Lewis – Ch 28 – Lower Respiratory Problems: Nursing Management – Flashcards
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How can you differentiate Acute Bronchitis from Pneumonia?
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Chest x-ray. There is no evidence of infiltrates on an X-ray of Acute Bronchitis versus Pneumonia.
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What is Pneumonia?
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An acute inflammation of the lung parenchyma and is most frequently caused by a MO.
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What age groups have the highest incidence of death with Pneumonia?
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Age groups 1 - 4 years old and over 65 years.
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What is the Etiology of Pneumonia?
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Most likely to result when the defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents. Decreased consciousness depresses the cough and epiglottal reflexes, which may allow aspiration of oropharyngeal contents into the lungs.
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What are the three ways organisms can cause pneumonia?
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1. Aspiration of normal flora from the nasopharynx or oropharynx. Many MO are normal inhabitants of pharynx in adults. 2. Inhalation of microbes present in the air. i.e., Mycoplasma pneumoniae and fungal pneumonias. 3. Hematogenous spread from a primary infection elsewhere in the body. i.e., Staphylococcus aureus.
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What are the different causes of Pneumonia?
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Bacteria, virus, Mycoplasma, fungi, parasites, and chemicals are all potential causes.
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What are the different types of Pneumonia?
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Community acquired pneumonia (CAP), or Hospital Acquired, Ventilator Associated and Health Care Associated Pneumonia (HAP).
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What is Community Acquired Pneumonia (CAP)?
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Pneumonia - A lower respiratory tract infection with onset in the community or during the first two days of hospitalization.
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What is Hospital Acquired Pneumonia (HAP)?
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Pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.
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What are the Risk Factors of Pneumonia?
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Aging, pollution, altered consciousness: alcoholism, head injury, seizures, anesthesia, drug overdose, stroke, altered oropharyngeal flora secondary to AB, bed rest and prolonged immobility, chornic diseases, debilitating illness, HIV, immunosuppressive drugs, inhalation or aspiration of noxious substances, intestinal and gastric feedings via NG or NI tubes, malnutrition, resident of long-term care, smoking, trach intubation, URI.
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What is Aspiration Pneumonia?
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A pneumonia that occurs from abnormal entry of secretions or substances into the lower airway. It usually follows aspiration of material from the mouth or stomach into the trachea and subsequently the lungs.
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Who are individuals at risk for Opportunistic Pneumonia?
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Altered immune responses - protein calorie malnutrition and/or immunodeficiencies (i.e., HIV), and following treatments with radiation therapy, chemotherapy, long term corticosteroid therapy.
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What is Pneumocystis jiroveci (PCP)?
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The cause of pneumonia usually in HIV cases. The onset is slow and subtle with symptoms of fever, tachpnea, tachycardia, dyspnea, nonproductive cough, and hypoxemia.
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What is Cytomegalovirus (CMV)?
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VIral pneumonia in immunocompromised patients, particularly in transplant patients. Member of the herpesvirus family. Can be a serious lung pathogen. Antivirals treat.
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What are the four characteristic stages of the pathophysiology of pneumonia?
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Congestion, Red hepatization, gray hepatization, and resolution.
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What is the congestion stage of the pathophysiology of pneumonia?
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After the organisms reach the alveoli, there is an outpouring of fluids into the alveoli. The organisms multiply in the serous fluid, and the infection spreads to adjacent alveoli. The presence of fluid in the alveoli interferes with gas exchange.
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What is the red hepatization stage of the pathophysiology of pneumonia?
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There is a massive dilation of the capillaries, and alveoli are filled with organisms, neutrophils, RBCs, and fibrin. The lungs appear red and granular, similar to the liver, which is why the process is called hepatization.
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What is the gray hepatization stage of the pathophysiology of pneumonia?
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Blood flow decreases, and leukocytes and fibrin consolidate in the affect part of the lung.
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What is the resolution stage of the pathophsyiology of pneumonia?
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Complete resolution and healing occur if there are no complications. The exudate is lysed and is processed by the macrophages. The normal lung tissue is restored, and the persons gas exchange ability returns to normal.
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What are the clinical manifestations of pneumonia?
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Sudden symptoms including feer, shaking, chills, shortness of breath, cough productive of purulent sputum (rust-colored sputum may be seen in pneumococcal pneumonia) and sometime pleuritic chest pain.
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What do assessments reveal about a person with pneumonia?
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Signs of pulmonary consolidation, such as bronchial breath sounds, crackles, dullness to percussion, and increased fremitus.
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What are atypical symptoms of Pneumonia?
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Gradual onset, dry cough, extrapulmonary manifestations such as fever, headache, myalgias, fatique, sore throat, nausea, vomiting and diarrhea. Crackles are often heard.
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What are initial manifestations of viral pneumonia?
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Chills; fever; dry non productive cough and extrapulmonary symptoms.
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What are complications of pneumonia?
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Pleurisy, pleural effusion, atelectasis, bacteremia, lung abcess, empyema, pericarditis, meningitis, endocarditis.
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What diagnostic studies are used for Pneumonia?
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History, physical examination, ABGs, sputum specimen for culture and gram stain to identify and chest x - ray.
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What is the Pneumococcal vaccine?
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Used to prevent S. pneumoniae (pneumococcus) pneumonia. Initial vaccination and re-vaccination after 5 years are recommended for individuals at risk.
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What is the treatment for Pneumonia?
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Prompt treatment with appropriate AB almost always cure bacterial and mycoplasmal pneumonia. Uncomplicated cases see results in 48 - 72 hours. Abnormal can last +7 days. Supportive measures: O2 therapy, analgesics, and antipyretics. Rest and activity. No treatment for viral.
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What is nutritional therapy for Pneumonia?
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Hydration, small frequent meals.
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What needs to be assessed for Pneumonia with a Nursing Assessment?
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Important Health History, Functional Health Patterns, General objective data, respiratory status, cardiovascular status, neurologic status, diagnostic findings.
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What past health history information should you assess with a patient with Pneumonia?
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Lung cancer; COPD, diabetes mellitus, chronic debilitating disease, malnutrition, altered conciousness, immunosuppression, exposure to chemical toxins, dust, or allergens.
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What medications should you assess for in a patient with Pneumonia?
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Use of AB, corticosteroids, chemotherapy, or any other immunosuppresants.
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What Surgery and other treatments should you assess for in a patient with Pneumonia?
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Recent abd or thoracic surgery, splenectomy, endotracheal intubation, or any surgery with general anesthesia; tube feedings.
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What health perception and health management patterns should you assess for in a patient with Pneumonia?
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Cigarette smoking, alcoholism, recent URI, malaise.
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What nutritional metabolic patterns should you assess for in a patient with Pneumonia?
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Anorexia, nausea, vomiting, chills.
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What activity exercise patterns should you assess for in a patient with Pneumonia?
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Prolonged bed rest or immobility, fatique, weakness, dyspnea, cough (productive or non-productive) and nasal congestion.
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What cognitive perceptual patterns should you assess for in a patient with Pneumonia?
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Pain with breathing, chest pain, sore throat, headache, abd pain, muscle aches.
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What general objective data should you assess for in a patient with Pneumonia?
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Fever, restlessness or lethargy, splinting of affected area.
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What Respiratory data should you assess for in a patient with Pneumonia?
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Tachypnea, pharyngitis; asymmetric chest movements or retraction; decreased excursion; nasal flaring; use of accessory muscles, grunting; crackles, friction rub on auscultation, dullness on percussion over consolidated areas, increased tactile fremitus on palpation; pink, rusty, purulent green or yellow or white sputum.
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What cardiovascular data should you assess for in a patient with Pneumonia?
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Tachycardia.
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What Neurologic data should you assess for in a patient with Pneumonia?
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Changes in mental status, ranging from confusion to delirium.
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What possible diagnostic findings may you see with a patient with Pneumonia?
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Leukocytosis; abnormal ABGs with decrease or normal PaO2, decrease PaCO2, and increased pH initially, and later decreased PaO2, increased PaCO2, and decreased pH, positive sputum gram stain and culture; patchy or diffuse infiltrates, abscesses, pleural effusion, or pneumothorax on chest x-ray.
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How can Pneumonia be prevented?
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Good health habits, frequent hand washing, eating a balanced diet, adequate rest, regular exercise, covering the mouth during cough and sneezing, washing hands after sneezing. Avoid cigarette smoke, avoid exposure to URIs.
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What Nursing Interventions should be implemented in a patient with Pneumonia in the hospital setting?
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Place patient with altered consciousness in side lying or upright position to prevent or minimize aspiration, turn or reposition 2 hours, encourage or assist in ambulation, practice of medical asepsis and adhereance to infection guidelines.
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What nursing diagnosis are common for Pneumonia?
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Impaired gas exchange, ineffective breathing pattern, acute pain.
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What is Tuberculosis (TB)?
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An infectious disease caused by Mycobacterium tuberculosis. It usually involves the lungs, but can also occur in other parts of the body. Second most cause of death from infectious diseases after HIV/AIDS.
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What persons are at risk for TB?
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Homeless, residents of inner city neighborhoods, foreign born persons, older adults, those in institutions (LTC, prisons), IV injecting drug users, persons at poverty level, and those with poor access to health care, immunosuppression from any etiology.
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What is the Etiology and pathophysiology of TB?
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Gram positive, AFB spread usually airborne droplets. Not highly infectious. Cannot be spread by books, hands, glasses or dishes. Small droplets remain airborne for minutes to hours, once inhaled they lodge in the bronchiole and alveolus. Infection occurs when there is an effective immune response and the bacteria become active.
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What factors influence likelihood of transmission of TB?
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1. Number of organisms expelled into the air. 2. Concentration of organism. 3. Length of time of exposure. 4. Immune system of the exposed person.
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What is LTBI?
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Latent TB infection - a person who does not have the active TB diseases. They do not have symptoms and cannot spread the germs to others.
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What is Class 0 for TB?
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No Tb exposure - not infective, negative PPD test.
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What is Class 1 for TB?
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TB exposure, no infection. No evidence of infection. Negative PPD.
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What is Class 2 for TB?
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Latent TB infection, no disease. TB without disease, reaction to PPD, negative bacteriologic studies, no x-ray findings, no clinical evidence of TB.
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What is Class 3 for TB?
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TB clinically active - positive bacteriologic studies or both a significant reaction to TB skin test and clinical or x-ray evidence of current disease.
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What is Class 4 for TB?
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TB, but not clinical active. No current disease (hx of previous episode of T abnormal, stable x-ray with a significant PPD reaction, negative bacteriologic studies, no clinical or x-ray evidence of current disease.
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What is Class 5 for TB?
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TB suspect (diagnosis pending); person should not be in this classification for more than 3 months.
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What are the clinical manifestations for TB?
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Early stages are usually free of symptoms. LTBI have positive skin test but asymptomatic. Active usually manifest with fatique, malaise, anorexia, unexplained weight loss, low grade fevers and night sweats.
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What are uncommon findings with TB?
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Dyspnea, hemoptysis (usually associated with advanced cases).
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What are the acute, sudden manifestations of TB?
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High fever, chills, generalized flu like symptoms, pleuritic pain, and a productive cough.
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What are complications of TB?
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Miliary TB, Pleural effusion and empyema, TB pnemonia, and organ involvement problems.
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What is Miliary TB?
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Large number of organisms can invade the bloodstream and spread to all organs. The involvement of many organs. Pt may be acutely ill with fever, dyspnea, and cyanosis or chornically ill with systemic manifestations of weight loss, fever, GI distrub, hepatomegaly, splenomegaly, and generalized lymphadenopathy.
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What is TB of the bone called?
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Pott's disease of the spine.
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What is a Tuberculin Skin Test?
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TST - using PPD is widely used to determine if a person is infected with M. tuberculosis. Test is admin by injection 0.1 mL of PPD intradermally on the forearm.
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Why are smaller induration reactions (>5mm) considered positive in a patient who is immunocompromised for a TST?
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Decreased response to TST.
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What are suggestive findings of TB with an x-ray?
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Upper lobe infiltrates, cavity infiltrates, and lymph node involvement.
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What bacteriologic studies can be done with TB?
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AFB test - three consecutive sputum specimens are colected on different days and are obtained for smear and culture. Can take up to 8 weeks, you can collect samples from gastric washings, CSF or fluid from effusion or abscesses.
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What is a QFT test?
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QuantiFERON-TB is a rapid diagnostic test where blood from the patient is placed in chambers along with mycobacterial antigens. If the patient is infected, lymphocytes in the blood will recognize these antigens and secrete y-interferon, a cytokine produced by lymphocytes. May be used instead of TST.
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What are the different diagnostic tests for Pulmonary Tuberculosis?
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H & P, TST, QFT, Chest x-ray, Bacteriologic studies, AFB, sputum culture.
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What collaborative therapy is used for Pulmonary Tuberculosis?
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Long term treatments with antimicrobial drugs, follow up bacteriologic studies and chest x-rays.
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What drugs are used for treatment of Tuberculosis?
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isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), ethambutol (Myambutol), rifabutin (Mycobutin), rifapentine (Priftin), streptomycin amiinoglycosides and fluroquinolones.
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What does a patient on Isoniazid (INH) receiving treatment for TB need to be aware of?
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Alcohol may increase hepatotoxicity of the drug, avoid alcohol, monitor signs of liver damage before and white taking.
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What is Directly Observed Therapy (DOT)?
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Provides antituberculosis drugs to patients and watching as they swallow the medications. It is preferred strategy for all patients with TB to ensure adherence.
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What is major factor in MDR TB?
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Noncompliance.
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What is the initial phase for option 1 for treatment of TB?
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4-drug regiment consisting of INH, rifampin, pyrazinamide, ethambutol. Given for 56 doses or 5 days/wk for 40 doses.
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What is the continuation phase of option 1 for treatment of TB?
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INH, rifamin daily for 126 doses or 5 days/wk DOT for 90 doses.
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What is the initial phase for option 2 for treatment of TB?
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4-drug regiment consisting of INH, rifampin, pyrazinamide, theambutol. Given daily for 14 doses, followed by twice weekly for 12 doses, or 5 days/wk for 10 doses, then twice weekly for 12 doses.
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What is the continuation phase of option 2 for treatment of TB?
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INH, rifampin twice weekly for 36 doses OR once weekly for 18 doses.
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What is the initial phase for option 3 for treatment of TB?
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4-drug regiment consisting of INH, rifampin, pyrazinamide, ethambutol. Given 3 times weekly for 24 doses.
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What is the continuation phase of option 3 for treatment of TB?
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INH, rifampin 3 times weekly for 54 doses.
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What is the initial phase of option 4 for treatment of TB?
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3-drug regiment consisting of INH, rifampin, ethambutol. Given daily for 56 doses OR 5 days/wk DOT for 40 doses.
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What is the continuation phase of option 4 for treatment of TB?
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INH, rifampin daily for 217 doses OR 5 days a week DOT for 155 doses.
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What is drug therapy for LTBI?
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Usually only one drug is needed. Isoniazid for 6 - 9 months, rifampin for 4 months.
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What is Bacille Calmette-Guerin (BCG) vaccine?
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A live, attenuated strain of Mycobacterium bovis. Given to infants in parts of the world where there is a high prevalence of TB. Can give a positive TST.
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What should the nurse assess in her Nursing Assessment?
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Assess for productive cough, night sweats, afternoon temperature elevation, weight loss, pleuritic chest pain, and crackles over the apices of the lungs.
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What are nursing diagnosis related to TB?
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Ineffective breathing pattern related to decreased lung capacity, imbalanced nutrition: less then body requirements related to chronic poor appetite, fatigue and productive cough. Noncompliance related to lack of knowledge of disease process, lack of motivation, and LT nature of treatment and lack of resources. Ineffective self-health management related to lack of knowledge about the disease process and therapeutic regimen. Activity intolerance related to fatigue, decreased nutritional status, and chronic febrile episodes.
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What are the goals of a patient with TB?
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Comply with therapeutic regimen, have no recurrence of the disease, have normal pulmonary function, and take appropriate measure to prevent the spread of the disease.
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What precautions should be taken if a patient with TB is hospitalized?
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Airborne precautions, and standard precautions.
