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Module 3 (MedSurg 1) > TB/Pneumonia/COPD > Flashcards

TB/Pneumonia/COPD Flashcards

1
Q

How do you diagnose pt with pneumonia?

A

Chest X-ray

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2
Q

When should you return for a secondary chest X-ray?

A

4-6 weeks

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3
Q

What should you teach a patient with pneumonia?

A

Finish all antibiotics
Call HCP if symptoms worsen

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4
Q

With a pneumonia patient, what test would the patient need after a chest X-ray?

A

Sputum sample

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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

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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)

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7
Q

Atelectasis interventions

A

not walking
ICS
TCDB
elevate HOB

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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

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9
Q

What color is the productive cough of a pneumonia patient?
These colors means

A

yellow, blood streaked, rusty sputum
means infection

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10
Q

Opportunistic Pneumonia bacteria

A

PCP (pneumocystitis carinii pneumonia)
MAC (Mycobacterium Avium Complex)

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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

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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

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13
Q

If the patient has pneumonia, delaying antibiotics causes

A

increase mortality

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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

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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

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16
Q

cause of aspiration pneumonia

A

pneumonitis is usually a secondary bacterial infection that occurs in 48-72 hours

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17
Q

Risk factors of aspiration pneumonia

A

Decreased loc
Difficulty swallowing
Ng tube
Alcohol intoxication
Gingivitis
Seizures

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18
Q

Aspirations pneumonia is usually located in

A

LLL
RLL
RUL
follow feeding tubes

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19
Q

In aspiration pneumonia, the secretions of anaerobic and anaerobic mix causing

A

foul odors

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20
Q

Does a healthy person aspirate?

A

no gag reflux intact

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21
Q

Aspiration pneumonia patients should lay

A

on side

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22
Q

Community aquired pneumonia happens during

A

winter and spring months

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23
Q

Community-acquired pneumonia occurs in

A

communities not hospitals
tx at home or hospital depends on the severity
need antibiotic tx asap

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24
Q

What organism usually causes Community acquired pneumonia

A

Streptococcus pneumoniae

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25
Q

Nosocomial pneumonia occurs

A

48 hours or more after admission
not incubating at time of admission
ventilator associated
Insurance will not cover

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26
Q

ventilator associated pneumonia

A

develops more than 48-72 hours after intubation
healthcare assocated

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27
Q

healthcare associated pneumonia

A

non hospitalized pt with extensive healthcare ocntact

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28
Q

How is nosocomial pneumonia spread?

A

Exposed to bacteria from respiratory devices and equipment, transmission by hands of healthcare workers.

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29
Q

Medical-acquired pneumonia if

A

been in hospital last 90 days or tx at a hemodialysis clinic in last 30 days

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30
Q

Beta-lactam drug is a

so must observe for how long?

A

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

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31
Q

Adverse effects of Beta-lactam

A

Rash
N/v/d
Ha
Stevens-Johnson syndrome
C-diff report bloody watery diarrhea
Anaphylaxis- does this usually happen 1st exposure?
- No antibodies develop

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32
Q

Cephalosporins considerations due to PCN

A

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

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33
Q

Cephalosporins include

A

cephalexin, cefdinir, cefixime, omnicef, Rocephin.

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34
Q

If a pt consumes alcohol after cephalosporins

A

alcohol intolerant for up to 3 days past last dose.

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35
Q

Cephalosporins are given

A

deep IM, PO, IV

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36
Q

Adverse effects of cephalosporins

A

Steven-Johnson syndrome
C-diff report watery bloody diarrhea to hcp
anaphylaxis
Renal failure
Abdominal pain

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37
Q

Which treatment is a big gun antibiotic and saved for last resort?

A

Carbapenems

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38
Q

Carbapenem types
not tested

A

Meropenem, imipenem, ertapenem
caution PCN

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39
Q

Adverse Effects of Carbpenems
**not tested

A

Pain redness at injection site
Rash
Constipation
Diarrhea
Nausea
h/a
Heart failure
Renal failure
Seizures - report
Watery bloody diarrhea -report

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40
Q

What should you avoid if taking macrolides (erythromycin)

A

grapefruit juice
increase blood level of digoxin or warfarin
broad spectrum

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41
Q

Quinolones Types

A

ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin

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42
Q

Quinolones Adverse effects

A

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

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43
Q

Mucinex and Robitussin are types of

A

expectorants

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44
Q

Max dose in 24 hours of Mucinex

A

2400 mg

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45
Q

Antitussives reasons

A
  • decrease cough reflex
  • opioid or nonopioid
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46
Q

Mucolytics reason

A

-decrease viscocity
-hypertonic saline

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47
Q

Antitussives adverse effects

A

dizzy
somnolence
fatigue
Teach to avoid activities with mental alertness or coordination

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48
Q

If antitussive contains codeine, monitor

A

respiration rate

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49
Q

Promethazine with codeine adverse effects

A

Life-threatening respiratory depression
seizures, apnea,angioedema, CNA depression, hyper excitability

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50
Q

Promethazine with codeine teaches pts

A

move slowly until known reaction to meds

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51
Q

Decongestants types

A

Afrin- oxymetazoline
Sudafed- pseudoephedrine
Zyrtec- cetirizine-pseudoephedrine
Allegra- fexofenadine-pseudoephedrine
Claritin- Loratadine-pseudoephedrine

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52
Q

Must teach for decongestants

A

don’t use longer than 3 days or can cause rebound congestion
effect BP
erthema, pain, increase inflammation

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53
Q

Decongestants - any product containing pseudoephedrine

A

s/s of cardiac dysfunction
max 7 days
avoid at bedtime

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54
Q

any product containing pseudoephedrine
Adverse effects

A

Htn
Tachyarrhythmia
Insomnia
Anxiety
Feeling nervous
Restlessness
A fib
Mi

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55
Q

Pneumonia vaccine name

A

pneumovax 23

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56
Q

What should you advise the patient on with pneumonia vaccine

A

Advise patient to report angioedema or s/s of thrombocytopenia

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57
Q

Important teachings about influenza vaccine

A

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.

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58
Q

TB bacteria caused by

A

Mycobacterium tuberculosis

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59
Q

TB is most commonly infected in the

A

lungs

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60
Q

Pts with TB love

A

o2

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61
Q

S/S of TB

A

Fatigue
Weakness
Anorexia/Weight loss
Night sweats
Low grade fever
Adenopathy
Malaise
Anxiety
Crackles
Diminished breath sounds
Hemoptysis
Chest pain
Productive cough

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62
Q

Isolation Precaution of TB

A

airborne precaution (negative pressure, N95)

63
Q

Can TB be suspended in the air for hours?

A

yes

64
Q

Transmission of TB requires

A

close, frequent, or prolonged exposure

65
Q

Can TB spread by touching, sharing food utensils, kissing, or other physical contact

A

no

66
Q

Risk factors of TB

A

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
Q

Healthcare workers do what process to test for TB

A

two step ensures future positive results accurately

68
Q

Sputum culture results can take up to

A

8 weeks

69
Q

PPD test for TB =

A

delayed hypersensitive, ID injection, read between 48-72 hours (later redue)

70
Q

TB skin test of height greater than 5 mm is a positive for

A

immunocompromised pts

71
Q

TB skin test of height greater than 10 mm is a positive for

A

high-risk pts

72
Q

TB skin test of height greater than 15 mm is a positive for

A

everyone

73
Q

How do you dx TB?

A

sputum test

74
Q

What is the order of testing and when do you start antibiotics for TB?

A

Skin test
chest x-ray
sputum sample on 2-3 days
start antibiotics
Interferon-Y release assays (t-cell lymphocytes)

75
Q

What shows a positive TB skin test?

A

Raised mm not redness

76
Q

Sputum is best taken in the

A

morning and label antibiotics

77
Q

Patient Teaching in TB

A

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
Q

S/S of liver complications

A

loss of appetite, fatigue, malaise jaundice, dark urine, unusual abdominal pain

79
Q

The pt with TB can go home?

A

yes

80
Q

TB nursing dx

A

Ineffective airway clearance
Ineffective breathing pattern
Fatigue
Impaired gas exchange
Ineffective health management

81
Q

Discharge Planning for TB

A

Case management- to refer to health department- medication cost- home health- community resources

82
Q

What isolation precaution should a pt with TB be in?

A

Airborne

83
Q

What PPE is needed for TB?

A

N95, gown, gloves, goggles, shoe covers

84
Q

1st Line Drugs for TB

A

Rifampin
Isoniazid / INH
Pyrazinamide
Ethambutol

85
Q

Isoniazid INH

A

Try B6 for neuropathy
Severe and possible fatal hepatitis monitor liver

86
Q

TB medications used for how long? and how many?

A

2 different meds
6-9 months

87
Q

Adverse Reactions to Isoniazid med

A

Increased liver enzymes
Neuropathy = B6
Neurotoxicity
Rash
Hepatitis
Injury of liver
Rhabdomyolysis
seizure

88
Q

Adverse Reactions of Rifampin

A

Hepatotoxicity
Anaphylaxis
Nephrotoxicity
Renal failure
Disseminated intravascular coagulation
Easy bleeding, slow clotting

89
Q

What is a common side effect of TB drugs that needs monitoring?

A

Hepatotoxicity, monitor liver functions

90
Q

Patient Teaching of Rifampin

A

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
Q

Adverse Effects of Pyrazinamide

A

Hyperuricemia
Nausea
Vomiting
Arthralgia
anemia
Hepatotoxicity

92
Q

When pyrazinamide and rifampin are combined

A

increases the risk of liver toxicity

93
Q

Pt Teaching of Pyrazinamide
Possibility of what

A

S/S of gout and cautious about sensitivity

94
Q

Adverse effects of Ethambutol

A

Hepatotoxicity
Anaphylaxis
Optic neuritis

95
Q

Pt. Teaching of Ethambutol

A

report any visual changes, or neuropathy to HCP
generally well tolerated

96
Q

Adverse effects of BCG Vaccine

A

Nausea
Lymphadenopathy
Increased frequency of urination
Hepatitis
Anaphylaxis

97
Q

the BCG vaccine is generally used for

A

military or foreign people
lead to false positive skin test

98
Q

Obstructive Lung Disease

A

Airway obstruction that is worse with expiration
Common disorders = asthma, emphysema, chronic bronchitis

99
Q

Emphysema Description

A

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
Q

Chronic Bronchitis “BLUE BLOATER” s/s

A
  • 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
Q

Chronic Bronchitis leads to

A

right-sided heart failure
with bilateral pedal edema and increase jugular vein distension

102
Q

Risk factors of Chronic Bronchitis

A

Cigarette smoking
Exposure to irritants
Genetic predisposition
Exposure to organic or inorganic dust
Exposures to noxious gases
Respiratory tract infection

103
Q

Dx Chronic Bronchitis

A

presence of cough and sputum production for at least 3 months for 2 consecutive years
-CXR, PFT, ABG, EKG, CBC, sputum

104
Q

Tx of Chronic Bronchitis

A

Smoking cessation
Avoidance of air pollutants
Antibiotics
Bronchodilators
Adequate hydration
Chest physiotherapy
Nebulizer treatments
Corticosteroids
Diuretic
Oxygen therapy

105
Q

Pt Teaching of Chronic Bronchitis

A
  • 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
Q

Discharge Planning of Chronic Bronchitis
Home meds

A

Consider pulmonary rehabilitation
Psychosocial consideration
Use bronchodilator 1st
Case management for oxygen, medication, home health
Importance of flu and pneumonia vaccine

107
Q

Pink Puffer descriptions

A

-skinny
-purse lips
- barrel chest
- accessory muscles
- slow, short
- semi fowlers, tripotty

108
Q

Emphysema “PINK PUFFER” s/s

A

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
Q

What happens to diaphragm with COPD?

A

flattens out

110
Q

Risk factors of COPD

A

Cigarette smoking* primary cause active and passive
Occupational chemicals and dust
Air pollution
Infection
Heredity
Aging- which came 1st?
Genetic susceptibilities

111
Q

COPD Dx confirmed by

A

spirometry
reduced FEV1/FVC Ratio
increased residual vol

112
Q

Spirometry shows

A

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
Q

ABG results for COPD

A

Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD

114
Q

CBC results in COPD

A

increase hemoglobin in later stages

115
Q

Tx of COPD

A

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
Q

Antitrypsin (AAT) deficiency

A

genetic risk factor for emphysema – accounts for 3% of emphysema- aat is an autosomal recessive disorder

117
Q

What is used for persons with AAT deficiency?

A

Augmentation therapy

118
Q

Severe AAT deficiency leads to

A

premature bullous emphysema in the lungs found on x-ray
result in insufficient inactivation and subsequent destruction of lung tissue.

119
Q

Pt Teaching for COPD

A

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
Q

Pursed lip breathing

A

2 count in and 4 count out

121
Q

Other consideration of COPD

A

Activity considerations
Pulmonary rehabilitation
Activity considerations
Sexual activity
Sleep
Psychosocial considerations
Nutritional considerations

122
Q

COPD Nursing Dx

A

Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
Insomnia

123
Q

Discharge Planning of COPD

A

Consider pulmonary rehabilitation
Psychosocial consideration
Use bronchodilator 1st
Case management for oxygen, medication, home health
Importance of flu and pneumonia vaccine

124
Q

Endurance of a pt with COPD

A

Shortness of breath while resting or with activity

125
Q

Crackles

A

high pitched heard during inspiration
may change with cough
D/C

126
Q

Rhonchi

A

rumbling coarse sounds
like a snore
during inspiration or expiration
may clear with coughing or suctioning
Continous

127
Q

Wheezing

A

musical noise during inspiration or expiration
1st heard about the expiration
Continuous

128
Q

Adverse Effects of Bronchodilators

A

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
Q

Short-acting bronchodilators types

A

Albuterol, Proventil, Max Air

130
Q

bronchodilators are a

A

smooth muscle relaxer

131
Q

Anticholinergic type

A

Ipratropium bromide
atrovent

132
Q

Anticholinergic is a

A

long-acting bronchodilator

133
Q

Adverse effects of Anticholinergics

A

Abnormal taste
Bronchitis
Mi
Anaphylaxis
Cva
Bronchospasm
Teaching = HA

134
Q

Pt Teaching Anticholonergic

A

Do not get in the eyes
Teach how to use properly
May cause dizziness, blurred vision

135
Q

methylxanthine types

A

Theo dur, theophylline
Bronchodilator

136
Q

adverse effects of methylxanthine

A

Nausea
Ha,
Insomnia
Tremors
Restlessness

Usually saved till last when other treatments are not working

137
Q

S/S of theophylline toxicity

A

Vomiting, arrhythmia , seizures

138
Q

Would you take methylxanthine with a caffeinated beverage?

A

no bc effect of absorption and theophylline levels in the blood

139
Q

types of Prednisone

A

Solu- Medrol , deltasone

140
Q

Prednisone is a

A

immunosuppressant

141
Q

Adverse reactions of prednisone

A

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
Q

Leukotriene agonists adverse reaction

A

Upset
Ha
Cough

143
Q

Leukotriene agonists types

A

Montelukast- singular

144
Q

Leukotriene agonists is used for

A

Helps with respiratory inflammation
Prevents airway edema
Monitor LFT’s and blood chemistry

145
Q

Leukotriene agonists Pt Teaching

A

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
Q

adverse effects of acetylcysteine

A

Pruritus’
n/v
Bronchospasm
Respiratory distress

147
Q

Descriptions of acetylcysteine

A

Drug has an odor
Liquid may become light purple which is normal

148
Q

acetylcysteine types

A

Mucomuyst

149
Q

acetylcysteine helps with

A

Mucolytic agent
Lowers mucus viscosity

150
Q

Hypoxia main symptom

A

restlessness

151
Q

Chronic hypoxia main symptom

A

clubbing

152
Q

Late hypoxia main symptom

A

cyanosis

153
Q

Symptoms of Hypoxia

A

Restlessness
Anxiety
Tachycardia Tachypnea

Late to

Bradycardia
Extreme restlessness
Dyspnea

Module 3 (MedSurg 1) (12 decks)

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