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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
Q

What are some ways of prevention of pneumonia?

A

Early identification and appropriate treatment

Vaccines

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26
Q

What are some types of vaccines for pneumonia?

A 
Pneumococcal 
PCV13- children under 2
PPSV23- adults 
Hib- children under 2
Influenza
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27
Q

What are some clinical manifestations of pneumonia?

A 
Fever, chills
Cough (productive, purulent)
Chest pain 
Blood-tinged sputum 
SOB
Decreased appetite
Cyanosis
Crackles
Wheezing
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28
Q

What are the lifespan considerations with infants and children?

A 
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
Q

What are the lifespan considerations of older adults?

A

Decreased cough and gag
Thick, viscous secretions
Decreased cilia
Meds, H/O smoking, COPD

30
Q

What are some diagnostic studies that can be performed for pneumonia?

A 
CXR
CT scan
Sputum C&S and Gram stain 
CBC with diff
Serology- pathogen antibodies 
Pulse ox 
ABG
Bronchoscopy
31
Q

What antibiotics might someone with pneumonia receive?

A 
PCN
Cephalosporins 
EES
TMP-SMZ
Azithromycin 
Clindamycin
32
Q

Meds might be changed after what?

A

Gram stain/cultures results are obtained

33
Q

Besides antibiotics, what may consist of pharmacologic therapy ?

A

Bronchodilators
Acetylcysteine- reduce mucous viscosity
Expectorants
Oxygen

34
Q

What are some non-pharmacological forms of therapy?

A

Liquids: 2.5-3 L/day
Incentive spirometer
Chest physiotherapy

35
Q

What does chest physiotherapy include?

A

Percussion
Vibration
Postural drainage

36
Q

In what position should a person with pneumonia be positioned?

A

Fowlers or high fowlers

37
Q

What can be used as a splint when coughing?

A

Pillow

38
Q

What should the nurse include in patient teaching for pneumonia?

A

Smoking cessation

Vaccines

39
Q

What is part of the nursing care for a patient with pneumonia?

A 
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
Q

What is important to ask the patient pertaining to antibiotics?

A

Allergies

41
Q

What is bronchiectasis?

A

Condition in which the lungs’ airways become damaged, making it hard to clear mucus

42
Q

What is pleuritis?

A

Inflammation of the tissues that line the lungs and chest cavity

43
Q

What is pleural effusion?

A

A buildup of fluid between the tissues that line the lungs and the chest

44
Q

What is lung abscess?

A

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
Q

What is empyema?

A

Collection of pus in a cavity in the body, especially in the pleural cavity

46
Q

Characteristics of TB?

A

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
Q

Risk factors of TB

A 
HIV/AIDS
Altered immune system 
Homelessness
Alcohol abuse
Foreign born 
Racial/ethic minorities
48
Q

Where can TB be spread to?

A

Brain
Bones
Urinary tract

49
Q

How does TB bacilli enter the lungs?

A

Droplet

50
Q

Macrophages isolate the TB bacteria and form what?

A

Tubercle

51
Q

What happens when a tubercle ruptures?

A

Bacilli will spread to upper loves of lungs and the TB becomes active

52
Q

What are some forms of prevention for TB?

A

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
Q

What are the clinical manifestations of TB?

A 
Fatigue 
Weight loss
Decreased appetite 
Low grade fever
Night sweats
Cough: dry first then productive and/or bloody 
Pneumothorax
54
Q

What are some diagnostic tests for TB?

A 
Positive PPD test 
Sputum smear for acid-fast bacilli 
Sputum culture 
CXR
HIV test
55
Q

What is the purpose of prophylaxis treatment for TB?

A

To prevent active disease

56
Q

What is involved in prophylaxis therapy for TB?

A 
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
Q

Why is more than one drug used in the treatment of active TB?

A

Bacilli will mutate to drug resistant bacteria

58
Q

How many months of treatment are needed if bacilli is protected in tubercle?

A

6 months or more

59
Q

For a newly diagnosed patient how many meds and for how long is the treatment of active TB?

What are the meds?

A

4 meds X 2 months

INH
Rifampin
Pyrazinamide
Ethambutol

60
Q

Characteristics of rifampin?

A

Causes body fluids to turn red-orange
No ASA with INH
May cause hepatitis

61
Q

What should be monitored with Rifampin?

A

CBC
LFT
Renal labs for toxicity

62
Q

What may a skipped dose of Rifampin lead to?

A

Fever

Flu like symptoms

63
Q

Characteristics of Isoniazid?

A 
Need pyridoxine (vitamin B6) concurrently to avoid peripheral neuropathy 
May cause hepatitis
64
Q

What should be avoided with Isoniazid?

A

Alcohol

65
Q

What should be observed for with Isoniazid?

A

Anemia
Bruising
Jaundice
Peripheral neuropathy

66
Q

What should be known about Pyrazinamide?

A

Take with food
No alcohol
Monitor LFT and uric acid
Report gout or liver symptoms

67
Q

What should be known about Ethambutol?

A

Baseline visual exam
May affect visual acuity and color discrimination
Monitor vision daily, LFT, and renal function

68
Q

What is part of the nursing care when dealing with a TB patient?

A

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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