Lower / Upper Respiratory Problems Flashcards by Katy Peterson

What is pneumonia?

Infection of lung parenchyma

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Which pneumococcal vaccines does the CDC recommend for adults?

1 dose PCV15 or PCV20 then 1 yr later, 1 dose PPSV23 (pneumovax 23)

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Who does the CDC recommend should get the pneumococcal vaccine?

Adults 19-64 with chronic diseases
All adults > 65 yrs

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Ways organisms reach the lungs to cause pneumonia

1 - aspiration (from nasopharynx or oropharynx)
2 - inhalation (of microbes in air from sick person)
3 - hematogenous (spread from primary infection elsewhere in body)

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Major risk factors for developing aspiration pneumonia

Decreased LOC
Difficulty swallowing
NG tube w/ or w/o tube feeding

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Clinical classifications of types of pneumonia

Community acquired
Hospital acquired
- ventilator associated
- nonventilator associated

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What are the parameters for pneumonia to be considered community acquired vs hospital acquired?

Community = not hospitalized on in LTC within 14 days of onset of symptoms

Hospital = occurs 48+ hours after hospitalization

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Main type of pathogen that causes community acquired pneumonia

*Streptococcus pneumonae (G+)

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Types of pathogens usually causing hospital acquired pneumonia

Pseudomonas aeruginosa
E. coli
Staph aureus
(Usually worse pathogens acquired in hospital)

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Pathogen that is multi-drug resistant and causes a lot of problems for pts with pneumonia

*Staphylococcus aureus

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Who is most at risk for multi drug resistant pneumonia?

Advanced age
Immunosuppression
Hx of antibiotic use
Prolonged mechanical ventilation

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Symptoms of pneumonia

Cough
*Fever, chills
Dyspnea, tachypnea
Hypoxemia
*Pleuritic chest pain (different from angina, will hurt to take deep breath or cough)
Green, yellow, or rust-colored sputum

Change in mentation for older* or debilitated pts (restless, lethargic, or confusion)

Tachycardia, fatigue, headache, poor appetite

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What will you find on assessment of a pt with pneumonia?

Fine or coarse crackles
Bronchial breath sounds (in areas other than bronchi)
Pleural friction rub
Increased fremitus
Dullness to percussion if pleural effusion
Splinting
Use of accessory muscles

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Complications a pt with pneumonia may have

Atelectasis (seen on X-ray)
Pleurisy (inflammation)
Pleural effusion
Bacteremia (bacteria in blood stream)
Pneumothorax (collapsed lung)
Acute respiratory failure (usually if they have other pulmonary disorders)
Sepsis/septic shock (if blood stream infection gets worse)
Lung abscess (from infection)
Empyema (infection in pleural space)

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Diagnostic tests done for pts who may have pneumonia

CXR
Sputum analysis (to determine pathogen)
CBC w/ diff (WBC count)
Pulse ox, ABGs (monitor)
Blood cultures (if infection suspected)
Thoracentesis (to get specimen of drainage)
Bronchoscopy w/ washings (to see if situation is worsening)
C-reactive protein - PNA v/s HF, RF (to look for inflammatory markers to determine what’s going on)

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Nursing actions for pts with pneumonia

Supplemental O2
C/DB, IS
BID oral hygiene
Therapeutic positioning
Rest & activity, early ambulation
RT: postural drainage and chest percussion
Adequate hydration
High calorie, small, frequent meals

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Medications nurses can expect pts with pneumonia to be administered

Analgesics (Tylenol)
Antipyretics
Expectorants
Antivirals/antibiotics

Antibiotics used for pneumonia

Vancomycin (Macrolides)
Levofloxacin (Levoquin) (fluroquinolone *tendon ruptures possible)
Ceftriaxone (Rocephan) (cephalosporin)
- if pt allergic to penicillin, but could have cross allergy

What does prompt tx of pneumonia look like?

Should see response in 48-72 hours
- decreased temp
- improved breathing
- decreased chest discomfort

Repeat chest X-ray in 6-8 days

Nursing diagnoses for pneumonia

Impaired gas exchange
Ineffective breathing pattern
Acute pain in chest
Activity intolerance

Two main kinds of lung cancer

Small cell lung cancer (SCLC) 20%
Non-small cell lung cancer (NSCLC) 80%

Characteristics of small cell lung cancer

Aggressive
Always systemic/metastasis

Types of non small cell lung cancer

Squamous cell
Adenocarcinoma
Large cell

Screening recommendations for lung cancer

Annually for high risk pts >55
(Using low dose CT)

Diagnostic studies for person suspected of having lung cancer

Chest X-ray Biopsy Cytology of early morning sputum CT scan, MRI PET scan (to look for metastasis)

Ways to obtain a biopsy of possible lung cancer

Bronchoscopy CT guided needle biopsy Thorocosopy (video assisted) Thoracentesis

Typical metastasis of lung cancer

Liver Brain Bones Adrenal glands

Assessment cues of lung cancer

Persistent cough not responsive to treatment Blood-tinged sputum Dyspnea Wheezing Chest pain Late, non-specific s/s: Fatigue, weight loss, N/V Dysphagia Superior vena cava syndrome

Small cell lung cancer treatment

(Aggressive = poor prognosis) Chemotherapy Prophylactic cranial radiation

Treatment for non-small cell lung cancer

Surgery Radiation Chemotherapy Immunotherapy Targeted therapy

What is paraneoplastic syndrome?

Lung cancer complication where hormones secreted by certain tumor cells cause endocrine problems (Most often caused by small cell lung cancer)

Types of endocrine problems that can be caused by paraneoplastic syndrome

Hypercalcemia SIADH

Emergency warning signs for Covid or Flu

*Hypoxia - need oxygen or Ventilatory support Severe dyspnea at rest SoP2 <94% on RA RR >30

Covid PPE requirements

Isolation & PPE Contact & Droplet precautions (+ airborne precautions if aerosolized procedure/treatment) N-95 Face shield Gown Shoe covers Gloves Goggles

Which admission labs indicate a poor prognosis for covid patients?

C-reactive protein (CRP) - due to inflammation D-dimer - checked when worried about clotting (risk for covid pt)

Most common flu test and why

Rapid influenza diagnostic test (RIDT) - antigen swab - only takes 15-30 min for results (RT-PCR takes days for results, Viral cultures take 3-10 days for results)

Types of flu vaccines:

High-dose - 4x antigen (65 yrs and older) Inactivated (IIV4) - quadrivalent Recombinant (RIV4) - egg free (18 yrs and older) Live attenuated (LAIV4) - nasal spray influenza

Who should not be given the live attenuated nasal spray flu vaccination?

Adults 50+ Pregnant women Hx severe allergic reaction to flu vaccine Immunocompromised People who have taken influenza antivirals w/in 48 hrs Caregivers for immunocompromised pts

Recommendations for flu vaccinations for pts with special considerations

Egg allergy, hives only: 1 flu vaccine per year Egg allergy more severe than hives: only 1 vaccine per year in medical setting where allergic reaction can be managed Hx of Guillain-Barré syndrome w/in 6 weeks of previous flu vaccine: should not be vaccinated

Medications for pts with the flu

Antivirals: within 24-48 hrs of symptoms Tamiflu - oral, IV Relenza - inhaled