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week 4 (resp disorders) Flashcards

1
Q

what is pneumonia

A

is an acute inflammation of the lungs parenchyma caused by a microbial agent

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2
Q

what protective defense mechanisms keep the airway distal to the larynx sterile?

A

includes filtering of air, humidification of inspired air, epiglottis closure over the trachea, and cough reflex

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3
Q

what is contracting pneumonia? what are the three methods that pneumonia can reach the lungs?

A

1) aspiration from the nasopharynx or oropharynx
2) inhalation of microbe present in the air
3) hematogones spread from a primary infection elsewhere in the body ie.staphlococcus aureus

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4
Q

what is community-acquired pneumonia

A

is defined as a lower respiratory tract infection of the lungs parenchyma with onset in the community
-most frequently occur in winter months or if there is a history of smoking

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5
Q

what prevention methods can be used for community-acquired pneumonia

A

prevention includes modifiable risk factors such as presence of COPD, recent use of antibiotics and conditions including the risk of aspiration

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6
Q

what is the second most common hospital-associated infection as has high mortality and morbidity rates?

A

hospital-acquired pneumonia

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7
Q

when does hospital-acquired pneumonia occur?

A

occurs 48 hours or longer after hospital admission

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8
Q

what may be some predisposing factors for hospital-acquired pneumonia?

A

immunosuppressive therapy, general debility and endotracheal intubation
pts with altered immune response are highly susceptible to respiratory infections

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9
Q

what individuals are at risk for opportunistic pneumonia?

A
  • severe protein-calorie malnutrition
  • those with immune deficiencies
  • those who have received transplants and been treated with immunosuppressive drugs
  • pts undergoing tx of radiation, chemo, and corticosteroids
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10
Q

what are some signs and symptoms of pneumonia?

A
  • loss of appetite, fatigue, changes in mental health
  • nausea, vomiting, or diarrhea
  • lower body temp and shaking chills
  • pain in chest while coughing or breathing
  • coughing may produce phlegm
  • shortness of breath and restlessness
  • fever and sweating
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11
Q

what are some clinical manifestations of Pnu.

A

usually a bunch of symptoms including sudden onset of fever, chills, productive cough with purulent sputum and chest pain

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12
Q

atypical (unusual) presentations of pnu include what?

A

headache, myalgias, fatigue, sore throat, and nausea

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13
Q

what are some manifestations of viral pnu are?

A

highly variable but may be characterized by chills, fevers, dry nonproductive cough

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14
Q

what are some complications of pnu?

A
  • generally, there are no complications
  • complications more frequently develop in those with underlying chronic disease and include pleurisy, pleural effusion, atelectasis, empyema, pericarditis, and bacteremia
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15
Q

what is pleurisy?

A

inflammation of the pleura

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16
Q

what is pleural effusion?

A

abnormal collection of pleural fluid that usually reabsorbs within 1-2 weeks

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17
Q

what is atelectasis?

A

collapse, airless alveoli; usually clear with effective coughing and deep breathing

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18
Q

what is pericarditis?

A

the spread of infection organism from an infection pleura to the pericardium

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19
Q

what is bacteremia?

A

can occur with pneumococcal pneumonia, more so with other adult patients

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20
Q

what are some signs of pulmonary consolidation?

A

dullness to percussion, increased fremitus, bronchial breath sounds and crackles may be heard

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21
Q

what is needed for the diagnosis of pnu?

A
  • chest x ray
  • sputum cultures are recommended if the presence of a drug -resistant pathogen or an oranism is suspected that is not covered by the usual empirical therapy
  • gram stain of the sputum provides info on the predominant causative organism
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22
Q

how many blood cultures may be done for a critically ill pt?

A

two blood cultures

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23
Q

what is ABG? what is it used to assess?

A

arterial blood gas - used to assess for hypoxia

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24
Q

what is a CBC and what is it used for

A

Complete blood count- is a blood test used to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia

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25
what is found in the majorty of pts with bacterial pneumonia?
leukocytosis
26
should all cultures be collected before initiating antibiotic therapy?
yes
27
in uncomplicated cases, the pt responsd to drug therapy usually between within what hours?
48 - 72 hours
28
what supportive measures can be used besides antibiotic therapy for pnu?
O2 therapy - to tx hypoemia alalgesics to releive the chest pain antipyretics to tx fever
29
what is recommended annually for individuals at high risk of developing pnu?
influenza vaccine
30
who is at high risk for pnu?
``` older adults nursing home residents pts with COPD diabeties health care workers ```
31
who is indicated for the pnumococcal vaccine?
chronic heart and lung disease pts diebetic pts pts recovering from severe illnesses 65 year and older in long term facility care
32
what is the tx of choice for otherwise healthy individuals with community acquired pnu?
macrolide (erythromycin, azithromycin, or clarithromycin)
33
what ppl are at risk of gram-negitive infections?
1) a COPD pts who has taken an oral steroid or antibiotics within the past 3 months 2) nursing home residents
34
what is required to treat gram negitive infections?
fluroquinolones (levofloacin, moxifloaxcin) | or amoxicillin and clavulanate
35
what are pts who are hosptialized on medical wards with bacteremic pneumococcal pneumonia treated with?
fluoroquinolone
36
fluid intake of at least ___ /day is important in the supportive tx of pnu
3/liters a day
37
intake of at least ____ calories per day should be maintained to provide energy for the increased metabolic processes in the pt
1500 calories
38
what are small, frequent meals better tolerated by?
people with dyspnea
39
how often should a nurse reposition a pt and why?
every 2 hours facilitates adequate lung expansion and to discourage pooling of secretions
40
what is theraputic positioning?
better oxygenation is achieved when the good lung is placed down to achieve maxium lung expansion
41
what is turberculosis?
- an infectious disease caused by M.tuberculosis - usually involves the lungs, also occurs in the larynx, kidneys and bones - kills more ppl worldwide than any other infectious disease
42
what is M.tuberculosis?
gram positive - acid-fast bacillus - usually spread from person to person via airborne droplets, which are produced when a infected individual with pulmonary or laryngeal tb coughs, sneezes, speaks, or sings
43
what happens when a TB lesion regresses and heals?
the infection enters a latent period in which it may persist without producing clinical symptoms of illness
44
in early stages of TB, are symptoms present?
no
45
what are some systemic manifestations of tb?
fatigue, malaise, wieght loss, low grade fevers, and night sweats
46
what are some pulmonary manifestations of tb?
cough that becomes frequent and produces muciod or mucopurulent sputum
47
what is used to diagnose tb?
the Tuberculin skin test - a positive reaction indicates presence of tb infection, but it doesnt shoe whether it is latent or active - induration greater than 5mm are considered positive
48
what are some other ways to diagnos TB?
chest X-ray (CXR): shows multinodular lymph node involvment with cavitation in the upper lobes of the lungs - three sputum samples collected on different days are obtained and sent for smear and culture - Quantiferon: tube blood test that recognizes antigens in TB positive pts
49
what is the main tx of TB?
drug therapy - active tb should be managed agressively - usually consists of a combo of at least 4 drugs
50
why is combination therapy need for tb pts?
it is needed to decrease the development of resistant strains of M.tuberculosis
51
how long should they receive tx for?
-infected pts should receive tx for at least 6 months beyond the conversion of sputum cultures to a negitive status
52
what are the four drugs used to tx TB?
rifampicin isoniazid pyrazinamide Ethambutol
53
what is direct observation therapy?
because of nonadherance being a mjaor factor in the emergence of multidrug reistance and tx failures, DOT is expensive but essential to public health issues -DOT involves observing the injection of every dose of mediation for the TB pts entire course of tx
54
where should a pts with TB be placed in a hosptial?
a pt with TB should be placed in isolation until the pt is considered noninfectious (three negitive AFB smears)
55
what should a pt with TB be taught?
to cover nose and mouth with paper tissue everytime he or she coughs, sneezes, or produces sputum -also taught careful handwashing techniques
56
what is Pulmonary Embolism?
PE is the blockage or pulmonary arteries by a thrombus, fat, or air embolus -the embolus travels with the blood flow through the small vessles until it lodges and obstructs perfusion of teh alveoli
57
where do most PE's arise from?
deep vein thromboses
58
where do lethal PE most commonly originate from?
the femoral or iliac veins
59
what are some clinical manifestations of PE?
- classic triad: dyspnea, chest pain, and hemoptysis | - symptoms may begin slowly or suddenly
60
what could a masssive emboli produce?
abrupt hypotension, pallor, severe dyspnea and hypoxemia | other symptoms: cough, fever, pleurtic chest pain, tachycardia
61
what are the causes of PE?
1) venous statis 2) trauma 3) hypercoagulability
62
what are some diagnostic tools for PE?
CT scan = most frequently used -contrast media is required to veiw blood vessles -Ventilation/ perfusion scan is done if pt cannot tolerate contract media -D-Dimer = controversial - is a lab test that measures the amount of cross-linked fibrin fragments disadvantage= neither specific or sensitive
63
how to prevent PE?
prevent VTE first (Venous thromboembolism (VTE) is a condition in which a blood clot forms and lodge in vessles) - to avoid this, includes use to compression devices, early ambulation, and use to anticoagulant meds
64
what drug therapy is available for PE?
Fibrinolytic drugs: Tissue plasminogen activator is a protein involved in the breakdown of blood clots. - unfractionated heparin IV - Enoxaparin is becoming more common - Warfain should be initated within the first 24 hrs and is typically administered for 3 to 6 months
65
what is pneumothorax?
- presense of air in the pleural space - should be suspected after any blunt trauma to chest wall (deep chest wound) - causes lung to collapes
66
what is open pneumothorax?
occurs when air enters the pleural space through an opening in the chest wall - Ex: gunshot wounds and surgical thoracotomies - often referred to as sucking chest wound - should be covered with a vented dressing - a vented dresssing is one secrued on the three sides and the forth side is left untapped (allows air to escape from vent and decrease likelihood of a tension pnueothorax developing
67
what is closed pneumothorax?
- has no associated external wound - most common form is a spontanous pneumothorax - caused by rupture of small blebs - occurs most commonly in underweight male cig smokers between age 20 and 40
68
what is tension pnuemothorax?
- a medical emergency - rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessles - can occur if the chest tubes are clammed or blocked in a pt with pneumothorax - nurse and paramedics are now trained to insert large-bore neddles to release trapped air
69
what are some clinical manifestations of pneumothroax?
- if it is small, mild tachycardia and dyspnea may be the only manifestations - if pneumothorax is large, resp distress may be present, including swallow, rapid respirations, dyspnea, air hunger and decreased o2 saturation - on auscultation, no breath sounds are over affected area - most definitive and common form of treatment is to insert a chest tube and connect it to a water-seal drainage

nurse 251 (14 decks)

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