TB/Pneumonia/COPD Flashcards
How do you diagnose pt with pneumonia?
Chest X-ray
When should you return for a secondary chest X-ray?
4-6 weeks
What should you teach a patient with pneumonia?
Finish all antibiotics
Call HCP if symptoms worsen
With a pneumonia patient, what test would the patient need after a chest X-ray?
Sputum sample
Pneumonia def
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
Pneumonia S/S
Fever with chills
Pleural pain
Dyspnea due to fluid
Hemoptysis
Productive or dry cough
Cough
Adventitious lung sounds (diminished or crackles)
Atelectasis interventions
not walking
ICS
TCDB
elevate HOB
Risk factors of pneumonia
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
What color is the productive cough of a pneumonia patient?
These colors means
yellow, blood streaked, rusty sputum
means infection
Opportunistic Pneumonia bacteria
PCP (pneumocystitis carinii pneumonia)
MAC (Mycobacterium Avium Complex)
Possible pneumonia lab and testing
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
When do you know the patient is getting better after pneumonia?
SaO2 greater than 95%
Repeat chest x-ray in 4-6 weeks
If the patient has pneumonia, delaying antibiotics causes
increase mortality
Tx of pneumonia
Antimicrobials based on causative agent
Humidified o2
Mechanical ventilation
High-calorie diet and adequate fluid why?
Losing fluids
Bronchodilators
Antitussives
Splint chest to cough
Aspiration pneumonia
Abnormal secretion enters into the lower airway. The cause of pneumonia is pneumonitis usually a secondary bacterial infection occurs in 48-72 hours
cause of aspiration pneumonia
pneumonitis is usually a secondary bacterial infection that occurs in 48-72 hours
Risk factors of aspiration pneumonia
Decreased loc
Difficulty swallowing
Ng tube
Alcohol intoxication
Gingivitis
Seizures
Aspirations pneumonia is usually located in
LLL
RLL
RUL
follow feeding tubes
In aspiration pneumonia, the secretions of anaerobic and anaerobic mix causing
foul odors
Does a healthy person aspirate?
no gag reflux intact
Aspiration pneumonia patients should lay
on side
Community aquired pneumonia happens during
winter and spring months
Community-acquired pneumonia occurs in
communities not hospitals
tx at home or hospital depends on the severity
need antibiotic tx asap
What organism usually causes Community acquired pneumonia
Streptococcus pneumoniae
Nosocomial pneumonia occurs
48 hours or more after admission
not incubating at time of admission
ventilator associated
Insurance will not cover
ventilator associated pneumonia
develops more than 48-72 hours after intubation
healthcare assocated
healthcare associated pneumonia
non hospitalized pt with extensive healthcare ocntact
How is nosocomial pneumonia spread?
Exposed to bacteria from respiratory devices and equipment, transmission by hands of healthcare workers.
Medical-acquired pneumonia if
been in hospital last 90 days or tx at a hemodialysis clinic in last 30 days
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
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
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
Cephalosporins include
cephalexin, cefdinir, cefixime, omnicef, Rocephin.
If a pt consumes alcohol after cephalosporins
alcohol intolerant for up to 3 days past last dose.
Cephalosporins are given
deep IM, PO, IV
Adverse effects of cephalosporins
Steven-Johnson syndrome
C-diff report watery bloody diarrhea to hcp
anaphylaxis
Renal failure
Abdominal pain
Which treatment is a big gun antibiotic and saved for last resort?
Carbapenems
Carbapenem types
not tested
Meropenem, imipenem, ertapenem
caution PCN
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
What should you avoid if taking macrolides (erythromycin)
grapefruit juice
increase blood level of digoxin or warfarin
broad spectrum
Quinolones Types
ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin
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
Mucinex and Robitussin are types of
expectorants
Max dose in 24 hours of Mucinex
2400 mg
Antitussives reasons
- decrease cough reflex
- opioid or nonopioid
Mucolytics reason
-decrease viscocity
-hypertonic saline
Antitussives adverse effects
dizzy
somnolence
fatigue
Teach to avoid activities with mental alertness or coordination
If antitussive contains codeine, monitor
respiration rate
Promethazine with codeine adverse effects
Life-threatening respiratory depression
seizures, apnea,angioedema, CNA depression, hyper excitability
Promethazine with codeine teaches pts
move slowly until known reaction to meds
Decongestants types
Afrin- oxymetazoline
Sudafed- pseudoephedrine
Zyrtec- cetirizine-pseudoephedrine
Allegra- fexofenadine-pseudoephedrine
Claritin- Loratadine-pseudoephedrine
Must teach for decongestants
don’t use longer than 3 days or can cause rebound congestion
effect BP
erthema, pain, increase inflammation
Decongestants - any product containing pseudoephedrine
s/s of cardiac dysfunction
max 7 days
avoid at bedtime
any product containing pseudoephedrine
Adverse effects
Htn
Tachyarrhythmia
Insomnia
Anxiety
Feeling nervous
Restlessness
A fib
Mi
Pneumonia vaccine name
pneumovax 23
What should you advise the patient on with pneumonia vaccine
Advise patient to report angioedema or s/s of thrombocytopenia
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.
TB bacteria caused by
Mycobacterium tuberculosis
TB is most commonly infected in the
lungs
Pts with TB love
o2
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
Isolation Precaution of TB
airborne precaution (negative pressure, N95)
Can TB be suspended in the air for hours?
yes
Transmission of TB requires
close, frequent, or prolonged exposure
Can TB spread by touching, sharing food utensils, kissing, or other physical contact
no
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
Healthcare workers do what process to test for TB
two step ensures future positive results accurately
Sputum culture results can take up to
8 weeks
PPD test for TB =
delayed hypersensitive, ID injection, read between 48-72 hours (later redue)
TB skin test of height greater than 5 mm is a positive for
immunocompromised pts
TB skin test of height greater than 10 mm is a positive for
high-risk pts
TB skin test of height greater than 15 mm is a positive for
everyone
How do you dx TB?
sputum test
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)
What shows a positive TB skin test?
Raised mm not redness
Sputum is best taken in the
morning and label antibiotics
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
S/S of liver complications
loss of appetite, fatigue, malaise jaundice, dark urine, unusual abdominal pain
The pt with TB can go home?
yes
TB nursing dx
Ineffective airway clearance
Ineffective breathing pattern
Fatigue
Impaired gas exchange
Ineffective health management
Discharge Planning for TB
Case management- to refer to health department- medication cost- home health- community resources
What isolation precaution should a pt with TB be in?
Airborne
What PPE is needed for TB?
N95, gown, gloves, goggles, shoe covers
1st Line Drugs for TB
Rifampin
Isoniazid / INH
Pyrazinamide
Ethambutol
Isoniazid INH
Try B6 for neuropathy
Severe and possible fatal hepatitis monitor liver
TB medications used for how long? and how many?
2 different meds
6-9 months
Adverse Reactions to Isoniazid med
Increased liver enzymes
Neuropathy = B6
Neurotoxicity
Rash
Hepatitis
Injury of liver
Rhabdomyolysis
seizure
Adverse Reactions of Rifampin
Hepatotoxicity
Anaphylaxis
Nephrotoxicity
Renal failure
Disseminated intravascular coagulation
Easy bleeding, slow clotting
What is a common side effect of TB drugs that needs monitoring?
Hepatotoxicity, monitor liver functions
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
Adverse Effects of Pyrazinamide
Hyperuricemia
Nausea
Vomiting
Arthralgia
anemia
Hepatotoxicity
When pyrazinamide and rifampin are combined
increases the risk of liver toxicity
Pt Teaching of Pyrazinamide
Possibility of what
S/S of gout and cautious about sensitivity
Adverse effects of Ethambutol
Hepatotoxicity
Anaphylaxis
Optic neuritis
Pt. Teaching of Ethambutol
report any visual changes, or neuropathy to HCP
generally well tolerated
Adverse effects of BCG Vaccine
Nausea
Lymphadenopathy
Increased frequency of urination
Hepatitis
Anaphylaxis
the BCG vaccine is generally used for
military or foreign people
lead to false positive skin test
Obstructive Lung Disease
Airway obstruction that is worse with expiration
Common disorders = asthma, emphysema, chronic bronchitis
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
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
Chronic Bronchitis leads to
right-sided heart failure
with bilateral pedal edema and increase jugular vein distension
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
Dx Chronic Bronchitis
presence of cough and sputum production for at least 3 months for 2 consecutive years
-CXR, PFT, ABG, EKG, CBC, sputum
Tx of Chronic Bronchitis
Smoking cessation
Avoidance of air pollutants
Antibiotics
Bronchodilators
Adequate hydration
Chest physiotherapy
Nebulizer treatments
Corticosteroids
Diuretic
Oxygen therapy
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
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
Pink Puffer descriptions
-skinny
-purse lips
- barrel chest
- accessory muscles
- slow, short
- semi fowlers, tripotty
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
What happens to diaphragm with COPD?
flattens out
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
COPD Dx confirmed by
spirometry
reduced FEV1/FVC Ratio
increased residual vol
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.
ABG results for COPD
Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD
CBC results in COPD
increase hemoglobin in later stages
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
Antitrypsin (AAT) deficiency
genetic risk factor for emphysema – accounts for 3% of emphysema- aat is an autosomal recessive disorder
What is used for persons with AAT deficiency?
Augmentation therapy
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.
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
Pursed lip breathing
2 count in and 4 count out
Other consideration of COPD
Activity considerations
Pulmonary rehabilitation
Activity considerations
Sexual activity
Sleep
Psychosocial considerations
Nutritional considerations
COPD Nursing Dx
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
Insomnia
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
Endurance of a pt with COPD
Shortness of breath while resting or with activity
Crackles
high pitched heard during inspiration
may change with cough
D/C
Rhonchi
rumbling coarse sounds
like a snore
during inspiration or expiration
may clear with coughing or suctioning
Continous
Wheezing
musical noise during inspiration or expiration
1st heard about the expiration
Continuous
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
Short-acting bronchodilators types
Albuterol, Proventil, Max Air
bronchodilators are a
smooth muscle relaxer
Anticholinergic type
Ipratropium bromide
atrovent
Anticholinergic is a
long-acting bronchodilator
Adverse effects of Anticholinergics
Abnormal taste
Bronchitis
Mi
Anaphylaxis
Cva
Bronchospasm
Teaching = HA
Pt Teaching Anticholonergic
Do not get in the eyes
Teach how to use properly
May cause dizziness, blurred vision
methylxanthine types
Theo dur, theophylline
Bronchodilator
adverse effects of methylxanthine
Nausea
Ha,
Insomnia
Tremors
Restlessness
Usually saved till last when other treatments are not working
S/S of theophylline toxicity
Vomiting, arrhythmia , seizures
Would you take methylxanthine with a caffeinated beverage?
no bc effect of absorption and theophylline levels in the blood
types of Prednisone
Solu- Medrol , deltasone
Prednisone is a
immunosuppressant
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
Leukotriene agonists adverse reaction
Upset
Ha
Cough
Leukotriene agonists types
Montelukast- singular
Leukotriene agonists is used for
Helps with respiratory inflammation
Prevents airway edema
Monitor LFT’s and blood chemistry
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
adverse effects of acetylcysteine
Pruritus’
n/v
Bronchospasm
Respiratory distress
Descriptions of acetylcysteine
Drug has an odor
Liquid may become light purple which is normal
acetylcysteine types
Mucomuyst
acetylcysteine helps with
Mucolytic agent
Lowers mucus viscosity
Hypoxia main symptom
restlessness
Chronic hypoxia main symptom
clubbing
Late hypoxia main symptom
cyanosis
Symptoms of Hypoxia
Restlessness
Anxiety
Tachycardia Tachypnea
Late to
Bradycardia
Extreme restlessness
Dyspnea
