Pneumonia/ TB Flashcards
What is pneumonia?
Acute inflammation of the lung parenchyma
May be infectious or not infectious
How do microbes enter the lungs?
Inhalation or aspiration of secretions from the oropharynx
Where can the microbes also enter besides the lungs?
Bloodstream
What are normal defenses against pneumonia?
Cough reflex
Pulmonary macrophages
Nasopharyngeal defenses
Cilia lining the respiratory tract
What do endotoxins cause?
Congestion and edema
What releases endotoxins?
Microbes
What happens to the alveoli and bronchioles when they are invaded?
Inflammation
Immune response
What are the different ways pneumonia is acquired?
Bacterial
Viral
Fungi
Aspiration
How does bacterial pneumonia occur?
Entrance to the lungs via bloodstream
Aspiration of resident bacteria
Person to person via droplet
Characteristics of bacterial pneumonia?
Damage cells and usually in one lung
Even distribution of microbes
What is the most common of bacterial pneumonia?
Streptococcus pneumoniae
What is a hospital associated bacterial pneumonia?
Staph aureus
What is walking pneumonia?
Caused by mycoplasmas
Symptoms similar to but milder than those of bacterial or viral pneumonia
Walking pneumonia typically affects what population?
School-age children and adults under 40.
How does viral pneumonia occur?
Enter from upper airway and infiltrate alveoli in one or both lungs
Characteristics of viral pneumonia?
Invade cells and kill them, send out debris
Patchy distribution
Influenza and adenovirus
What are some other causes of infectious pneumonia?
Fungi and protozoa
What is aspiration pneumonia?
Infectious or non-infectious
Chemical injury and inflammatory response
What are some causes of aspiration pneumonia?
Food
Emesis
Reflux
Hydrocarbons
What are some complications of pneumonia ?
Bronchiectasis Pleuritis Pleural effusion Lung abscess Empyema
What are risk factors for pneumonia ?
Infants Elderly HIV/AIDS Cancer, organ transplant Chronic illnesses- DM, cardiac, respiratory Endotracheal intubation (VAP) NG tubes Smoking, alcoholism
What is VAP?
Ventilator Associated Pneumonia
Why are infants at risk?
Immature immune system
Why are the elderly at risk?
Decreases cough and gag
What are some ways of prevention of pneumonia?
Early identification and appropriate treatment
Vaccines
What are some types of vaccines for pneumonia?
Pneumococcal PCV13- children under 2 PPSV23- adults Hib- children under 2 Influenza
What are some clinical manifestations of pneumonia?
Fever, chills Cough (productive, purulent) Chest pain Blood-tinged sputum SOB Decreased appetite Cyanosis Crackles Wheezing
What are the lifespan considerations with infants and children?
Airway shorter and more narrow High risk of obstruction Higher O2 consumption Tachypnea, intercostal retractions, nasal flaring Blood cultures Usually bacterial Recover faster than adults Common in kids with CF
What are the lifespan considerations of older adults?
Decreased cough and gag
Thick, viscous secretions
Decreased cilia
Meds, H/O smoking, COPD
What are some diagnostic studies that can be performed for pneumonia?
CXR CT scan Sputum C&S and Gram stain CBC with diff Serology- pathogen antibodies Pulse ox ABG Bronchoscopy
What antibiotics might someone with pneumonia receive?
PCN Cephalosporins EES TMP-SMZ Azithromycin Clindamycin
Meds might be changed after what?
Gram stain/cultures results are obtained
Besides antibiotics, what may consist of pharmacologic therapy ?
Bronchodilators
Acetylcysteine- reduce mucous viscosity
Expectorants
Oxygen
What are some non-pharmacological forms of therapy?
Liquids: 2.5-3 L/day
Incentive spirometer
Chest physiotherapy
What does chest physiotherapy include?
Percussion
Vibration
Postural drainage
In what position should a person with pneumonia be positioned?
Fowlers or high fowlers
What can be used as a splint when coughing?
Pillow
What should the nurse include in patient teaching for pneumonia?
Smoking cessation
Vaccines
What is part of the nursing care for a patient with pneumonia?
Antibiotics as ordered Antipyretics I&O: encourage fluids Assess sputum color Ongoing resp. assessment Position changes, ambulation Deep breath and cough Suction Assess for pleuritic pain O2 as needed
What is important to ask the patient pertaining to antibiotics?
Allergies
What is bronchiectasis?
Condition in which the lungs’ airways become damaged, making it hard to clear mucus
What is pleuritis?
Inflammation of the tissues that line the lungs and chest cavity
What is pleural effusion?
A buildup of fluid between the tissues that line the lungs and the chest
What is lung abscess?
Formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
Pus-filled cavity is often caused by aspiration,
What is empyema?
Collection of pus in a cavity in the body, especially in the pleural cavity
Characteristics of TB?
Chronic recurrent infectious disease
Mycobacterium TB
Major public health concern early 20th century
Remains prevalent worldwide
Rare in US except in high risk populations
Risk factors of TB
HIV/AIDS Altered immune system Homelessness Alcohol abuse Foreign born Racial/ethic minorities
Where can TB be spread to?
Brain
Bones
Urinary tract
How does TB bacilli enter the lungs?
Droplet
Macrophages isolate the TB bacteria and form what?
Tubercle
What happens when a tubercle ruptures?
Bacilli will spread to upper loves of lungs and the TB becomes active
What are some forms of prevention for TB?
Screen high risk people with PPD
Prophylactic treatment of latent disease
Compliance with treatment
Hospitalized patient in negative airflow room with “airborne” precautions
Staff wear fitted N-95 mask
What are the clinical manifestations of TB?
Fatigue Weight loss Decreased appetite Low grade fever Night sweats Cough: dry first then productive and/or bloody Pneumothorax
What are some diagnostic tests for TB?
Positive PPD test Sputum smear for acid-fast bacilli Sputum culture CXR HIV test
What is the purpose of prophylaxis treatment for TB?
To prevent active disease
What is involved in prophylaxis therapy for TB?
Positive PPD, negative CXR Household exposure to TB Single drug treatment Isoniazid for 6-9 months BCG vaccine if INH is contraindicated People with BCG vaccines will likely always have positive PPD
Why is more than one drug used in the treatment of active TB?
Bacilli will mutate to drug resistant bacteria
How many months of treatment are needed if bacilli is protected in tubercle?
6 months or more
For a newly diagnosed patient how many meds and for how long is the treatment of active TB?
What are the meds?
4 meds X 2 months
INH
Rifampin
Pyrazinamide
Ethambutol
Characteristics of rifampin?
Causes body fluids to turn red-orange
No ASA with INH
May cause hepatitis
What should be monitored with Rifampin?
CBC
LFT
Renal labs for toxicity
What may a skipped dose of Rifampin lead to?
Fever
Flu like symptoms
Characteristics of Isoniazid?
Need pyridoxine (vitamin B6) concurrently to avoid peripheral neuropathy May cause hepatitis
What should be avoided with Isoniazid?
Alcohol
What should be observed for with Isoniazid?
Anemia
Bruising
Jaundice
Peripheral neuropathy
What should be known about Pyrazinamide?
Take with food
No alcohol
Monitor LFT and uric acid
Report gout or liver symptoms
What should be known about Ethambutol?
Baseline visual exam
May affect visual acuity and color discrimination
Monitor vision daily, LFT, and renal function
What is part of the nursing care when dealing with a TB patient?
Negative airflow isolation room until sputum smears negative x3
Mask on patient for transporting
Patient education: disease process, adherence to medication regime, prevention of spread, nutrition
Fluids: 2-3 L/day
