Upper/Lower Infectious/Non-Infectious Diseases Flashcards
Chronic airflow limitations (CAL)
asthma and COPD (chronic bronchitis and emphysema)
Causes of Asthma
inflammation and hyper responsiveness of airways to common stimuli
inflammation in the mucous membranes and hyper responsiveness constricts the bronchial smooth muscle
intermittent if well controlled
triggers of asthma
allergens
cold air/poor air quality
exercise
respiratory illness/ URI
general irritants
microorganisms
GERD
diagnostics on asthma
ABG (hypoxemia or acidosis)
PFTs
treatment and nursing care for asthma
goal: control and prevent episodes, improve airflow, relieve symptoms
medications: inhaled or systemic; preventative and rescue; bronchodilators and anti-inflammatory agents
avoidance of triggers, inhalers and nebulizers, oxygen therapy if extreme
status asthmaticus
severe and life threatening
treatment: oxygen, IV fluids, potent systemic bronchodilation, IV steroids, epinephrine
emergency intubation
can develop pneumothorax and cardiac respiratory arrest
absence of wheezing can indicate complete airway obstructions
COPD causes
chronic exposure to irritants, commonly smoking.
causes inflammation, congestion, mucosal edema and bronchospasm.
only effects airways, not alveoli
production of large amounts of thick mucus
EMPHYSEMA
emphysema
chronic exposure to irritants cause damage to the alveoli and small airways.
air trapping occurs in alveoli as it loses elasticity and are destroyed and small airways collapse
decrease surface area for gas exchange
hyperinflation of lung
abnormal excretion of proteases, an enzyme that breaks down the elastin in the alveoli
Symptoms of COPD
dyspnea
orthopnea
cough with sputum production
use of accessory muscles
hypoxemia
chronic acidosis
weight loss
fatigue
barrel chest
cyanosis
clubbing of fingers
anxiety
diagnostics for COPD
ABG
sputum sample
CBC
chest xray
chest CT
PFTs
nursing care for COPD
attain or maintain gas exchange within the patient’s baseline and control symptoms
O2 therapy: O2 sat between 88-90
Hypoxic vasoconstriction with emphysema (blood shunting from unhealthy part of lung to healthy part… artificial O2 will mess up this process)
Positioning; elevate the HOB, tripoding
Cessation of smoking
energy conservation
breathing exercise
nutritional counseling
medications (bronchodilators, anti-inflammatories, mucolytic agents)
COPD complications
hypoxemia
acidosis
respiratory infection
cardiac failure
cardiac dysrhythmias
Nursing implications of the older adult with chronic respiratory condition
rest periods between activities/ADLs
Upright position while eating meals to prevent aspiration
Encourage nutritional fluid intake after the meals
Schedule drugs around routine activities to promote adherance
Encourage patient notification for infection symptoms
cause of cor pulmonale
right sided heart failure caused by pulmonary disease
increased vascular resistance in the lung causes the right side of the heart to work harder against the increased pressure
right side of the heart enlarges and can cause a back flow of blood into the venous system
cor pulmonale symptoms
hypoxemia
dyspnea
cyanosis
JVD
systemic edema
acidosis
fatigue
enlarged liver
chest pain
cor pulmonale diagnostics
ABG
BNP
Echocardiogram
Rt heart cauterization
Ventilation Perfusion scan
cor pulmonae treatment and nursing care
medications
oxygen therapy
heart/lung transplant
Lung cancer
leading cause of cancer deaths word-wide. poor long-term survival due to late stage diagnosis. staged to assess size and extent of disease (metastasis)
types of lung cancer
small cell lung cancer- worse prognosis, chemo
non small cell lung cancer- better prognosis, surgery
causes of lung cancer
exposure to inhaled irritants over time
cancer cells arise from the bronchial epithelium secondary to irritation/inflammation
genetic predisposition
lung cancer symptoms
dyspnea
persistent cough or change in cough
hemoptysis/ rust colored sputum
hoarseness
late signs of lung cancer
weight loss
fatigue
dysphagia
anorexia
lung cancer diagnostic
Chest xray
chest CT
bronchoscopy with biopsy
CT guided biopsy
Open lung biopsy
PET scan
Thoracentesis
treatment and nursing care for lung cancer
surgical intervention; best option of NSCLC
chemotherapy: best option for SCLC
Radiation therapy: used in conjunction with other treatments
palliative treatment with lung cancer
goal: comfort and symptom relief
Oxygen
medications
radiation (decrease tumor size/pain relief)
thoracentesis (dyspnea management)
purpose of lung cancer chest tubes
collects air, fluid, or blood from the pleural space
allows the lung to re-expand
prevents air from re-entering the pleural space
wet drainage system
nursing care for lung cancer chest tubes
ensure dressing is tight and intact around tubing
assess SOB and breath sounds
check alignment of trachea
Palpate for puffiness or crackling
observe for signs of infection
check to see if tube ‘eyelets’ (holes indicating dislodgment) are visible
Keep drainage system lower than the level of the patient’s chest
asses for tidaling
watch for tension pneumothorax and SQ emphysema
lung cancer chest tube emergencies
tracheal deviation
sudden onset or increased intensity of dyspnea
O2 sat less than 90
Drainage greater than 70mL/hr
eyelets on the chest tube
chest tube falls out of patient’s chest
What are some most common types of
pneumonia? (Select all that apply)
A. community acquired
B. hospital acquired
C. ventilator associated
D. healthcare associated
E. dormant pneumonia
ABCD
Which clinical manifestations would the
nurse most likely see in a client
diagnosed with pneumonia? (Select all
that apply)
A. Chest discomfort
B. Dyspnea
C. Fever
D. Cough
E. Myalgia
F. Increased respiratory rate
ABCDEF
Which diagnostic tests does the nurse
initially expect to be ordered for the client
with pneumonia? (Select all that apply)
A. Pulse oximetry
B. Arterial blood gases
C. Chest X-ray
D. Chest CT
E. Sputum culture
F. Complete Blood Count (CBC)
G. Complete Metabolic Panel (CMP)
H. Coagulation panel
I. Pulmonary function test
ABCEF
When caring for a client with
pneumonia, which nursing
intervention is the highest
priority?
A. Increase fluid intake
B. Encourage deep breathing exercises
and controlled coughing
C. Ambulate as much as possible
E. Maintain a nothing-by-mouth (NPO)
B
What should the nurse include in
discharge teaching for a client to
prevent further pneumonia? (Select all
that apply)
A. Continue IV antibiotics
B. Continue breathing exercises
C. Healthy balanced diet
D. Decrease fluid intake
E. Avoid crowded public areas
F. Annual flu vaccine
G. Pneumococcal vaccine
BCEFG
The nurse is caring for clients in the pulmonary unit and suspects that one has tuberculosis. What is the priority nursing intervention in this situation?
A. Move the client to an airborne isolation unit
B. Emphasize hand washing after handling soiled tissues
C. Inform the client about adherence with the prescribed medications regimen
D. Report the client’s condition to the primary healthcare provider
A
Which of the following is a correct
statement about tuberculosis?
A. An infected person is infectious long
before manifestations of disease occur
B. An infected person is not infectious
until manifestations of disease occur
C. Transmission occurs when in contact
with bodily fluids
D. Incidence of TB is on a steady decline
B
Which of the following clients is at
highest risk for TB?
A. 79-year old with DM who lost 15 lb
over the past 3 months
B. 68-year old with hypothyroidism who
is receiving food stamps
C. 49-year old with anorexia who is a
Russian immigrant
D. 65-year old with HIV who is homeless
D
What are the symptoms of pulmonary
TB? (Select all that apply)
A. Sudden fatigue and lethargy
B. Progressive weight loss
C. Low-grade fever
D. Cough with blood-tinged sputum
E. Sharp localized chest pain
F. Night sweats
G. Increased appetite
BCDF
All of the following diagnostic test
confirm active TB infection, EXCEPT:
A. Mantoux skin test
B. NAA blood test
C. QFT-G blood test
D. Sputum culture
A
Which statement made by the client
about TB medications indicates a need
for further teaching?
A. “My urine may turn orange.”
B. “I can stop my medications after 60
days of treatment”
C. “I will need to monitor my liver tests”
D. “My fatigue will diminish gradually
over time”
B
Which statement made by the client
indicates understanding of home self-
care?
A. “I can resume my vegan diet as soon
as I feel better”
B. “I will wear a mask when I am out
for 6 months or longer”
C. “Once I started my TB drugs, I am no
longer contagious”
D. “My family will have to get tested
for TB”
D
A client is being treated for influenza A (H1N1). The nurse has provided instructions to the client about how to decrease the risk of transmission to others. Which client statement indicates a need for further instruction?
A. “I should practice respiratory hygiene/cough etiquette.“
B. “I should avoid contact with the elderly or children.”
C. “I should take Tamiflu for the rest of the flu season”
D. “I should allow visitors for short periods of time only.”
C
A client is being treated for influenza A
(H1N1) and preparing for discharge.
What should the nurse include in the
education?
A. Return to work as long as acetaminophen is
keeping fever down
B. Resume normal physical activities
C. Increase fluid intake and monitor for dehydration
D. Wear a mask when around others that are
immunocompromised
C
patho of sleep apnea
cyclical obstruction of the upper airway during sleep secondary to muscle relaxation
breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum of 5 times in an hour
when airway is obstructed apnea occurs and the patient is awakened
apnea increases blood CO2 and leads to acidosis (on a chronic level it can cause sedation)
causes of sleep apnea
most common cause is upper airway obstruction by the soft palate or tongue. can have a neurological cause
contributing factors of sleep apnea
obesity
large uvula
short neck
smoking
enlarged tonsils or adenoids
oropharyngeal edema
signs and symptoms of sleep apnea
patient is often unaware
persistent daytime sleepiness/lethargy
wakes up tired
frequent disruptions in sleep
snoring
irritability and personality changes
assessment of sleep apnea
Epworth Sleepiness Scale
Polysomnography
Overnight strip oximetry
nonsurgical interventions for sleep apnea
change in sleep position
weight loss
position fixing devices to prevent subluxation of tongue/neck structures
drug therapy approved for sleep apnea
non invasive positive-pressure ventilation NIPPV
surgical intervention for sleep apnea
adenoidectomy- remove tonsils
uvulectomy- remove uvula
UPP- remodeling entire posterior oropharynx
Tracheostomy- for severe sleep apnea if not relieved by other interventions
pneumonia
excess fluid in the lungs resulting from an inflammatory process
inflammation triggered by many infectious organisms and inhalation of irritating agents
develops when the immune system cannot overcome the invading organisms
pneumonia types
community acquired CAP
hospital acquired HAP
health care associated HCAP
ventilator associated VAP
community acquired pneumonia CAP
acquired in community
hospital acquired pneumonia HAP
diagnosis less than 48 hours after admission to hospital
health care associated pneumonia HCAP
diagnosis greater than 48 hours after admission to a hospital and has had recent treatment at a health care facility (inpatient or outpatient)
ventilator associated pneumonia VAP
diagnosis within 48-72 hours of intubation
pneumonia risk factors
older adult
not vaccinated for flu or pneumococcal
Chronic health problems
limited mobility
uses tobacco or alcohol
altered LOC
aspiration
poor nutritional status
immunocompromised status
mechanical ventilation
pneumonia prevention
avoid risk factors
annual influenza vaccine
pneumococcal vaccine
avoid crowded areas during flu season
hand washing
cough, turn, and move if you have impaired mobility
Clean respiratory equipment
avoid indoor pollutants
stop smoking
drink 3L of fluid each day as recommended with diet
CM of pneumonia
increased RR or dyspnea
hypoxemia
cough
purulent, blood tinged, or rust colored sputum
fever with or without chills
pleuritic chest discomfort
acute confusion from hypoxia
pneumonia lab results
sputum by gram stain, culture, and sensitivity testing
CBC to assess elevated WBC
blood culture
ABGs
serum lactate level
procalcitonin
BUN and electrolytes
pneumonia imaging assessment
chest x ray
pulse ox
invasive tests: transtracheal aspiration, bronchoscopy, direct needle aspiration of the lung
Priority nursing diagnosis for pneumonia
impaired gas exchange related to decrease diffusion at the alveolar- capillary membrane
pneumonia nursing interventions
O2 therapy
monitor pulse ox
cough and deep breath every 2 hours
incentive spirometry
adequate hydration
assess fluid status
drug therapy
pulmonary tuberculosis patho
highly communicable
mycobacterium tuberculosis
transmitted via aerosolization (airborne route)
secondary TB patho
reactivation of the disease in a previously infected person
more likely in older adults and people who are immunocompromised
pulmonary TB risk factors
those in constant, frequent contact with an untreated person
those who are immunocompromised
people who live in crowded areas
abusers of injections drugs or alcohol
immigrants from countries with a higher incidence of TB
pulmonary TB assessment history
past exposure
country of origin or travel to countries where incidence of TB is high
had the BCG vaccine
CM of pulmonary TB
progressive fatigue and lethargy
nausea and anorexia
weight loss
low-grade fever
night sweats may occur
pulmonary TB diagnostice tests
NAA nucleic acid amplification test
QuantiFERON TB Gold test
Pulmonary TB PPD skin test
area of induration- localized swelling with hardness of soft tissue
pulmonary TB interventions
combination drug therapy is most effective method of treatment and preventing transmission
2-3 drug combinations
typical drug treatment for 6-12 months
pulmonary TB discharge education
infection prevention
cover mouth and nose with a tissue when coughing or sneezing
wear a mask when in contact with crowds
all members of a household must undergo TB testing
what precautions do we use for pulmonary TB
Airborne precautions- negative flow isolation room
influenza patho
high contagious acute viral infection respiratory
CM of influenza
rapid onset
severe headache
muscle aches
fever
chills
fatigue
weakness
N/V/D
Influenza prevention
yearly vaccinations for the prevention of influenza are recommended
patient education for influenza
hand hygiene
staying home from gatherings when sick
covering mouth and nose with a tissue when sneezing and coughing
avoid close contact with other people
influenza treatment/interventions
antiviral agents
drugs that shorten the duration
rest for several days
increase fluid intake unless contraindicated
saline gargles for sore throat
antihistamines may reduce rhinorrhea
droplet precautions if hospitalized
