respiratory infections Flashcards by Glen McCormick

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

filters

How well did you know this?

Not at all

Perfectly

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

infection

How well did you know this?

Not at all

Perfectly

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

Trachea (windpipe)

How well did you know this?

Not at all

Perfectly

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

alveoli, pneumonia

How well did you know this?

Not at all

Perfectly

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

lungs

How well did you know this?

Not at all

Perfectly

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.

fluid

How well did you know this?

Not at all

Perfectly

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

mucous and cilia

How well did you know this?

Not at all

Perfectly

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

airway resistance

How well did you know this?

Not at all

Perfectly

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

Gerontologic changes

How well did you know this?

Not at all

Perfectly

Increased risk of infection
Increased risk of aspiration
Decreased exercise capacity

Gerontologic changes

How well did you know this?

Not at all

Perfectly

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

ABG

How well did you know this?

Not at all

Perfectly

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

Pulse oximetry, COPD

How well did you know this?

Not at all

Perfectly

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

Cultures, prior

How well did you know this?

Not at all

Perfectly

anemia, abnormal hemoglobin, high carbon monoxide, dark skin, wearing nail polish

Inaccurate reading OF PULSE OX

How well did you know this?

Not at all

Perfectly

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.

stuff for cultures

How well did you know this?

Not at all

Perfectly

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

Chest xray-

How well did you know this?

Not at all

Perfectly

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

4 -6

How well did you know this?

Not at all

Perfectly

Only able to give up to___ liters in this method.

nasal cannula. Most used. 6

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

nebulizer treatments

How well did you know this?

Not at all

Perfectly

_____________: most common cause of illness

Upper airway infection

How well did you know this?

Not at all

Perfectly

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

Common cold

How well did you know this?

Not at all

Perfectly

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.

rhinitis

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

rhinitis

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.

rhinitis

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

viral rhinitis

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

viral rhinitis

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

rhinosinusitis

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

rhinosinusitis

how do you differentiate between bacterial and viral rhinosinusitis?

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

What treatment is given for bacterial rhinosinusitis?

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

What medicines are given for viral sinusitis?

Viral Decongestants, saline spray

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

teaching instructions for rhinosinusitis

Acute- sudden painful inflammation of the pharynx- sore throat

pharyngitis

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

pharyngitis

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

strep A pharyngitis

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

strep a pharyngitis

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

nursing care/education for strep a pharyngitis

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

tonsillitis

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

frequent swallowing. bleeding from mouth is also common.

Obesity, male gender, postmenopausal status, and advanced age

risk factors for OSA

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

OSA

What are the 3 Ss for sleep apnea diagnosis?

snoring, sleepiness, and significant other report of sleep apnea

Sx: Frequent loud snoring with breathing cessation

OSA

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

treatment for OSA

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

OSA

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.

OSA

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

atelectasis

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

atelectasis

S/S: dyspnea, cough, and sputum production

s/s of atelectasis

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

prevention for atelectasis

COUGH stands for

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

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

tracheobronchitis

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

tracheobronchitis

Antibiotics based on organism Fluid intake Humidification Analgesics

tracheobronchitis treatment

Inflammation of lung parenchyma (functioning parts of the lungs- bronchi, alveoli…) Could be bacterial, viral, or fungal

pneumonia

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

Pneumonia and influenza

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

Community Acquired pneumonia

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

Health care acquired pneumonia

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

Hospital acquired pneumonia

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

Hospital acquired pneumonia

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 ______

aspiration, aspirated aspiration pneumonia

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

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

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

risk factors for pneumonia

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

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

s/s of pneumonia

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

sitting on the side of the bed to breath

History (recent uri) Chest xray, blood culture, sputum exam CBC, chemistry Prevention: Pneumococcal vaccine- for all 65 and over

assessment/diagnostic findings for pneumonia

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)

medical management for pneumonia

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

nursing care for viral pneumonia

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 ______

ELDERLY , gerontological considerations for those with pneumonia

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)

assessment you need to do with pneumonia

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

goals for pneumonia patients

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

nursing interventions for pneumonia patients

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.

monitoring and managing potential complications of pneumonia

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.

B. The patient has just finished eating lunch.

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.

C. The patient can produce the specimen by coughing.

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

Transporting the specimen to the lab

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

Refrigerating the specimen until it can be taken to the lab