PC617-Pulmonary Disorders Flashcards
Tuberculosis
Mycobacterium tuberculosis
Primary TB
LTBI
Secondary TB
Usually pulmonary
apex of the lung (high oxygen area)
TB clinical manifestations
fatigue anorexia weight loss night sweats low grade diurnal fever cough chest pain
TB exam
Rales in upper posterior area
maybe evidence of plueral effusion
lymphadenopathy
TB testing
Mantoux test- read in 48-72 hours
two step testing -healthcare workers who have not been tested in over 12 months over 45 yrs of age
Anergy-Immune system compromised
QFT-G-blood test. comes back in 24 hours (expensive)
Chest x-ray- if positive, to exclude pulmonary disease; if neg, then prophylaxis with INH
TB Tx with INH
Induration >5mm Consider positive with -HIV clients Close contacts of positive case person with fibrolytic lesions -organ transplant recipients -Other immunocompromised clients
TB DX
Induration >10mm
-recent immigrant
-residents in high risk community (jail, nursing home, etc)
-low income population, medically underserved
-children younger than 4
infants, children, adolescents exposed to adult with TB
TB DX-
Induration >15
person with no risk factors
TB Tx
Treat even if they had BCG vaccine
Side effects of INH-
Liver disease, Hepatitis
TB Tx
Add B6 to decrease risk of person getting peripheral neuropathy in those with diabetes, uremia, alcoholic, pregnant, seizure disorder
If positive x-ray- refer and report to HD
INH
Take for 9 mos. 5mg/kg or up to 300mg daily
Do not do Mantoux test if +Hx of TB
Influenza
Acute infection of the respiratory tract -Spread by droplet -highly contagious -Fever, chills, nasal congestion,with clear drainage, sore throat,-cough is most prominent Fever peaks in about 24 hrs`
Influenza tests
Rapid test or expensive cell cultures. Takes 2-7 days
Influenza Treatment
rest, fluids, antipyretic
Antiviral meds
Oseltamivir and Zanamivir-Reduce only by a day
Must start within 48 hours
May use prophylactically in high risk persons
Influenza vaccine is best prevention
Asthma
Chronic inflammatory disorder
Triggered by allergens, infections, exercise, ASA, etc.
Asthma S/S
episodic wheezing with dyspnea
wheezing
breathlessness, anxiety, sptum production
Most COMMON-cough
Exercise Induced Asthma-least brought on by swimming and could be caused by change in movement of air
Can treat with SABA or in children Cromolyn as 2nd choice if happens often.
Asthma
Acute severe asthma can be brought on by self-mediating with SABA
Chronic Stable Asthma
controlled with meds
Look at the step system and tx
On Asthma flashcards
Spirometry
get personal best.
Mild asthma will have decreased PEFR, FEV1, MMEFR
Bronchospasm=decreased FEV1, MMEFR and FEV1/FVC ratio
To diagnose Asthma
decreased obstruction after inhalation of bronchodilator
EIA
Tx with SABA and spacer, check for heart disease
Cromolyn for long term use if needed
Very safe
Mild Asthma
Add ICS and remind to rinse mouth and spit after use. Could get thrush. Remind client it will not work for 2-3 weeks
ACUTE Bronchitis
Transcient inflammation fo the trachea and major bronchi
Begins with URI, cough that causes burning pain in chest and when symptoms subside, client still has cough
Acute Bronchitis
Coarse rales, wheezes and rhonchi
Dx: s/s. No testing
Cough, normal VS
Acute Bronchitis
Could be caused by viral illness, socioeconomic deprivatoin, anxiety, depressoin, stress
Acute Bronchitis
Refer if not responding to treatment in 2 weeks.
Education-side effects of medication. Cough may persist for 10-14 days
Tx;: rest, fluids, inhaler, Dextramethorphan
Pneumonia-Bacterial
most common organism-CAP=streptococcus pneumoniae
leading cause of death from infectious disease
Pneumonia
Tactile fremitis, fine rales, Temp over 102, RR high, If over 60 may need to be hospitalized
Pneumonia
increased tactile fremitis
egophany
consolidation
Pneumonia-Bacteria
Consider hospitalization if HR>30, multilobar infiltrates, BUN>20, WBC,4000, confusion/disorientation
If treating as outpatient
-Need to do cultures
Treat with Macrolides or Doxycycline as 1st line
If co-morbidities or high risk resistance- treat with -Moxifloxacin, gemifloxacin, levofloxacin
If not these, Macrolide +augmentin
Gram Negative Pneumonia
Haemophilus influenza
- older adults
- w/ COPD
- chest pain
- x-ray with consolidation
Atypical Pneumonia-Mycoplasma Pneumonia
Fine rales, interstitial changes in lungs, but no consolidation, blister on TM, WBC normal or slightly elevated.
Younger people who live in dorms, etc.
Pneumonia education
rest, increased fluids, antipyretic, take all medications, avoid cough suppresent, follow up in 24 hours or have come back in 24-48 hours
Smoking
Most preventable disease
1 in 5 deaths related to smoking
only 7% succeed in quitting
Six stages of change
What are they
Precontemplation- Not even considering
FNP should listen to their perception and raise doubts
Contemplation-Shows awareness
FNP should evoke reasons to change
Dtermination-“I’ve got to do something”
Determine the steps with client
Action-Patient stops
Help with the steps
Maintenance-Sustains change
Prevent relapse
Relapse-slips occure 3-4 times before actual success
Avoid discouragement
Ask the 4 A’s
Ask-about smoking at every visit
Advise-about benefits
assist-help with barriers
Arrange-a follow up visit
Concerns for stopping smoking
Women-weight gain
Men-Tell them it effects breathing and affects athletic image
Adolescents-Point out appearance effects
Adults-Health concers
Pregnant women
Causes low bithweight babies, asthma for small children in a smokers home, otitis media in infants/toddlers
Pharmo interventions for smoking
Many
Nocotine replacements
gum, patch, inhaler, nasal spray
these add nocotine to the body, so warn client to not smoke
Bupropion -Wellbutrin; Zyban)
Not with seizure disporder, reduce if liver problems, effects dopamine. Take 1-2 weeks before you stop smoking, not with eating disorders
Varenicline (chantix)
Increases risk for heart attacks, binds nicotine receptors in the pleasure area. Can cause neuro-psychiatric problems, thoughts of suicide
Cold Turkey
has the most success
Nic-Vax
facilitates nicotine antibody development that prevents nicotine from getting to the brain
