Lower / Upper Respiratory Problems Flashcards
What is pneumonia?
Infection of lung parenchyma
Which pneumococcal vaccines does the CDC recommend for adults?
1 dose PCV15 or PCV20 then 1 yr later, 1 dose PPSV23 (pneumovax 23)
Who does the CDC recommend should get the pneumococcal vaccine?
Adults 19-64 with chronic diseases
All adults > 65 yrs
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)
Major risk factors for developing aspiration pneumonia
Decreased LOC
Difficulty swallowing
NG tube w/ or w/o tube feeding
Clinical classifications of types of pneumonia
Community acquired
Hospital acquired
- ventilator associated
- nonventilator associated
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
Main type of pathogen that causes community acquired pneumonia
*Streptococcus pneumonae (G+)
Types of pathogens usually causing hospital acquired pneumonia
Pseudomonas aeruginosa
E. coli
Staph aureus
(Usually worse pathogens acquired in hospital)
Pathogen that is multi-drug resistant and causes a lot of problems for pts with pneumonia
*Staphylococcus aureus
Who is most at risk for multi drug resistant pneumonia?
Advanced age
Immunosuppression
Hx of antibiotic use
Prolonged mechanical ventilation
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
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
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)
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)
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
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
