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Acute Viral Rhinitis "Common cold" Etiology & risk factors

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Also called coryza & is the most prevalent infectious disease--caused by viruses that invade the upper respiratory tract through airborne droplets. These droplets are spread through breathing, sneezing, or coughing or by direct hand contact.

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Acute Viral Rhinitis "common cold" Signs & Symptoms

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Most contagious during 1st 3 days--nasal dryness & stuffiness, sneezing, runny nose, headache, sore throat, lethary, & fatigue

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Acute Viral Rhinitis "common cold" Complications

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Viral or bacterial pneumonitis

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Acute Viral Rhinitis "common cold" Medical diagnosis

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Patient history or physical exam

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Acute Viral Rhinitis "common cold" Medical Treatment

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Rest, fluids, proper diet, antipyretics, & analgesics--antibiotics are given when the cold is a bacterial infection

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Acute Viral Rhinitis "common cold" Assessment

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Symptoms, past medical history, & drug history Physical exam of thenose, throat, ears, neck, & chest

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Actue Viral Rhinitis "common cold" Nursing diagnosis, goal, & outcome criteria

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Ineffective Therapeutic Regimen Management is the primary nursing diagnosis Goal: full recovery w/no complications Assessing effective pt management: patient's verbalization of content presented & stmt of intent to follow plan of care

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Acute Viral Rhinitis "common cold" Interventions

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Primary nursing intervention is "patient teaching" Rest & daily fluid intake of 2-3 L, if not contraindicated Humidifier may provide comfort by keeping mucous membranes moist. Fever can be treated w/antipyretics Avoid contact w/others, especially those who are at risk for infection.

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Acute Bronchitis Etiology & Risk factors

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Common cold that may follow a viral infection such as cold or influenza--usually viral in origin but bacterial causes also common. Irritation & inflammation may occur throughout upper respiratory tract, resulting in ^ mucus production. Hallmark sign is ^ mucus production.

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Acute Bronchitis Signs & Symptoms

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fever, cough, yellow or green sputum, rapid breathing, & occasionally chest pain

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Acute Bronchitis Medical diagnosis

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health history & physical findings

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Acute Bronchitis Medical treatment

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Consists of a broad-spectrum antibiotic, such as ampicillin, tetracycline, or erythromycin, for 7-10 days--hospitalization is usually unnecessary

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Acute Bronchitis Nursing Care

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Similar to that for the common cold Encourage patients who are taking antibiotics to take th full course of medication

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Infuenza: Etiology

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Actual viral respiratory infection accompanied by fever

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Influenza: Complications

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Bronchitis; viral or bacterial pneumonia; less common complications are myocarditis, pericarditis, Reye's syndrome, confusion, seizures, Guillain-Barre' syndrome, toxic shock syndrome, myositis, & renal failure

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Influenza: Signs & Symptoms

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chills, fever, sore throat, muscular pain, headache, & dry, hacking cough--not as common for nasal drainage in flu symptoms like there is for the common cold

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Influenza: Medical diagnosis

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history & physical findings

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Influenza: Medical treatment

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Rest, fluids, proper diet, antipyretics, analgesics, & antiviral agents. Best treatment: prevention through immunization 1st generation flu meds--type "A" flu--Cemtrail & Flumidine 2nd generation flue meds--type "A" & "B" flu--Tamiflu & Rolenza

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Influenza: Nursing care

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Similar to that of the common cold Immunization for people at high risk

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Pneumonia: Etiology & Risk factors

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Inflammation of certain parts of lung such as alveoli & bronchioles--Caused by infectious agents or non infectious agents--Smokers are more likely to contract pneumonia, also those w/altered consciousness from alcohol, seizures, anesthesia, or drug overdose; those immunosuppressed; chronically ill who are malnourished; & people on bed rest w/prolonged immobility

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Infectious agents that cause pneumonia

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bacteria, fungi, & non specific virus

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Non-infectious agents that cause pneumonia

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irritating fumes, dust, & chemicals that are inhaled or foreign matter that is aspirated

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Pneumonia: Pathophysiology

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Classified according to causative organism, bacteria or viruses--When pathogens invade lungs, inflammation causes fluid accumulation in affected alveoli--capillaries dilate & neutrophils, RBCs, & fibrin fill alveoli (hepatization)--lung appears red & granular; blood flow decreases & leukocytes & fibrin infiltrate & consolidate--as infection resolves, consolidated material dissolves & is ingested & removed by macrophages.

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Pneumonia: Types

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Community Acquired Pneumonia Health Care Associated Pneumonia (HCAP)

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Pneumonia: Complications

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Pleurisy, pleural effusion, & atelectasis Less common: lung abscesses, delayed resolution, & emphysema(presence of purulent exudate in the pleural cavity) Systemic complications: pericatditis, arthritis, meningitis, & endocarditis

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Prevention of Pneumonia

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Hand Washing Vaccines

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Prevention of Aspiration

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Sit upright w/feet on floor for PO meds Elevate HOB w/tube fed patients Elevate HOB w/meds if unable to sit up Be on guard w/stroke patients & decreased LOC

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Preventions of HCAP

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Ambulate Incentive Spriometry Ventilator bundles: patients that are on vents are more likely to have HCAP--this is a "bundle" of strategies that nurses an use to prevent this

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Pneumonia: Signs & Symptoms

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Fever, chills, sweats, chest pain, cough, sputum production, hemoptysis (coughing up blood), dyspnea, headache, & fatigue

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Signs & Symptoms of Bacterial pneumonia

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abrupt severe shaking & chills, sharp, stabbing lateral chest pains, especially with coughing & breathing; & intermittent cough w/rusty sputum

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Signs & Symptoms of Viral pneumonia

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burning or searing chest pain in the sterna area; a continuous, hacking, barking cough producing small amounts of sputum; and a headache

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Pneumonia: Medical Diagnosis

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History & physical exam, sputum culture & Gram stain, chest radiography, CBC, & blood culture

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Pneumonia: Medical Treatment

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^ fluid intake (at least 3L q 24 hr), limited acitivity or bed rest, antipyretics, analgesics, oxygen & aerosol intermittent positive-pressure breathing (IPPB) therapy. Bacterial pneumonias are treated w/appropriate antibacterials. Vaccination: unconjugated vaccine is administered q 5 yrs & is given to adults w/chronic illnesses, 65+, or in long term nursing homes

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Pneumonia: Interventions Ineffective Airway Clearance; Impaired Gas Exchange

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Encourage coughing, turning Encourage deep breathing, give oxygen

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Pneumonia: Interventions Activity Intolerance

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Help with ADLs Schedule nursing care to prevent overtiring the patient

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Pneumonia: Interventions Imbalanced Nutrition: Less than body requirements

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High protein, soft diet Monitor weight by weighing each day before breakfast Monitor albumin & lymphycyte blood counts to maintain adequate protein levels.

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Pneumonia: Interventions Risk for Deficient Fluid Volume

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Patient should consume 3 L of fluids per day if not contraindicated. IV fluids if patient cannot drink Giving the patient hard candies stimulates thirst

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Pneumonia: Interventions Pain

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Administer analgestics as ordered Splint for deep breathing & coughing

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Pneumonia: Interventions Prevention of Aspiration Pneumonia

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Keep suction equipment on hand Position patients upright for meals Semisolids are more easily swallowed than liquids, so thickening liquids may need to be dne Keep patient head elevated for at least 30 min after eating

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Patient Education

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Drink liquids & healthy eating Report abnormal signs & symptoms Ambulate Finish all courses of antibiotics & antivirals Turn away from behaviors that endanger health-smoking

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Lung Abscess

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Localized area of lung destruction caused by liquefaction necrosis, which is usually related to pyogenic bacteria

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Causes of Lung Abscess

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pneumonia, aspiration, alcoholic blackouts, seizures, swallowing problems, TB, AIDS

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Signs & Symptoms of Lung Abscess

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foul smelling sputum, pleuratic chest pain, decreased breath sounds

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Legionnaires Disease

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Thrives in warm, stagnate water found in certain plumbing systems, hot water tanks & spas Transmitted via aerosolized water vapor--such as showers, spas, hot tubs Most susceptible: elderly, smokers, chronic lung disease, & immunocompromised

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Legionnaires Disease Signs & Symptoms

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Incubation time is 2-10 days; malaise, anorexia, myalgia, H/A--rapid fever, chills, cough, some people have abdominal pain & diarrhea--CXR will show pneumonia. Treatment: Erythromycin REPORTABLE DISEASE!!

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Acute Respiratory Distress Syndrome (ARDS) Etiology & Risk Factors

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Progressive pulmonary disorder that follows trauma to the lung--From 1-96 hrs after trauma, pulmonary infiltrates develop & lung compliance decreases--fluid shifts into the interstitial spaes in the lungs & into the alveoli, causing pulmonary edema. Production of surfactant decreases--leading to atelectasis--patient becomes hypoxemic

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Signs & Symptoms of ARDS

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^ respiratory rate is the 1st sign; fine crackles; restlessness, agitation, & confusion; pulse rate ^, & cough may be present

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Medical Diagnosis of ARDS

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History & physical; ABG analysis & chest radiographs--Blood pH rises & CO2 falls at first due to hyperventilation

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Medical Treatment of ARDS

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Mechanical ventilator w/positive end-expiratory pressure Sedation or pharmacologic paralysis Drug therapy depends on underlying cause

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Respiratory Arrest

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Cessation of breathing Can happen when ARDS is not treated promptly Know basic CPR Mechanical ventilation is necessary at this time

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Mechanical Ventilation

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providing respiratory support by means of a mechanical device called a ventilator--most commonly called for in pts w/acute respiratory failure who are unable to maintain adequate gas exchange in the lungs--this may be evidenced by tachypnea or bradypnea w/an elevated or a stable PaCO2, low PaO2, or low pH

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Types of Mechanical Ventilation

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Volume cycled Pressure cycled Time cycled

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Volume cycled

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delivers a constant present amt of oxygenated air to the patient--most commonly used type

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Pressure cycled

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pushes air into the lungs until a preset pressure is reached, is not widely used for continuous mechanical ventilation

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Time cycled

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ventilators deliver oxygenated air during a preset length of time--most commony used in children & infants

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Delivery Methods: Mechanical Ventilation

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depending on the patient's needs, vents may be programmed to control or assist the rate of ventilation. The most frequently used modes are intermittent mandatory vent & syncronized intermittent mandatory vent--these modes provide assistance w/ventilation by allowing th epatient to breathe spontaneously between a preset # of ventilator breaths

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Positive End: Mechanical Ventilation

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expiratory pressure may be prescribed to keep the pressure in the lungs greater than the atmospheric pressure at the end of expiration--this reduces the collapse of small airways & alveoli

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Ventilators can give

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oxygen concentrations ranging from 21% (atmospheric oxygen) to 100% oxygen--Oxygen concentration is dependent on the patients needs

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Mechanical Ventilation: Nursing Care

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Monitor settings Be sure that high & low pressure settings are on Have manual resuscitator & O2 source readily available Do not allow water to accumulate in tubing Monitor VS Establish an alternate way of communicatin if patient cannot speak

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Respiratory Acidosis

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Retention of CO2 by the lungs pH 45 HCO3 - WNL

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Respiratory Acidosis: Etiology

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Hypoventilation Pneumonia COPD Chest wall injury Head injury Drug Overdose Asphyxiation Acute Respiratory Failure

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Respiratory Alkalosis

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Decreased CO2 levels pH > 7.45 PaCO2 <35 HCO3 - WNL

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Respiratory Alkalosis: Etiology

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Hyperventilation Fever Pain ASA Overdose Anemia

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