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Med Surge 4th exam > PNA > Flashcards

PNA Flashcards

1
Q

An acute inflammation of the bronchi in the lower respiratory tract that occurs w/or after a viral infection w/cough its most common symptom is defined as:

A

acute bronchitis

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2
Q

These symptoms: cough that last 10-20 days w/clear, mucoid sputum; HA, malaise, SOB, low-grade fever are associated with what lower respiratory tract infection:

A

Acute bronchitis

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3
Q

What are the usual tx for acute bronchitis;

A

fluids, rest, antiinflammatory meds, cough suppressants, and bronchodilators may be Rx.

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4
Q

How can you tell the difference between PNA from acute bronchitis:

A

X-rays will show no evidence of consolidation or infiltrates for bronchitis as seen in PNA

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5
Q

A highly contagious infection of the lower respiratory tract w/gram negative bacillus; dangerous to children, especially under 6 mo; w/a 6-10 wk characteristic cough followed by inspiratory gasps and a “whooping” sound is defined as:

A

Pertussis

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6
Q

What is the Rx tx for pertussis:

A

Zithromax

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7
Q

An acute inflammation of the lung parenchyma caused by a microbial organism is defined as:

A

Pneumonia

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8
Q

PNA occurs as a result of what:

A

PNA occurs when defense mechanisms becomes or are overwhelmed by the virulence or quantity of infectious agents

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9
Q

What age groups have high incidences of death d/t morbidity:

A

65 yo

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10
Q

What are the defense mechanism that PNA can compromise:

A

filtration of air, warming/humidification, epiglottis closure over the trachea, secretion of immunoglobin-A, mucociliary escalator mechanism, and alveolar macrophages

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11
Q

How doe altered LOC predispose a pt to PNA:

A

depresses cough and epiglottic reflexes allowing aspiration of organisms into the lungs

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12
Q

How does tracheal intubation predispose a pt to PNA:

A

Interferes w/cough reflex and mucociliary escalator

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13
Q

How does air pollution, smoking, and toxic gases predispose a pt to PNA:

A

Impairs the mucociliary escalator mechanism

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14
Q

How do diseases, such as DM, EtOH, leukemia predispose a pt to PNA:

A

They are associated w/increased frequency of gram negative bacilli in the oropharynx

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15
Q

Some other predisposing factors of PNA include:

A

immunosuppression d/t drugs, HIV, age, malnutrition; immobility; altered oropharangeal flora (d/t abx); NPO status, poor oral hygiene; tracheoesophageal fistulas

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16
Q

When an organism reaches the lungs from the nasopharynx or oropharynx; these organisms that cause most PNA of healthy adults utilize what type of method in catching PNA:

A

aspiration

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17
Q

When organisms are present in the air that’s inhaled causing PNA (mycoplasma PNA and fungal pna) will utilize what type of method in catching PNA:

A

inhalation

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18
Q

When an organism spreads from a primary infection elsewhere in the body (S. aureus) utilizes what type of method in catching PNA:

A

hematogenous

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19
Q

This Type of PNA are pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway is defined as what type of PNA:

A

Aspiration

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20
Q

What is the most common form of infection associated with aspiration PNA:

A

Bacterial infection that normally resides in the upper airways

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21
Q

Where can aspiration PNA occur at:

A

Community or Hospital

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22
Q

What are some other substances (other than bacteria) may be aspirated:

A

gastric contents, exogenous chemical contents, irritating gases

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23
Q

How can aspirating PNA impair lung defenses:

A

Causes inflammatory changes which leads to bacterial growth resulting in PNA

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24
Q

What are some of the common conditions that increase the risk of aspirating PNA:

A

Decreased LOC, difficulty swallowing, and nasogastric secretions

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25
Q

If the aspirating material is an inert substance, such as barium, then this type of aspirating PNA is caused by:

A

mechanical obstruction of the airways

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26
Q

If the aspirating material is gastric juices, then this type of aspirating PNA is caused by:

A

chemical injury within 48-72 hrs later

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27
Q

What are the types of PNA classifications:

A

CAP, HAP, ventilator-associated PNA (VAP), health care associated PNA (HCAP), PNA in the immunocompromised host, aspiration PNA

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28
Q

This classification of PNA is a lower respiratory infection with onset in the community or during the first 2-days of hospitalization is classified as:

A

Community-acquired PNA; w/o comorbidity 60 yo pts

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29
Q

The main causative agent that causes CAP requiring hospitalization si:

A

Gram + streptococcus PNA

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30
Q

Streptococcus, haemophilus influenza, legionella, S. aureus, viruses are causative agents of CAP PNA:

A

CAP

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31
Q

This classification of PNA occurs >48 hrs after admission in pts w/no evidence of infection at the time of admission and who haven’t been incubated at time of admission; has the highest mortality rates (30-50%) is classifies as:

A

HAP or nosocomial PNA

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32
Q

This classification of PNA occurs > 48 hr after endotracheal intubation is classified as:

A

VAP (ventilator-associated PNA)

33
Q

Both gram - and gram + (and viruses/fungi in an immunocompromised pt) are causative agents for what classification of PNA:

A

HAP and VAP

34
Q

This classification of PNA occurs in a pt who has hospitalization > 2 days in the last 90 days;resided in a long-term care facility; IV antibiotic therapy/chemo/wound care/or attended a hemodialysis/or hospital clinic in the last 30 days is classified as:

A

HCAP (health-care Associated PNA)

35
Q

What are the immunocompromised predisposing factors to PNA:

A

Long use of corticosteroids; chemotherapy; nutritional depletion; AIDS; genetic immune disorders; use of broad-spectrum antimicrobial agents

36
Q

What is a common type of PNA in HIV pts that have subtle onset w/progressive dyspnea, fever, nono-productive cough; rarely observed is classified as:

A

Pneumocytosis PNA (PCP-AKA Pneumocystis jiroveci)

37
Q

What are the types of opportunistic PNA with the immunocompromised:

A

PCP, CMV (cytomegalovirus), Mycobacterium TB, and other fungi

38
Q

A pt presents to hospital w/c/o of a progressive, non-productive cough, slight fever, tachypnea, weight loss, tachycardia. What type of CXR of the lungs would you expect to see and what PNA may cause these S/S:

A

A pt’s CXR presents diffuse bilateral alveolar pattern (massive consolidation if the disease is wide spread) typically seen in PCP pts.

39
Q

What is the pathophysiology of PNA:

A

Aspiration of infectious agent–>release of endotoxin from infections agent–>Congestion–>red hepatization–>leukocyte infiltration–>gray hepatization–>Resolution

40
Q

What phase of PNA is the healing process if no complications are present; exudate is lysed and macrophaged; normal lug tissue is restored; gas exchange returns to normal:

A

resolution

41
Q

What phase of PNA will you see massive dilation of the capillaries, alveoli are filled with the infectious agent/neutrophils/RBCs/fibrin; the lungs appear large and granular:

A

Red hepatiation

42
Q

What phase of PNA occurs when the organisms reach the alveoli causing an outpouring of fluid into the alveoli; organisms multiply in the fluid; infection spreads to adjacent alveoli; gas exchange is altered:

A

congestion

43
Q

What phase of PNA would you see blood flow decrease; leukocytes and fibrin consolidate in the affected area of the lung:

A

Gray hepatization

44
Q

What occurs from hypoventilation d/t PNA:

A

ventilation perfusion mismatch in the affected area resulting in arterial hypoxemia

45
Q

When one or more lobes are involved in PNA, the disease is termed:

A

lobar PNA

46
Q

PNA that is distributed in a patchy fashion, originating in one or more localized areas within the bronchi and extending to the adjacent lung parenchyma is defined as:

A

Broncho-PNA

47
Q

What are the classic manifestations of PNA:

A

fever; cough (productive or not); dyspnea; leukocytosis

48
Q

What are the other clinical manifestations of PNA:

A

tachypnea; tachycardia; chills; use of accessory muscles; crackles; increased tactile fremitus; purulent sputum (only sign seen in COPD pts; anorexia

49
Q

What may be the only PNA S/S seen in COPD pts:

A

Purulent sputum w/slight changes in RR status.

50
Q

Subjective data from PNA pts include:

A

exposure to predisposing factors, onset/progression of S/S of illness; PMHx; recent hospitalizations;surgeries; health patterns

51
Q

What are the types of diagnostic studies for PNA:

A

pt hx; physical examination; CXR; blood culture; sputum gram stain and culture; ABG panel

52
Q

What are gerontologic considerations concerning PNA:

A

Classic S/S are not usually seen with the elderly; instead confusion, general deterioration, weakness, abd symptoms, tachycardia, anorexia

53
Q

These characteristics: dyspnea, tachypnea, nasal flaring, altered chest excursion belong to what type of nsg dx:

A

Ineffective breathing pattern

54
Q

These characteristics: ineffective cough, thick, tenacious sputum, abnormal breath sounds, dyspnea belongs to what type of nsg dx:

A

ineffective airway clearance

55
Q

These characteristics: fatigue, unwillingness or inability to exert self, dyspnea, increased pulse and respirations, dizziness on exertion belongs to what type of nsg dx:

A

activity intolerance

55
Q

These characteristics: ineffective cough, thick, tenacious sputum, abnormal breath sounds, dyspnea belongs to what type of nsg dx:

A

ineffective airway clearance

56
Q

These characteristics: fatigue, unwillingness or inability to exert self, dyspnea, increased pulse and respirations, dizziness on exertion belongs to what type of nsg dx:

A

activity intolerance

58
Q

These characteristics: lack of exposure to or unfamiliarity with information belongs to what type of nsg dx:

A

Knowledge deficit

59
Q

These characteristics: lack of exposure to or unfamiliarity with information belongs to what type of nsg dx:

A

Knowledge deficit

60
Q

What are some goals in the care of PNA pts:

A

Improved airway pattern, no signs of hypoxia, adequate fluid intake

61
Q

What are some goals in the care of PNA pts:

A

Improved airway pattern, no signs of hypoxia, adequate fluid intake

62
Q

How is drug therapy initiated for PNA:

A

Initiated by classification of PNA; pt’s comorbidities; result of C & S and gram stains

63
Q

What is the initial drug therapy for CAP:

A

Empiric for a minimum of 5 days until culture and sensitive tests are available; pt should be afebrile before Rx is D/C

64
Q

What is the empiric therapy for CAP:

A

broad spectrum based on MDR assessment until C & S results are available and therapy is narrowed to avoid MDR emergence

65
Q

What other drugs are used in conjunction with Abx for PNA:

A

analgesics/antipyretics, steroids, antiviral drugs for viral PNA

66
Q

What are some other collaborative management in conjunction of Abx and related drugs for PNA:

A

O2 therapy; restricted activity during febrile phase; fluid intake up to 3L/day; IVF/electrolyte replacement; adequate nutritional intake

67
Q

What are some complications to PNA therapy:

A

Shock, RR failure, atelectasis; pleural effusion; meningitis; superinfection

68
Q

What are the guidelines for continuation PNA therapy after initiation:

A

Clinical improvement occurs w/in 3-5 days after initiation of therapy; monitor for changes in physical and mental status

69
Q

How is shock and RR failure manage in a PNA pt:

A

VS, SpO2 values, S/S of deterioration; INTUBATION and MECHANICAL VENTILATION MAY BE REQUIRED!!!

70
Q

What is atelectasis and how is that managed in a PNA pt:

A

Collapsed airless alveoli; managed by coughing and deep breathing

71
Q

What is pleural effusion and how is it managed in a PNA pt:

A

Fluid in the pleural space; managed by aspirating via thoracentesis (needle in back for aspirating fluid) or chest tube.

72
Q

IF the PNA pt is drowsy, confused, or disoriented, what should be assessed:

A

Pt should be assessed for meningitis by having the lumbar punctured for evaluation

73
Q

What are the measures to preventing PNA for pts identified to be at risk of acquiring PNA:

A

Pre/post-op teaching, proper pt positioning, avoid overmedication of sedatives or analgesics, strict medical asepsis, strict aseptic sterile technique

74
Q

What are PNA prevention vaccines:

A

Influenza immunization annually (especially for elderly and pts w/lung/heart/metabolic diseases); Pneumococcal vaccine (same target groups for influenza repeated once in 5 yrs in certain populations)

75
Q

What is the Healthy People 2020 goals for PNA:

A

90% >65 yo receive flu shot once a year and to receive Pneumonia vaccine

76
Q

expected PNA pt outcomes:

A

Demonstrates improved airway patency as evidenced by adequate O2 via pulse ox, normal temp, normal/improved BS, effective coughing

77
Q

expected PNA pt outcomes:

A

Rests and conserves energy by limiting activities and remaining in bed while symptomatic and gradually increasing activities

78
Q

expected PNA pt outcomes:

A

maintaining adequate hydration (3L/day) as evidence by adequate fluid intake and urine output and normal skin turgor

Med Surge 4th exam (8 decks)

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