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Med Surg Cert

Influenza infectious disease caused by ribonucleic acid (RNA) viruses that can affect humans, birds, and other mammals A, B, and C can infect humans
Avian Influenza infected migratory & domestic birds shed virus in saliva, nasal secretions, feces Strain: H5H1 Transmission limited to people and some animals
Influenza Signs & Symptoms fever, cough, sore throat, muscle aches also eye infections, PNA, acute respiratory distress diarrhea, vomiting, and abd pain may occur
Influenza Diagnosis chest xray - may show PNA, infiltrates, or consolidations sputum gram stains & culture isolate virus
Influenza Treatment Neuraminidase inhibitor - oseltamivir (Tamiflu), peramivir (Rapivab), and sanamivir (Relenxa) can reduce severity & duration M2 inhibitors - amantadine & rimantadine (Flumadine) for pandemic (resistance may develop) maintain fluid/electrolyte balance
Influenza Nursing Interventions standard and contact precautions, fit-tested ventilator, hand hygiene eye protection within 3' of patient maintain patent airway, suctioning
Pleural Effusion accumulation of fluid in pleural space occurs secondary to other disease states empyema - accumulation of pus & necrotic tissue in pleural space; blood (hemothorax) and chyle (chylothorax) may also collect in this space
Exudative Pleural Effusion caused by inflammation of pleura causes - bacterial or fungal empyema or pneumonitis, chest trauma, collagen disease, malignancy, myxedema, pancreatitis, PE, subphrenic abcess, and TB
Transudative Pleural Effusion caused by excessive hydrostatic pressure or decreased osmotic pressure causes - HF, hepatic disease with ascites, hypoalbuminemia, and peritoneal dialysis
Pleural Effusion Signs and Symptoms most common - pleuritic pain and dyspnea decreased chest wall movement, decreased breath sounds over affected area, dullness on percussion infection from empyma may cause - cough, fever, night sweats
Pleural Effusion Diagnosis and Treatment chest xray can diagnose CT of chest, bronchoscopy, pleurocentesis, US underlying cause should be treated thoracentesis - remove fluid (chest tube for continued drainage) thoracotomy if thoracentesis ineffective abx for empyema (depends on organism)
Pleural Effusion Nursing Intervention watch for respiratory distress or pneumothorax after thoracentesis encourage deep breathing and IS maintain integrity of chest tubes; monitor amount, color, consistency of drainage; check for air leaks
Pneumonia acute lung infection with inflammation accompanied by accumulation of exudate in the alveoli major cause of morbidity and mortality among elderly and chronically ill
Pneumonia Risks risk increases with aspiration, CNS depression, chronic illness, COPD, dehydration, trach, immobility, immunosuppression, intubation, pain in thoracic cavity, anesthesia may result from bacterial, fungal, or viral infection; exposure to chemical irritan
Pneumonia Signs and Symptoms common - dyspnea, tachypnea, fatigue, & fever cyanosis/hypoxia in advanced disease cerebral hypoxia - irritability or restlessness crackles, rhonchi, bronchial breath sounds over consolidation; wheezes over affected areas; decreased in advanced disease
Pneumonia Diagnosis chest xray, ABG, sputum culture (bacterial), serologic testing (viral) needle or open biopsy to obtain lung tissue specimen (fungal)
Pneumonia Treatment and Nursing Intervention antibiotics to eradicate infecting organisms bronchodilator to open narrowed airways teach effective coughing/deep breathing, hydration, pain management, hand hygiene
Pulmonary Edema the collection of fluid in the interstitium and alveoli of the lungs as pressure rises in pulmonary vessels can result from ARDS, fluid overload, left-sided HF, mitral stenosis, MI, PE
Pulmonary Edema Effect on Left Ventricle L ventricle can't pump blood from heart; increased resistance = fluid backs up into lungs; surface tension increases, alveoli shrink, lungs become stiff = diff breathing; hypoxemia/altered V/Q ratio; fluid moves into larger airways -> pink, frothy sputum
Pulmonary Edema Signs and Symptoms tachycardia & -pnea, hypoTN; 3rd & 4th heart sounds; skin cold & clammy; dysp, pulm HTN; distended jugular veins; blood-tinged or pink, frothy sputum lung auscultation = dependent crackles confusion, decreased urine output, diaphoresis, lethargy
Pulmonary Edema Diagnosis and Treatment CXR, ABG diuretic; inotropic drugs = increase myocardial contractility, nitro = reduce pre & afterload, and vassopressor; morphine = decrease preload, RR, anxiety if no response = intra-aortic balloon pump or surgery (angioplasty, bypass, valve repair)
Pulmonary Edema Nursing Intervention semi-Fowlers to maximize oxygenation and reverse hypoxemia strict I/O to assess effectiveness of diureti
Pulmonary Embolism blockage in pulm vasculature; bone, air, fat, amniotic fluid, thrombus, foreign object lung isnt perfused = altered V/Q ratio = alveolar collapse -> atelectasis & hypoxemia; pulm infarction may occur can cause pulm HTN, right HF, ventricular hypertrophy
Pulmonary Embolism Risk Factors afib, COPD, family hx of PE, birth control, prior embolism, venous injury or stasis
Pulmonary Embolism Signs and Symptoms dyspnea with CP; pleuritic CP may be pulm infarction; hemoptysis, anxiety, restlessness, hypoTN, tachycardia; crackles, pleural friction rub, wheezes; lowgrade fever may have arrhythmia, cyanosis, diaphoresis fat embolism - confusion, dyspnea, petechiae
Pulmonary Embolism Diagnosis and Treatment ABG, CXR, ECG, lung scintigraphy, MRI, pulm abgiography, V/Q lung scan DVT - contrast venography, Doppler heparin gtt; warfarin embolectomy; vena cava filter; diuretic (for fat em); abx (for septic em); anti-arrhythmic for arrhythmia with ischemia
Pulmonary Embolism Nursing Intervention cough/deep breath; hydration; ambulation, ROM; TED hose; don't raise knees (obstructs venous flow); elevate legs
Severe Acute Respiratory Syndrome (SARS) life-threatening viral infection believed to be coronavirus (mutated from animals) incubation period - 2-7 days risk factors - close contact/contact with exhaled droplets/bodily secretions from infected person, or travel to endemic area
Severe Acute Respiratory Syndrome (SARS) Signs and Symptoms early stages - nonproductive cough, rash, high fever, headache, body aches, PNA later stages - SOB and respiratory distress
Created by: chllewellyn