Respiratory Disorders Flashcards
Client with pneumonia
Infectious:
- Bacteria, viruses, fungi, protozoa, other microbes
Noninfectious:
- Aspiration of gastric contents, inhalation of toxic or irritating gases
Community- acquired:
- Streptococcus pneumoniae most common
Nosocomial (hospital acquired):
- Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginaosa, E. Coli
Opportunistic:
- Pneumocystitis carinii in immunocompromised persons
Collaborative Care:
Prevention if key component, especially with vulnerable populations
Immunization
Pneumococcal vaccine: antigens from 23 types of pneumococcus, imparts life-long immunity
Influenza vaccine: recommended for high-risk populations
Medications
Antibiotics: initially according to gram stain, pattern of lung involvement, then according to C&S results
Bronchodilators: improve ventilation, reduce hypoxia
Sympathomimetics: albuterol, metaproterenol
Methylxanthines: theophylline, aminophylline
Expectorants: Acetylcysteine (Mucomyst) as inhalation; guaifenesin
Respiratory Treatments
Incentive spirometry, suctioning
Oxygen: according to clients needs: range form cannula to intubation and mechanical ventilation
Chest Physiotherapy
Percussion: rhythmic clapping on chest wall to reduce lung consolidation, prevent atelectasis
Vibration: application of pressure with repeated tensing of hand over involved areas to facilitate movement of secretions into larger airways
Postural Drainage: positioning client to facilitate drainage of secretions from lung segment
Complementary Therapies
Herbs: echinacea, goldenseal, ma huang
Nursing Care/ Health Promotion
Vaccinations against pneumonia Preventive measures in high risk groups - Increase mobility - Good hydration, nutrition - Prompt detection and prompt treatment of pneumonia
Nursing Diagnoses
Ineffective airway clearance
Ineffective breathing pattern
Activity intolerance
Home Care
Usually treated in community unless respiratory status compromised
Preventive measures
Recognition of manifestations
Supportive care to maintain clients health
Completion of any antibiotic therapy
Continue with medical appointments for follow-up
TB: Collaborative Care
Significant public health threat with development of drug-resistance strains; focus includes:
- Early detection
- Accurate diagnosis
- Effective disease treatment
- Prevention of spread of TB
Non-compliance with prescribed treatment is a major problem
TB: Treatment
Treatment usually lasts for many months and sometimes years
Successful treatment of TB:
- Depends on the compliance of the patient
- The failure of the patient to take the medications as prescribed is the most important cause of failure to cure TB
- Health department can demand direct monitoring of patient compliance with therapy
TB: Medications
Isoniazid (INH) antibiotic to prevent TB form becoming active
Rifampin (RMP) used for active TB
Pyrazinamide (PZA) used for active TB
Ethambutol (EMB) used for active TB
TB: Medications Prevention and Treatment
Prophylactic treatment to prevent active TB
- Clients with positive TB skin test
- Close contact of persons with positive sputum
6-12 months of Isoniazid orally (300 mg)
Bacilli Calmette -Guerin (BCG) vaccine given to infants
Toronto researchers (October 2013) developed a booster that will reactivate immunity (still in trials)
TB: Treatment
Treatment for active disease uses 2 or more medications to prevent TB organism from mutating into drug-resistant forms
- Initial regimen is 2 months daily treatment with INH, Rifampin, Pyrazinamide, Ethambutol to kill any resistant strains
- 4 more months (or depending on compliance) of two meds depending on C&S
May use Streptomycin if compliance is an issue as it is an injection
TB
Baseline testing prior to antituberculosis drug therapy
- Liver function tests before Isoniazid (INH)
- Vision examination before ethambutol
- Audiometric testing before streptomycin therapy
TB
Twice weekly therapy administered under direct supervision of public health personnel if non compliant
Effectiveness of therapy assessed by repeat sputum specimens and chest x-rays
TB
With adherence to treatment
- negative sputum specimens within 3 months; relapse rate with current treatment is
Nursing Care TB: Assessment
Risk for infection - Negative flow room - HEPA-filtered respirator - Respiratory isolation Deficient knowledge Ineffective therapeutic regimen management
TB: Continuing Care
Teaching to reduce spread
Regular screening of high-risk individuals
Medication Administration
COPD: Collaborative Care
Smoking abstinence is key to prevention and slowing progression
Treatment focuses on symptom relief, minimizing obstruction, slowing disability
COPD: Treatment
Medications Oxygen Smoking cessation Fluid and nutritional support Airway clearance procedures Breathing exercises Lung transplant or lung reduction surgery
COPD: Medications
Immunization against pneumococcal pneumonia
Antibiotics for infection
Bronchodilators: improve airflow and reduce air-trapping (Adrenergic stimulants, anticholinergics, methylxanthine)
Corticosteroids if asthma component of COPD
Alphal - antitrypsin replacement therapy, if emphysema due to genetic defect; given IV on weekly basis
COPD: Treatment
Remain inside during times of significant air pollution; air filters and air conditioning
Pulmonary hygiene measures:
- Hydration
- Effective cough: “huffing” between relaxed breathing
- Percussion and postural drainage
Avoiding cough suppressants and sedations
Regular exercise program:
- Improve tolerance
- Improve ability for ADLs
- Prevent physical deterioration
Breathing exercises to slow respiratory rate and relieve accessory muscle fatigue
- Pursed lip breathing
- Abdominal breathing
COPD: Oxygen
Long term therapy used for severe, progressive hypoxemia
Intermittent or continuous, only at night
If oxygen administered without intubation and mechanical ventilation, be cautious
- Clients have chronic elevated carbon dioxide levels and do not respond to that as a stimulus to breath
- Client only responds to low levels of oxygen as stimulus to breathe; giving high flow rates of oxygen will reduce stimulus to breathe
COPD: Surgery/ Complementary Therapies
Surgery Lung transplantation may be only option if medical therapy not effective Complementary therapies: - Limit salt and dairy intake - Use of herbal teas - Acupuncture
Stop or never start smoking
COPD: Nursing Care
Assessment of airway Ineffective airway clearance Imbalanced nutrition: less than body requirements Ineffective coping Decisional conflict: smoking
COPD: Nursing Diagnoses
Ineffective Airway Clearance: prepare for intubation and mechanical ventilation, if client status is deteriorating
Imbalanced nutrition: Less than body requirements
- Diet high in protein and fats without excess carbohydrates to minimize carbon dioxide
- Specific oral supplements
Compromised family coping
Decisional conflict: Smoking
COPD: Home Care
Education focuses on:
- Effective coughing and breathing techniques
- Preventing exacerbations
- Managing prescribed therapies
COPD: Continuing Care
Effective coughing and breathing exercises
Nutrition and fluid intake
Exercise and activity
Avoid crowds and infection exposure risks
Stress reduction
Recognition of symptoms
Medication administration
SELF DIRECTED
Epiglottis
Croup
RSV - Respiratory syncytial virus
Asthma
Chronic inflammatory disorder Recurrent episodes of: - Wheezing - Breathlessness - Chest tightness - Coughing Common in children and adults
Asthma: Treatment
Treatment goals are to control symptoms, prevent acute attacks - Teaching PEFR monitoring Medications - Anti-inflammatory agents - Rapid and long-acting bronchodilators - Leukotriene modifiers - Anticholinergic drugs Complimentary therapy Prevention
Client with Asthma: Disease Monitoring
Peak expiratory flow rate (PEFR) Used on day to day basis Evaluates: - Severity of bronchial hyperresponsiveness - Severity of airway obstruction
Client with Asthma: Preventive Measures
Avoidance of allergens and triggers
- Modification of home environment (eliminate dust, install air filters)
- Removal of pets
- Eliminate all tobacco smoke
- Wear mask during exercise in cold weather
- Early treatment of respiratory infections
Asthma: Medications
Anti-inflammatory agents - Corticosteroids: block late response to inhaled allergens, reduce bronchial hyperresponsiveness - Inhaled or systemic Non-Steroidal Anti-inflammatory Agents - Inhibit release of mediator substance - Cromolyn sodium, nedocromil
Asthma: Medications (Bronchodilators)
Adrenergic Stimulants
- Relax smooth muscle and bronchodilation
- Oral or inhaled (metered dose inhaler); albuterol
Methylxanthines
- Theophylline (oral), aminophylline (IV)
- Serum theophylline levels: Therapeutic 10-20 ug/mL
Anticholinergic Agents
- Ipatropium bromide (metered dose inhaler)
Leukotriene modifiers
- Reduce inflammatory response in asthma
- Oral medications: zafirlukast, zileuton
Asthma: Complementary Therapies
Herbal Biofeedback Yoga Breathing techniques Acupuncture Homeopathy Massage
Asthma: Nursing Diagnoses
Ineffective airway clearance
Ineffective breathing patterns
Anxiety
Therapeutic Regimen Management
Asthma: Home Care
Educate Client to:
- Promote good health
- Manage acute episodes
- Eliminate triggers
- Use PEF meter
- Followed prescribed medications
Asthma: Nursing Care
Assessment of airway Ineffective airway clearance Fatigue Anxiety Ineffective Therapeutic Regimen Management
Cystic Fibrosis: Medications
Dornase alfa enzyme to liquefy secretions
Immunizations against respiratory infections, influenza vaccine
Medications to reduce inflammation and treat infection
- Bronchodilators
- Antibiotics
CF: Nursing Care
Similar to care of other clients with COPD
DB&C exercises
Percussion
CF: Nursing Diagnoses
Ineffective airway clearance
Imbalanced nutrition: less than body requirements
Interrupted family process
CF: Home Care
Extensive education and support for client and family in maintaining pulmonary function
