TB/Pneumonia/COPD Flashcards
1
Q
How do you diagnose pt with pneumonia?
A
Chest X-ray
2
Q
When should you return for a secondary chest X-ray?
A
4-6 weeks
3
Q
What should you teach a patient with pneumonia?
A
Finish all antibiotics
Call HCP if symptoms worsen
4
Q
With a pneumonia patient, what test would the patient need after a chest X-ray?
A
Sputum sample
5
Q
Pneumonia def
A
Infection that inflamed your lung’s air sacs (alveoli)
- fill up with fluid/pus and trap air in distal tubules
- decrease in gas exchange and increase in exudate
6
Q
Pneumonia S/S
A
Fever with chills
Pleural pain
Dyspnea due to fluid
Hemoptysis
Productive or dry cough
Cough
Adventitious lung sounds (diminished or crackles)
7
Q
Atelectasis interventions
A
not walking
ICS
TCDB
elevate HOB
8
Q
Risk factors of pneumonia
A
Chronic Illness Debilitation
Cancer
Abdominal or thoracic surgery
Atelectasis
Smoker
Alcoholic bc aspiration
Elderly
Recent flu or upper lung infection
Chronic respiratory disease
Malnutrition
Sickle Cell Disease
Immunosuppressive therapy
noxious gas exposure
aspiration
9
Q
What color is the productive cough of a pneumonia patient?
These colors means
A
yellow, blood streaked, rusty sputum
means infection
10
Q
Opportunistic Pneumonia bacteria
A
PCP (pneumocystitis carinii pneumonia)
MAC (Mycobacterium Avium Complex)
11
Q
Possible pneumonia lab and testing
A
Chest x-ray***
Sputum culture- to know type
Cbc- WBc usually greater than 14
Pulse ox/ Abg’s
Blood cultures
Thoracentesis – draw fluid out of lungs
Bronchoscopy
CRp
12
Q
When do you know the patient is getting better after pneumonia?
A
SaO2 greater than 95%
Repeat chest x-ray in 4-6 weeks
13
Q
If the patient has pneumonia, delaying antibiotics causes
A
increase mortality
14
Q
Tx of pneumonia
A
Antimicrobials based on causative agent
Humidified o2
Mechanical ventilation
High-calorie diet and adequate fluid why?
Losing fluids
Bronchodilators
Antitussives
Splint chest to cough
15
Q
Aspiration pneumonia
A
Abnormal secretion enters into the lower airway. The cause of pneumonia is pneumonitis usually a secondary bacterial infection occurs in 48-72 hours
16
Q
cause of aspiration pneumonia
A
pneumonitis is usually a secondary bacterial infection that occurs in 48-72 hours
17
Q
Risk factors of aspiration pneumonia
A
Decreased loc
Difficulty swallowing
Ng tube
Alcohol intoxication
Gingivitis
Seizures
18
Q
Aspirations pneumonia is usually located in
A
LLL
RLL
RUL
follow feeding tubes
19
Q
In aspiration pneumonia, the secretions of anaerobic and anaerobic mix causing
A
foul odors
20
Q
Does a healthy person aspirate?
A
no gag reflux intact
21
Q
Aspiration pneumonia patients should lay
A
on side
22
Q
Community aquired pneumonia happens during
A
winter and spring months
23
Q
Community-acquired pneumonia occurs in
A
communities not hospitals
tx at home or hospital depends on the severity
need antibiotic tx asap
24
Q
What organism usually causes Community acquired pneumonia
A
Streptococcus pneumoniae
25
Nosocomial pneumonia occurs
48 hours or more after admission
not incubating at time of admission
ventilator associated
**Insurance will not cover**
26
ventilator associated pneumonia
develops more than 48-72 hours after intubation
healthcare assocated
27
healthcare associated pneumonia
non hospitalized pt with extensive healthcare ocntact
28
How is nosocomial pneumonia spread?
Exposed to bacteria from respiratory devices and equipment, transmission by hands of healthcare workers.
29
Medical-acquired pneumonia if
been in hospital last 90 days or tx at a hemodialysis clinic in last 30 days
30
Beta-lactam drug is a
so must observe for how long?
Penicillin
- Amoxicillin, Ampicillin, Augmentin
Given IM, IV, PO
**Well traveled to all areas of the body**
Alternative Birth control
**Most observe pt 30 mins past injection for allergic reactions**
31
Adverse effects of Beta-lactam
Rash
N/v/d
Ha
Stevens-Johnson syndrome
**C-diff report bloody watery diarrhea**
Anaphylaxis- does this usually happen 1st exposure?
- No antibodies develop
32
Cephalosporins considerations due to PCN
If allergic to PCN, do the benefits outweigh the risks of trying cephalosporins
- minor reaction = OK
-major reaction = reconsider
**similar cross sensitivity happens in 3-16% of pts**
33
Cephalosporins include
cephalexin, cefdinir, cefixime, omnicef, Rocephin.
34
If a pt consumes alcohol after cephalosporins
alcohol intolerant for up to 3 days past last dose.
35
Cephalosporins are given
deep IM, PO, IV
36
Adverse effects of cephalosporins
Steven-Johnson syndrome
**C-diff** report watery bloody diarrhea to hcp
**anaphylaxis**
**Renal failure**
Abdominal pain
37
Which treatment is a big gun antibiotic and saved for last resort?
Carbapenems
38
Carbapenem types
**not tested**
Meropenem, imipenem, ertapenem
**caution PCN**
39
Adverse Effects of Carbpenems
**not tested
Pain redness at injection site
Rash
Constipation
Diarrhea
Nausea
h/a
**Heart failure
Renal failure
Seizures - report
Watery bloody diarrhea -report**
40
What should you avoid if taking macrolides (erythromycin)
**grapefruit juice**
increase blood level of **digoxin or warfarin**
**broad spectrum**
41
Quinolones Types
ciprofloxacin, norfloxacin, **levofloxacin**, moxifloxacin
42
Quinolones Adverse effects
**report tendon pain risk for rupture**
**Avoid exposure to sun or artificial sun teach patient to cover skin up and use sun screen**
**full glass of water**
Dizziness- teach patient to move and get up slowly
Liver and Renal failure
43
Mucinex and Robitussin are types of
expectorants
44
Max dose in 24 hours of Mucinex
2400 mg
45
Antitussives reasons
- decrease cough reflex
- opioid or nonopioid
46
Mucolytics reason
-decrease viscocity
-hypertonic saline
47
Antitussives adverse effects
dizzy
somnolence
fatigue
**Teach to avoid activities with mental alertness or coordination**
48
If antitussive contains codeine, monitor
respiration rate
49
Promethazine with codeine adverse effects
**Life-threatening respiratory depression**
seizures, apnea,angioedema, CNA depression, hyper excitability
50
Promethazine with codeine teaches pts
move slowly until known reaction to meds
51
Decongestants types
Afrin- oxymetazoline
Sudafed- pseudoephedrine
Zyrtec- cetirizine-pseudoephedrine
Allegra- fexofenadine-pseudoephedrine
Claritin- Loratadine-pseudoephedrine
52
Must teach for decongestants
don't use longer than 3 days or can cause rebound congestion
effect BP
erthema, pain, increase inflammation
53
Decongestants - any product containing pseudoephedrine
s/s of cardiac dysfunction
max 7 days
avoid at bedtime
54
any product containing pseudoephedrine
Adverse effects
Htn
Tachyarrhythmia
Insomnia
Anxiety
Feeling nervous
Restlessness
A fib
Mi
55
Pneumonia vaccine name
pneumovax 23
56
What should you advise the patient on with pneumonia vaccine
Advise patient to report angioedema or s/s of thrombocytopenia
57
Important teachings about influenza vaccine
Teach patient even after vaccine can still get the flu but should be less severe.
Instruct patient to immediately report s/s of Guillain-Barre syndrome.
Advise patient to report severe or unusual adverse reactions following vaccination.
58
TB bacteria caused by
Mycobacterium tuberculosis
59
TB is most commonly infected in the
lungs
60
Pts with TB love
o2
61
S/S of TB
Fatigue
Weakness
**Anorexia/Weight loss
Night sweats**
Low grade fever
Adenopathy
Malaise
Anxiety
**Crackles
Diminished breath sounds**
**Hemoptysis
Chest pain
Productive cough**
62
Isolation Precaution of TB
airborne precaution (negative pressure, N95)
63
Can TB be suspended in the air for hours?
yes
64
Transmission of TB requires
close, frequent, or prolonged exposure
65
Can TB spread by touching, sharing food utensils, kissing, or other physical contact
no
66
Risk factors of TB
Homeless
Close together
Residents of inner-city neighborhoods
Foreign-born persons
Living or working in institutions (includes health care workers)
IV injecting drug users
Poverty, poor access to health care
Immunosuppression
Cancer, elderly, super young, meds
Asian descent
67
Healthcare workers do what process to test for TB
two step ensures future positive results accurately
68
Sputum culture results can take up to
8 weeks
69
PPD test for TB =
delayed hypersensitive, ID injection, read between 48-72 hours (later redue)
70
TB skin test of height greater than 5 mm is a positive for
immunocompromised pts
71
TB skin test of height greater than 10 mm is a positive for
high-risk pts
72
TB skin test of height greater than 15 mm is a positive for
everyone
73
How do you dx TB?
sputum test
74
What is the order of testing and when do you start antibiotics for TB?
Skin test
chest x-ray
sputum sample on 2-3 days
**start antibiotics**
Interferon-Y release assays (t-cell lymphocytes)
75
What shows a positive TB skin test?
Raised mm not redness
76
Sputum is best taken in the
morning and label antibiotics
77
Patient Teaching in TB
Tx takes **6-9 months**
**importance of taking meds as prescribed**
no hx of hepatotoxicity or liver disease
take med with food to avoid GI symptoms (tuna and aged cheese - tyramine)
= administer 1 hour prior to meal or 2 hours after
**avoid alcohol**
78
S/S of liver complications
loss of appetite, fatigue, malaise jaundice, dark urine, unusual abdominal pain
79
The pt with TB can go home?
yes
80
TB nursing dx
Ineffective airway clearance
Ineffective breathing pattern
Fatigue
Impaired gas exchange
Ineffective health management
81
Discharge Planning for TB
Case management- to refer to health department- medication cost- home health- community resources
82
What isolation precaution should a pt with TB be in?
Airborne
83
What PPE is needed for TB?
N95, gown, gloves, goggles, shoe covers
84
1st Line Drugs for TB
Rifampin
Isoniazid / INH
Pyrazinamide
Ethambutol
85
Isoniazid INH
Try B6 for neuropathy
**Severe and possible fatal hepatitis** monitor liver
86
TB medications used for how long? and how many?
2 different meds
6-9 months
87
Adverse Reactions to Isoniazid med
Increased liver enzymes
**Neuropathy** = B6
**Neurotoxicity**
Rash
Hepatitis
**Injury of liver**
Rhabdomyolysis
seizure
88
Adverse Reactions of Rifampin
**Hepatotoxicity**
Anaphylaxis
Nephrotoxicity
Renal failure
Disseminated intravascular coagulation
Easy bleeding, slow clotting
89
What is a common side effect of TB drugs that needs monitoring?
Hepatotoxicity, monitor liver functions
90
Patient Teaching of Rifampin
May cause sun sensitivity
Report any bleeding, pain, fatigue, or jaundice to HCP
Monitor LFTs
Interfere with **birth control**
**Fluids turn reddish-orange and stain soft contact lens**
91
Adverse Effects of Pyrazinamide
Hyperuricemia
Nausea
Vomiting
Arthralgia
anemia
**Hepatotoxicity**
92
When pyrazinamide and rifampin are combined
increases the risk of liver toxicity
93
Pt Teaching of Pyrazinamide
Possibility of what
S/S of gout and cautious about sensitivity
94
Adverse effects of Ethambutol
Hepatotoxicity
Anaphylaxis
Optic neuritis
95
Pt. Teaching of Ethambutol
report any visual changes, or neuropathy to HCP
generally well tolerated
96
Adverse effects of BCG Vaccine
Nausea
Lymphadenopathy
Increased frequency of urination
Hepatitis
Anaphylaxis
97
the BCG vaccine is generally used for
military or foreign people
**lead to false positive skin test**
98
Obstructive Lung Disease
Airway obstruction that is worse with expiration
Common disorders = asthma, emphysema, chronic bronchitis
99
Emphysema Description
Airflow limitation **not fully reversible**
Generally **progressive**
Abnormal **inflammatory response** of lungs to noxious particles or gases
Symptoms occur in middle adult years
Incidence increases with age
100
Chronic Bronchitis "BLUE BLOATER" s/s
- airway flow problem
- color dusky to **cyanotic**
- recurrent **cough and increased sputum production**
- **hypoxia**
- **hypercapnia**
- **respiratory acidosis**
- high Hgb and RR
- exertional dyspnea "wheezing"
- pulmonary hypertension
- increase in smokers
- **digital clubbing**
*cardiac enlargement
*use of **accessory muscles** to breathe
101
Chronic Bronchitis leads to
right-sided heart failure
with bilateral **pedal edema and increase jugular vein distension**
102
Risk factors of Chronic Bronchitis
Cigarette smoking
Exposure to irritants
Genetic predisposition
Exposure to organic or inorganic dust
Exposures to noxious gases
Respiratory tract infection
103
Dx Chronic Bronchitis
presence of cough and sputum production for at least 3 months for 2 consecutive years
-CXR, PFT, ABG, EKG, CBC, sputum
104
Tx of Chronic Bronchitis
Smoking cessation
Avoidance of air pollutants
Antibiotics
**Bronchodilators**
Adequate hydration
Chest physiotherapy
Nebulizer treatments
**Corticosteroids
Diuretic
Oxygen therapy**
105
Pt Teaching of Chronic Bronchitis
- Instruct on the benefits of not smoking or being around secondhand smoke
- Importance of early medical treatment at the first sign and symptoms of getting sick
- May have to sleep semi fowlers
- Instruct on importance of oxygen if they are prescribed
106
Discharge Planning of Chronic Bronchitis
Home meds
Consider pulmonary rehabilitation
Psychosocial consideration
Use **bronchodilator 1st**
Case management for oxygen, medication, home health
Importance of flu and pneumonia vaccine
107
Pink Puffer descriptions
-skinny
-purse lips
- barrel chest
- accessory muscles
- slow, short
- semi fowlers, tripotty
108
Emphysema "PINK PUFFER" s/s
increase CO2 Retention
mental status changes due to retaining CO2
minimal cyanosis
purse lip breathing
dyspnea/tachypnea
**hyper resonance on chest percussion**
orthopedic
**barrel chest**
**exertional dyspnea**
**prolonged expiratory time**
chronic cough
speaks in short jerky sentences
anxious
**accessory muscles**
thin appearance
**respiratory acidosis**
109
What happens to diaphragm with COPD?
flattens out
110
Risk factors of COPD
Cigarette smoking* primary cause active and passive
Occupational chemicals and dust
Air pollution
Infection
Heredity
Aging- which came 1st?
Genetic susceptibilities
111
COPD Dx confirmed by
spirometry
reduced FEV1/FVC Ratio
increased residual vol
112
Spirometry shows
how well you breathe in and out. Breathing in and out can be affected by lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis, and cystic fibrosis.
113
ABG results for COPD
Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD
114
CBC results in COPD
increase hemoglobin in later stages
115
Tx of COPD
Avoidance of smoke and air pollution
Bronchodilators
Antibiotics
Flu vaccine
Pneumonia vaccine
Adequate hydration
Oxygen therapy for hypoxia
Mucolytics
Corticosteroids
Lung transplant
Diuretics for edema
116
Antitrypsin (AAT) deficiency
genetic risk factor for emphysema – accounts for 3% of emphysema- aat is an autosomal recessive disorder
117
What is used for persons with AAT deficiency?
Augmentation therapy
118
Severe AAT deficiency leads to
premature bullous emphysema in the lungs found on x-ray
result in insufficient inactivation and subsequent destruction of lung tissue.
119
Pt Teaching for COPD
**Pursed lip breathing**
Instruct on the benefits of not smoking or being around secondhand smoke
Importance of early medical treatment at the first sign and symptoms of getting sick
May have to **sleep semi fowlers**
Instruct on importance of **oxygen if they are prescribed**
120
Pursed lip breathing
2 count in and 4 count out
121
Other consideration of COPD
Activity considerations
Pulmonary rehabilitation
Activity considerations
Sexual activity
Sleep
Psychosocial considerations
Nutritional considerations
122
COPD Nursing Dx
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
Insomnia
123
Discharge Planning of COPD
Consider pulmonary rehabilitation
Psychosocial consideration
Use bronchodilator 1st
Case management for oxygen, medication, home health
Importance of flu and pneumonia vaccine
124
Endurance of a pt with COPD
Shortness of breath while resting or with activity
125
Crackles
high pitched heard **during inspiration**
may change with cough
D/C
126
Rhonchi
rumbling coarse sounds
like a snore
during inspiration or expiration
may clear with coughing or suctioning
Continous
127
Wheezing
musical noise during inspiration or expiration
1st heard about the expiration
Continuous
128
Adverse Effects of Bronchodilators
Tachycardia
Palpitations
Chest pain
Tremors
**Ha
Dizziness**
Nervousness
Report signs or symptoms of **hypokalemia, a fib**
Call hcp if you are requiring more frequent use of medication
129
Short-acting bronchodilators types
Albuterol, Proventil, Max Air
130
bronchodilators are a
smooth muscle relaxer
131
Anticholinergic type
Ipratropium bromide
atrovent
132
Anticholinergic is a
long-acting bronchodilator
133
Adverse effects of Anticholinergics
Abnormal taste
Bronchitis
Mi
Anaphylaxis
Cva
**Bronchospasm
Teaching = HA**
134
Pt Teaching Anticholonergic
Do not get in the eyes
Teach how to use properly
May cause **dizziness, blurred vision**
135
methylxanthine types
Theo dur, theophylline
Bronchodilator
136
adverse effects of methylxanthine
Nausea
Ha,
**Insomnia
Tremors
Restlessness**
Usually saved till last when other treatments are not working
137
S/S of theophylline toxicity
Vomiting, arrhythmia , seizures
138
Would you take methylxanthine with a caffeinated beverage?
no bc effect of absorption and theophylline levels in the blood
139
types of Prednisone
Solu- Medrol , deltasone
140
Prednisone is a
immunosuppressant
141
Adverse reactions of prednisone
htn
Osteoporosis
Mood disturbance
Poor healing of wounds
Monitor b/p
Monitor blood glucose levels
Avoid live vaccines
Avoid contact with chicken pox or measles patients
Watch for **peptic ulcer disease
Anxiety
Depression
Fluid retention
Cuase GI upset** if not with food
142
Leukotriene agonists adverse reaction
Upset
Ha
Cough
143
Leukotriene agonists types
Montelukast- singular
144
Leukotriene agonists is used for
Helps with respiratory inflammation
Prevents airway edema
Monitor LFT’s and blood chemistry
145
Leukotriene agonists Pt Teaching
Do not discontinue or decrease dose with approval of hcp
Medication should be taken at bedtime
This drug may cause aggressive behavior, agitation, dream disorder, or hallucinations
146
adverse effects of acetylcysteine
Pruritus'
n/v
Bronchospasm
Respiratory distress
147
Descriptions of acetylcysteine
Drug has an odor
Liquid may become light purple which is normal
148
acetylcysteine types
Mucomuyst
149
acetylcysteine helps with
Mucolytic agent
Lowers mucus viscosity
150
Hypoxia main symptom
restlessness
151
Chronic hypoxia main symptom
clubbing
152
Late hypoxia main symptom
cyanosis
153
Symptoms of Hypoxia
Restlessness
Anxiety
Tachycardia Tachypnea
Late to
Bradycardia
Extreme restlessness
Dyspnea
