Respiratory Diseases Flashcards
ARDS
Adult Respiratory Distress Syndrome
- Sudden onset of progressive pulmonary disorder
- REDUCED PERFUSION TO THE LUNGS caused by different factors
- Caused by LUNG FLUID and leads to EXTRAVASCULAR LUNG FLUID
- FLUID BUILD UP in ALVEOLI when surfactant production falls causing collapse of alveoli
Causes of Adult Respiratory Distress Syndrome
- Aspiration of gastric contents
- Chest ( VIRAL and BACTERIAL PNEUMONIA)
- Fractured bone with emboli
- Smoke and chemical inhalation
- O2 toxicity
- Drug overdose
- Shock
- Trauma
- DIC
- Burns
- Neuro injuries
Signs/Symptoms of ARDS and Care Mgmt
- Dyspnea and Tachypnea
- RAPID/SHALLOW BREATHING
- Restlessness/Apprehension
- Increased pCO2 and Decreased SpO2
Care Mgmt:
- SEDATIVES to REDUCE RESTLESSNESS
- May need mechanical vent with PEEP ( Positive End Expiratory Pressure) for severe hypoxemia
PEEP may cause DECREASE CARDIAC OUTPUT, HYPOTENSION, and TACHYCARDIA
Date Collection for ARDS
- Tachypnea
- Dyspnea
- Decreased breath sounds
- Deteriorating ABG levels
- Hypoxemia despite high concentrations of delivered oxygen
- Decreased pulmonary compliance
- Pulmonary infiltrates
Asthma
- Known as Respiratory Airway Disease (RAD)
- Narrowing/inflammation of airway (bronchi or bronchioles)
- Respiratory disorder characterized by wheezing, chest tightness, dyspnea and cough with recurrent episodes of precipitated allergens, infections, strenuous exercise, and exposure to cold environment or emotional stress
- No CURE can only be controlled
Treatment for Asthma (meds) and side effects
- Bronchodilators ( inhaler or nebulizer)
- S/E
Jittery, nervousness, tachycardia, palpitations, nausea, diarrhea
Acute Bronchitis
- An inflammation of the bronchi resulting from BRONCHIAL TISSUE IRRITATIONS secondary to smoking, chemicals, and pollens
- Often follows a cold or URTI ( Upper Respiratory Tract Infection )
- Viral or bacterial
- Radiology film reveals no infiltrates or consolidation
Signs and Symptoms of Acute Bronchitis
- Productive cough ( clear to purulent )
- Fever ( Mild to Moderate )
- Dyspnea
Diagnostic Tests for Acute Bronchitis/ Treatments
- Chest X Ray
- CBC
- Pulse Ox
- Pulmonary function test using PEAK FLOW
Chronic Bronchitis
- Inflammation or irritation of one or more bronchial tubes
- Productive cough for at least 2-3 continuous months for 3 years
- CIGARETTE SMOKING is the the MAIN CAUSE of chronic bronchitis
Signs and Symptoms of Chronic Bronchitis
- Chest tightness
- Exertional dyspnea
- Diminished breath sounds with wheezing
- Activity intolerance
- Recurrent respiratory infection
Acute Bronchitis (Meds)
Benzonatate ( Tessalon Perles ), Guaifenesin ( Robitussin) , Promethazine ( Phenergan)
( These are cough and antihistamines )
Cor Pulmonale
- CHANGE IN STRUCTURE OF HEART as a result of respiratory disorder
- COPD PRODUCES PULMONARY HYPERTENSION
- RIGHT SIDED HEART FAILURE ( enlargement of the right ventricle due to high BP in the lungs usually caused by chronic lung disease
Signs and Symptoms of Cor Pulmonale
- Shortness of breath on exertion
- Easy fatigability, chest pain, palpitations, ankle, leg, and abd swelling
Emphysema
- Chronic obstructive disease of the lungs with significant over distention of the alveoli
- Bronchitis and Emphysema = COPD
Primary factors of Emphysema
- SMOKING
- Air pollution
- Environmental exposure
- Allergy
- Infection
- AGING and GENETIC PREDISPOSITION
Signs and Symptoms of Emphysema/COPD
- Dyspnea, worse on exertion ( prolonged exertion )and exercising
- Coughing
- Excessive mucous production
- Shortness of breath and tightness of chest
- Wheezing
- Use of accessory muscles
* Tripod posture
* Barrel chest - Inward movement of the lower chest with inspiration ( associated with severe hyperinflation)
- PROLONGED EXPIRATORY PHASE
- PULSUS PARADOXUS may be present ( Heart sounds heard precordium when radial pulse is not felt )
Nursing Interventions for Emphysema/COPD
- VS
- OXYGENATION USUALLY BY NASAL CANNULA at 1-2 L,
- VENTURI- MASK ALLOWS MORE PRECISE O2 ADMINISTRATION ( maintain PaO2 between 55- 65
MEDS on COPD/ EMPHYSEMA
BRONCHODILATORS
* Aminophylline * Terbutaline ( Brethine )
INHALED ANTICHOLINERGIC
* Ipratroprium ( ATROVENT)
INHALED BETA AGONISTS
* ALBUTERTOL * METAPROTERENOL ( Alupent )
CORTICOSTEROIDS
* Inhaled or Oral ( Prednisone )
BROAD SPECTRUM ANTIBIOTICS
INCREASE IN FLUID INTAKE to 3 L A DAY TO THIN SECRETIONS or give MUCOLYTICS
PURSE- LIP BREATHING
Nursing Alert/Pt Teaching (COPD)
- NO CURE
- Ensure adequate rest periods
- Monitor pulse ox ( continuous or periodically)
- Teach Pt. how to control breathing pattern and PURSE LIP EXHALATION to AVOID TACHYPNEA and EXCESSIVE HYPERVENTILATION
- TRIPOD POSITION to maximize respiratory muscles
- TEACH AND ENSURE CORRECT USE OF BRONCHODILATOR INHALERS TO PROMOTE BRONCHODILATION
- O2 inhalation usually by NASAL CANULA at (1-2 L) USE VENTURI ALLOWS MORE PRECISE O2
- AVOID IRRITANTS ( CIG SMOKE, PERFUMES) might trigger BRONCHOSPASM
- USE OF INHALED or ORAL PREDNISONE corticosteroid as prescribed. TEACH PURSE-LIP BREATHING
QUIT SMOKING by using prescribed
- Zyban ( buproprion) or Chantix ( varenicline) or Nicotine patch
Pursed- Lip Breathing
Pursed- lip breathing works by helping your air passages STAY OPEN LONGER ( lengthening expiration ) to allow for more normal oxygen exchange. PROMOTES CARBON DIOXIDE ELIMINATION (prevents early airway collapse)
How to do Purse- Lip breathing ?
- Relax your neck and shoulder muscles and inhale slowly through your nose for at least 2 counts
- Pucker your lips as if to blow out a candle
Exhale slowly and gently through your pursed lips for at least twice as long as you inhaled ( count to 4 )
Histoplasmosis
- SYSTEMIC FUNGAL INFECTION
- Inhalation of dust contaminated by Histoplasma capsulatum ( transmitted through bird manure )
- Lungs almost infected but can affect other internal organs
- Fungus is found in Southern parts of the US and South America
Signs and Symptoms of Histoplasmosis
- Similar to pneumonia or TB ( Cough, fever, chills)
- Anorexia, nausea, vomiting, generalized weakness, body aches, and joint pains
- Amphoterecin B ( Fungizon ) administration
- Meds: Tylenol, steroids, antiemetic
- Monitor BUN and Creatinine
Aspergillosis
- Caused by opportunistic fungal infection called aspegillus causing pulmonary infection when inhaled
- Aspergullius LIVES IN SOIL, AIR, and WATER
Aspergillosis Pt Teaching
Avoid cool and wet places and household dust
Aspergillosis
Symptoms/ Treatment/ Nursing considerations
- Fever, cough, chest pain, and hemoptysis
- Systemic Antifungal Fungizone
- Premedicate with Benadryl and Tylenol 30 min prior to the start of Amphotericin B IV treatment
Pneumonia
- An infection of the pulmonary (lung) tissue including interstitial spaces, the alveoli, and the bronchioles
- Caused by viruses bacteria, Protozoa, mycobacterium, mycoplasma, and rickettsia
Right middle lobe lung is the most common site of what ?
Aspiration pneumonia as the right main bronchus is shorter and wider ( easily catching foreign body or patient’s own secretions)
What type of isolation and PPE does pneumonia require
- DROPLET
- Surgical mask, gloves, and gown
How long can a surgical mask be worn ?
20-30 minutes (if greater), moisture will build up and make the mask ineffective against maintaining sterility
Data Collection for Pneumonia
- Fever
- Chills
- Headache
- Muscle pain
- SOB
- Non- productive cough to productive cough
- Use of accessory muscles for breathing
- Rhonchi and wheezes
- Mental status changes
- Sputum production
Diagnostic Tests for Pneumonia
- Chest x- ray
- Blood tests ( CBC and basic metabolic panel )
- Sputum culture and sensitivity
Diet for Pneumonia/ Interventions
- Admin O2
- Provide CPT
- Semi Fowler’s position
- Monitor/record color, consistency, and amount of sputum
- Provide a balance of rest and activity, increasing activity gradually
- High protein
- High calorie ( unless overweight )
- Increase fluid intake ( Avoid milk because it thickens secretions)
- Fluids ( up to 3 L) such as
Water
Cranberry
Pineapple
Grapefruit juice
If not contraindicated because it may help cut mucus
Pulmonary Edema
- ACCUMULATION OF EXTRAVASCULAR FLUID IN THE LUNG OFTEN CAUSED BY CHF (Fluid build up in alveoli, fluid leakage into lungs )
- FLUID BACK UP INTO PULMONARY VEINS when the heart’s pumping power on LEFT SIDE is weaker that normal
- May cause respiratory failure
Signs/Symptoms of Pulmonary Edema
- Dyspnea
- SOB
- Gasping for air
- Restlessness
- Anxiety Tachycardia
- Tachypnea
- Pink-tinged frothy phlegm
- Sweating
- Inspiratory and expiratory wheeze
- Neck vein distention ( RIGHT SIDE HF)
Diagnostic Test for Pulmonary Edema
- Chest radiograph
- Electrocardiogram
- CBC
- CMP ( comprehensive metabolic panel)
- Echocardiogram
Nursing Management for Pul Edema
M(orphine sulfate)
A(minophylline)
D(igitalis)
D(iuretics)
O(xygen)
G( ABG )
Monitor response to therapy
Why do you give morphine in Pulmonary edema ?
- Promotes venous pooling
- Reduces oxygen demand due to anxiety
- Conserves oxygen to the myocardium
- DO NOT GIVE TO STROKE PT WITH HEAD INJURY ( pupils constrict )
- COPD
- CARDIOGENIC SHOCK
- There is NO CONSTIPATION when taking for FIRST FEW DAYS
- MONITOR FOR RESPIRATORY DEPRESSION AND DROP IN BP
What does Aminophylline do for Pulmonary Edema ?
- May prevent bronchospasm associated with pulmonary congestion
- Relax bronchospasm when if wheezing
- SHOULD BE ATTACHED TO HEART MONITOR WHEN INFUSING THIS MED
- MONITOR FOR TACHYCARDIA AND DYSRHYTHMIAS
Why do you give Digoxin to Pulmonary edema ?
- It improves cardiac contractility increasing the output of left ventricle
- Hold if pulse is <60/min
- ASSESS FOR TOXICITY
What Diuretics do you give to pulmonary edema ?
- Lasix (furosemide) This causes vasodilation and peripheral venous pooling
- Bumex (bumetanide)
- Demadex (torsemide)
- Edercin (ethacrynic)
- Loop diuretics in acute pulmonary edema (given IV)
- Indwelling cath may be inserted in acute condition
- Upon discharge oral form is administered by LVN or RN
Causes for Pulmonary Edema
CARDIOGENIC
- Congestive Heart Failure
- Myocardial Infarction
- Abnormal Heart Valves
NONCARDIOGENIC
- Rapid infusion
- Fluids or blood ( TRALI ) transfusion-related acute lung injury
- cocaine
- smoking
- lung infection
- trauma
- severe infection
- ARDS
- kidney failure
Pleural Effusion
- Abnormal collection of fluid in the pleural space between the visceral and parietal pleura
- 5-15 ml to prevent friction if greater than 25ml it is considered effusion
- 300ml or more before becoming symptomatic
- Thoracentesis is performed for therapeutic and diagnostic test
Causes for pleural effusion
- CHF
- Pneumonia
- Pulmonary embolism
- Liver disease
- ESRD
- Cancer
- Nephrotic syndrome
Data Collection
- Pleuritic pain that increases with inspiration
- DYSPNEA
- DECREASED MOVEMENT OF CHEST WALL ON AFFECTED SIDE
- DRY NON- PRODUCTIVE COUGH CAUSED BY BRONCHIAL IRRITATION
- TACHYCARDIA
- INCREASE TEMP
- DECREASED BREATH SOUNDS ON AFFECTED SIDE
- CHEST X-RAY FILM SHOWS PLEURAL EFFUSION AND MEDIASTINAL SHIFT AWAY FROM FLUID IF EFFUSION GREATER THAN 250 mL
(Pleural Effusion) Pt. Teaching/Post procedure
- Explain
- POSITION SEMI- FOWLERS
- CHEST X-RAY REQUIRED BEFORE PROCEDURE
POST
- Monitor for signs of respiratory distress
- Obtain a chest X-Ray Film
Pleurectomy
- Surgically stripping the parietal pleura away from the visceral pleura
- Produces strong inflammatory reaction that promotes adhesion formation between the two layers during healing
Pleurodesis
- Involves the instillation of a sclerosing substance into the pleural space via thoracotomy tube
- Creates an inflammatory response that scleroses tissues together
Empyema
- COLLECTION OF PUS WITHIN PLERAL CAVITY
- THICK, OPAQUE, FOUL SMELLING
- Common cause is PULMONARY INFECTION and LUNG ABSCESS caused by thoracic surgery or chest trauma ( Bacteria introduced into pleural space)
Treatment ( Empyema)
- Focuses on treating the infection and emptying empyema cavity
- reexpanding the lung
- Controlling infection
Data Collection ( Empyema)
- Recent febrile illness or trauma
- CHEST PAIN
- COUGH
- DYSPNEA
- Anorexia weight loss
- Malaise
- Night sweats
- Pleural exudate on chest x- ray
Interventions ( Empyema)
- Monitor breath sounds
- SEMI- FOWLERS or HIGH
- Coughing/Deep breathing
- Antibiotics as prescribed
- Thoracentesis or chest tube insertion to promote drainage and lung expansion
Pulmonary Embolism
- OBSTRUCTION TO PULMONARY ARTERY BY BLOOD CLOT
- Blood is usually in the PERIPHERAL DEEP VEINS OF THE LEG
- Blood is DISINTEGRATE AND CIRCULATED TO THE LUNG CAUSING OBSTRUCTION
- Thrombus forms Detaches and travels to right side of heart and then lodges in branch of pulmonary artery
Risk Factors for Pulmonary Embolism
- PROLONGED INACTIVITY or BED REST
- CHF
- MI
- RECENT SURGERY
- LEG INJURY
- TRAUMA TO PELVIS
- MALIGNANT DISEASE
- CLIENT ON BC PILLS
- HYPERCOAGULABLE CONDITION
- OBESITY
- PREGNANCY
- HISTORY OF THROMBOEMBOLISM
- FAT EMBOLI AFTER LONG BONE FRACTURE
Signs/Symptoms ( Pulmonary Embolism)
- DYSPNEA
- TACHYPNEA/TACHYCARDIA
- SHORTNESS OF BREATH/ANXIETY
- HYPOTENSION
- HYPOXEMIA
- FEVER
- DECREASE Pa02 (partial pressure of 02 in ABG)
- INCREASE Pc02 ( partial pressure in carbon dioxide in blood)
- WEAKNESS/RESTLESSNESS
- ALTERED LOC
- CRACKLES/WHEEZES
- BLOOD TINGED SPUTUM
- DISTENDED NECK VEINS
- CYANOSIS
Diagnostic Tests for Pulmonary Embolism
- Chest X- Ray
- Lung Scan ( V/Q scan )
- ABG
- D-Dimer ( < 250)
- EKG
- Pulmonary angiogram
Treatments for Pulmonary Embolism
- OXYGEN THERAPY
- ANTICOAGULANTS (HEPARIN BOLUS AND DRIP)
- TRAP EASE VENA CAVA FILTER or GREENFIELD VENA CAVA FILTER for recurrent pulmonary embolism
Protime
10.6 - 12.9 seconds
INR
2.0 - 3.0 Prophylaxis/ Treatment venous thrombosis, Pulmonary embolism
On Heparin PTT or APTT
24 -37 seconds
Surgical intervention for blood clot
- Intraluminal
- Vena Cava Filter (Garfield or Trap- Ease filter
- Ligation
- Plication
- Clipping of vena cava and embolectomy
What is the therapeutic time for prothrombin ?
1.5 - 2 times
What does heparin do ?
It STOPS FURTHER THROMBUS FORMATION and EXTENDS the CLOTTING TIME of the blood
What is S T A I R and what does this stand for ?
Thrombolytics
Streptase (streptokinase)
T-pA (Tissue plasminogen activator) * Must be stored in refrigerator*
Abbokinase (urokinase)
Integrilin (eptifibatide)
Retavase (retaplase)
Nurse Alert* Administer initial intravenous bolus over 1 min, follow by prescribed drip. Monitor for any bleeding
DO NOT INSERT after Clot buster has been given
Foley Cath
NGT
Digital exam
Low- Molecular weight Heparin
Lovenox (Inoxaparine)
1mg/kg SubQ BID
Arixtra (fonduparanux)
SubQ ONCE DAILY
Other Blood Thinners (PET PAX)
Pradaxa (Dibigatron) - PREVENT STROKE & BLOOD CLOTS WITH A-FIB. NO NEED TO MONITOR INR
Eliquis (Apixaban) - PREVENT DVT
Ticlid (Ticlopidine)
Plavix (Clopidrogel)
Aggrenox (Dipyridamole/ASA)
Xarelto (Rivaroxaban)
Side Effects of Anticoagulants/Thrombolytics
- Bruising
- Hematoma
- Gum bleeding
- Epistaxis
- Hemoptysis or Hematemesis
- Back pain
- Stomach pain
- Increased abd girth
- Black Tarry stools
- Heavy periods
- Vaginal bleeding
- Internal Bleeding
- Decreased BP
- Altered Breathing
Risk Factors for DVT
- Venous Injury
Surgery Trauma
- Poor Blood Circulation
HF
Increased blood thickness
Small blood clots
Prolonged immobilization
Increased Blood Clotting
Anticlotting factor deficiencies
Autoimmune disorders
Certain cancers
Platelet disorders
Is VENOUS OCCLUSION RED or BLUE ?
RED
Arterial is ?
BLUE/COLD
Why is Venous more common to have clots ?
- Have Valves
- Can NOT FLOW BACK
- MOVE SLOW
When it is WARM, RED, and/or pain in leg is this Arterial or Venous ?
Venous
Majority of DVTs occurs in only one leg at a time. TRUE or FALSE
TRUE
Can DVT in the thigh cause symptoms in both the thigh and leg ?
Yes
What are the Diagnostic Tests for the Leg (DVT)
- Doppler Ultrasound
- Venogram
- Impedance Plethsmography (IPG)
How do you assess DVT ?
- PAIN & TENDERNESS IN CALF of affected extremity
- Pain ESPECIALLY ON DORSOFLEXION of FOOT also called HOMAN’S SIGN
- Extremity will appear larger than the other caused by edema
- Affected extremity will be WARM TO TOUCH
Warfarin interaction with Herbals ( Can Increase INR )
- Garlic
- Ginger
- Ginseng
- Ginkgo
- Guarana
- Chamomile
- St. John’s Wort
What decreases INR ?
- Antacids
- Barbiturates
- Corticosteroids
- Grapefruit/ grapefruit juice
- Oral contraceptives and estrogen
- Quinidine ( this is an antiarrhythmic drug)
- Rifampin (Antibiotic)
- Tamoxifen ( Treats breast cancer )
- Vitamin K rich foods
What are substances that can increase INR ?
- Alcohol
- Aspirin
- Cephalosporins (Antibiotic)
- Fluconazole (Anti-Fungal)
- GARLIC
- GINSENG
- GINGKO BILOBA
- GINGER
- GUARANA
- Heparin
- Macrolides (Antibiotics)
- Penicillins ( HIGH DOSE)
- Sulfa Compounds
- Thyroxin (Synthroid)
- Ticlopidine (Ticlid)
- Clopidrogel (Plavix)
How many days does it take before the therapeutic effect of warfarin is exhibited ? What should should you monitor ?
3-4 Days and monitor the INR
What are the safety precautions when administering heparin ?
- Convenient sites are the lower abd fat pad ( to avoid inadvertent intramuscular injection, injection near an incision and hematoma formation)
- Common location site is the fatty area anterior to either iliac crest
- AVOID INJ SITES WITHIN 2 IN. OF UMBELLICUS BECAUSE OF POSSIBILITY OF ENTERING A LARGER BLOOD VESSEL
- AVOID THIN LAYERS OF SKIN
- ALERT - Elderly begin to lose SubQ fat padding ( EXAMINE FOR SAFE SITES ON SKIN)
Is Heparin safe in pregnancy ?
YES
MNEUMONIC: COUMADIN
Contraindicated in lactating women, hemophilia, dyscrasias, active bleeding
Oral anticoagulant
Usual side effect is BLEEDING
Monitoring of PT/INR
AVOID GREEN LEAFY VEGGIES AND FRUITS WITH GREEN SKIN
DRUG ANTIDOTE IS VIT K
INSTITUTE BLEEDING PRECAUTIONS
NO TO MANUAL RAZOR
What is the antidote for Heparin overdose ?
Protamine Sulfate
How can Heparin be administered ?
SubQ, Bolus, IV Drip
Is aPTT obtained before initiation of Heparin ?
YES, Every 6 hours thereafter until stable, the daily
Pulmonary Hypertension
- Abnormally high blood pressure in the arteries of the lungs
- It makes the right side of the heart work harder than normal when blood is pumped through arteries in the lungs
What may cause Pulmonary Hypertension ?
- Autoimmune diseases that damage the lungs ( such as scleroderma and RA
- Birth defects of the heart
- PULMONARY EMBOLISM
- CHF
- HEART VALVE DISEASE
- HIV
- COPD
- Pulmonary fibrosis (scarring of lungs)
- Obstructive sleep apnea
Signs and symptoms of Pulmonary Hypertension
- SOB
- Light-headedness during activity is OFTEN FIRST SYMPTOM
- Palpitations may be present
- Over time, symptoms OCCUR with LIGHT ACTIVITY OR EVEN REST
Other symptoms: - Swelling of ankle and leg
- Cyanosis of lips or skin
- Chest pain ( Usually front of chest)
- Dizziness or fainting
- Fatigue
- Weakness
Patient Teaching for Pulmonary Hypertension
- QUIT SMOKING
- AVOID PREGNANCY
- AVOID HEAVY PHYSICAL ACTIVITIES AND LIFTING
- Avoid traveling in HIGH ALTITUDES
- Keep up to date with yearly flu and pneumococcal vaccines every 5 years
Treatments for Pulmonary Hypertension
- AmbrisenTAN( Letairis ); Prevents thickening of blood vessels ESPECIALLY THOSE IN LUNGS AND HEART, also LOWERS BP IN LUNGS
- BosenTAN (Tracleer)
- Calcium Channel Blockers AmlodiPINE (Norvasc), FelopiDINE (Plendil),
NicardiPINE (Verapamil) - Diuretics
- Prostacyclin or similar medicines ( Prostaglandin)
- Sildenafil (Viagra) or other erectile dysfunction medications
Sarcoidosis
- An IMMUNE DISORDER AFFECTING ANY ORGAN
- MAINLY LUNG CAUSING SCARING OF LUNG TISSUES
- Bacteria produce VIT D and this condition may suffer VIT D TOXICITY
What should you avoid in Sarcoidosis ?
- AVOID BEING IN SUN ALOT
- AVOID VIT D FORTIFIED MILK
Symptoms of Sarcoidosis
- Cough that does NOT go away
- Fever
- Weight loss
- reddish bumps or patches on the skin or under the skin
- Swollen painful joints
- Kidney stones
Systemic or topical steroids for 1 - 2 years or life long
Symptomatic Sarcoidosis
No Treatment Required
Asymptomatic
Obstructive Apnea
- WHEN MUSCLES AT THE BACK OF THROAT RELAX causing airways to NARROW or COLLAPSE
- Oxygen levels DECREASED during DEEPER SLEEP causing apnea
- CHOKING OR GAGGING
- Being overweight can cause sleep apnea
What are 3 non invasive breathing machines that deliver positive airway pressure support ?
- APAP (Automatic)
- BiPAP (BiLevel)
- CPAP (Continuous)
APAP
- A machine that automatically adjusts the amount of pressure into the airway on a breath-by-breath basis
- Allows least amount of pressure to keep the airway open while the user sleeps
- this machine “SENSES” the amount of pressure needed per breath
- Can also function as a CPAP machine with a preset pressure per breath
BiPAP
- Delivers TWO DIFFERENT PRESSURES
- INSPIRATORY & EXPIRATORY ARE DIFFERENT AS MACHINE ALTERNATES BETWEEN PRESSURES
- Able to provide DUAL PRESSURES INSPIRATORY AND EXPIRATORY
What are common side effects with the BiPAP machine ?
- THROAT/NASAL IRRITATION
- Skin lesion
- bloated stomach
- Ear discomfort can lead to hearing difficulties or disrupt ability to sleep at night
CPAP
- Allows airways pressure to REMAIN OPEN while the person is sleeping to prevent apneic episodes
- Most commonly used in to treat OBSTRUCTIVE APNEA
- DELIVERS CONSISTENT PRESET PRESSURE BASED ON MD’S PRESCRIPTION, AFTER SLEEP APNEA STUDY
What are common side effects of the CPAP machine ?
- Dizziness
- Nasal congestion
- Runny nose
- Worsening headache if with sinusitis and deviated septum
- Noisy and uncomfortable
Tuberculosis
- HIGH CONTAGIOUS
- ACUTE or CHRONIC disease caused by mycobacterium tuberculosis
- An aerobic bacterium that PRIMARILY AFFECTS PULMONARY SYSTEM
- ESPECIALLY HIGHER LOBES WHERE OXYGEN CONTENT IS
HIGHEST - Radiograph film shows pulmonary infiltrates
Can TB Effect other parts of the body ?
YES
- Brain
- Intestines
- Peritoneum
- Kidney
- Joints
- Liver
What type of transmission precaution is used for TB
- AIRBORNE BY DROPLET INFECTION
- When an infected individual coughs, sneezes, laughs, or sings TB ENTERS AIR, MAY BE INHALED BY OTHERS
How do you determine weather someone is infected with TB
X-RAY
Disease progression (TB)
- DROPLETS ENTER THE LUNGS, BACTERIA FORMS TUBERCLE LESION
- Defense system encapsulate the tubercle, leaving a scar
- If no encapsulation, bacteria may ENTER LYMPH NODES and CAUSE INFLAMMATORY RESPONSE (Granulomatous inflammation)
- IF ACTIVE PHASE, TB can cause necrosis and cavitation in the lesions, leading to rupture, the spread of necrotic tissue, and damage to various parts of the body
Client History (TB)
- Past Exposure to TB
- CLIENT’S COUNTRY OF ORIGIN AND TRAVEL TO FOREIGN COUNTRIES IN WHICH INCIDENCE OF TB IS HIGH
- RECENT HISTORY OF FLU, PNEUMONIA, FEBRILE ILLNESS, COUGH, OR FOUL-SMELLING SPUTUM PRODUCTION
- PREVIOUS (+) TESTS FOR TB
- RECENY BACILLE CALMETTE-GUERIN VACCINE, THIS IS GIVEN TO PEOPLE IN FOREIGN COUNTRIES TO PRODUCE RESISTANCE TO TB
If an individual who has received a bacilli Calmette Guerin vaccine what will their skin test result be ?
- POSITIVE
- INDIVIDUAL WILL NEED A CHEST X-RAY
When do individuals with TB begin to feel symptoms ?
Individuals will not feel symptoms until disease is well advanced
Signs/Symptoms of TB
- Fatigue/Lethargy
- Weight loss
- Anorexia
- After rise of fever
- Cough
- Night sweats
- Hemoptysis (Bloody Sputum)
- Low- Grade Fever
- PERSISTENT COUGH AND PRODUCTION OF MUCOID AND MUCOPURULENT SPUTUM ( BLOOD STREAKED SPUTUM)
- CHEST TIGHTNESS
- DULL, ACHING CHEST PAIN THAT MAY ACCOMPANY COUGH
Does a physical exam of the chest provide conclusive evidence of TB ?
NO
Does a chest X-RAY provide a definitive presence of TB ?
NO, But the presence of multinodular infiltrates with calcification in the upper lobes suggests TB
If the disease is active, what may be seen on the chest x-ray ?
Caseation and inflammation
How can you determine weather TB disease is in the advanced stage ?
- Bronchial breath sounds
- Dullness with percussion over involved parenchymal areas
- RHONCHI
- CRACKLES (ADVANCED)
- Partial obstruction of a bronchus caused by endobronchial disease or compression by lymph nodes maybe produce localized wheezing and dyspnea
Isolation Precaution
-AIRBORNE ( once inhaled, the TB bacilli will begin to multiply in 18-24 hrs)
What PPE is used for TB ?
- N-95 or called particulate mask
What is HEPA Filtration ?
- High- Efficiency Particulate
- Negative Air Flow (NAF) room >12 of air changes per hour (ACH)
- Usually 6-12 air exchange every hour
Diagnostic Test for TB
- Mantoux Test (PPD); A standard Tests for TB
- Tine Test
- QuantiFERON- TB Gold test
- Sputum cultures
Explain what is done in a Mantoux Test (PPD)
- Administer 0.1 of 5 units tuberculin units PPD INTRADERMALLY
- REACTIVE OR RAISED SKIN RAISED SKIN GREATER THAN 10mm AFTER (48-72 hrs) MEANS STRONG INDICATION OF TB
- Looking for thickness and hardening of tissues ( NOT ERYTHEMA)
What gauge needle is used for a PPD, what degree of angle, and how many inches ?
- 26 60 27 gauge needle is used
- 5 - 15 Degree angle INTRADERMAL
- 1/4 - 1/2- inch needle with BEVEL UP
Is redness without induration considered negative for a PPD test ?
YES
How many mm of induration is considered POSITIVE in people with HIV, RECENT CONTACT WITH ACTIVE TB, ORGAN TRANSPLANTED, and IMMUNOCOMPROMISE ?
5mm or greater is CONSIDERED POSITIVE
How many mm of induration is CONSIDERED POSITIVE for IV DRUG USERS, SUBSTANCE ABUSE, ALCOHOL, LEUKEMIA ?
10mm or more
How many mm of induration is considered POSITIVE REGARDLESS OF MEDICAL CONDITION ?
15mm or more is POSITIVE
If no induration, how will you record it ?
0mm
DO NOT RECORD AS “POSITIVE or “NEGATIVE”
ONLY RECORD MEASUREMENT IN MM
Can anyone have a TB Test ?
YES CAN BE GIVEN TO - Infants - Pregnant women - HIV Infected people with no potential problem
How many months to treat uncomplicated TB ? And what kind of drugs are used ?
- 2 Months
- Using BACTERIAL DRUGS such as:
ISONIAZID
ETHAMBUTOL
RIFAMPIN
PYRAZINAMIDE
How many times are Sputum smears done ?
- EVERY 2 WEEKS until NEGATIVE
- DOES NOT become NEGATIVE IN 3-5 months
Tine Test
- MULTIPLE PUNCTURE TEST
- USED FOR SCREENING ONLY to detect if someone is infected
Is a small reaction (5mm of firm swelling at site) considered to be positive ?
- YES
- POSITIVE IN PEOPLE WHO ARE HIGH RISK WITH:
HIV
RECEIVED AN ORGAN TRANSPLANT
SUPPRESSED IMMUNE SYSTEM
TAKING STEROID THERAPY ( about 15 mg of prednisone per day for 1 month)
CLOSE CONTACT WITH PERSON WHO HAS ACTIVE TB
CHANGES ON X-RAY THAT LOOK LIKE PAST TB
10mm or greater is considered positive in ?
- Known NEGATIVE TEST IN THE PAST 2 YEARS
- Diabetes
- Kidney failure
- Or other conditions that increase their chance of getting active TB
- Health care workers
- Injection drug users
- IMMIGRANTS who moved from a country (Latin America, Asia, Africa) with HIGH TB RATE in the PAST 5 YEARS
- Students/Employees working in certain group living settings
PRISONS
NURSING HOMES
HOMELESS SHELTERS - Children younger that 4 years ( Infants, children, adolescents exposed to adults in high risk categories
15mm or greater is considered positive in ?
- ANY PERSON
- PERSONS WITH NO KNOWN FACTORS FOR TB
What are standard precautions when transporting patient with TB?
- Patient MUST WEAR A MASK ( DROPLET OR AIRBORNE)
PRECAUTION FOR AIRBORNE( DOORS ) for TB
- Doors CLOSED AT ALL TIMES
- May COHORT WITH SAME MICROORGANISM
PRECAUTION FOR DROPLET (DOORS) for TB
- Door MAY REMAIN OPEN
- SPACE BETWEEN PTs , Visitors, and staff
- 3 FT or GREATER
Latent TB Infection
- A condition in which TB BACTERIA ARE ALIVE, BUT INACTIVE IN THE BODY
- NO SYMPTOMS
- DON’T FEEL SICK
- CAN’T SPREAD TB TO OTHERS
- USUALLY HAVE POSITIVE TB TEST
- MAY DEVELOP TB IF NO TREATMENT IS GIVEN FOR TB INFECTION
PATIENT TEACHING FOR LTBI
- After taking medicine for about (2-3 WEEKS), you may NO LONGER BE ABLE TO SPREAD TB BACTERIA TO OTHERS
- BE ABLE TO GO BACK TO DAILY ROUTINE
- MAY RETURN TO WORK or SCHOOL
QuantiFERON- TB TEST (QFT)
- QFT MEASURES IMMUNE REACTIVITY TO MYCOBACTERIUM TB ( Bacterium that causes TB)
- WHOLE BLOOD TEST for DIAGNOSING LTBI
- If NOT DETECTED and TREATED, LTBI may later DEVELOP into TB DISEASE
AIRBORNE PRECAUTIONS
- KEEP DOOR CLOSED AT ALL TIMES
- NEGATIVE AIRFLOW ROOM (NAF)
- Airborne Infection Isolation Room (AIIR)
- MAY COHORT ( SAME MICROORGANISM )
- Transport ONLY WHEN NECESSARY
- PLACE MASK WHEN TRANSPORTING
Also for Measles
TB
Varicella (CHICKEN POX) until lesions are crusted
DROPLET PRECAUTIONS
- PRIVATE ROOM
- CLOSE ASAP
- May COHORT SAME MICROORGANISM
- WEAR MASK WITHIN 5Ft of client
- APPLY MASK WHEN TRANSPORTING
- SPATIAL BETWEEN CLIENTS, VISITORS, STAFF
3Ft or greater
Sputum Cultures
- SPUTUM SPECIMENS ARE OBTAINED FOR AN ACID FAST SMEAR
- SPUTUM CULTURE IDENTIFYING TB (CONFIRMS) THE DIAGNOSIS!
- AFTER MEDS ARE STARTED SPUTUM SAMPLES ARE TAKEN AGAIN TO DETERMINE EFFECTIVENESS OF THERAPY
- Most clients have NEGATIVE CULTURES AFTER (3 Months)
