Lower Respiratory Tract Disorders Flashcards
Acute bronchitis
Inflammation of bronchial tree Secondary to URI Viral Exposure to inhaled irritants Thick secretions become a culture medium
S&S of acute bronchitis
Productive cough Rhonci Wheezing Dyspnea Chest pain Low grade fever
How is acute bronchitis diagnosed?
CXR
Sputum culture
Medical management of acute bronchitis
Cough syrup
Antipyretics
Bronchodilators- albuterl, ventolin, proventil
Antibiotics (if it worsens)
Important interventions for acute bronchitis
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
NIs for acute bronchitis
Rest to conserve energy Vaporizer to add humidity to air Increased fluid intake Avoid dairy Elevate HOB with pillows Instruct deep coughing
Bronchiectasis
Dilation of the bronchial airways
Airways become flabby and scarred
Can be localized or general
Difficult to expectorate secretions (makes bacteria grow)
Bronchiectasis etiology
Usually secondary to CF, asthmas, TB, bronchitis, exposure to toxin, or tumor
Cilia function reduced
Airway obstruction from excess secretions
S&S of bronchiectasis
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
Diagnositc tests for bronchiectasis
Chest x-ray?
CT
Bronchoscopy
Sputum cultures
Therapeutic measures for bronchiectasis
Keep airways free of secretions
Control infection
Correct underlying problems
Treatment of bronchiectasis
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
Pneumonia
Acute inflammation/infection of the lungs
Microorganisms release toxins, causing damage to mucous and alveolar membranes (edema &exudate)
Types of pneumonia:
Bacterial pneumonia
Community-acquired pneumonia- strem, staph, chalmydia, & mycoplasma pneumonia HAP- E. coli Haemophilus influenzae Kelsieall pneumonia MRSA Pseudonomas
Types of pneumonia:
Viral pneumonia
Influenzae- most common
Less ill than with bacterial
Antibiotics- non effective
Types of pneumonia:
Fungal pneumonia
Candida
Aspergillus
Pneumocystis carinii
Types of pneumonia:
Aspiration pneumonia
Decreased LOC Impaired swallowing ETOH ingestion Stroke General anesthesia Seizures GERD Increases risk for bacterial pneumonia
Types of pneumonia:
Ventilator-associated pneumonia (VAP)
ET tube keeps glottis open
Secretions easily aspirated
Types of pneumonia:
Hypostatic pneumonia
Hypoventilating clients
Immobile
Shallow respirations
Secretions pool in dependent areas of lungs
Types of pneumonia:
Chemical pneumonia
Inhalation of toxic chemicals
Increases risk for bacterial pneumonia
Pneumonia prevention
Vaccine- streptococcus pneumonia for: >65 years High risk populations Booster in 1 year New vaccines cover more strains of the strep infection
Nursing care of pneumonia
HOB elevated (fowlers or semi)
Cough, turn, deep breathe
Good hand washing
Get them up and moving
S&S of pneumonia
Fever Shaking Chills Chest pain Dyspnea Fatigue Productive cough Crackles or wheezed
What is the sputum color in pneumonia patients?
Purulent
Rust colored
Blood tinged
Atypical pneumonia
Not caused by traditional organisms
“walking pneumonia”
Distinction between atypical and typical is medically insufficient
Need to know exact causal organism
Atypical pneumonia causative agents
Mycoplasma
Chlamydia
Viral
Diagnostic tests for pneumonia
CXR
Sputum and blood cultures (be sure mouth is rinsed, can use nebulizer mist treatemnt, leuki-trap)
CBC-WBC will prob be >15000
Therapeutic measures of pneumonia
Broad spectrum antibiotics
Once cultures are back, may use narrow spectrum antibiotics
If viral- rest and fluids, anti-viral meds
Medications for pneumonia
Expectorants Bronchodilators Analgesics Nebulizers Metered-dose inhalers Supplemental O2
The elderly & pneumonia
New onset confusion or lethary
New onset fever and dyspnea
Can spread to meninges, blood, joints, pericardium, or endocardium
Complications with the elderly and pneumonia
Common wiht unerlying chronic diseaes
Pleurisy
Pleural effusion
Atlectasis
Pneumonia and the older adult
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"
Parts of the body that TB affects
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
True or false: TB is transmitted through air and easy to transmit from person to person
False:
Most people exposed do not become infection because of the upper airway cilia; it prevents TB organisms from reaching the lungs
Tuberculosis
Mycobacterium tuberculosis
Chronic pulmonary and extrapulmonary infectious disease
May be asymptomatic
Prevalent in people infected with HIV or compromised immune system
How long can TB survive in human tissue
> 50 years
How many americans are infected with TB?
15 million
What happens if lungs are involved with TB?
The immune system surrounds it with neutrophils and alveolar macrophages
A lesion called a tubercle is formed, which seals off bacteria and prevents spread
S&S of TB
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
High risk groups for TB
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
Prevention of spreading TB
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
Primary prevention of TB
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
Tests for TB
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
Sputum cultures for TB
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
TB pathophsyiology
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
Spreading of TB
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
Skin tests: anergy
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
Classifying a TB skin test:
Size of induration 5 mm or > is considered postive for:
HIV infected people
Recent contacts of infectious TB cases
Organ transplant recipients
Immunosuppressed
Classifying a TB skin test:
Size of induration 10 mm or > is considered postive for:
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
Classifying a TB skin test:
Size of induration 15 mm or > is considered postive for:
People with no risk factors for TB
Laten TB patients…
Dont feel sick
Have positive PPD
Could develop active TB later if not treated
First line drugs for TB
INH
Rifampin
Pyrazinamide
Ethambutol
Second line drugs for TB
Refabutin Rifapentine Para-aminoslicylic acid Streptomycin Levofloxacin Ethionamide Amikacin
INH in Combo Therapy
Kills bacteria by making it difficult for bacteria to build cell walls
- Rifampin
- Pyrazinamide
- INH
- Ethambutol
1st Stage INH in Combo Therapy
2 month course of treatment to kill as many bacteria as possible
2nd Stage INH in Combo Therapy
Some medicines are stopped and others continued for 4 or more months
TB Therapeutic Measure Tips
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
Active TB must be isolated until…
sputum no longer contains TB
NI Precautions for TB
(-) 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
Legionnaire’s Disease (Bacteria, transmission, what it is)
Legionella pneumophila: Gram (-) bacteria
H2O and airborne
Legionnaire’s disease is life threatening pneumonia
Anthrax Pathophysiology
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
Pleurisy (Pleuritis) Pathophysiology and Complications
Inflamed pleural membranes
Usually related to another pulmonary disease (TB, Pneumonia, Tumor, Trauma)
May lead to pleural effusion
If untreated, empyema can result
S&S of Pleurisy
Sharp pain in inspiration Pain with coughing and sneezing Shallow and rapid breathing Fever Chills Elevated WBC Pleural friction rub
Pleurisy Tests
Chest X-Ray
CBC
PFT
Thoracentesis
Therapeutic Measures for Pleurisy
Treat underlying cause
NSAIDS or opioids for pain
Nerve block
Pleural Effusion Etiology
Excess fluid accumulates in pleural space
1-15 mL fluid = normal
>25 mL is abnormal
Transudate - watery fluid
Exudate Fluid - contains WBCs and proteins
S&S Pleural Effusion
Dependent on amount of fluid Pain SOB Cough Tachypnea Dull to percussion Decreased breath sounds Friction rub
Pleural Effusion Tests
Chest X-Ray
Thoracentesis
Fluid for C + S
Pleural Effusion Therapeutic Measures
Bed rest Therapeutic thoracentesis Maybe chest tube Talc or other scaring substance may be injected to pleural space to eliminate space Treat underlying condition
NI’s for Pleural Effusion
Position comfortably on affected side to splint chest Apply heat to area Teach S&S of exacerbation TCDB Q2H Excellent prognosis
Empyema
Collection of pus in pleural space
Pulmonary Fibrosis
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
