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exam II A&C > respiratory infections > Flashcards

respiratory infections Flashcards

1
Q

Defense mechanisms
Filtration of air
Warming and humidification
Nose ____ impurities (Nasal mucosa traps most organisms in inhaled air. Air is moistened, warmed

A

filters

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2
Q

Paranasal sinuses are 4 pairs of bony cavities lined with nasal mucosa connected to ducts that drain into nasal cavity.
Common site of ______

A

infection

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3
Q

_____ serves as the passage between the larynx and the right and left main stem bronchi.

A

Trachea (windpipe)

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4
Q

______ are where gas exchange happens.. In ______ there is inflammation and mucous in the alveoli. Mucous decreases ability for gas exchange.

A

alveoli, pneumonia

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5
Q

The lower respiratory tract- ______
Right lung has upper, middle and lower lung
Left Lung has upper and lower

A

lungs

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6
Q

The lungs and pleural wall are lined with a membrane called the pleura. There is pleural _____ between the membranes that lubricates the thorax and lungs and permit smooth motion of the lungs during inspiration and expiration.

A

fluid

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7
Q

Bronchi and bronchioles are lines with cells that have __________ that move the mucous and foreign substances away from the lungs nad toward the larynx.

A

mucous and cilia

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8
Q

Determined by the size of airway, lung volumes, and airflow velocity
Increased resistance requires greater effort to move air
Causes:- contraction of bronchial smooth muscles- asthma
Thickening of bronchial smooth muscles- chronic bronchitis

A

airway resistance

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9
Q

Gradual decline in respiratory function
Alveoli have less available surface area available for exchange of 02 and carbon dioxide
Then alveoli begin to lose elasticity
Decreased ability to move air in and out of lungs

A

Gerontologic changes

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10
Q

Increased risk of infection
Increased risk of aspiration
Decreased exercise capacity

A

Gerontologic changes

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11
Q
  • assess for appropriate oxygenation and adequate removal of carbon dioxide- arterial puncture of (usually) radial artery
A

ABG

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12
Q
  • monitor for subtle or sudden changes in oxygen saturation Values normal values 95-100% (except for ______ patients)
A

Pulse oximetry, COPD

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13
Q

may be performed to check for pathogens responsible for illness (sputum, maybe blood)

All cultures should be performed ______ to antibiotic therapy
Results 48-72 hours, preliminary results within 24 hours

A

Cultures, prior

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14
Q
  • anemia, abnormal hemoglobin, high carbon monoxide, dark skin, wearing nail polish
A

Inaccurate reading OF PULSE OX

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15
Q

Cultures may be done on throat for severe and ongoing sore throats

Rapid strep tests provide results in 15 minutes
Nasal swabs to test for influenza

If patient isn’t able to expectorate sputum- coughing can be induced by administering aerosolized hypertonic solution by nebulizer.
Sputum needs to be taken to lab quickly. Shouldn’t be taken to lab if it has been setting an undertermined amount of time. Also make sure they know it is sputum not spit you need.

A

stuff for cultures

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16
Q

Routine on patient with lower respiratory problems
Normal pulmonary tissue is radiolucent and tumors, fluid etc shows up as a density

A

Chest xray-

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17
Q

Appropriate 02 levels determined by arterial blood gases
Nasal cannula- most often used. Low to medium concentration
Usually under _____ liters- over that causes irritation of nose and pharynx

If your patient is wearing oxygen make sure to check skin around mask, nares, and behind ears for breakdown.

If your patient is wearing a mask and needs to remove it, it will be necessary to place a nasal cannula

May be humidified

A

4 -6

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18
Q

Only able to give up to___ liters in this method.

A

nasal cannula. Most used. 6

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19
Q

Do not use for less than ___ liters to prevent rebreathing of CO2

A

simple mask generally used for short period of time. 6-10 l. 6

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20
Q
A

Face tent. Often used for patients who have some type of nasal/tonsil surgery for extra humidification/ oxygen.

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21
Q
A

Non rebreather mask
This provides the patient with an oxygen concentration of nearly 100%. Use over 6 l of ox to make sure patient isn’t reinhaling too much CO2

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22
Q

Handheld
Delivers a mist to lungs as patient inhales
Med- bronchodilator or mucolytic
Visible mist must be available for it to work

A

nebulizer treatments

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23
Q

_____________: most common cause of illness

A

Upper airway infection

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24
Q

______ is most frequently occurring URI.
URI occur when virus or bacteria are inhaled.
Viruses are more common

A

Common cold

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25
Q

group of disorders characterized by inflammation and irritation of the mucous membranes of the nose- viral such as common cold. Also due to allergens, seasonal or drug induced.

A

rhinitis

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26
Q

Runny nose, nasal congestion, sneezing, nasal itching, headache

A

rhinitis

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27
Q

Management depends on cause
Education- Avoid exposures to allergens
Encourage flu vaccine especially to older adults and high risk population

Remove from allergen if is allergy related.
If viral then symptom management may be indicated. Antihistamines,

Potential allergens: dusts, molds, animals fumes, odors, powders, sprays, and tobacco smoke.

A

rhinitis

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28
Q

Management depends on cause
Education- Avoid exposures to allergens
Encourage flu vaccine especially to older adults and high risk population

Remove from allergen if is allergy related.
If viral then symptom management may be indicated. Antihistamines,

Potential allergens: dusts, molds, animals fumes, odors, powders, sprays, and tobacco smoke.

A

rhinitis

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29
Q

Common cold
Infectious acute inflammation of mucous membranes of the nasal cavity Highly contagious because virus is shed 2 days before symptoms appear

A

viral rhinitis

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30
Q

Sx- low grade fever, nasal congestion, rhinorrhea, nasal discharge, halitosis, sneezing, watery eyes, scratchy throat, general malaise, chills, headache, muscle aches- may exacerbate fever blister (herpes simplex)
Symptomatic management- adequate fluids, prevention of chilling, rest, expectorants, NSAIDS, antihistamines for sneezing ,runny nose and congestion
Mucinex (Guaifenesin)- expectorant may help with removal of secretions
No antibiotics

A

viral rhinitis

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31
Q

Inflammation of sinuses and nasal cavity
Usually follows a viral URI or cold or allergic rhinitis
Nasal congestion caused by inflammation edema, and fluid secondary to URI leads to obstruction of sinuses Good medium for bacteria growth

A

rhinosinusitis

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32
Q

Sx of bacterial- purulent nasal drainage, nasal obstruction, facial pain, pressure or sense of fullness, headache, fever symptoms for more than 10 days after initial onset
Sx of viral- similar but without high fever and generally no facial pain, pressure, or fullness- occur for fewer than 10 days

A

rhinosinusitis

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33
Q

how do you differentiate between bacterial and viral rhinosinusitis?

A

assess tenderness to palpation of sinuses.
bacterial will have facial pain, viral will not have pain

34
Q

What treatment is given for bacterial rhinosinusitis?

A

Treatment 5-7 days of antibiotics
Antibiotics should be administered as soon as bacterial rhinosinusitis is determined
Antibiotics- Augmentin, Levaquin

35
Q

What medicines are given for viral sinusitis?

A

Viral
Decongestants, saline spray

36
Q

Instruct patients to humidify the air and use warm compresses. Avoid swimming, diving, and air travel during infection. Instruct and have patient demonstrate use of nasal spray
Educate that prolonged use of decongestant should be avoided due to rebound congestion
Pain relief= Tylenol, advil, naproxen, aspirin

Teach the importance of use of antibiotics correctly and to continue medications until complete

Teach that fever, severe headache, and nuchal rigidity (stiffness of neck inability to bend neck are signs of complication

A

teaching instructions for rhinosinusitis

37
Q

Acute- sudden painful inflammation of the pharynx- sore throat

A

pharyngitis

38
Q

Peaks during winter due to being indoors and exposure to others
Spreads easily in droplets of coughs and sneezes as well as hands exposed to contaminated fluid
Viral infection is responsible for most
Bacterial most often is group A streptococcus (strep throat)
Strep warrants antibiotic use

Viral is treated with supportive measures. Antibiotics have no effect

Strep is a more severe illness can cause infection in the blood stream, meningitis, rheumatic fever, nephritis

A

pharyngitis

39
Q

Sudden development of painful sore throat 1-5 days after exposure
Malaise, fever, myalgia, headache, nausea
Tonsils swollen and read
May or may not have exudate
Roof of mouth may be red
Foul breath

A

strep A pharyngitis

40
Q

Rapid strep test
Amoxicillin

Penicillin 5 days
Once daily Zithromax may be used for 3 days

aspirin, acetaminophen, acetaminophen with codeine may be prescribed

Gargles with benzocaine may be used

Liquid or soft diet during acute stage
Severe situations when patient unable to take fluids– IV

A

strep a pharyngitis

41
Q

Symptom management
instruct to report s/s of worsening
Ice collar around throat
Warm salt water gargle
Delay returning to work until 24 hours after start of antibiotic
Don’t share eating utensils
Clean telephone after use
Use of tissue, disposal of tissue
Replace toothbrush with new one
instruct to report s/s of worsening: dyspnea, drooling, inability to swallow, inability to fully open mouth

Instruct to complete antibiotic

A

nursing care/education for strep a pharyngitis

42
Q

Symptoms: sore throat, fever, snoring, and difficulty swallowing
Reoccuring or hypertrophy of tonsils- may have tonsillectomy
Postop- risk of hemorrhage
Sx of postop complication- bleeding, fever, throat pain, ear pain
Teach- use liquid Tylenol with or without codeine
May be required to take a full course of antibiotics
Warm salt water rinses may be used to deal with thick mucous and halitosis after surgery
Maintain good hydration
Soft diet
Avoid smoking

A

tonsillitis

43
Q

what is the hallmark sign that your patient has hemorrhaged post of from tonsilitis?

A

frequent swallowing. bleeding from mouth is also common.

44
Q

Obesity, male gender, postmenopausal status, and advanced age

A

risk factors for OSA

45
Q

Larger neck circumference and increased amounts of fat can compress the upper airway.
Upper airway tone is reduced during sleep. Pharynx is a collapsible tube
High prevalence of HTN
Increased risk of MI and stroke

A

OSA

46
Q

What are the 3 Ss for sleep apnea diagnosis?

A

snoring, sleepiness, and significant other report of sleep apnea

47
Q

Sx: Frequent loud snoring with breathing cessation

A

OSA

48
Q

CPAP, devices to prevent lying on back, weight loss, avoidance of alcohol

A

treatment for OSA

49
Q

Interferes with ability to get adequate rest, affects memory, learning, and decision making

A

OSA

50
Q

Breathing cessation of 10 seconds or longer- at least 5 episodes in an hour followed by awakening abruptly with a loud snort as blood oxygen level drops.

A

OSA

51
Q

Closure or collapse of alveoli- most common seen in post op

A

atelectasis

52
Q

Excessive secretions or mucus plus may cause obstruction of airflow and cause ___ in an area of the lung

A

atelectasis

53
Q

S/S: dyspnea, cough, and sputum production

A

s/s of atelectasis

54
Q

Prevention: frequent turning, early mobilization, deep breathing, incentive spirometer, directed cough

A

prevention for atelectasis

55
Q

COUGH stands for

A

Incentive spirometry
Cough and deep breath
oral care
understanding patient education
get out of bed
head of bed elevated

56
Q

Acute inflammation of the trachea and bronchial tree. Often follows infection of upper respiratory tract

A

tracheobronchitis

57
Q

Dry irritating cough and scant amount of mucous, may have sternal soreness, fever, chills, night sweats, headache, and general malaise.
As it progresses: short of breath, noisy breathing, and purulent sputum. If severe may have blood in secretions

A

tracheobronchitis

58
Q

Antibiotics based on organism
Fluid intake
Humidification
Analgesics

A

tracheobronchitis treatment

59
Q

Inflammation of lung parenchyma (functioning parts of the lungs- bronchi, alveoli…)

Could be bacterial, viral, or fungal

A

pneumonia

60
Q

____ and _____ are the most common causes of death by infectious organisms

A

Pneumonia and influenza

61
Q

Occurs either in the community or within 48 hours of entering a facility
Pneumococcus most common cause in adults younger than 60
H. Influenza frequently affects over 60 and those with comorbid conditions
Viruses are most common cause in infants and children, rare in adults

A

Community Acquired pneumonia

62
Q

Often multidrug resistant organisms
Identifying is crucial, hard to treat
Long term care center

A

Health care acquired pneumonia

63
Q

Comorbid conditions, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, hypotension, metabolic disorders
Inappropriate use of antibiotics, use of NG tubes
Common organisms:
E coli, H influenzae, MRSA, s. pneumoniae.
Most colonized with multiple bacteria
Often accompanied by bacteremia, and positive blood cultures
MRSA pneumonia- private room, contact precautions used (gown, mask, gloves, antibacterial soap), decreased number of people in contact

A

Hospital acquired pneumonia

64
Q

Appears 48 hours or more after admission, without signs,sx on admission

DON’T NEED TO KNOW DIFFERENT ORGANISMS, JUST KNOW THEY HAVE DIFFERENT ONES AND THAT THEY CAN BE HARD TO GET RID OF

MRSA INFECTION –PRIVATE ROOM AND DROPLET PRECAUTIONS

HAP -48 HOURS AFTER PNEUMONIA

A

Hospital acquired pneumonia

65
Q

Entry of substances into lower airway
Bacterial infection from ______ of bacteria that normally live in upper airway
Gastric contents, chemicals, or irritating gases may be ______

A

aspiration, aspirated
aspiration pneumonia

66
Q

Inflammatory reaction can occur in alveoli producing exudate which interferes with exchange of oxygen and carbon dioxide
WBC migrate to the alveoli and fill the normally air filled space
Secretions and edema may partially occlude bronchi or alveoli .
In a person with reactive airway disease may also have bronchospasms

A

how pneumonia decreases amount of oxygen able to get to the blood

67
Q

Residence in LTC facility
Tube feedings
COPD, diabetes, heart failure, malnutrition, AIDS

A

risk factors for pneumonia

68
Q

risk factors for pneumonia

A

Residence in LTC facility
Tube feedings
COPD, diabetes, heart failure, malnutrition, AIDS

69
Q

Shortness of breath, fever, chest discomfort due to cough, history of upper respiratory infection, rapid respiration, orthopnea, poor appetite, diaphoresis, tires easily, rusty- blood tinged sputum, crackles, purulent sputum

A

s/s of pneumonia

70
Q

orthopnea is a s/s of pneumonia, what would the patient be doing who has this?

A

sitting on the side of the bed to breath

71
Q

History (recent uri)
Chest xray, blood culture, sputum exam
CBC, chemistry

Prevention: Pneumococcal vaccine- for all 65 and over

A

assessment/diagnostic findings for pneumonia

72
Q

Appropriate antibiotic (will do antibiotic prior to culture results (but after collection) as culture takes 24 hours for preliminary report)
IV fluids and antibiotics if patient needs
PO antibiotics as soon as patient is able
Clinically stable- discharge from hospital (varies, temp below 100, heart rate less than 100, resp less than 24, bp greater than 90 and 02 greater than 90% and able to maintain oral intake and normal baseline mental status)

A

medical management for pneumonia

73
Q

Primarily supportive
Hydration and antipyretics
Antitussives
Warm moist inhalation
Bedrest
If hypoxemia occurs- oxygen administered
Pulse ox/ABG

A

nursing care for viral pneumonia

74
Q

May be primary dx or complication of chronic disease
Often difficult to treat and have higher mortality rate
Different symptoms
Supportive treatment: caution and frequent assessment due to risk of fluid overload- IV hydration, supplemental 02, assist with deep breathing, cough, position changes frequently, and early ambulation

General deterioration, weakness, abdominal sx, anorexia, confusion, tachycardia, and tachypnea may signmal onset. Classic sx of cough chest pain sputum production and fever may be masked or absent.

BE CAREFUL WITH IV FLUID RATES IN ______

A

ELDERLY ,

gerontological considerations for those with pneumonia

75
Q

Pulse ox
Lung sounds
Vital signs (fever, tachycardia, tachypnea)
Cough and sputum production
Pain, fatigue
Dyspnea
Older adults( unusual behavior, altered mental status, and heart failure)

A

assessment you need to do with pneumonia

76
Q

Improved airway patency
Maintenance of proper fluid volume
Maintenance of proper nutrition
Understanding of treatment protocol
Increased activity

A

goals for pneumonia patients

77
Q

Airway patency:
Increase fluids to thin secretions
Humidification of oxygen or air
Deep breathing, incentive spirometer
Administer and titrate oxygen per protocol or as prescribed
Promote fluid intake:
Increase fluids (carefully in those with heart failure)
Maintain nutrition (decreased appetite):
Fluids with electrolytes
Small frequent meals
Nutritional drinks
IV fluids and nutrients if needed

increased respirations leads to an increased loss of insensible fluids

A

nursing interventions for pneumonia patients

78
Q

Observe for response to antibiotic therapy
Check culture to see if correct antibiotic
Assess for confusion and other more subtle changes to cognitive status

Patients usually respond within 24 to 48 hours TO THE ANTIBIOTIC IF ITS CORRECT

Confusion related to worsening of pneumonia is a poor sign. Confusion may be related to hypoxemia, fever, dehydration, sleep deprivation, or developing sepsis.

A

monitoring and managing potential complications of pneumonia

79
Q

Why might the collection of a sputum specimen be delayed up to 2 hours?

A. The patient is taking an afternoon nap.
B. The patient has just finished eating lunch.
C. Pain medication has just been administered.
D. The family is visiting.

A

B. The patient has just finished eating lunch.

80
Q

Which criterion makes it appropriate for the nurse to delegate to nursing assistive personnel (NAP) the skill of collecting a sputum specimen?

A. The skill takes little time to complete.
B. The likelihood of infection is minimal.
C. The patient can produce the specimen by coughing.
D. The agency offers training in this skill for NAP.

A

C. The patient can produce the specimen by coughing.

81
Q

What is the role of nursing assistive personnel (NAP) when a sputum specimen is collected by means of nasotracheal suctioning?

A. Manipulating the suction catheter
B. Setting up the sterile field
C. Applying sterile gloves
D. Transporting the specimen to the lab

A

Transporting the specimen to the lab

82
Q

Which action would help to ensure that the results of a suctioned sputum specimen culture are reliable?

A. Placing the specimen in a biohazard bag
B. Obtaining the specimen when the patient coughs without prompting
C. Wearing sterile gloves to suction the patient
D. Refrigerating the specimen until it can be taken to the lab

A

Refrigerating the specimen until it can be taken to the lab

exam II A&C (7 decks)

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