Lewis – Ch 28 – Lower Respiratory Problems: Nursing Management – Flashcards

Unlock all answers in this set

Unlock answers
question
How can you differentiate Acute Bronchitis from Pneumonia?
answer
Chest x-ray. There is no evidence of infiltrates on an X-ray of Acute Bronchitis versus Pneumonia.
question
What is Pneumonia?
answer
An acute inflammation of the lung parenchyma and is most frequently caused by a MO.
question
What age groups have the highest incidence of death with Pneumonia?
answer
Age groups 1 - 4 years old and over 65 years.
question
What is the Etiology of Pneumonia?
answer
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.
question
What are the three ways organisms can cause pneumonia?
answer
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.
question
What are the different causes of Pneumonia?
answer
Bacteria, virus, Mycoplasma, fungi, parasites, and chemicals are all potential causes.
question
What are the different types of Pneumonia?
answer
Community acquired pneumonia (CAP), or Hospital Acquired, Ventilator Associated and Health Care Associated Pneumonia (HAP).
question
What is Community Acquired Pneumonia (CAP)?
answer
Pneumonia - A lower respiratory tract infection with onset in the community or during the first two days of hospitalization.
question
What is Hospital Acquired Pneumonia (HAP)?
answer
Pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.
question
What are the Risk Factors of Pneumonia?
answer
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.
question
What is Aspiration Pneumonia?
answer
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.
question
Who are individuals at risk for Opportunistic Pneumonia?
answer
Altered immune responses - protein calorie malnutrition and/or immunodeficiencies (i.e., HIV), and following treatments with radiation therapy, chemotherapy, long term corticosteroid therapy.
question
What is Pneumocystis jiroveci (PCP)?
answer
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.
question
What is Cytomegalovirus (CMV)?
answer
VIral pneumonia in immunocompromised patients, particularly in transplant patients. Member of the herpesvirus family. Can be a serious lung pathogen. Antivirals treat.
question
What are the four characteristic stages of the pathophysiology of pneumonia?
answer
Congestion, Red hepatization, gray hepatization, and resolution.
question
What is the congestion stage of the pathophysiology of pneumonia?
answer
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.
question
What is the red hepatization stage of the pathophysiology of pneumonia?
answer
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.
question
What is the gray hepatization stage of the pathophysiology of pneumonia?
answer
Blood flow decreases, and leukocytes and fibrin consolidate in the affect part of the lung.
question
What is the resolution stage of the pathophsyiology of pneumonia?
answer
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.
question
What are the clinical manifestations of pneumonia?
answer
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.
question
What do assessments reveal about a person with pneumonia?
answer
Signs of pulmonary consolidation, such as bronchial breath sounds, crackles, dullness to percussion, and increased fremitus.
question
What are atypical symptoms of Pneumonia?
answer
Gradual onset, dry cough, extrapulmonary manifestations such as fever, headache, myalgias, fatique, sore throat, nausea, vomiting and diarrhea. Crackles are often heard.
question
What are initial manifestations of viral pneumonia?
answer
Chills; fever; dry non productive cough and extrapulmonary symptoms.
question
What are complications of pneumonia?
answer
Pleurisy, pleural effusion, atelectasis, bacteremia, lung abcess, empyema, pericarditis, meningitis, endocarditis.
question
What diagnostic studies are used for Pneumonia?
answer
History, physical examination, ABGs, sputum specimen for culture and gram stain to identify and chest x - ray.
question
What is the Pneumococcal vaccine?
answer
Used to prevent S. pneumoniae (pneumococcus) pneumonia. Initial vaccination and re-vaccination after 5 years are recommended for individuals at risk.
question
What is the treatment for Pneumonia?
answer
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.
question
What is nutritional therapy for Pneumonia?
answer
Hydration, small frequent meals.
question
What needs to be assessed for Pneumonia with a Nursing Assessment?
answer
Important Health History, Functional Health Patterns, General objective data, respiratory status, cardiovascular status, neurologic status, diagnostic findings.
question
What past health history information should you assess with a patient with Pneumonia?
answer
Lung cancer; COPD, diabetes mellitus, chronic debilitating disease, malnutrition, altered conciousness, immunosuppression, exposure to chemical toxins, dust, or allergens.
question
What medications should you assess for in a patient with Pneumonia?
answer
Use of AB, corticosteroids, chemotherapy, or any other immunosuppresants.
question
What Surgery and other treatments should you assess for in a patient with Pneumonia?
answer
Recent abd or thoracic surgery, splenectomy, endotracheal intubation, or any surgery with general anesthesia; tube feedings.
question
What health perception and health management patterns should you assess for in a patient with Pneumonia?
answer
Cigarette smoking, alcoholism, recent URI, malaise.
question
What nutritional metabolic patterns should you assess for in a patient with Pneumonia?
answer
Anorexia, nausea, vomiting, chills.
question
What activity exercise patterns should you assess for in a patient with Pneumonia?
answer
Prolonged bed rest or immobility, fatique, weakness, dyspnea, cough (productive or non-productive) and nasal congestion.
question
What cognitive perceptual patterns should you assess for in a patient with Pneumonia?
answer
Pain with breathing, chest pain, sore throat, headache, abd pain, muscle aches.
question
What general objective data should you assess for in a patient with Pneumonia?
answer
Fever, restlessness or lethargy, splinting of affected area.
question
What Respiratory data should you assess for in a patient with Pneumonia?
answer
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.
question
What cardiovascular data should you assess for in a patient with Pneumonia?
answer
Tachycardia.
question
What Neurologic data should you assess for in a patient with Pneumonia?
answer
Changes in mental status, ranging from confusion to delirium.
question
What possible diagnostic findings may you see with a patient with Pneumonia?
answer
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.
question
How can Pneumonia be prevented?
answer
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.
question
What Nursing Interventions should be implemented in a patient with Pneumonia in the hospital setting?
answer
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.
question
What nursing diagnosis are common for Pneumonia?
answer
Impaired gas exchange, ineffective breathing pattern, acute pain.
question
What is Tuberculosis (TB)?
answer
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.
question
What persons are at risk for TB?
answer
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.
question
What is the Etiology and pathophysiology of TB?
answer
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.
question
What factors influence likelihood of transmission of TB?
answer
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.
question
What is LTBI?
answer
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.
question
What is Class 0 for TB?
answer
No Tb exposure - not infective, negative PPD test.
question
What is Class 1 for TB?
answer
TB exposure, no infection. No evidence of infection. Negative PPD.
question
What is Class 2 for TB?
answer
Latent TB infection, no disease. TB without disease, reaction to PPD, negative bacteriologic studies, no x-ray findings, no clinical evidence of TB.
question
What is Class 3 for TB?
answer
TB clinically active - positive bacteriologic studies or both a significant reaction to TB skin test and clinical or x-ray evidence of current disease.
question
What is Class 4 for TB?
answer
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.
question
What is Class 5 for TB?
answer
TB suspect (diagnosis pending); person should not be in this classification for more than 3 months.
question
What are the clinical manifestations for TB?
answer
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.
question
What are uncommon findings with TB?
answer
Dyspnea, hemoptysis (usually associated with advanced cases).
question
What are the acute, sudden manifestations of TB?
answer
High fever, chills, generalized flu like symptoms, pleuritic pain, and a productive cough.
question
What are complications of TB?
answer
Miliary TB, Pleural effusion and empyema, TB pnemonia, and organ involvement problems.
question
What is Miliary TB?
answer
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.
question
What is TB of the bone called?
answer
Pott's disease of the spine.
question
What is a Tuberculin Skin Test?
answer
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.
question
Why are smaller induration reactions (>5mm) considered positive in a patient who is immunocompromised for a TST?
answer
Decreased response to TST.
question
What are suggestive findings of TB with an x-ray?
answer
Upper lobe infiltrates, cavity infiltrates, and lymph node involvement.
question
What bacteriologic studies can be done with TB?
answer
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.
question
What is a QFT test?
answer
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.
question
What are the different diagnostic tests for Pulmonary Tuberculosis?
answer
H & P, TST, QFT, Chest x-ray, Bacteriologic studies, AFB, sputum culture.
question
What collaborative therapy is used for Pulmonary Tuberculosis?
answer
Long term treatments with antimicrobial drugs, follow up bacteriologic studies and chest x-rays.
question
What drugs are used for treatment of Tuberculosis?
answer
isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), ethambutol (Myambutol), rifabutin (Mycobutin), rifapentine (Priftin), streptomycin amiinoglycosides and fluroquinolones.
question
What does a patient on Isoniazid (INH) receiving treatment for TB need to be aware of?
answer
Alcohol may increase hepatotoxicity of the drug, avoid alcohol, monitor signs of liver damage before and white taking.
question
What is Directly Observed Therapy (DOT)?
answer
Provides antituberculosis drugs to patients and watching as they swallow the medications. It is preferred strategy for all patients with TB to ensure adherence.
question
What is major factor in MDR TB?
answer
Noncompliance.
question
What is the initial phase for option 1 for treatment of TB?
answer
4-drug regiment consisting of INH, rifampin, pyrazinamide, ethambutol. Given for 56 doses or 5 days/wk for 40 doses.
question
What is the continuation phase of option 1 for treatment of TB?
answer
INH, rifamin daily for 126 doses or 5 days/wk DOT for 90 doses.
question
What is the initial phase for option 2 for treatment of TB?
answer
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.
question
What is the continuation phase of option 2 for treatment of TB?
answer
INH, rifampin twice weekly for 36 doses OR once weekly for 18 doses.
question
What is the initial phase for option 3 for treatment of TB?
answer
4-drug regiment consisting of INH, rifampin, pyrazinamide, ethambutol. Given 3 times weekly for 24 doses.
question
What is the continuation phase of option 3 for treatment of TB?
answer
INH, rifampin 3 times weekly for 54 doses.
question
What is the initial phase of option 4 for treatment of TB?
answer
3-drug regiment consisting of INH, rifampin, ethambutol. Given daily for 56 doses OR 5 days/wk DOT for 40 doses.
question
What is the continuation phase of option 4 for treatment of TB?
answer
INH, rifampin daily for 217 doses OR 5 days a week DOT for 155 doses.
question
What is drug therapy for LTBI?
answer
Usually only one drug is needed. Isoniazid for 6 - 9 months, rifampin for 4 months.
question
What is Bacille Calmette-Guerin (BCG) vaccine?
answer
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.
question
What should the nurse assess in her Nursing Assessment?
answer
Assess for productive cough, night sweats, afternoon temperature elevation, weight loss, pleuritic chest pain, and crackles over the apices of the lungs.
question
What are nursing diagnosis related to TB?
answer
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.
question
What are the goals of a patient with TB?
answer
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.
question
What precautions should be taken if a patient with TB is hospitalized?
answer
Airborne precautions, and standard precautions.
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New