Respiratory Flashcards
Rhinitis
- allergic rhinitis: inflammation caused by allergens
- can be occupational
- can be seasonal or all year round
- associated with co morbidity like asthma
- 3/4 asthmatics have rhinitis
Rhinitis: symptoms
-nasal running
-nasal blocking
-sneezing
-itching
occurs more than 2 hours per day for longer than 2 weeks
Sinusitis
-inflammation of sinuses caused by an infection
Complications of sinusitis
- chronic nasal obstruction
- sleep apnea
- anosmia: loss of smell
- chronic sore throat
- orbital cellulitis
- cavernous sinus thrombosis
- Brian abscess
- meningitis and septicemia
- general malaise and chronic headache
Flu
- sudden onset of symptoms
- occasional sneezing
- early sore throat and cough
- severe muscle aches
- severe malaise and fatigue
- substernal burning
- headache
- lasts 6-7 days
- high fever 102-104
cold
- gradual onset of symptoms
- sneezing
- mild sore throat and cough, peak at 2-3 days
- runny nose
- slight muscle aches
- mild malaise and fatigue
- mild/none chest symptoms
- 3-4 days of duration
- no/mild fever less than 100
Nursing diagnosis for flu
- fluid volume deficit
- imbalanced body temperature
- altered nutrition
- actue pain
Flu nursing intervention
- administer analgesics, antipyretics and decongestants as ordered
- follow droplet and standard precautions
- provide cool humidified air and change daily to prevent pseudomonas superinfection
- encourage rest and fluids
- administer IV fluids as ordered
- administer oxygen therapy as ordered
- monitor vitals
- monitor I &Os and signs of dehydration
- monitor for pneumonia
- encourage to use mouthwash or warm saline gargles to ease sore throat
- warm bath or heating bad to relieve myalgia
Pneumonia: definition
inflammation of the lung parenchyma by various microorganisms, bacteria, fungi, and viruses: infection is deep in lungs
-infection causes inflammation which attracts WBCs to fill alveoli causing decreased ability for as exchange causing poorly oxygenated blood
how do the elderly report pneumonia
-confusion caused by decreased circulation to the brain
-lethargy
-weakness
often without cough and fever
Community acquired pneumonia
- occurs with 48hrs of admission
- caused by: strep pneumonia and H influenza (elderly)
- insidious onset: related to upper respiratory infections like otitis media
Hospital acquired pneumonia
- onset is after 48hours of hospitalization
- antibiotic resistant pathogens (MRSa/ VRE)
- higher morality rate
- causative factos: pseudomonas, staph aureus, kelbisella
- subtype: ventilator associated pneumonia
risk for pneumonia
- elderly
- very young
- underlying health problems: COPD, DM
- patients with HIV or are immunosuppressed: chemo
- travel
- recent upper respiratory infection or flu
pneumonia: clinical manifestations
- varies from slow to sudden onset: depends on organism
- shaking chills, fever
- pleurtic chest pain
- productive cough
- increased respiratory rate/ dyspnea
pneumonia: diagnosis
- chest xray: determines diagnosis
- sputum specimen: determines organism
- blood cultures: determine organism
-blood and sputum cultures taken before antibiotic therapy is started
initial treatment fo pneumonia
- oxygenation assessment
- start abx after culture: should improve in 24-48 hours
- initially use broad spectrum abx
- after C &S results start Iv antibiotics hen PO abx
ongoing treatment of pneumonia
- assess vitals and O2
- comfort, positing,
- administer meds
- splint for pleuritic chest pain
- supplemental oxygen
- fluids,
- respiratory therapist: postural drainage/ percussion
- suction if needed
- rest and increase activity when fever subsides
- stop smoking
- pneumovax on discharge
- flu vaccine can lead to PNA
complications of pneumonia
- Empyema: build up of pus or fluid with demonstrable bacteria in pleural space
- pleural effusion
- septic shock
- respiratory
aspiration pneumonia
- food enters trachea instead of esophagus and causes infection
- inhalation of bacteria in oropharynx and/or content of oropharyngeal/gastric content
aspiration pneumonia: those at risk
- impaired LOC
- depressed cough reflex
- dysphagia
- GE reflux
- vomiting
- supine positioning
prevention aspiration pneumonia
- head of bed elevated with sedated/intubated/NGt
- NGT- tube feeds off when flat
- check placement of NGT
- during emesis: turn on side if sedated or flat if unable to sit up
tuberculosis: definition
- highly contagious respiratory infection caused by mycobacterium tuberculosis bacilli
- airborne droplets
- can travel to meningitis, kidney, bones, lymph ode
- initial infection occur 2-10 weeks after exposure
Latent tuberculosis
- after exposure: localized infection in lungs that walled off by immune system
- no symptoms and not contagious
- can reactivate: when immune system is stressed
- usually positive in PPD
active tuberculosis
-exposed person develops acute illness
symptoms
- varied to none; insidious
- early on: may be asymptomatic
- cough: starts nonproductive and becomes mucoplurulent sputum; may have hemoptysis
- night sweats
- loss of appetite
- unintended weight loss
- malaise
- SOB
AFB smear
- acid fast smear
- done while culture is being tested
- if postive: could be m. tuberulosis or other mycobacteria
AFB culture
need a sputum sample
-maytakes weeks for culture to grow
tuberculosis diagnosis: specimen
-3 consecutive sputum specimen, collected 8-24hrs intervals with at least one in the morning
-must have at least 2mL
-
tuberculosis diagnosis
- culture
- afb smear
- tuberculin skin test
- chest Xray: show small patchy infiltrations of early lesions in upper lung
- cavitation and scar tissue
tuberculin skin test (Mantoux/PPD)
- only way to identify exposure before it progresses to active disease
- repeat test after 1-3 weeks after initial test in recommended for older adults: may have decreased response to tuberculin because of viral, bacterial infection and malnutrition
positive ppd fining
15mm induration for people without risk factors
- 10mm: resident of long term care families, drug abusers, medically underserved, healthcare workers
- 5mm: HIV positive, recent contact with active TB
management of tuberculosi
- isolation
- INH or rifampin, monitor liver toxicity
- multiple drug combination-
- DOT: directly observed therapy: recommenced for high risk/ unreliable patients: treat them in hospital
nursing considerations for TB
- adhere to medication regime
- take on empty stomach
- INH avoid: histamine: red wine, aged cheese– flushing, h/a, hypotension, light headedness
- Rifampn interaction cause them to be ineffective: beta blockers, anticoagulants, birth control pills: check LFT, BUN, creatine
- prevent TB spread
- reportable to health department
TB nursing priorities
- adequate ventilation/oxygenation
- prevent spread with PPE
- support behaviors to maintain health
- promote effective coping strategies
- provide information about disease/prognosis and treatment need
tramission of TB
- airborn precaution/ isolation with negative pressure room
- N95
- discontinue: no evidence of infectiousness: cough decreased, sputum culture show less organism or negative
airborne precaustion
- Are used to prevent transmission of microorganisms spread on very small particles that drift on air currents such as droplet nuclei, dust particles. These organisms can remain suspended in the air for long periods of time
- Pulmonary Tuberculosis (TB)Varicella (Chicken Pox)Measles
