Respiratory Disorders Flashcards
Legionnaires Disease
- Legionella Pneumophila
- Gram Negative
- Has extrapulmonary manifestations
- Transmission is droplets via mist
- Incubation 2-10 days
- Diagnose with PCR, urinary antigen, patchy unilobar infiltrates
Acute Bacterial Pneumonia
- Streptococcus Pneumoniae
- resides in respiratory tract of 70% of people
- Transmission via respiratory droplets or aspiration
- incubation 24-48 hours
Septic Pneumonia Manifestations
- Increase WBC
- Increase procalcitonin
- acidosis
- (+) blood culture
- abnormal kidney/liver function
Pneumonia Interventions
- Antibiotic, antifungal, antiviral
- Bronchodilators
- mucolytics, expectorants
- IV fluids
- O2
- diet high in protein, rest
- chest physiotherapy
Aspiration Pneumonia
- Caught through aspiration
- predisposing factors: neurological disorder, upper GI disorder, mechanical disruption
Pneumocytosis Jiroveci Pneumoniae
-Opportunistic
-airborne transmission
-incubation up to 197 days
-diagnosed with:
diffuse, bilateral, interstitial infiltrates
tinctorial staining
fluorescent antibody
PCR
Viral Pneumonia
- airborne transmission
- responsible for 10% of cases
- incubation 2-5 days
- organisms: RSV, flu, adenovirus, measles, covid
Primary Atypical Pneumonia
- Mycoplasma pneumoniae
- gram negative
- manifestation: URI, acute bronchitis, CAP
- transmission: respiratory droplets
- incubation 2-3 weeks
- diagnosis: hemolysis main, patchy opacities, streaks of interstitial infiltrates, areas of atelectasis
Pneumonia Manifestations
Neuro: headache, mood swings, confusion
Respiratory: dyspnea, cough, crackles, sputum, hemoptysis, hypoxia
Cardiovascular: pleuritic pain, tachycardia
Integumentary: fever, chills, fatigue, malaise
gastro: loss of appetite, nausea, vomiting
Pneumonia Classifications
- Community Acquired: streptococcus pneumoniae, influenza
- Healthcare Associated: ventilator associated, pseudomonas aeruginosa, escherichia coli
- Opportunistic: pneumocystis jiroveci, mycobacterium tuberculosis
Pneumonia Pathophysiology
Affects the parenchyma, caused by aspiration of microorganisms thru nasopharynx, they get trapped in cilia and lead to alveolar edema –> dyspnea, hypoxemia
TB Treatment Lengths
Latent: 1 to 2 antibiotics for 12-16 weeks
Active: 3 to 4 antibiotics for 18-31 weeks
TB Pharmacological Treatments
Isoniazid -used for prophylaxis, 1st line treatment -peripheral neuropathy is the # 1 side effect due to B6 deficiency Rifampin -Combination drug -red/orange body fluids is a symptom Ethambutol -treatment of active TB in combination -Optic neuritis is as symptom Pyrazinamide -hepatoxicity
TB isolation precaustions
Airborne isolation precautions
Can be removed if: clinical improvement, on meds minimum of 2 weeks, 3 consecutive negative AFB smears
TB Sputum Tests
Sputum Smear -read in 24 hours -(+) acid fast bacteria -need 3 specimens, 8-24 hours apart Sputum Culture -gold standard -growth of tubercle bacilli -confirms TB diagnosis
TB Blood Tests
IGRA -for people who had BCG -Can't be followed up QuantiFERON TB gold T-spot TB test
TB Skin Test
TST, PPD Test, Mantoux test
- intradermal
- read within 2-3 days
- negative TB test means TB is unlikely
- must have a 2nd test if positive
TB Manifestations
- chest pain
- weight loss
- chills
- long-term cough
- fever
- fatigue
- night sweats
- no appetite
- cough up blood
TB Pathophysiology
TB inhaled thru airborne droplets, they multiply in the alveoli, macrophages and T-Lymphocytes form granulomas, some TB is released when macrophages die and spread in blood
CPAP vs BiPAP
CPAP
-continuous pressure on inhale
BiPAP
-Pressure during inhale and exhale
OSA risk factor reduction
- Weight loss
- Smoking Cessation
- Avoid supine position when sleeping
- Limit alcohol
- CPAP and BiPAP
OSA Diagnostic Criteria
STOP & BANG test more than 5 checked recommend for a sleep study
Polysomnography
OSA Manifestations
- Snoring
- AM headache
- Excessive daytime sleepiness
- mood change
- difficulty concentrating
- waking with chest pain/dry mouth
OSA pathopysiology
While awake small airway and neuromuscular compensation, at sleep onset you loose neuromuscular compensation and decreased pharyngeal muscle activity and the airway collapses. Apnea occurs leading to hypoxia and hypercapnia and increased ventilary effort. This leads to arousal, and airway is restored, and hyperventilation occurs
Metabolic Alkalosis Causes
- Over use of antacids
- Diuretic therapy
- Loss of acid via GI tract
Metabolic Acidosis Causes
- Diabetic ketoacidosis
- hyperchloremic acidosis
- kidney disease
- lactic acidosis
- salicylate (aspirin) poisoning
- dehydration
- starvation
Respiratory alkalosis causes
- hyperventilation
- stimulation of respiratory center through sepsis, brain injury, or aspirin overdose
Respiratory Acidosis Causes
- airway obstruction
- depression of respiratory center
- chronic respiratory problems
metabolic alkalosis nursing interventions
- -monitor vitals
- assess neurological level
- monitor ABGs
- administer IV and electrolytes (NaCl)
Metabolic Alkalosis Symptoms
Respiratory: slow, shallow breathing Neurological: irritability, disorientation, belligerence Cardiovascular: dysrhythmia Neurological: tingling, cramps, tetany Gastro: anorexia, nausea, vomiting
metabolic acidosis nursing interventions
- monitor vitals
- monitor neurological status
- position pt. to facilitate breathing
- admin O2 to correct lactic acidosis
- monitor ABGs
- monitor HCO3 and K+
- administer IV (lactated ringers)
- admin NaHCO3 caustiously
- high carb, low fat diet
- cardiac monitoring
metabolic acidosis symptoms
respiratory: kassmaul breathing, fruity breath
neurological: headache, lethargy, confusion, coma
cardiovascular: arrythmia, hypotension
neurological: tingling and numbness
gastro: abdominal pain, anorexia, nausea, vomiting
increased blood K+
Respiratory Alkalosis Nursing Interventions
- have pt. breathe slow and less deeply
- monitory vitals
- monitor ABGs
- monitor serum potassium
- administer sedatives caustiously
- reinforce pt. teachings like antianxiety
decreased K+ outside cell
Respiratory Alkalosis Symptoms
respiratory: periods of apnea and hyperventilation
neurological: light headedness, confusion, lethargy
cardiovascular: tachycardia, arrythmia
neurological: tingling, hyperreflexia, tetany, seizure
gastro: epigastric pain, nausea, vomiting
Respiratory Acidosis Nursing Interventions
- maintain patent airway
- admin O2 cautiously
- monitor vitals
- monitor serum potassium
- administer sedatives cautiously
- reinforce pt. teachings
Respiratory Acidosis Symptoms
Respiratory: rapid and shallow breathing that leads to shallow and depressed
Neurological: dizziness, disoriented, headache, coma, muscle twitches, seizures
Cardiovascular: arrythmia, hypotension
increased K+ in blood
Uncompensated vs. partially compensated vs. fully compensated
Uncompensated: pH abnormal, either HCO3 or CO2 normal, either HCO3 or CO2 abnormal
Partially Compensated: pH abnormal, both CO2 and HCO3 abnormal
Full Compensation: pH normal, both CO2 and HCO3 abnormal
Lungs role in maintaining acid/base
-alternate rate and depth of breathing to eliminate CO2 during acidosis and retain CO2 during alkalosis
Kidney’s role in maintaining acid/base
excrete H+ in acidosis
absorb HCO3 in acidosis
conserve H+ in alkalosis
eliminate HCO3 in alkalosis
Thoracentesis
removes fluid/air from around lungs
tests for infection/cancer
Thoracotomy Incisions
Posterolateral -gold standard for thorax access Anterolateral -can be used for cardiac Axillary -quicker recovery -less muscles damage, less pain
Thoracotomy
surgical opening to gain access into pleural space, most painful manage pain with PCEA or PCA
Pleural Disorder Symptoms
- chest pain
- diminished/absent breath sounds
- asymmetrical chest wall movement
- cough
- fever
- SOB
- cyanosis
COPD non-pharmacological therapy
- pursed lip breathing
- increase fluid intake
- small frequent meals
- percussion/postural drainage
- smoking cessation
COPD Pharmacotherapy
- short an long acting beta 2 agonist
- corticosteriods
- anticholinergics
- mucolytic/expectorant
- broad spectrum antibiotic
- O2 therapy
COPD diagnostic findings
- ABG - respiratory acidosis
- CBC - Increased RBC
- decreased FEV1
- decreased FVC
- increased RV
- increased airway resistance
diagnosed as FEV1/FVC ratio of less than 70% in addition to manifestations
COPD risk factors
- smoking
- lung irritants
- family history with AATD gene
- history of childhood respiratory infections
Bronchitis Symptoms
- productive cough
- cough that lasts longer than 3 months
- fatigue
- dyspnea
- cyanosis
- rhonci
Bronchitis pathopysiology
loss of cilia leads to hypertrophy/hyper secretion in goblet cells/mucous glands. Chronic inflammation occurs and obstructs airflow
Emphysema Symptoms
- Wheezing
- Cough
- use of accessory muscles
- increased respiratory rate with prolonged expiratory phase
- anorexia/weight loss
- wheezing
Emphysema pathophysiology
hyperinflation of lungs, respiratory acidosis
breakdown of elastin in lung tissue leads to increased size of airspace. Increase of alveolar space causes loss of elastic recoil, air trapping, and imbalance of lung proteases. Diffuse airway narrowing.
