respiratory fx ppt 9 Flashcards
pneumonia
inflammation of lung parenchyma
CAP
community acquired pneumonia
occurs in community setting or WITHIN 48 hours after hospitalization
rate increases with age
HCAP
healthcare associated pneumonia
multi-drug resistant
occurs in non-hospitalized pt with extensive healthcare contact (SNF, chemo, dialysis, wound care)
HAP
hospital acquired pneumonia
develops 48+ hrs after admission
high mortality rate (33%)
immunocompromised at risk
VAP
ventilator associated pneumonia a type of HAP r/t endotracheal intubation; increases with duration of mech. ventilation under 96 hrs = antibiotic sensitive over 96 hrs = MDR bacteria
S. pneumoniae
most common cause of CAP in pts under 60 w/o comorbidities pts over 60 with comorbidities upper respiratory tract gram positive organism
H. influenzae
CAP that frequently affects older adults and pts with comorbidities
cough or low-grade fever may be present for weeks before diagnosis
COPD!!!!
M. pneumonia
mycoplasma pneumonia
CAP spread by DROPLET
affects respiratory tract, including bronchioles
earache and bullous myringitis are common
risk factors for pneumonia
CHF DM alcoholism COPD AIDS influenza CF
s/s streptococcal pneumonia
sudden onset chills fever pleuritic pain tachypnea resp distress
s/s viral, mycoplasma, legionella
bradycardia
general s/s pneumonia
resp tract infection headache fever pleuritic pain, myalgia rash pharyngitis
diagnostics
chest xray
blood culture
sputum culture
bronchoscopy
pneumococcal vaccincation
reduces incidence of pneumonia
reduces cardiac hospitalizations
reduces deaths among elderly
nursing assessment
vitals (tachypnea?) secretions cough inspect/auscultate chest mental status changes
aspiration pneumonia
inhalation of foreign material into lungs
serious complication of pneumonia
aspiration pneumonia s/s
tachycardia
dyspnea
central cyanosis
HTN or hypotension
aspiration pneumonia risk factors
seizure, brain injury, decreased LOC
stroke, cardiac arrest
flat position
swallowing disorders
prevent aspiration by:
elevate head of bed 30-45 deg use sedatives sparingly check feeding tube placement assess for GI residuals <150 mL obtain swallowing evaluation prior to feeding
COPD
progressive disease of airflow obstruction
preventable, treatable, irreversible
COPD pathophysiology
airflow limitation
changes/narrowing in airways 2/2 chronic inflammation
ongoing injury/tissue repair process causes scar tissue formation and narrowing of airways
chronic bronchitis
cough and sputum production for at least 3 months in each of 2 consecutive years
ciliary fxn reduced
alveoli become damaged
pt more susceptible to resp dysfunction
emphysema
abnormal distention of air spaces beyond terminal bronchioles
destroys walls of alveoli, decreasing surface area
hypoxemia leading to pulm HTN
right sided HF
COPD risk factors
smoking secondhand smoke prolonged occupational exposure age deficiency of alpha1-antitrypsin
COPD s/s
chronic cough
sputum production
dyspnea
barrel chest
COPD assessment
pulmonary fxn test
spirometry
ABGs
chest x ray
COPD complications
respiratory insufficiency/failure
pneumonia
chronic atelectasis
pneumothoriax
COPD medical mgmt
promote smoking cessation reduce risks, manage exacerbations provide O2 pneumococcal vaccine influenza vaccine
COPD surgical mgmt
bullectomy - remove bullae, reduce dyspnea, improve lung fxn
lung volume reduction - palliative; remove portion of diseased lung tissue
COPD medications
bronchodilators corticosteroids antibiotics mucolytics antitussive
COPD nursing mgmt
achieve airway clearance
improve breathing pattern
improve activity tolerance
pleural effusion
fluid collection in pleural space
2/2 HF, TB, pneumonia
s/s pleural effusion
fever, chills
pleuritic pain
dyspnea, coughing
difficulty laying flat
pleural effusion assessment
decreased/absent breath sounds
decreased fremitus
dull percussion
trachial deviation away from affected side
pleural effusion diagnosis
chest x ray/chest CT
thoracentesis
pleural biopsy
pleural effusion medical mgmt
thoracentesis
chest tube placed
pleural effusion nursing mgmt
monitor I&O
pain mgmt
positioning
