respiratory Flashcards
upper airway infections
upper respiratory infection, acute tracheobronchitis, acute rhinosinusitis, acute pharyngitis
upper respiratory tract consists of…
nasal cavity, pharynx, ;larynx
lower respiratory tract consists of…
trachea, primary bronchi, lungs
viral rhinitis
aka the common cold; most common URI, occurs d/t inhalation of bacteria or virus (majority viral); hospitalization is rare
clinical manifestations of URI
10 symptoms- low grade fever, nasal congestion, rhinorrhea (runny nose), halitosis (odorous breath), sneezing, teary/watery eyes, sore throat, general malaise, chills, headache/muscle aches
managing URI
pharmacologic interventions vary depending on causative organism; nursing promotes supportive care such as treating symptoms with antipyretics, decongestants, nasal spray, analgesics, fluids, and rest; if given anti biotic encourage completion
acute bronchitis
inflammation of trachea and bronchi; usually follows a URI; most often it is mild and caused viral; usually URI travels down
clinical manifestations of brinchitis
mucopurulent sputum (cloudy appearance), dry cough that worsens at night and becomes productive in 2-3 days, progressive symptoms can be dyspnea stridor or wheezing (watch for progressive symptoms because of severity)
managing bronchitis
watch for resp. distress, treat the symptoms with antipyretics/cough suppressants etc., increase fluids intake
acute rhinosinusitis
inflammation/infection of the nose and sinuses that usually follows a URI; can be bacterial or viral (ABRS or AVRS) but bacterial accounts for >60%;
risk factors for developing acute rhinosinusitis
deviated septum, hypertrophied turbinates, nasal polyps, tumors
treating ABRS vs AVRS
ABRS is treated with antibiotics and supportive care and AVRS is treated with supportive care
role of sinuses
help voice sound the way it does (congestion of sinus makes voice sound congested), filters air
clinical manifestations fo ABRS/AVRS
purulent nasal drainage, nasal obstruction, facial pain/pressure/fullness, congestion/stuffiness, localized/diffuse headache,
difference in clinical manifestations of ABRS vs AVRS
ABRS- high fever and symptoms lasing >10 days, more severe; AVRS- lower intensity of symptoms, shorter duration (<10 days), no high fever
management of ABRS/AVRS
medication depends on cause (bacterial or viral), supportive care (nasal saline lavage, decongestants, topical nasal decongestants, adequate fluids, rest), educate pt on appropriate use f OTC and nasal spray, complete antibx fully
complications of ABRS/AVRS
MENINGITIS; educate pt on symptoms such as fever, severe headache, nuchal rigidity
acute pharyngitis
sudden inflammation of pharynx (usually caused by virus); 5-15% have group A beta-hemolytic streptococcus (strep throat- bacterial)
viral pharyngitis vs bacterial pharyngitis
viral subsides in 3-10 days; bacterial is more severe and an lea to complications if untreated
general clinical manifestations of pharyngitis
fiery-red pharyngeal membrane and tonsils; lymphoid follicles swollen with white-purple exudate, enlarged cervical lymph nodes, no cough, possible fever and malaise, halitosis
difference in manifestations of pharyngitis bacterial vs viral
bacterial pharyngitis- swollen uvula, red/swollen tonsils, white spots, red/swollen throat, gray/furry tongue; viral pharyngitis- red/swollen tonsils, red/swollen throat
management of acute pharyngitis
determine if viral or bacterial with RADT; antibx if bacterial, supportive care for viral and bacterial, analgesics; soft/liquid diet in acute stage; severe cases may require IV fluids; educate pt to call with severe symptoms- dyspnea, drooling, inability to swallow, inability to fully open mouth
upper airway conditions
obstructive sleep apnea and epistaxis
OSA- obstructive sleep apnea
periods of apnea during sleep caused by recurrent airway obstruction and decreased ventilation; pt typically unaware of obstruction but report insomnia and difficult staying asleep; muscles relax when sleeping obstructing airway causing pt to jar awake
risk factors for developing sleep apnea
obesity, male gender, postmenopausal status, advanced age
clinical manifestations of OSA
3 S’s- snoring sleepiness, significant other reporting sleep apnea episodes; chronic fatigue, hypersomnolence (daytime sleepiness); awakening at night and unable to return to sleep
management of sleep apnea
diagnosed with sleep study; mandibular advancement device are first step; CPAP/BiPAP are second or alternative option; surgeries like tonsillectomy to create more space, uvulopalatopharyngoplasty (reconstruction), or nasal septoplasty
CPAP vs BiPAP
CPAP- continuous positive airway pressure- keeps airway from collapsing; BiPAP- bilevel positive airway pressure- makes breathing easier and results in lower average airway pressure
epistaxis
rupture or distended vessels in mucous membrane of nose (commonly anterior septum)
management of epistaxis
sit pt upright with head tilting forward (to prevent swallowing/aspiration of blood) and pinch soft outer nose at mid septum for 5-10 minutes; prolonged bleeding may require nasal decongestants to vasoconstrict; if both ineffective then cauterization
if cause of epistaxis cannot be identified…
nose is packed with impregnated gauze and may remain in nose for 3-4 days; antibx may be prescribed
education for pt with epistaxis
avoid exercise, spicy foods, smoking tobacco, blowing nose, straining, high altitudes, nasal trauma; instruct pt to call if recurrrent bleed cannot be stopped after 15 minutes of pressure
lower respiratory infections
pneumonia, influenza, COVID-19, tuberculosis
pneumonia
infection of pulmonary tissue (bacterial, viral, or fungal); inflammatory edema stiffens lung, decreases compliance and capacity to cause hypoxemia; community acquired or healthcare associated
community acquired pneumonia
rate increases with age, bacterial- S.pneumoniae is most common, viral- RSV or COVID-19
healthcare associated pneumonia
48+ hours post hospitalization and often caused by MDROs (multi drug resistant organisms)
clinical manifestations of pneumonia
CXR shows consolidation, infiltrates, or pleural effusion, elevated WBCs and ESR, fever, chills, cough, dyspnea, tachypnea, rhonchi/wheezing, pleuritic pain, sputum production (culture needed to identify cause), mental status changes
management of pneumonia
oxygen therapy, antibx, supportive care meds; monitor resp. status for signs of distress; encourage cough/deep breathing/incentive spirometer; place in semi-fowlers and change position frequently; suction if unable to clear secretions; encourage fluid intake, high cal/high protein diet, balance rest and activity; should receive pneumococcal vaccine as recommended
influenza
highly contagious acute viral infection with several strains (A, B, C, H1N1); prevention is key
ways to prevent influenza
annual vaccine, avoiding infected people, frequent and proper handwashing, cleaning and disinfecting contaminated surfaces
clinical manifestations of influenza
acute onset, fever, myalgias (pain/aches), headache, fatigue/weakness/anorexia, sore throat/cough, rhinorrhea
management of influenza
supportive care measures- rest, fluids, antipyretics, antitussives; administer antiviral meds as prescribed (tamiflu within 48 hours)
COVID-19
infectious respiratory illness caused by novel coronavirus SARS-CoV-2; primarily spreads via respiratory droplets (cough sneeze or close contact); incubation period usually 2-14 days
clinical manifestations of COVID-19
common- fever, cough, SOB, fatigue, aches, loss of smell/taste; less common- sore throat, headache, chills, GI symptoms; severe symptoms- pneumonia, ARDS, organ failure; some individuals are asymptomatic
COVID-19 diagnosis/management
based on symptoms, history, and lab resuls (PCR/antigen test); supportive care; severe cases may require hospitalization for O2 therapy, ventilator support; antiviral meds may be indicated (nirmatrelvir-ritonavir) and must be administered within 5 days of symptom onset; COVID vaccines are vital in preventing severe illness/transmission
antiviral should be reserved for…
those individuals who cannot handle the virus
COVID-19 nursing interventions
infection prevention (hand hygiene, masks, PPE), isolation precautions (droplet, airborne, contact), respiratory support, emotional support, health education, monitoring and reporting
Tubeculosis
highly contagious communicable disease caused by M. tuberculosis; airborne, exudative response causes nonspecific pneumonitis and granulomas in lung tissue; onset is insidious and pt are unaware until disease is advanced
tuberculosis causes
bacteria forms tubercle lesion and immune system encapsulates tubercle leaving a scar; if no encapsulation then bacteria can enter lymph and cause inflammatory response called granulomatous inflammation leading to primary lesions forming
active phase of TB
infection causes necrosis and cavitation in lesions that can rupture and spread necrotic tissue damaging various parts of body; need Xray to confirm because recent BCG vaccine causes positive skin test (mantioux/PPD)
risk factors for developing TB
12- elderly, <5 years old, unpasteurized milk if cow infected, homeless, low socieoconomic group, minorities, refugees, frequent contact with untreated/undiagnosed individual, those in crowded living areas, malnutrition, immune dysfunction, alcohol abuse/IV drug use
clinical manifestations of TB
may be asymptomatic in primary phase, fatigue, lethargy, anorexia, weight loss, low grade fever, chills, night sweats, persistent cough (can be blood streaked but usually dry), chest tightness, dull aching chest pain with cough
testing for TB
CXR may show caseation and inflammation, advanced may show partial obstruction of bronchus from endobronchial disease (wheezing and dyspnea present), TB skin test (positive result does not mean active), quantiferon TB gold test (sensitive and rapid blood test), sputum culture to confirm
managing TB
goal is to prevent transmission, reduce symptoms, and prevent progression; risk of transmission decreases after 2-3 weeks of treatment, treatment for up to 12 months, educate importance on compliance; well balanced diet; sputum culture every 2-4 week until 3 negative test consecutively
chronic pulmonary disorders
asthma, COPD, cystic fibrosis
asthma
chronic inflammatory disorder of airways causing varying degrees of obstruction; marked by hyperresponsiveness to stimuli, bronchioole inflammation, bronchoconstriction, mucus production; often reversible with treatment
status asthmaticus
severe life-threatening episode refractory to treatment
clinical manifestations of asthma
wheezing or crackles, absent/diminished lug sounds, restlessness, diaphoresis, cyanosis, decreased O2 sat., accessory muscle use, tachypnea/hyperventilation, prolonged exhalation, tachycardia
management of acute asthma attack
monitor vitals (O2 sat and peak flow), high fowlers, administer O2, stay with client to decrease O2, administer bronchodilators corticosteroids and ag. sulfate, auscultate lung sounds before during and after treatment
IV Magnesium sulfate works
by further dilating bronchioles and relaxes muscles
cystsic fibrosis
chronic multisystem autosomal recessive trait disorder characterized by exocrine gland dysfunction; progressive and incurable; mucus produced by exocrine glands is abnormally thick tenacious and copious causing obstruction of small passageways of affected organs
organsprimarily affected by CF
respiratory, gastointestinal (pancreas), and reporductive
diagnosing CF
positive chloride sweat test; increased sodium and chloride in sweat/saliva
clinical manifestations of cystic fibrosis
emphysema and atelectasis as airways increasingly obstructed; chronic hypoxemia that leads to pulmonary HTN and eventually cor pulmonale d/t contraction and hypertrophy of pulmonary arteries, pneumothorax d/t bullae rupture, hemoptysis, wheezing/cough/dyspnea/cyanosis, clubbing and barrel chest, recurrent bronchitis and pneumonia, O2 therapy, lung transplant, supplemental pancreatic enzymes
goal during CF
prevent and treat pulmonary infections by improving aeration, removing secretions, administering antibiotics; encourage physical exercise to stimulate mucus expectoration; encourage high cal/high protein diet (vit. ADEK)
medications for CF
bronchodilators and meds to decrease viscocity of mucus such as pulmozyne or 7% N.S.
treatment of CF
chest physiotherapy, flutter mucus clearing device, handheld percussors, special vest device, positive expiratory pressure mask (CPAP)
chronic obstructive pulmonary disease
characterized by airflow obstruction- emphysema and chronic bronchitis; both are caused by tobacco smoke; both lead to pulmonary insufficiency, pulmonary HTN, cor pulmonale; not completely reversible
chronic bronchitis
productive cough >3 months at a time for more than two consecutive years; bronchial tubes become inflamed and excessive mucus production occurs, “blue bloater”, causes peripheral edema
emphysema
air sacs are damaged and enlarged causing hyperinflation and breathlessness; “pink puffer”, barrel chest
clinical manifestations of COPD
cough, exertional dyspnea, wheezing/crackles, sputum production, weight loss, barrel chest, accessory muscle use, prolonged expiration, orthopnea, cardiac dysrhythmias, congestion/hyperinflation on CXR, ABG show acidosis and hypoxemia, decreased capacity on PFT
cor pulmonale
vasoconstriction in one part of the lung causing blood to shunt to another area of lung but pressure is increased in that area
managing COPD
monitor vitals (O2 sat., ABG), admin O2, fowlers position and leaning forward, respiratory treatments and CPT, educate on tripod breathing and pursed lip breathing, bronchodilators, corticosteroids, mucolytics, antibiotics, high cal/high protein diet with 2-3L fluids, suction as needed
lower respiratory conditions
atelectasis, pleural effusion, empyema, pleurisy, aspiration
atelectasis
collapse of alveoli; can be acute or chronic; occurs as a result of ventilation; can be caused by reduced ventilation or obstruction; post-op pt at high risk
causes of atelectasis
foreign body, tumor/growth, altered breathing patterns, retained secretions, pain, prolonged supine position, increased abdominal pressure, reduced lung volumes from MSK/neuro disorders, surgery
clinical manifestations of atelectasis
dyspnea, cough, sputum production, hypoxemia, decreased breath sounds/crackles, respiratory distress, tachycardia, tachypnea, pleural pain, central cyanosis
prevention of atelectasis
frequent turning, early ambulation, lung volume expansion maneuvers (deep breathing/incentive spirometer), positive end respiratory pressure (PEEP), CPAP
pleural effusion
collection of fluid in pleural space; any condition that interferes with secretion or drainage will lead to pleural effusion
clinical manifestations of pleural effusion
pleuritic pain that worsens with inspiration, progressive dyspnea, nonproductive cough, tachycardia, possible fever, decreased breath sounds over affected area, shown on CXR
management of pleural effusion
treat underlying cause, fowlers position, encourage coughing/deep breaths, monitor lung sounds, prep for thoracentesis, if recurrent then prep for pleurectomy or pleurodesis
empyema
collection of pus within pleural cavity; mainly caused by pulmonary infection or lung abscess; thick malodorous opaque fluid
clinical manifestations of empyema
recent febrile illness or trauma, chest pain, cough, dyspnea, anorexia, weight loss, malaises, fever, chills, night sweats, pleural exudate on CXR
management of empyema
monitor lung sounds, semi/high fowlers, encourage deep breath and cough, administer antibx, educate on chest splinting, assist with thoracentesis or chest tube
pleurisy
inflammation of visceral and parietal membranes; caused by pulmonary infarction or pneumonia; visceral and parietal membranes rube during respiration and cause pain; usually only on one side and lower lateral region
clinical manifestations of pleurisy
stabbing pain that worsens during cough or deep breathing; pleural friction rub auscultated
management of pleurisy
treat underlying cause, monitor lung sounds, administer analgesics, apply heat/cold, encourage cough and deep breath with chest splinting
aspiration
inhalation of foreign materials causing inflammatory reaction, hypoventilation, and ventilation-perfusion mismatch
risk factors for apsiration
decreased LOC, brain injury, swallowing disorders, stroke
why is aspiration so dangerous?
can lead to pneumonia
preventing aspiration
swallowing screening, elevate head off bed, avoid stimulation of gag reflex with suctioning and other procedures, check NG placement prior to feeding, soft diet with small bites, no use of straws
