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210 Ch. 23

Lower Resp Tract Disorders

Atelectasis? How it develops? At: closure or collapse of alveoli Dev: acute in postop/immobile/decr ventilation/blockage/xtra pressure on lung
Diff b/n pleural effusion? pneumothorax? hemothorax? eff: fluid in pleural space(bn parietal and visceral pleurae) pneu: air in space hemo: blood in space
s/s of atelectasis? dyspnea, cough, sputnum acute: resp distress showing tachyc/tachyp/pleural pain/central cyanosis(late sign of hypoxia)
Nsg preventions for atelectasis turn, mobilization, deep breathing(q2h), incentive spir. Mgmt secretions: cough/suction/nebulizer/CPT
Other nsg mgmt when first line measures fail PEEP(+ end-expiratory pressure)- mask that provides exp resistance CPPB(continuous pos press breathing)
Tx for pleural effusion? thoracentesis - needle aspiration of fluid, or chest tube
what is acute tracheobronchitis? inflammation of mucous membranes of trachea/bronchial tree.
Manifestations of tracheobronchitis? TX? scanty sputum at first, fever, chills, insp stridor, exp wheeze, purulent sputum tx: fluids to thin secretions, moisture
Two classifications of pneumonia CAP-community-acquired: w/in 1st 48h after hospitalization. HAP- hospital-acquired/nosocomial: More than 48h after admission
CAP types Steptococcal pneumonia 14% mortality rate winter/Af Am/elderly/COPD, heart failure, alcoholism, asplenia, DM s/s: pain, quick onset tx: penicillin
Haemophilus influenza 30% mortality rate alcoholics/elderly/DM/COPD/child<5y s/s: assoc with URI tx: amoxicillin
Legionnaires' Disease 15-50% mortality rate summer/fall, older men/smokers/excavation sites s/s: flu like tx: fluoroquinolone,azithromycin
Mycoplasma pneumonia Viral Chlamydial tx: macrolie, tetracycline oseltamivir/zanamivir fluoroquinolone
HAP Pseudomonas Pn 40-60% mortality cancer/burns/lung disease s/s: productive cough, fever, chill tx: betalactam + cipro, levofloxin, aminoglycoside
Staphylococcal pn 25-60% mortality drug users/hiv/MRSA s/s: hypoxemia, cyanosis, necrotizing inf tx: vancomycin, linezolid
Klebsiella pn 40-50% mortality alcoholic/COPD/elderly s/s: tissue necrosis, cough, fever tx: levofloxacin, piperacillin/tazobactam + amikacin
Pneumonia in Immunocompromised PCP, fungal, mycobacterium(TB) from corticosteroids, chemo, AIDS
Aspiration Pn aspirate GI contents, gases, chemical contents
Who should get pnue vaccine? >65, immunocompetent, asplenia(w/o spleen)
Complications of pneumonia hypotension, shock, resp failure, heart failure, dysrhythmias, pericarditis, pleural effusion
what is silent aspiration non-fx nasogastric tube allows gastric contents to accumulate in stomach Placement is key to prevention
When is residual volume checked in tube feedings? q4h and if >200-250ml residual volume, then pt shows intolerance to feedings
what is SARS viral resp illness caused by coronavirus. s/s: fever >100.4, coughing, trouble breathing tx: droplet/contact/airborne
TB preventions negative pressure private room, fitted respirators, standard precautions
What is the Mantuox test for TB Dx of TB How: deposit purified protein PPD subq w/ bevel of needle facing up to create bleb/wheal. Results in 48/72h Reaction pos: induration(hardening) and erythema
Induratino measurements for pos TB 0-4mm- not signuficant >5mm- sig for at risk(HIV+, contact, + chest xray) >10mm- sig with impaired immunity Pos not mean active TB, immunocompromised may be + and not show = anergy
What may be diff for elderly wtih TB tests s/s of confusion, fever, anorexia, wt. loss. TB test can show no reaction or delay up to wk(recall phenomenon), need 2nd test
TB tx? antifubercolosis agents 6-12mos with 3-4 or more meds INH, Rifampin, pyrazinamidem, ethambutol Nsg Intv: compliance
contraindications for IHH and rifampin INH avoid tyramine(tuna, aged cheese) (Vit B given with INH) Rifampin: alter metabolism and make less effecitve of BB, warfarin, dig, corticosteroids, oral contraceptives
Lung abscess s/s? tx? necrosis of pulmonary parenchyma by inf s/s: pleural friction rub, crackles tx: clindamycin(Cleocin)
Peurisy s/s? tx? nsg mgmt? inflamm both layers of pleurae s/s: knifelike pain, maybe one side s/s effusion: sob, pain, decr chest wall excursion tx: indomethacin(anti-inflamm) nsg: splinting, thoracentesis
Empyema s/s? tx? nsg? thick, purulent fluid in space w/ walled off area s/s: like pneumonia dx: chest CT tx: drainage, abx nsg: breathing excercises
Pulmonary Edema s/s? tx? fluid in alveolar space/lung tissue from heart prob(LV), pneumonectomy, pneumothorax dx: crackles, frothy secretion tx: fix problem
Acute Resp Failure vs chronic acute: ventilation/perfusion impaired..PaO2<50, PaCO2>50, pH<7.35 chronic: long period, by COPD, neuromuscular diseases
ARDS Acute Resp Distress Syndrome from acute lung injury 4-48h leading to hypoxemia tx: PEEP, nutritional support 35-45kcal/kg/day nsg: turning(prone), decr anxiety, sedate(ativan/versed/propofol/precedex), paralytics(pavulon/norcuron/tracrium/zemuron
pulmonary arterial hypertension two types? MAP>25, wedge press <15mmHg 1.idiopathic,primary from known cause: women, 20-40y, death in 5y 2.From known cause
Pulmonary arterial htn s/s? tx? s/s: dyspnea(exertion/rest), chest pain, weakness, fatigue, syncope, Rside heart failure tx: viagra/tracleer/thelin/letairis
Pulmonary Heart Disease-Cor Pulmmonale RV enlarges of heart from diseases(COPD, pulmonary htn) tx: treat cause
Pulmonary Embolism obstruction of pulmonary art or branch by thrombus from venous sys or Rside of heart.
risk factors for PE venous stasis, injury, tumor, polycythemia, splenectomy, vascular dis, DM, COPD, HF, obesity, preg, elderly, oral contraceptives
Emergency mgmt for PE O2, ABGs, CT, ECG, catheter if suffered embolism, stockings
anticoagulation therapy for PE heparin continued til INR is 2.0-2.5 then need to take same kind of warfarin PO
Thrombolytic therapy for PE urokinase, streptokinase, alteplase
Sarcoidosis mostly of lung w/ s/s dyspnea, cough, hemoptysis, congestion
Lung Cancer Staging and types 1.sm cell cancer 2. non-sm cell cancer sqaumous cell, lg cell, adenocarcinoma Stage 1 to IV(metastatic) Cough that changes can mean cancer
Rib fractures 1-3 means? 5-9? lower? 1-3: high mortality bc subcl aa/vv 5-9: most common lower: spleen/liver injury tx: control pain
Flail chest? 3 or more adjacent ribs fractured at 2 or more sites..free floating rib segments tx: airway/secretions/pain
what is a contrecoup contusion contused lung occurs on other side of pt of body impact
Gunshot wounds classified by 3 types of velocity? Factors to determine? low, med, high factor: distance from which gun was fired, caliber of gun, size of bullet
Nsg intv to mgmt gunshot wound to chest maintain cardiopulmonary fx, assess further injuries, type blood for transfusion, peripheral pulses, lg bore IV line, catheter, NG tube, chest tube
What causes a pneumothorax? pleural space exposed to pos atmospheric pressure. Normal is neg or subatmospheric simple/traumatic
tension pneumothorax? air pulled into pleural space from lacerated lung or chest wall wound and gets trapped, not expelled. Lung collapse, heart/trachea shift to unaffected side(mediastinal shift). Incr press so decr circulation. tx: chest tube in 2nd intercostal space
When is a thoracotomy needed in open pneumothorax? If >1500ml blood aspirated by thoracentesis or >200ml/h from chest tube
Created by: palmerag