management of pts with chest and lower respiratory Flashcards
atelectasis
complete or partial collapse of the entire lung or area of the lung. When tiny alveoli within the lung become deflated
pneumonia
fluid in the lungs, one of the most common causes of death in U.S.
aspiration
something going down the wrong pip (ex. fluid into lung)
tracheobronchitis
inflammation of the trachea and bronchi (purulent sputum) classified as respiratory tract infection
pulmonary tuberculosis
serious infection caused by bacterium mycobacterium tuberculosis that involves the lungs but may spread to other organs, highly contagious (put in negative pressure room)
acute atelectasis
when the lung recently collapsed and is primarily notable only for airlessness (take care of right away)
chronic atelectasis
the affected area characterized by a complex mixture of airlessness, infection, widening of the bronchi, destruction, and scarring (maintenance)
who’s at risk for atelectasis
surgical patients, immobilized patients, increased age
symptoms of atelectasis
increasing dyspnea, cough, sputum production, respiratory distress, tachycardia, tachypnea, central cyanosis (late sign)
prevention for atelectasis
early mobilization, frequent turns, manage secretions, IS, deep breathing, fluids
before and after breathing treatment, what do you assess
pulse ox
types of pneumonia: community acquired
get it when out in public, symptoms can occur less than 48 hours after admitted
types of pneumonia: health care associated
non hospital areas (nursing homes, rehab) occurred in another health care setting
types of pneumonia: hospital acquired
more than 48 hours after admitted they develop pneumonia (hospitals fault)
types of pneumonia: ventilator associated
48 hours after intubated (ex. came into hospital had brain bleed and needed to be intubated, 48 hours after admitted on a ventilator)
types of pneumonia: immunocompromised
HIV/ AIDS/ cancer pts
types of pneumonia: aspiration pneumonia
water down into lungs and can’t cough it up (risk are stroke pts/ babies/ older population with weakness in swallowing muscles)
pneumonia can be
viral, fungal, or bacterial
path-physiology of pneumonia
presence of bacterial, mycobacterial, viral, or fungal in the lung -> causes inflammation in the lung tissues (alveoli) -> affects ventilation and diffusion -> decrease in alveolar oxygen tension mismatched ventilation & perfusion -> arterial hypoxemia
risk factors for pneumonia
age, exposure, immune state, nutritional state/ impaired swallowing, prolonged mobility, smoking
what types of patients may have pneumonia onto of another disease
COPD pts, cystic fibrosis pts, cancer pts
s/sx of pneumonia
hypoxia, fever, orthopnea, tires easily, sputum production (green/ blood tinged)
how to diagnose pneumonia
initial assessment (check BUN & creatinine before giving dye), sputum culture, chest xray, bronchoscopy, tissue biopsy
for pneumonia, when checking the CBC what might you see
high WBC, decrease in hemoglobin (all protein is going to make WBC to fight infection and leaves hemoglobin on back burner -> oxygen level will go down)
Tx for pneumonia
check cultures (need deep mucus, not just spit), start with broad spectrum antibiotic and later change as needed, oral or IV
prevention of pneumonia
flu shot, pneumococcal vaccine (older adults or chronic illness pt), avoid pollutants, avoid infectious situations, maintain hydration, physical activity, isolate if infected, hand hygiene
pleural effusion
extra fluid in the pleural space between the visceral and parietal membrane (doesn’t allow lungs to expand)
if WBC is low you can indicate
viral infection or chronic stress
if WBC is high you can indicate
bacterial infection or acute stress
complications if covid 19
pleural effusion, shock & respiratory failure
covid 19 is what type of transmission
viral, air borne, droplet
TB is transmited by
airborne, droplet (coughing, sneezing laughing)
TB can spread to
lungs, meninges (in brain), kidneys, bones, lymph nodes
s/sx of pulmonary TB
low grade fever, cough, night sweats, fatigue, weight loss
how to diagnose pulmonary TB
being suspicious, pt history, rust colored sputum, acid fast bacillus smear, sputum culture, skin testing, chest xray, TB blood tests
CDC recommended TB test
quantiferon TB gold test instead of Mantoux
if you get the Mantoux TB test (intradermal injection of PPD), if it comes back positive what does that mean
it does not mean you have active TB, just means you may have been exposed
positive result of Mantoux testing will look like what
induration at site (hardening)
TB treatment
combination of 4 drugs (INH, rifampin, ethambutol, pyrazinamide
with TB to prevent neuropathy what do you treat with
INH & vit B6
2 phases when treating TB
initial phase: INH, rifampin, pyrazinamide, ethambutol for 8 weeks
continuation phase: INH & rifampin for 4-7 months more
(risk or transmission decreases after 2-3 weeks of therapy)
side effect of INH
polyneuropathy (treat with vitamin B6)(monitor liver function)
side effect of rifampin
orange urine, secretions, strains contacts & clothes & skin (monitor AST/ALT & liver function)
side effects of ethambutol
optic neuritis (monitor vision changes, renal function, liver function)
side effects of pyrazinamide
joint pain (monitor uric acid/ can get hyperuricemia, AST/ALT, liver function)
pt education when treating for TB
liver function must be monitored, assure that meds are being taken, no alcohol intake, teach prevention of transmission, staff be fit tested for N95
with a pleural effusion what can be done to tx
thoracentesis
pleurisy
inflammation of the pleural space, when you take a deep breath since there is not enough surfactant in between the two membranes, it tears, sharp stabbing pain on inspiration
pneumothorax
occurs when the pleural space is exposed to positive atmosphere pressure (air in thoracic cavity)
pneumothorax can occur from
a stabbing, gun shot, punctured lung from the ribs, chest surgery, putting a central line in place
symptoms of a pneumothorax
SOB, acute chest pain, decreased blood pressure, decreased blood O2, increased HR/ acute distress, pain, tachypnea, respiratory discomfort, absent breath sounds, will be gasping for air, cyanosis
pneumothorax is what type of diagnosis
an emergency
tx for pneumothorax
chest tube (so positive air pressure doesn’t go into cheat cavity)
thoracotomy
creation of a surgical opening into the thoracic cavity (may be for diagnose of lung or chest disease, obtain biopsy)
lung wedge resection
takes a small chunk of lung, will heal and be fine
lobectomy
takes the upper lobe of lung
pneumonectomy
takes the whole lung out (whole one side)
segmentectomy
takes part of a lobe (part of one lobe of three on one side)
decortication
removing scar tisse
chest tubes are placed
in pleural space to drain fluid, air, or blood/ keep chest tubes machine below chest level
placement of chest tube on upper chest for
air removal
placement of chest tube on lower chest for
fluid, blood removal
chest tubes are
one way system to allow air or fluid out of cavity and non back in
with chest tubes you want to look for
redness, drainage, crepitus (bubble wrap looking under skin) DO NOT WANT
ocean chest tube: chamber A
chamber A: suction chamber, where the water level should be, water up to ml of suction
ocean chest tube: chamber B
water seal, should see water go up and back down (tidaling)
ocean chest tube: chamber C
should not see any bubbling in chamber C- if you see bubbling then you have a leak somewhere
ocean chest tube: chamber D
drainage: will go from sangious to serous sanguineous to serous (at the end of each shift mark and initial drainage mark)
if tidaling has stopped in chamber B that means
lung have reexpanded or if fluctuation has stopped that could mean a blockage
when to assess chest tubes
every hour for the first 8 hours after placement then every 8 after that (if see bright red blood over 100ml/hr notify provider/ dark red drainage is normal: old blood just document
if drainage stops assess pt first (auscultate lungs- you do not want to hear diminished lung sounds)
what never to do with chest tubes
never strip or milk chest tube, never want to see continuous bubbling in water seal/ air leak (only want to see in A), never clamp a chest tube during transport
if a chest tube becomes disconnected
cough and exhale immediately (you don’t want air rushing in) apply occlusive dressing (petroleum gauze) secured on 3 side (not 4, one side needs to be open to allow air out)
lung cancer is the leading cause of
death and 2 most common cancer in both men and women
risks factors for lung cancer
smoking, genetic, environmental exposures (radon gas, 2nd hand smoke, asbestos, workplace)
classification of lung cancer
small cell (SCLC) 10-15%, non small cell large cell (NSCLC) 80-85%/ squamous- adenocarcinoma (most prevalent)
symptoms of lung cancer
cough, voice changes, hemoptysis, dyspnea, weight loss, pain (depends on location, existence of metastases, site)
90% of lung cancers start where
bronchial epithelium
tx for lung cancer
radiation, surgery, chemotherapy, palliative
pulmonary embolism
obstruction of the pulmonary artery or one of its branches by a clot from the venous system (blood clot in circulation of the lung, comes from a DVT through vein coming back to R side through pulmonary artery into either lung)
what medication to give with PE/ treatment
heparin/ enoxaparon/ tPA, surgery (IVC filter), anticoagulation therapy, IV lines
s/sx of PE
dyspnea, chest pain, anxiety, fear, diaphoresis, hemoptysis (coughing up blood), syncope, tachypnea, sudden death
prevention of PE
active leg exercises, early ambulation, SCDs/ ted hose
diagnoses if PE
blood tests (ABGs), chest xray, ultrasound (check for DVT), CT, V/Q scan (measures perfusion and ventilation), pulmonary angiogram, MRI
