X Respiratory (Grant) Flashcards
External Respiration
exchange of O2 and CO2 btwn lung and envt
Internal Respiration
exchange of O2 and CO2 at cellular level
Ventilation
movement of air in and out of alveoli
Diffusion
molecular mvmt from UP concentration to LO concentration
Factors affecting diffusion
- surface are of lung
- thickness of alveoli lining
- concen of gases
Upper Resp Tract
- Nose (entry way, air filtered, warmed)
- Pharynx (5” length, 3 subdivisions)
- Larynx (voice box)
- Trachea (wind pipe)
Pharynx: 3 subdivision
- Nasopharynx, addenoids
- Oropharynx, tonsils
- Laryngopharynx
- inner lining is continuous-
- infection in pharynx w lead to inner ear d/t connection to eustachian tubes
Larynx
Voice box
- connects to pharynx w trachea
- made of 9 areas of cartilage
- largest area (Thyroid, adams apple)
- same side in men/women until puberty when boys grow and become larger.
Trachea
Wind Pipe
- into mid chest , L/R bronchi
- contains C shaped cartilage rings. allows expansion when swallow
Lower Resp Tract
-Brochial tree
(Brochioles, alveolar ducs, alveoli)
-L (has horizontal slant) R (larger, enters into lunch. More vulnerable because of vertical tube.
-Risk for aspiration
Mechanics of Breathing
Lungs: occupy most of the thoracic space (visceral and parental pleura)
Respiratory Mvmt and Ranges: rhythmic mvmts of chest walls, ribs and muscles allow air to be inhaled and exhaled.
Parietal Pleura
touches outside thoracic cavity.
Visceral Pleura
touches the lung. Membrane is air tight, keeping lungs inflated.
Mediastinum
- Heart, Great Vessels
- are protected by sternum, ribs, thoracic vertebrae
Regulation of Respiration
Nervous Control: medulla oblongata, pons, chemoreceptors (in carotid and aorta)
The Medulla Oblongata and Pons control what?
rate and depth of respiration
Chemoreceptors in Medulla respond to changes in what?
- CO2 levs and CSF pH.
- w send message to lungs to change depth and rate
- CO2 in blood (Carbonic Acid) is a chem stimulant for respiratory regulation.
- UP CO2 = UP ACIDIC
- more alkaline after exhale
Normal Respiration Rate
14-20
affected by Age, Sex, Activity, Disease, Temp
Normal blood pH
7.35 - 7.45
Assess of Resp System: Subjective Data
- SOB (cause, duration, cough during, sudden, gradual, upon waking, running, walking)
- Dyspnea
- Cough (mucous color, amount, harsh, dry, hacking?)
- what causes your SO
Assess of Resp System: Objective Data
- Expression, chest mvmt, respirations
- respiratory distress, wheezes, orthopnea (have to sit/stand to breath)
- adventitious breath sounds (abnormal)
Adventitious Breath Sounds
- Sibilant Wheezes
- Sonorous wheezes
- Crackles
- Pleural friction rubs
Adventitious Breath Sounds: Sibilant wheezes
abnormal breath sounds
- hissing/whistling heard on inspiration or expiration
- air passing through obstructed airway
Adventitious Breath Sounds: Sonorous wheezes
snoring (aka Ronchi)
-low pitch, loud, course, snoring sound. Heard on expiration in trachea and bronchi
Adventitious Breath Sounds: Crackles
- bubbling, cracking, short, interrupted on inspiration.
- sounds like rubbing hair, rice crispies
- air forced thru fluid/mucous/pus filled passage way r/t inflammation d/t infection in bronchi/alveoli
Adventitious Breath Sounds: Pleural Friction Rubs
low pitched grating, creaking sound. Inflamed pleural rubbing together
Assessment of Respiratory System
- while breathing, does chest expand evenly on both sides?
- note: rate, rhythm, depth, effort of breathing
- Hyperpnea (exaggerated, deep, rapid, labored resp)
- Tachypnia (fast breathing)
- Cheyne Stokes breathing
- listen for wheezes
- observe pt chest (normal, barrel?)
- look at posterior chest. deformities? Scoliosis?
- palpate chest for areas of tenderness?
- visible abnormal tumor/mass?
- respiratory expansion while breathing
- Tactile Fremitus (vibratory tremors that can be felt thru chest while speaking, UP vibrations w PNA or completely absent. Problem indicative of obstuction)
Hyperpnea / Hyperpnoea
increased depth of breathing when required to meet metabolic demand of body tissues, such as during or following exercise, or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anemia.
What can you determine from Precussing lungs?
- Resonant Sounds: normal, lo pitched, hollow, heard over normal lung tissue
- Fluid buildup?
- Hyper resonance: louder, lower pitched than resonant. More likely to hear over thin adult or children. Hear in hyperinflated lungs w air (i.e. COPD, Ashtma)
- Typanic Sound: hollow drum like sound, hi pitch, heard over stomach area, indicatove of pheumothorax (collapsed lung). w be normal in abd area, not chest area
Hypoxia - SS
Lo O2
- anxiety, restlessness
- LO concentration
- vertigo
- behavioral changes
- UP pulse
- Bradycardia, as hypoxia INC
- UP respiration/depth
LATE SS:
- shallow, slow resp
- changes in color (palor)
Lab & DX Tests
- Chest Roentgenogram (xrays)
- Computed tomoraphy (CT)
- Mediastinoscopy
- Laryngoscopy
- Bronchoscopy **
- Sputum Specimen
- Cytological Studies
- Thoracentesis
- Arterial Blood Gasses (ABG)
- Pulse Oximetry
Dx Tests: Chest Roentgenogram
Visualization of chest/lungs, size/shape, position of lungs to detect tumors, foreign bodies etc.
Dx Tests: Computed Tomography
CT, slices of pulmonary tissue. look for pulmonary lesions
- painless, non invasive
- anxiety, enclosed space
Dx Tests: Helical/Spiral CT Scan
- more accurate than regular CT scans.
- If contrast used, can pick up pics in seconds.
- improved imaging
Dx Tests: Pulmonary Angiography
- Contrast looking at pulmonary arteries to detect embolism or lesions.
- Congenital or acquired lesions.
- For an emboli, w do lung scan first then this
Dx Tests: PFTs, Pulmonary Function Test
- Umbrella term, several tests
- measuring functionality of lungs
- measurement obtained w spirometer
Types of Pulmonary Function Tests
- TIDAL VOLUME: vol air inhaled/exhaled in normal breath
- INSPIRATORY RESERVE: max vol air normally inspired
- EXPIRATORY RESERVE: max vol air normally exhaled, by forced expiration
- RESIDUAL VOLUME: vol air left in lungs after max expiration
Mediastinoscopy
- visualization of mediastinum under General Anes.
- incision made into upper mediastinum
- gather sample of lymph nodes and/or biopsy if needed
Laryngoscopy
- Direct visualization of Larynx to detect lesions and evaluate laryngal functioning and any inflammation
- can use for biopsy or to remove polyps.
Bronchoscopy ***
- direct vis larynx, trachea, bronchi
- introduced thru nose or mouth using flexible fiberoptic scope.
- sometimes direct into trachea
- used to treat lung disease, obtain biopsy, remove foreign objects
- collect sputum
Bronchoscopy: NI
- NPO until gag reflex returns
- semi fowler
- lie on side to help w secretions
- monitor for laryngal edema or spasms
- stridor d/t obstruction
- scope could cause inflammation
- UP Dyspnea
- monitor SS of Hemorrhage
Sputum Specimen
for microscope eval
Cytological Studies
test on body secretions, sputum, pleural fluid to detect abnormal or malignant cells
Thoracentesis ***
- insert needle thru chest wall, pleural space for aspiration of fluid
- for Dx or therapeutic purposes
- Removed fluid w be examined (WBC, RBC, Glucose, Protein Culture for abnormal cells.
- can detect malignant cells.
- color of fluid ,amount
- insertion site
***Thoracentesis: NI
- explain to pt (really Dr’s job but nurse should know)
- need written consent
- pt anxious, provide support
- asst pt w position
- 30* HOB raised
- check VS, Resp (through out procedure)
- no more than 1300ml removed w/in 30 min to prevent intra vascular shift
- could lead to pulmonary edema
- after procedure, place pt on unaffected side
- specimen sent to lab ASAP
Arterial Blood Gasses (ABG)
- hurts
- measures ability of lungs to oxygenate arterial blood adequately
Pulse Oximetry
provide continual monitoring of SAO2 (sat of Oxy)
-not in strong sunlight**, can affect reading. pull curtains
Epistaxis
Nose bleed
Epistaxis: Cause
- congestion of nasal membrane leading to capillary rupture
- primary or secondary
- pick nose
- menstruation
- severe dryness (use humidifier)
- foreign body in nose
- excessive nose blowing
- deviated septum
Epistaxis: Subjective Data
-Deviation, severity
Epistaxis: Objective Data
1 nostril or both
anterior or posterior
Epistaxis Types
Anterior: 90%, constant ooze
Posterior: farther back in nasal cavity. Profuse, arterial origin
RSK: airway compromise, aspiration of blood, difficulty controlling bleeding
Epistaxis can contribute to HTN
anxiety of bleed causes HTN
Epistaxis: Assess
- bright red bleeding from one or both nostrils
- can lose as much as 1L/hr
- women, menstruation d/t hormones fluctuating Estrogen
- BP, TP, Resp
- evidence of hypovolemic shock (LO BP, if low enough, can stop bleeding
Epistaxis: NI
- sitting position,leaning forward
- direct pressure by pinching nose
- ice compress to nose
- nasal packing (saturated)
- cautery using silver nitrate
- balloon tamponada (foley like catheter inserted in nose, inflate balloon to put presssure against vessel to stop bleeding
- Rhinoscopy w lighted speculum to look into nasal passageway
- ABX profilactically to LO risk for infect
- saline spray
- humidifier
- vaseline on nostrils to prevent dryness
Deviated Septum/Nasal Polyps
- congenital abnormality
- injury
- nasal septum deviates from midline and can cause a partial obstruction
- nasal polyps are tissue growths usually d/t prolonged inflammation
- pt w seasonal allergies
Deviated Septum/Nasal Polyps: SS
- stertorous respirations (snoring)
- dyspnea
- postnasal drip
Deviated Septum/Nasal Polyps: NI
- MEDS (corticosteroids(prednisone), antihistamines, abx)
- Analgesics
- Nasaseptoplasty
- Nasal polypectomy
- sinus X-rays (polyps, dev septum)
- nasal packing after Sx to stop bleeding for 24hrs
- check for hemorrhage (excessive swallowing)
- sucking sound normal d/t packing
- maintain nasal mucosea hydration, nasal irrrigarion w saline
- vaseline to nares for dryness
- Semi Fowlers, UP breathing, drainage, LO edema
- NO nose blowing
- NO bend over
- encourage mouth breathing
- no heavy lifting/straining
- NO ASA (hemrrorhage
- NO ETOH, TOBACCO
- patent airway
- some meds cause Rebound Effect and stop working and start to cause the original symptoms (i.e. Affrin)
MED: Prednisone
- Corticosteroid
- LO polyps, reduce size
MED: Antihistamine
- LO congestion
- SS of allergies
MED: Abx
profilactically
MED: Analgesics
pain, HA
Allergic Rhinitis (runny nose) and Allergic Conjunctivitis
antigen/antibody reactions in nasal membranes, nasopharynx and conjuctiva d/t allergies
Allergic Rhinitis/Conjunctivitis: Causes
-pollen
-trees/grass
-weeds
-mold spores
-fungi
-dust
common among adults/children. can result in loss work/school
-seasonal mostly sometimes perennial
Allergic Rhinitis/Conjunctivitis: SS
- edema
- photophobia
- excessive tearing
- blurring of visa
- pruritis
- excessive nasal secretions and/or congestion
- sneezing
- cough
- HA
Allergic Rhinitis/Conjunctivitis: NI
- avoid allergen
- antihistamines (rotate when intolerance)
- Decongestants (actifed/sudafed)
- Analgesics (HAs, Sinuses)
- Hot packs over facial sinuses
- Arizona/NM better climate for allergies
OSA, Obstructive Sleep Apnea
- cessation of spontaneous respiration
- partial or complete obstruction during sleep, causing apnea
- can cause hypopnea (shallow/slow resp)
- occurs when tongue and soft palate fall back and completely or partially obstruct pharynx
- lasts 15-90 sec. during period pt can experience hypoxemia LO PAO2
OSA: SS
- snorts and loud gasps, grunts
- causes soft palate to move out of the way?
- about 2-400 x per night per 6-8hr sleep
- frequent waking
- insomnia
- tired, sleepy during day d/t bad sleep
- loud snoring
- am HAs d/t hyprcapnea (CO2 retention) —> vasodilation of cerebral bv
- personality changes —> stroke
- systemic HTN
- cardiac dysrythmia
Chronic Sleep Loss: SS
- cardiovascular disease
- inability to concentrate
- impaired mem
- failure to comp daily tasks
- interpersonal difficulties
- male (Impotence)
- driving accidents
- severe depression
OSA: Obstructive SLeep Apnea, RSK factors
- 2ce MEN
- risk UP w Age
- weight gain/obesity
- loss of pharyngeal muscle strength
- obesity (larangyl fat, tongue/soft pallet enlarged)
- Naso allergies
- polyps
- septal deviation (DEC diameter of Pharynx)
- Pharangeal structural abnormalities (enlarged tonsils, long tongue, elongated uvula)
OSA: Dx tests
Polysomnography: monitor chest/abd mvmt, oral nasal air flow SPO2 Ocular movement HR rhythm
OSA: NI
- avoid sedatives, ETOH, 3-4hrs before sleep
- weight loss if obese
- teach use oforal appliances that bring mandible and tongue forward to enlarge airway space
- support groups
- CPAP machine use (attached high floater for continuous pos sir pressure, poor compliance)
- BYPAP machines (bi level pos airway pressure)
- Sx
Upper Airway Obstruction
- Inflammation of tissue
- Dentures
- Aspiration (vometus, secretion –> PNA)
- tongue
- laryngeal spasm (stridor, d/t tetany)
Upper Airway Obstruction: SS
- stertorous respiratoins (snoring)
- altered resp rate and character, apnea periods
- hypoxia, cyanosis (LO O2)
- wheezing, stridor
Upper Airway Obstruction: NI
- ***Open airway, restore patency
- remove obstruction
- artificial airway, teach
- heimlic maneuver
CA of Larynx (Voice Box)
- squamous cell carcinoma
- majority of malignancies develop from lining of larynx
- heavy smoking, ETOH (chewing tobacco, pipes, cigars)
- vocal abuse (singers, actioneers)
- family Hx
- CA usually located on Glottis (true vocal chord)
- slow growing d/t low lymphatic blood supply
CA of Larynx (Voice Box): Prognosis
- If tumor limited to Glottis, 80-90% cure rate.
- If OUT of Glottis area, NOT GOOD
CA of Larynx (Voice Box): SS
- prgressive/persisitent hoarseness
- Pain radiating to ear (Otalgia, ear pain)
- Difficulty swallowing
- Hemoptysis (blood in sputum)
- persistant burning throat
CA of Larynx (Voice Box): NI
-Radiation (shrink cells)
-Sx
..Partial Laryngectomy:Partial w get temp teach.
..Total Laryngectomy removing diseased vocal chords and.or portion of thyroid cartilage. PERM Trach. loose sense of smell, lose voice
..Radical neck dissection
CA of Larynx (Voice Box): NI (cont)
- Airway maintenance (suctioning)
- skin care around teach
- monitory I+O
- tube feedings (temp)
- facial /neck disfigurement (psych support)
- support group
- communicating (white board, hand gestures)
- cover stoma in cold weather
Types of Traches
Voice Restoration Programs:
Electrolarynx: place wand over teach
Esophageal Speech: burp talking , teach person how to speak using muscles. takes practice, diff to understand
TEP (Traches Esophageal Puncture): one way valve surgically implanted where stoma would be. Put finger over device to speak.
-Heat Moisture Exchange?
Acute Rhinitis (common cold)
Inflammation of the mucous membranes of the nose and accessory sinuses
- Rhinovirus (most common, ~100 strains)
- Droplet transmission
Acute Rhinitis (common cold): SS
- thin, serous nasal exudate
- productive cough
- sore throat
- fever
- sinus congestion
- nasal drip (throat irritation, HA, Otogia)
- 24-48hrs after exposure
- contagious first 3 days
- Bacterial w last longer, worse
SARS, Severe Acute Respiratory Syndrome
-Conglomeration of different symptoms etc. Not directly specific.
CAUSE: **Corona Virus, Rhino Virus (common cold)
Corona Virus: from family of virus’ that cause many acute respiratory illness
SARS: Spread
- close contact
- droplet
- touching contaminated objects
SARS: SS
- Fever UP 101*
- HA
- Malaise
- Muscle aches
- dry cough (sometimes leads to SOB)
- Dyspnea
- Hypoxia
- 20% need intubation/mech ventilation
- lungs look patchy upon X-ray (fluid in space)
SARS: Dx
- lung xray (normal at first –> patch, fluid in space)
- tissue cultures (serum antibodies)
- nasal pharangeal swabs (antibodies)
- bronchoalveolar lavage (wash out deeper secretions)
- been to Asia? Toronto recently?
SARS: MM/NI
- no definitive Tx
- Treat symptoms
- ABX if bacterial
- Ribaviran (antiviral)
- Resp Isolation (if SARS suspected)
- Corticosteroids
- infection control nurse w notify healt dept on Dx. pt on isolation
- return back to work once fever resolved and resp symps better
Administration of Steroid Inhalers
- Sit or Stand
- shake canister several times thorough mix
- breath out thru mouth –> empty lungs
- breath in slowly thru mouth, w canister to mouth. Less canister to allow med to be released while inhaling.
- hold breath, keep mowh closed for 20s
Swine Flu (H1N1, Influenza A)
human to human contact
- new type of flu virus
- rapid spread
- some ppl partial immune from previous exposure or vaccine
- all flus genetically drift (change regularly, new vac)
- much more serious in kids
SPREAD: droplets, touching objects
Swine Flu: SS
- HA
- Body Aches
- severe N/V/D
- Runny nose
in Kids can be more serious
-Changed in Mental Status, Behavior, Cognitive
Swine Flu: Dx
- have you been around anyone with H1N1?
- nasal swab
- if suspect H1N1, treat
Swine Flu: Risk Fct
- obesity
- LO immune
- DM
- Nursing Homes/LTC (elderly)
- pregnant
- Under2yrs
- Asthma/COPD
- Cardiovascular Probs (except HTN)
- liver/kidney probs
Swine Flu: Tx
- Anti Viral (Tamiflu, Relenza) most effective in first 48hrs
- Peramivir (only in hospital, IV admin. Must be approved by FDA Emerg Use Authorization)
Swine Flu: Prognosis
- Most people recover w/o antiviral
- flu vaccine in 2010/11, now contains H1N1
- children 10UP, 1 shot vaccine. Protection w/in 8 days
- children 10LO, 2 doses, 3 wks apart
- not mandatory except for Med Field, Military
Acute Rhinitis (common cold): MM/NI
- no specific Tx
- may do throat/sputum culture
- analgesic (ASA, Tylenol, no asa for kids, can get Reye syndrome, kidney liver shut down)
- Antipyretic
- cough suppressant
- expectorant (loosen mucous)
- Abx, if infection present
- encourage fluids
- warm compress for sinus
- good hand washing
- proper disposal of used tissues
- resolves 7-10days
- cause of most absentee work/school
Acute Rhinitis (common cold): Alternative Tx
EXPECTORANT:
.Anise
.Coats foot (also antitussive)
.Horehound (also antitussive)
SORE THROAT: .Mint .Spearmint .Slippery Elm .honey/lemon .boiled onion/honey/lemon
FEVER/HA:
.Boneset
.Feverfew
.White willow
BOOST IMMUNE SYST:
.Echinacea
.Golden Seal
DYSPNEA:
.breathing ever
.massage
Acute Follicular Tonsillitis
- Inflammation of tonsils
- Bacterial (strep most common) or Viral
- most common in school aged children
- tonsils help ward off infection
- sometimes adenoids removed as well
Acute Follicular Tonsillitis: SS
- Enlarged, tender, cervical lymph nodes
- sore throat / Otolgia
- Fever, Chills
- Enlarged, purulent tonsils
- Elevated WBC
Acute Follicular Tonsillitis: DX
- Throat culture
- CBC (UP WBC)
- ABx ( based on pathogen)
Acute Follicular Tonsillitis: MM/NI
-Abx, Analgesics, Antipyretics
-warm saline gargles (temporary)
-Tonsillectomy and adenoidectomy (for chronic tonsillitis)
-
Acute Follicular Tonsillitis: Tonsilectomy POST OP
Tonsillectomy and adenoidectomy (for chronic tonsillitis)
- monitor for hemorrhage (excessive swallowing)
- IV fluids until nausea subsides
- ice cold liquid, ice cream
- ice collar (vasoconstrictor, min bleed)
- avoid coughing, sneezing, vigorous nose blowing
- sponge soaked w epinephrine sol to help w minor bleeding.
- meticulous oral care
- normal diet after couple days
Laryngitis
- inflammation of the larynx (voice box) d/t virus or bacteria
- not contagious
- Chronic or Acute
- may cause seer resp distress in children under 5 b/c larynx so small that any inflation w block airway.
Laryngitis: SS
- hoarseness
- voice loss
- scratchy/ irritated throat
- persistent cough
Laryngitis: MM/NI
- Viral, treat symptoms
- Abx, bacterial
- Analgesics
- Antipyretics
- Antitussives
- Warm/cool mist vapor
- limite use of voice
Pharyngitis
Inflammation of the pharynx (location of tonsils/adenoids)
- chronic or acute
- often come w a common cold
- viral, most common
- bacterial, strep, stpah
- most common throat inflammation
- pharynx = 5”
- Severe Acute Pharangytis —> Strep Throat. contagious 2-3 days after onset of SS.
Pharyngitis: SS
- dry cough
- tender tonsils
- enlarged cervical lymph glands
- red, sore throat
- fever
- diff swallowing
Pharyngitis: MM/NI
- Abx, Analgesics(Tylenol), Antipyretics
- warm or cool mist vaporizer
- Abx (Penicillin, Erythromycin)
Sinusitis
inflammation of the sinuses
- NOT contagious
- usually begins w URI, Viral or Bact –> sinus infection
- PNA or Nasalpolyps
- acute or chronic
Sinusitis: SS
- constant severe headache
- pain and tenderness in sinus region
- purulent exudate
- malaise
- Fever
Sinusitis: MM/NI
- Abx
- Analgesics (tylenol w codeine)
- Antihisthamines (Benda=ryl, Zyrtec)
- Vasoconstrictor nasal spray (Afrin)
- Warm mist vapor
- warm moist packs
- nasal windows (Sx for better drainage).
- Saline imigration
- ice compress
POST Sx:
monitor for hemorrhage
visual acuity (affect optic nerve)
Sinusitis: Dx
.Xray (cloudiness in sinus’), can see fluid filled cavities
.Transillumination: bring light, close lips around and infected areas will show up dark. normal sinuses w look translucent.
Acute Bronchitis
Lower Airway
- inflammation of trachea and bronchial tree
- usually secondary to URI
- exposure to inhalted irritants
- caused: Rhinivirus
Acute Bronchitis: SS
- Productive cough, wheezes, crackles (clear, white, yellow, green sputum)
- dyspnea, chest pain, tightness
- low grade fever, chills
- malaise, HA
- fatigue
- residual cough for weeks post bronchitis
Acute Bronchitis: Cause
- most common cause
- Smoking
- Air Pollution
- Dust/Toxic gases
- repeated bouts can lead to chronic bronchitis –> COPD/ASTHMA
Acute Bronchitis: MM/NI
- Cough Suppressants
- antitussives
- antipyretics, tyenol
- bronchodilators (open narrow passageway)
- Abx, if bac
- Vaporizer (moisture/loosen mucos)
- encourage fluids (hydrate, loosen fluids)
- breathing excer.
Acute Bronchitis: Dx
- Chest xray
- sputum test
- PFTs’
Acute Bronchitis: Rsk Factors
- smoking
- LO immune system
- air pollucon/dust/toxicg gas
- elderly/very young
- exp to irritantas (@work)
- gastric reflux
- cold weather can trigger
Legionnaires’ disease
legionella pneumophila bacteria
- thrives in water reservoirs
- causes life threatening pneumonia –>Lung Consolidation and Alveolar Necrosis (lungs become firm and inelastic)
- leads to resp failure, renal failure, cateremic shock and ultimately death
- rapid progress, 2-10days
- some don’t show simp for 10 days
- NOT CONTAGIOUS, not transmitted by infected ppl. need to breath in thru lungs
Legionnaires’ disease: Contract
- aspiration
- pt w abnormal gag reflux (smokers, lung disease, LO immune system)
- drink contaminated water
- bacteria found on plastic, rubber, wood
Lung Consolidation
lungs become firm and in-elastic (Legionnaires disease)
Legionnaires’ disease: SS
- elevated temp
- HA
- non productive cough / productive
- difficult and rapid respirations, crackles or wheezes upon auscultation
- tachycardia
- signs of shock
- hematuria (blood in urine d/t renal failure)
- GI symptoms (diarrhea)
Legionnaires’ disease: Dx
- specialized cultures w legionella medium (test sputum to see if it grows)
- antibody testing
Legionnaires’ disease: Rsk
Lung Disease
Smokers
Legionnaires’ disease: MM/NI
- Oxygen
- Mech vent, intubation if necc
- IV therapy (maintain E balance, hydration)
- Abx (Erythromycin, Macrolides type, Quinolone type, Tetracyclin, Doxycyclin
- Antipyretics
- Vasopressors (if sings of shock)
- Temp Dialysis (acute renal failure)
- Analgesics (comfort)
Legionnaires’ disease: Prognosis
- 80-90% recover w/in first year
- death rate UP w pre-existing problems (COPD)
- smokers need to quit for life
- 10-20% develop breathing probs (mech ventilation)
- reported to health dept
Anthrax
- Bacillus Anthracis bacteria
- spread by direct contact w bac or spores
- 3 types: Cutaneous, GI, Inhalational
-3 types of Anthrax
- CUTANEOUS: enter thru skin, cut/abrasian. Most common type. from touching skin/fur animals. SS: pruritic reddened macule or papule –> vesicle
- GI: least common. after ingestion of contacmin organs (undercooked food). germinate in mouth/esoph/stom/intes, can cause ulcers, SS: inflamed GI track, N/V/F/Abd pain, D, Sepsis, death w no Rx. similar to common cold
- INHALATION: most deadly. develops w spored deeply inhale into lung. Immune cells carry bacteria to lymph system –> spread thru body
Anthrax: SS
- cold, flu like symptoms
- hemorrhage, tissue necrosis and lymphedema (UP fluid in soft tissue d/t blockage in lymp syst.
Anthrax: Dx
- chest xray
- mediasteinal widening (rule out PNA)
- rapid DNA test (Mayo Clinic)
Anthrax: MM
-Abx, Cipro**, Vibracycin, PCN
Tuberculosis
- inhalation of tubercle bacillus (Mycobacterium tuberculosis), Bacterial
- infection versus active disease
- spread thru blood stream and lymph nodes to other parts of body where it destroys tissue of organs it attacks.
- mostly found in lungs
- most people w TB are asymptomatic
- Inactive / latent form can live in body for years
- can be contagious but difficult to become infected
- only 10% ppl exposed w develop. 90% w have latent form
- can live mos in dark place, in dried sputum for months
- Direct Sunlight kills
TB: Dx
PRESUMPTIVE Dx
- Mantoux tuberculin skin test (w 2-10wks exposure). read test 2-3 days later. read area of INDURATION (hard, raised). Redness is normal.
- Chest Xray
- Acid fast bacilli smear x3 (bacteria can’t be washed away after using acid to stain it)
- NAA (Nuclei Acid Amplification, Newer test, using Sputum, result in few hours,)
- QFT-G: blood test more reliable than PPD. Detects protein antigen from Mycobacterium. Approved in 2004, FDA
CONFIRMED Dx
-Sputum Cx, pos for TB bacilli
-
TB: Risk
- HIV
- LO Immune System
- Elderly
- fatal if un Rx
- can kill tissue of affected organ
TB: Types
Chronic Pulmonary: in lung
Extra Pulmonary: outside lung
TB: SS
EARLY: Asymtomatic
- Fever
- Weight Loss, weakness
- productive cough, hemoptysis, dry cough
- **chills, night sweats ** (Active TB)
Effects: Extra Pulmonary (Outside of Lung)
- Respiratory
- GI
- Kidneys
- Urinary Tract
- Bones
- Joints
- Nervous Syst
- Lympth Nodes
- Skin
- TB Arthiritis (in large bearing weight joints)
TB: Prognosis
- good w Tx
- Death w no Tx
- requires long Tx
- 50% DO NOT complete therapy
- resistant TB cases reported among HIV pt w rapid disease progression
- 75-90% mortality rate in HIV
- Bacterium can survive more than 50yrs in human tissue. can become active when you are elderly.
TB: MM/NI
- Tuberculosis isolation (acid fast bacilli AB)
- Multiple meds
- prevent complications and illness transmission
- Isolation for LARYNGEAL and PULMONARY TB
- children w Pulmonary DON’T need Isolation because their sputum has low bacteria count and they rarely cough it up.
- Tx 6-9mos, longer if Extra Pulmonary
PNA
- cause of 10% hospital admissions
- most common cause of death from an infection
- inflammatory process of bronchioles and the alveolar spaces d/t infection
- *Bacteria, Virus, mycoplasma, fungi, parasites
PNA: SS
- productive cough
- severe chills, UP temp
- UP Heart Rate
- UP Respiration
- Dyspnea
PNA: Risk
- Oversedation, inadequate ventilation, aspiration
- common Winter/Early Spring
- infants, elderly
- recent anestesia
- ETOH (aspirate w drunk)
- Damaged resp defense mechanisms (COPD, Influenza, Trach)
- Any disease affecting antibody response
PNA: Transmission
- aspiration of infected materials into distal bronchioles and alveolar
- direct and indirect contact
Necrotizing PNA
Death of lung tissue d/t pathological changes in lung. usually d/t aspiration of vomitus. Usually altered state of consciousness (Sz, ETOH, Anestesia, Shock)
VAP (Ventilation Assoc PNA)
type of aspiration PNA in pt w intubation, mech vent, endotracheal tube keeps glottis open, introducing bacteria aspiration to lungs
Aspiration PNA
UP risk , bacterial PNA
Types of PNA
- Bacterial PNA: pus formation exudate, SS: lung consolidation
- Mycoplasmal/Viral: produces interstitial inflam SS: NO Lungh Consolidation
- Fungal/Mycobacterial: patchy distribution d/t necrosis. dev of cavities in lung. (fungi, candida/aspergillus)
- StreptococcalPneumococcal: SS, sudden onset, 90% of bacterial, chest pain, chills, F/HA, cyanosis, cough w rust sputum, crackles, friction rub, hypoxemia (as blood shunted away from area of consolidation)
- Stapholococcal: similar SS, to strep BUT Sputum is Copius and Salmon colored
- Klebsiella:
- Haemophilus
- Mycoplasmal
Klebsiella PNA
- gram neg bacteria
- common in sick pt on vents, IV catheters, Wounds, LT Abx
SS: similar to STREP BUT
- onset more gradual
- mortality UP if not Rx by second day of onset
Haemophilus PNA
- often follows URI
- Elderly, HIV, COPD
SS:
- low grade fever
- croupy cough
- SOB
- arthralgia (joint pain)
- yellow/green sputum
Mycoplasmal aka Walking PNA
Influenza virus
- HA, F
- Malaise
- Chills
- severe cough, non productive
- LO breath sounds, Crackles
- WBC (normal)
- Chest Xray (clear)
SS: Mild
- patient in general less ill than bacterial
- irritating cough –> bloody sputum
- Myalgia
- Anorexia
- WBC (normal)
PNA Assessment
Subjective Data
- what are symptoms?
- F, nights sweats?
Objective Data
- VS q 2h-sputum (amount, color, consistenc)
- Dyspnea
- Cyanosis
- use of accessory muscles
- on inspiration: crackles
- pleural effusion
PNA DX
- Blood/Sputum Culture
- Chest Xray
- WBC (leukocytosis in bacterial PNA)
- PFTs (lung volume LO)
- ABG (altered gas exchange)
- Pulse Ox
PNA: MM/NI
- Oxygen (nasal canula/face mask)
- **Chest percussion (am, before breakfast)
- Encourage cough, deep breath
- Abx (penivillin, erythromycin, tetracycline)
- Analgesics (chest pain, sore)
- **Expectorants
- **Bronchodilators
- Humidifier (drain/loosen)
- Hi Fowlers
- GOOD lung side down
- suction prn
- Percussion
- encourage rest
- limit visitors
- pt conserving energy
- hydrate
- at least 1500cal per day
PNA: Complications
- pleurisy
- Atalectasis
- pleural effusion
PNA: NI
-assist in pt conserving energy
How to Collect Sputum
- rinse mouth
- collect before meals (avoid vomit)
- deep cough from lungs
- spit into cup
- send to lab ASAP
PNA: Prognosis
- w resolve in 2-3 wks w Tx
- major cause of death in critical ill
- Bacterial aspiration PNA (LO Prognosis)
