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Med/Surg 1 Exam 3 > Pneumonia/ TB > Flashcards

Pneumonia/ TB Flashcards

1
Q

What is pneumonia?

A

Acute inflammation of the lung parenchyma

May be infectious or not infectious

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2
Q

How do microbes enter the lungs?

A

Inhalation or aspiration of secretions from the oropharynx

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3
Q

Where can the microbes also enter besides the lungs?

A

Bloodstream

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4
Q

What are normal defenses against pneumonia?

A

Cough reflex
Pulmonary macrophages
Nasopharyngeal defenses
Cilia lining the respiratory tract

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5
Q

What do endotoxins cause?

A

Congestion and edema

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6
Q

What releases endotoxins?

A

Microbes

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7
Q

What happens to the alveoli and bronchioles when they are invaded?

A

Inflammation

Immune response

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8
Q

What are the different ways pneumonia is acquired?

A

Bacterial
Viral
Fungi
Aspiration

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9
Q

How does bacterial pneumonia occur?

A

Entrance to the lungs via bloodstream
Aspiration of resident bacteria
Person to person via droplet

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10
Q

Characteristics of bacterial pneumonia?

A

Damage cells and usually in one lung

Even distribution of microbes

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11
Q

What is the most common of bacterial pneumonia?

A

Streptococcus pneumoniae

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12
Q

What is a hospital associated bacterial pneumonia?

A

Staph aureus

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13
Q

What is walking pneumonia?

A

Caused by mycoplasmas

Symptoms similar to but milder than those of bacterial or viral pneumonia

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14
Q

Walking pneumonia typically affects what population?

A

School-age children and adults under 40.

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15
Q

How does viral pneumonia occur?

A

Enter from upper airway and infiltrate alveoli in one or both lungs

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16
Q

Characteristics of viral pneumonia?

A

Invade cells and kill them, send out debris
Patchy distribution
Influenza and adenovirus

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17
Q

What are some other causes of infectious pneumonia?

A

Fungi and protozoa

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18
Q

What is aspiration pneumonia?

A

Infectious or non-infectious

Chemical injury and inflammatory response

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19
Q

What are some causes of aspiration pneumonia?

A

Food
Emesis
Reflux
Hydrocarbons

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20
Q

What are some complications of pneumonia ?

A 
Bronchiectasis 
Pleuritis 
Pleural effusion 
Lung abscess 
Empyema
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21
Q

What are risk factors for pneumonia ?

A 
Infants 
Elderly 
HIV/AIDS
Cancer, organ transplant 
Chronic illnesses- DM, cardiac, respiratory 
Endotracheal intubation (VAP)
NG tubes
Smoking, alcoholism
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22
Q

What is VAP?

A

Ventilator Associated Pneumonia

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23
Q

Why are infants at risk?

A

Immature immune system

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24
Q

Why are the elderly at risk?

A

Decreases cough and gag

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25
What are some ways of prevention of pneumonia?
Early identification and appropriate treatment | Vaccines
26
What are some types of vaccines for pneumonia?
``` Pneumococcal PCV13- children under 2 PPSV23- adults Hib- children under 2 Influenza ```
27
What are some clinical manifestations of pneumonia?
``` Fever, chills Cough (productive, purulent) Chest pain Blood-tinged sputum SOB Decreased appetite Cyanosis Crackles Wheezing ```
28
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 ```
29
What are the lifespan considerations of older adults?
Decreased cough and gag Thick, viscous secretions Decreased cilia Meds, H/O smoking, COPD
30
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 ```
31
What antibiotics might someone with pneumonia receive?
``` PCN Cephalosporins EES TMP-SMZ Azithromycin Clindamycin ```
32
Meds might be changed after what?
Gram stain/cultures results are obtained
33
Besides antibiotics, what may consist of pharmacologic therapy ?
Bronchodilators Acetylcysteine- reduce mucous viscosity Expectorants Oxygen
34
What are some non-pharmacological forms of therapy?
Liquids: 2.5-3 L/day Incentive spirometer Chest physiotherapy
35
What does chest physiotherapy include?
Percussion Vibration Postural drainage
36
In what position should a person with pneumonia be positioned?
Fowlers or high fowlers
37
What can be used as a splint when coughing?
Pillow
38
What should the nurse include in patient teaching for pneumonia?
Smoking cessation | Vaccines
39
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 ```
40
What is important to ask the patient pertaining to antibiotics?
Allergies
41
What is bronchiectasis?
Condition in which the lungs' airways become damaged, making it hard to clear mucus
42
What is pleuritis?
Inflammation of the tissues that line the lungs and chest cavity
43
What is pleural effusion?
A buildup of fluid between the tissues that line the lungs and the chest
44
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,
45
What is empyema?
Collection of pus in a cavity in the body, especially in the pleural cavity
46
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
47
Risk factors of TB
``` HIV/AIDS Altered immune system Homelessness Alcohol abuse Foreign born Racial/ethic minorities ```
48
Where can TB be spread to?
Brain Bones Urinary tract
49
How does TB bacilli enter the lungs?
Droplet
50
Macrophages isolate the TB bacteria and form what?
Tubercle
51
What happens when a tubercle ruptures?
Bacilli will spread to upper loves of lungs and the TB becomes active
52
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
53
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 ```
54
What are some diagnostic tests for TB?
``` Positive PPD test Sputum smear for acid-fast bacilli Sputum culture CXR HIV test ```
55
What is the purpose of prophylaxis treatment for TB?
To prevent active disease
56
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 ```
57
Why is more than one drug used in the treatment of active TB?
Bacilli will mutate to drug resistant bacteria
58
How many months of treatment are needed if bacilli is protected in tubercle?
6 months or more
59
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
60
Characteristics of rifampin?
Causes body fluids to turn red-orange No ASA with INH May cause hepatitis
61
What should be monitored with Rifampin?
CBC LFT Renal labs for toxicity
62
What may a skipped dose of Rifampin lead to?
Fever | Flu like symptoms
63
Characteristics of Isoniazid?
``` Need pyridoxine (vitamin B6) concurrently to avoid peripheral neuropathy May cause hepatitis ```
64
What should be avoided with Isoniazid?
Alcohol
65
What should be observed for with Isoniazid?
Anemia Bruising Jaundice Peripheral neuropathy
66
What should be known about Pyrazinamide?
Take with food No alcohol Monitor LFT and uric acid Report gout or liver symptoms
67
What should be known about Ethambutol?
Baseline visual exam May affect visual acuity and color discrimination Monitor vision daily, LFT, and renal function
68
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

Med/Surg 1 Exam 3 (5 decks)

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