants
Thick secretions become a culture medium
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2
Q

S&S of acute bronchitis

A 
Productive cough
Rhonci
Wheezing
Dyspnea
Chest pain
Low grade fever
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3
Q

How is acute bronchitis diagnosed?

A

CXR

Sputum culture

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4
Q

Medical management of acute bronchitis

A

Cough syrup
Antipyretics
Bronchodilators- albuterl, ventolin, proventil
Antibiotics (if it worsens)

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5
Q

Important interventions for acute bronchitis

A 
Get pt. to move
Dangle
Sit at 90 degrees with arms on piilows
OOB to chair QID
Sitting the patient upright activates reflexive CV changes that produce fluid shift in lung and chest blood vessels
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6
Q

NIs for acute bronchitis

A 
Rest to conserve energy
Vaporizer to add humidity to air
Increased fluid intake
Avoid dairy
Elevate HOB with pillows
Instruct deep coughing
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7
Q

Bronchiectasis

A

Dilation of the bronchial airways
Airways become flabby and scarred
Can be localized or general
Difficult to expectorate secretions (makes bacteria grow)

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8
Q

Bronchiectasis etiology

A

Usually secondary to CF, asthmas, TB, bronchitis, exposure to toxin, or tumor
Cilia function reduced
Airway obstruction from excess secretions

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9
Q

S&S of bronchiectasis

A 
Recurrent lower resp. infections
Copious and purulent secretions
Produces up to 200 mL of thick, foul pulmonale-smelling sputum with one cough
Dyspnea
Wheezes and crackles
Cor pulmonale
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10
Q

Diagnositc tests for bronchiectasis

A

Chest x-ray?
CT
Bronchoscopy
Sputum cultures

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11
Q

Therapeutic measures for bronchiectasis

A

Keep airways free of secretions
Control infection
Correct underlying problems

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12
Q

Treatment of bronchiectasis

A 
Bronchitol (from of mannitol; draws fluid into airways to liquefy mucous)
Antibiotics
Bronchodilators
Mucolytic agents
Expectorants
Chest PT- cup shaped hand, percussion
Chest wall oscillation vest
O2
Fluids 
Lung transplant
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13
Q

Pneumonia

A

Acute inflammation/infection of the lungs

Microorganisms release toxins, causing damage to mucous and alveolar membranes (edema &exudate)

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14
Q

Types of pneumonia:

Bacterial pneumonia

A 
Community-acquired pneumonia- strem, staph, chalmydia, & mycoplasma pneumonia
HAP- E. coli
Haemophilus influenzae
Kelsieall pneumonia
MRSA
Pseudonomas
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15
Q

Types of pneumonia:

Viral pneumonia

A

Influenzae- most common
Less ill than with bacterial
Antibiotics- non effective

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16
Q

Types of pneumonia:

Fungal pneumonia

A

Candida
Aspergillus
Pneumocystis carinii

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17
Q

Types of pneumonia:

Aspiration pneumonia

A 
Decreased LOC
Impaired swallowing
ETOH ingestion
Stroke
General anesthesia
Seizures
GERD
Increases risk for bacterial pneumonia
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18
Q

Types of pneumonia:

Ventilator-associated pneumonia (VAP)

A

ET tube keeps glottis open

Secretions easily aspirated

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19
Q

Types of pneumonia:

Hypostatic pneumonia

A

Hypoventilating clients
Immobile
Shallow respirations
Secretions pool in dependent areas of lungs

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20
Q

Types of pneumonia:

Chemical pneumonia

A

Inhalation of toxic chemicals

Increases risk for bacterial pneumonia

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21
Q

Pneumonia prevention

A 
Vaccine- streptococcus pneumonia for:
>65 years
High risk populations
Booster in 1 year
New vaccines cover more strains of the strep infection
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22
Q

Nursing care of pneumonia

A

HOB elevated (fowlers or semi)
Cough, turn, deep breathe
Good hand washing
Get them up and moving

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23
Q

S&S of pneumonia

A 
Fever
Shaking
Chills
Chest pain
Dyspnea
Fatigue
Productive cough
Crackles or wheezed
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24
Q

What is the sputum color in pneumonia patients?

A

Purulent
Rust colored
Blood tinged

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25
Q

Atypical pneumonia

A

Not caused by traditional organisms
“walking pneumonia”
Distinction between atypical and typical is medically insufficient
Need to know exact causal organism

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26
Q

Atypical pneumonia causative agents

A

Mycoplasma
Chlamydia
Viral

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27
Q

Diagnostic tests for pneumonia

A

CXR
Sputum and blood cultures (be sure mouth is rinsed, can use nebulizer mist treatemnt, leuki-trap)
CBC-WBC will prob be >15000

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28
Q

Therapeutic measures of pneumonia

A

Broad spectrum antibiotics
Once cultures are back, may use narrow spectrum antibiotics
If viral- rest and fluids, anti-viral meds

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29
Q

Medications for pneumonia

A 
Expectorants
Bronchodilators
Analgesics
Nebulizers
Metered-dose inhalers
Supplemental O2
30
Q

The elderly & pneumonia

A

New onset confusion or lethary
New onset fever and dyspnea
Can spread to meninges, blood, joints, pericardium, or endocardium

31
Q

Complications with the elderly and pneumonia

A

Common wiht unerlying chronic diseaes
Pleurisy
Pleural effusion
Atlectasis

32
Q

Pneumonia and the older adult

A 
Lifestyle is important
Flu and pneumococcal vaccine
Exercse
Smoking cessation
Healthy eating
Good hygiene
Rest and sleep
Elderly are at risk for complications because of reduced immune response
"Old man;s friend"
33
Q

Parts of the body that TB affects

A 
Middle ear
Tonsils
To oppsite lung or to other parts of same lung
Pericardium
CNS (brain and meninges)
Intestine
Blood, spine, muscles
Gentials (especially epididymis)
Liver, spleen, peritoneum, 
Adrenal glands
Ureter
Bladder
Adnexa
Prostate
Seminal vesicles
34
Q

True or false: TB is transmitted through air and easy to transmit from person to person

A

False:
Most people exposed do not become infection because of the upper airway cilia; it prevents TB organisms from reaching the lungs

35
Q

Tuberculosis

A

Mycobacterium tuberculosis
Chronic pulmonary and extrapulmonary infectious disease
May be asymptomatic
Prevalent in people infected with HIV or compromised immune system

36
Q

How long can TB survive in human tissue

A

> 50 years

37
Q

How many americans are infected with TB?

A

15 million

38
Q

What happens if lungs are involved with TB?

A

The immune system surrounds it with neutrophils and alveolar macrophages
A lesion called a tubercle is formed, which seals off bacteria and prevents spread

39
Q

S&S of TB

A 
Symptoms start with chronic, productive cough
Insidious
Fever (low-grade)
Can lead to pulmonary fibrosis
Weight loss
Weakness, fatigue
Productive cough
Blood tinged sputum
Later = fever with chills and night sweats (drenching night sweats)
Hemoptysis
Chest pain
40
Q

High risk groups for TB

A 
HIV infected clients
Close contact with infected people
Children & elderly
Immunosuppressed
Born in countries with high incidence of TB
Substance abusers
LTC residents
Low income people
HCWs
41
Q

Prevention of spreading TB

A

Clean, well ventilated rooms
Negative pressure rooms
Staff to wear high efficency filtration masks
Vaccine availabe
If non compliant, PO meds must be observed by nurse
D.O.T

42
Q

Primary prevention of TB

A

Public education
Good, general health practices
Immunizations
PPD screening of high risk groups
Trace active cases and start early treatment
Well balanced diet; Protein, Vitamin A, Vitamin C
Teaching at public health fairs, clinics, schools, jobs

43
Q

Tests for TB

A

Mantoux TB skin test- a(+) (>5mm) reaction within 48-72 hours (+2-10 weeks after exposure)
POSITVE test means the person is infected or has been exposed to the tubercle bacilli
If not positive, may repeat in 1-3 weeks
CXR and 3+ acid fast smears are diagnositc
TB culture takes 6-8 weeks
QuantiFERON-TB GOLD (QFT-G) is new rapid diagnostic test… results in a few hours

44
Q

Sputum cultures for TB

A

Instruct client to bring secretions up from lungs (cough)
Make sure they are well hydrated (increase fluid intake if necessary)
Good mouth care
Not just after eating
Specimen should go directly to the lab

45
Q

TB pathophsyiology

A

Caused by mycobacterium tuberculosis
Acid-fast (when washed with acid in the lab an dstained, when rinsed, the stain remains or stays “fast”)
Can live in dark places and dried sputum for months
Sunlight can usually kill it

46
Q

Spreading of TB

A

Through droplets from inhalation
Disseminates to the lymph nodes and other parts of the body
May be “infected” but may not develop active disease
If latent, body builds immunity to disease

47
Q

Skin tests: anergy

A

Inability of the immune system to react to an antigen
Candida or mumps skin test is given
If either is positive, the immune system is intact
—mark with marker
—May use one arm or another per facility policy

48
Q

Classifying a TB skin test:

Size of induration 5 mm or > is considered postive for:

A

HIV infected people
Recent contacts of infectious TB cases
Organ transplant recipients
Immunosuppressed

49
Q

Classifying a TB skin test:

Size of induration 10 mm or > is considered postive for:

A

Recent immigrants (within 5 years) from high-prevalence countries
IV drug users
Residents and workers from prisons, LTC, etc
Lab personnel
Children <4 years
Children if exposed to high risk adults

50
Q

Classifying a TB skin test:

Size of induration 15 mm or > is considered postive for:

A

People with no risk factors for TB

51
Q

Laten TB patients…

A

Dont feel sick
Have positive PPD
Could develop active TB later if not treated

52
Q

First line drugs for TB

A

INH
Rifampin
Pyrazinamide
Ethambutol

53
Q

Second line drugs for TB

A 
Refabutin
Rifapentine
Para-aminoslicylic acid
Streptomycin
Levofloxacin
Ethionamide
Amikacin
54
Q

INH in Combo Therapy

A

Kills bacteria by making it difficult for bacteria to build cell walls

  • Rifampin
  • Pyrazinamide
  • INH
  • Ethambutol
55
Q

1st Stage INH in Combo Therapy

A

2 month course of treatment to kill as many bacteria as possible

56
Q

2nd Stage INH in Combo Therapy

A

Some medicines are stopped and others continued for 4 or more months

57
Q

TB Therapeutic Measure Tips

A

Toxic to the liver
2 or 3 antibitoics are given simultaneously to allow for lower doses or each drug thus reducing SEs
Drugs must be taken 6-9 months or up to 2 years

58
Q

Active TB must be isolated until…

A

sputum no longer contains TB

59
Q

NI Precautions for TB

A 
(-) air pressure 
Closed doors and windows
RA exhausted outside
Use of particulate respiration masks 
Hygiene teaching 
Medication adherence 
Patients cover mouth and nose when coughing
60
Q

Legionnaire’s Disease (Bacteria, transmission, what it is)

A

Legionella pneumophila: Gram (-) bacteria
H2O and airborne
Legionnaire’s disease is life threatening pneumonia

61
Q

Anthrax Pathophysiology

A

Mostly deadly
Develops when spores are inhaled deep into the lungs
Immune cells sent to fight lung infection carry some spores back to lymph system which spreads
Widening mediastinum

62
Q

Pleurisy (Pleuritis) Pathophysiology and Complications

A

Inflamed pleural membranes
Usually related to another pulmonary disease (TB, Pneumonia, Tumor, Trauma)
May lead to pleural effusion
If untreated, empyema can result

63
Q

S&S of Pleurisy

A 
Sharp pain in inspiration 
Pain with coughing and sneezing 
Shallow and rapid breathing 
Fever
Chills 
Elevated WBC 
Pleural friction rub
64
Q

Pleurisy Tests

A

Chest X-Ray
CBC
PFT
Thoracentesis

65
Q

Therapeutic Measures for Pleurisy

A

Treat underlying cause
NSAIDS or opioids for pain
Nerve block

66
Q

Pleural Effusion Etiology

A

Excess fluid accumulates in pleural space
1-15 mL fluid = normal
>25 mL is abnormal

Transudate - watery fluid
Exudate Fluid - contains WBCs and proteins

67
Q

S&S Pleural Effusion

A 
Dependent on amount of fluid 
Pain 
SOB 
Cough 
Tachypnea
Dull to percussion 
Decreased breath sounds 
Friction rub
68
Q

Pleural Effusion Tests

A

Chest X-Ray
Thoracentesis
Fluid for C + S

69
Q

Pleural Effusion Therapeutic Measures

A 
Bed rest 
Therapeutic thoracentesis 
Maybe chest tube
Talc or other scaring substance may be injected to pleural space to eliminate space 
Treat underlying condition
70
Q

NI’s for Pleural Effusion

A 
Position comfortably on affected side to splint chest 
Apply heat to area 
Teach S&S of exacerbation 
TCDB Q2H 
Excellent prognosis
71
Q

Empyema

A

Collection of pus in pleural space

72
Q

Pulmonary Fibrosis

A

Interstitial lung disease
Group of disorders that causes scarring and fibrosis of lung tisse
May be due to injury to alveoli (becomes thick and scared)
Inflamed tissues are gradually replaced by

Exam 7 (6 decks)

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