management of patients with chest and lower resp Flashcards
name some inflammatory and infectious pulmonary disorders
- atelestasis
- tracheobronchitis
- pneumonia
- covid-19
- aspiration
- pulmonary tuberculosis
- lung abcess
name some noninvasive respiratory therapies
- incentive spirometer
- small volume nebulizers
- chest physiotherapy (postural drainage, percussion/vibration, pulmonary rehab)
what is atelectasis
closure or collapse of alveoli, can be acute or chronic
acute = take care of it quickly
chronic = maintenance therapy
describe the pathophysiology of atelectasis
reduced ventilation or obstruction of air to and from alveoli -> alveoli unable to absorb air dut to blockage and collapse ->
alveolar air absorbed into blood stream->
air can no lnger get into alvoli ->
lung become airless->
alveoli collapse
what are some risk factors for atelectasis
- surgical patients (immobilized, intubation, pain)
- immobilized patients
- increased age (osetoporotic changes, muscles weaker and cartilage stiffens)
what are some clinical manifestaions of atelectasis
- increasing dyspnea
- cough
- sputum production
- resp distress
- tachycardia/tachypnea
- central cyanosis (late sign, theyre probs getting intubated)
usually given breathing tx, assess pulse ox b4 and after
what are some prevention interventions for atelectasis
- early mobilization
- frequent turns
- manage secretions (suction and fluids)
- incentive spirometry
- deep breathing
- fluids
what is pneumonia
inflammation of lung parenchyma caused by microorganisms
can be viral, fungal, or caused by bacteria
one of the most common causes of death in the US -> work on prevention
name some different types of pneumonia and describe them
- community acquired pneumonia (CAP): get while out in public, signs and symptoms occured before being admitted
- health care associated pneumonia (HCAP): nonhospital areas, acquired in another healthcare setting
- hospital acquired pneumonia (HAP): occurs more than 48hrs after being admitted
- ventilator associated pneumonia (VAP): occurs 48hrs after intubation
- pneumonia in the immunocompromised host: host is at higher risk for it
- aspiration pneumonia: sucked water into lungs and can’t get it out, stroke patients at risk
describe the pathophysiology of pneumonia
presence of pathogen or foreign subatance in the lung ->
causes inflammation in lung tissues (alveoli)->
affects ventilation and diffusion ->
decrease in alveolar oxygen tension mismatched ventilation/perfusion->
arterial hypoxemia
what are some risk factors for pneumonia
- age
- exposure
- immune state
- nutritional state/impaired swallowing
- prolonged immobility
- smoking
- CA, COPD, cystic fibrosis
what are some signs and symptoms of pneumonia
they vary based on type and where its at
- hypoxia
- fever (increased WBC and decreased Hgb)
- orthopnea
- tires easily
- sputum production (green or blood tinged)
how do you diagnose pneumonia
- clinical assessment
- sputum culture
- chest xray
- bronchoscpy
- tissue biobsy
- CT (check kidney labs)
whats included in the treatment of pneumonia
- antimicrobials
- check cultures (before drugs) (sputum culture)
- start broad spectrum
- change drug as needed
- usually oral/IV
describe prevention of pneumonia
- influenza vaccine give yearly (quality measure for hospitals)
- pneumococcal vaccine may give booster
- avoid pollutants
- avoid infectious situations
- maintain adequate hydration and nutrition
- balance activity and rest activities
- isolate infectious persons
- wash hands
describe covid and what complications may occur
- sars-cov-2 virus
- viral transmission
- various levels of infection
- repidly mutates
- complications: shock, resp failure, pleural effusion
describe the spread of covid
- spreads person-person through resp droplets
- close contact less than 6 feet apart
- community spread
- no evidence spread through food
- possible spread by touching contaminated surfaces
- unsure of weather effects on virus
- symptoms may occur 2-14 days after exposure
describe prevention of covid
- wash hands
- avoid touching eyes, nose, and mouth
- avoid large crowds/close contact
- wear mask in public
- cover coughs and sneezes
- clean and disinfect
- monitor health daily
what does a chest xray look like for a covid patient
looks like glass shards in that bitch
how will viruses affect WBC count
decrease
how will infection affect WBC count
increase
what are some high risk populations for covid
- older adults
- nursing home and LTC facilities
- underlying medical conditions
- racial/ethnis minority groups
- pregnancy and breastfeeding
- disabilities
- developmental and behavioral disorders
- substance abusers
- homelessness
- group homes
what are some symptoms of covid
- fever
- chills
- cough
- SOB
- fatigue
- body aches
- HA
- new loss of taste or smell
- sore throat congestion/runny nose
- nausea/vonmiting
- diarrhea
what are some complications that may occur due to covid
- pneumonia
- resp failure
- acute respiratory distress syndrome (fluid in the lungs)
- sepsis
- multipl organ failure
- cardiac injury
- inflammation of the heart, brain, or muscles
- secondary baceterial infections
- blood clots in veins and arteries of lungs, heart, legs, or brain
- multisystem inflammatory syndrom in children
describe pulmonary tuberculosis
- chronic and infectious disease of the lungs
- can spread to other tissues like meninges, kidneys, bones, and lymph nodes
- mycobacterium tuberculosis
describe how pulmonary tuberculosis is a wroldwide health prob
- associated with poverty, malnutrition, overcorwding, substandard housing, inadequate health care
- highly contagious via inhaled organisms
- spread from person to person by airborne transmission
- droplet nuclei
- talking, coughing, sneexing, laughing, or singing
what are some risk factors for pulmonary TB
- close contact with an infected person
- immunocompromised
- substance abuse
- pre-existing medical conditions
- immigration from countries with TB rates
- overcrowded population
- patient not identified or isolated adequately
- inadequate therapy (med coverage)
- inadequate ventilation of room
- isolation room not negative pressure airflow
- patient not masked when out of room (duck bill mask)
what are some signs and symptoms of pulmonary TB
- low grade fever
- cough
- night sweats
- fatigue
- weight loss
- rust colored sputum
how is TB diagnosis made
- being suspicious
- history
- “rust” colored sputum
- acid fast bacillus smear (contains mycobateria)
- sputum culture
- skin testing
- chest xray (lesions in upper lobe)
- TB blood tests
which test is preferred to diagnose TB
quanterferon gold
describe mantoux testing
- skin testing for TB
- indtredermal injection of PPD
- relies on antibody results (read 48-72 hours after injection)
- positive = induration (hardening at site)
what drug is given as prophylaxis for contacts/converters/high risk individuals for TB
isoniazid (INH)
B6 given with it bc it can cause polyneuropathy
what 4 drug combination is used in the initial treatment of TB
- INH
- rifampin
- pyrazinamide (PZA)
- ethambutol
for 8 weeks
what drugs are used as continuation of TB treatment
2 drugs for 4-7months (INH and rifampin)
risk of transmission decreases after 2-3 weeks of therapy
what are the side effects of INH
neuropathy, hard on liver (monitor function)
what are the side effects of rifampin
turns urine orange, can stain clothes, contacts, and skin
monitor liver function
what are the side effects of ethambutol
optic neuritis
monitor renal and liver function
what are the side effects of PZA
joint pain and hyperuricemia
monitor uric acid and monitor liver function
what are some patient education things to include for tb treatment
no alcohol bc of liver shit
need to be compliant
describe pleurisy
inflammation of lung linings, not enough surfactant, lining tears
sharp stabbing pain on inspiration
describe pleural effusion
too much fluid in pleural space
thoracentesis is done
what is a pneumothorax
occurs when the pleural space is exposed to positive atmospheric pressure
air in the thoracic cavity, can cause tracheal devation and pressure on the heart
name and describe the different types of pneumothorax
- spontaneous (simple)
- trauma (blunt: rib fracture, penetrating: stab wound/GSW)
-
post surgical (chest surgery, central line placement)
-tension pneumothorax (air enters cavity and cant escape -> pressure builds and lung collapses -> shifts organs)
is pneumothorax an emergency?
yep, patients condition can decline quickly
what are some symptoms of pneumothorax
- acute distress
- pain - sudden, pleuritic
- tachypnea
- resp discomfort
- absent breath sounds
- anxiety, agitation
- instant central cyanosis
- air hunger
- inscreased HR
- diaphroesis
what is the treatment of pneumothorax
- chest tube
- oxygen if tension pneumothorax
what is a thoracotomy
creation of a surgical opening into the thoracic cavity
what are soem indications for a thoracotomy
- diagnose lung disease
- diagnose chest disease
- obtain biopsy
name some thoracic surgeries and describe em a little
- wedge resection (for diagnosis, just take a little and it comes back)
- lobectomy (take a lobe outta there)
- pneumonectomy (take the whole fuckin lung)
- decortication (removing scar tissue)
done to diagnose, cure, and treat
describe pre op for thoracic surgery
- assess functional reserve (can the other lung take over?)
- determine liklihood of recovery and survival
- ensure optimal condition for surgery
- determine baseline labs
- pre op testing
describe post op mamanegment of thoracic surgery
- may be on vent/may have chest tube
- promote airway clearance
- manage pain
- maintain fluid volume
- monitor for complications
what are some possible complications of thoracic surgery
- immobility - atelectasis
- bleeding
- pneumothorax
- infection
- resp and/or heart failure
- fistula formation (opening between airway and other structure)
what are chest tubes
placed in pleural space to drain fluid, blood, and air
where is the chest tube placed to remove air
upper
where is the chest tube placed to remove fluid or blood
lower
describe nursing management of chest tubes
- must be one way system to allow air or fluid out of cavity and none back in
- keep below the level of the chest (40cm or more)
- pain management
- site assessment: check for redness or drainage, check integrity of dressing, subQ emphysema)
what are some possible complications of chest tubes
- atelectasis
- infection
- re-accumulation of air in pleural space
what should the nurse know about the chest tube?
- know the purpose of tube for the patient
- assess and maintain for patency (DO NOT rely on bubbling)
- use caution before clamping (may be vent for thoracic cavity)
- assess and manage pain
- drainage from tube should be sanguinous when new then transitons to serous and amount should decrease over time
the first chamber (A) on the chest tube drainage system is…
the suction chamber, should see gently bubbling
the B chamber on the chest tube drainage system is….
the water seal chamber
should see tidaling when patient breathes in
the C chamber on the chest tube drainage system is…
it has water in it and you should not see bubbling
what can it indicate if there is bubbling in the C chamber
there is a leak in the system
what is the D chamber of the chest tube drainage system
where the drainage goes
the ocean system is for draining…
fluid
the oasis system is for draining…
air
what is the leading cause of cancer death in both men and women?
lung cancer
has low survival rates bc theres no ealy diagnosis and 70% spread at diagnosis
what are some different classifcations of lung cancer
- small cell (SCLC) 10-15%
- non small cell large cell (NSCLC) 80-85% (squamous and adenocarcinoma)
adenocarcinoma is the most prevalent
what are some risk factors of lung cancer
- cigarette smoking (90%)
- genetic
- envirnmental exposures: radon gas, second hand smoke, asbestos, work place cancer causing agents
what are some symptoms fo lung cancer
- depends on the location of the tumor
- degree of obstruction
- existence of metastases
- cough, voice changes, hemoptysis
- dyspnea, weight loss, pain
what is used to diagnose lung cancer
- CXR
- CT scan
- PET scan
- MRI
- biopsy - must have cytology/tissue sample to identify cells
where do 90% of lung cancers start
bronchial epithelium
treatment of lung cancer depends on…
- tumor cell type
- stage of disease
- overalll status
whats included in treatment for cure or palliation of symptoms for lung cancer
- radiation
- surgery
- chemotherapy
- palliative
what are some treatment related complications of lung cancer
- respiratory failure
- vent dependency
- pulmonary fibrosis (lungs get scarred)
- pericarditis (heart cant beat)
- myelitis
- cor pulmonale (right sided HF)
- pulmonary toxicty
- pneumonitis
need max psychosocial support and education about disease
what is pulmonary embolism
obstruction of the pulmonary artery or one of its branches by a clot from the venous system (like DVT)
common disorder
pulmonary embolism is associated with…
- trauma
- surgery
- pregnancy
- HF
- > 50 years
- hypercoagulable states
- prolonged immobility
symptoms of pulmonary embolism depend on…
size of clot and area affected
what are some symtpoms of pulmonary embolism
- dyspnea
- CP
- sudden/pleuritic
- anxiety
- fear
- apprehension
- diaphoresis
- hemoptysis
- syncope
- tachypnea
- sudden death
what are some diagnostics used for pulmonary embolism
- early recognition is important (death can occur within 1hr of onset of symptoms)
- clinical assessment of risk factors
- chest xray
- EKG
- pulse ox
- ABGs
- V/Q scan
- spiral CT
- D-dimer assay
- ultrasound (check for DVT)
- pulmonary angiogram
- MRI
describe prevention of pulmonary embolism
- active leg exercises
- early ambulation
- antiembolism stockings/SCDs
describe treatment of pulmonary embolism
meds:
-blood thinners (heparin, warfarin, apixaban)
-thrombolytics (tPA)
surgical procedures:
- clot removal
- vein filters
oxygen therpy and active IV lines
