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N3561 Exam 2

Asthma Risk Factor Risk factors for developing Asthma •Genetics •Immune response “ hygiene hypothesis” •Allergens •Exercise- exercise induced asthma •Air pollutants- smoke ,climate, •Occupational factors- 15% diagnosed are r/t job related exposure •Respi
Asthma side effects? Can be severe & life threatening odyspnea at rest ocan speak in words not sentences oSitting forward oWheezing oRR > 30 oPulse > 120 oAccessory muscle use oAgitated oPeak expiratory flow < 40% of personal best or < 150 L/minute oNeck vein dissention IN SE
Asthma Symptoms Can be severe & life threatening odyspnea at rest ocan speak in words not sentences oSitting forward oWheezing oRR > 30 oPulse > 120 oAccessory muscle use oAgitated oPeak expiratory flow < 40% of personal best or < 150 L/minute oNeck vein dissention IN SE
Nursing Management for Asthma Teach patient to identify & avoid known personal triggers • if triggers can not be avoided – teach the patient how to premedicate prior to exposure of known trigger •Acute management – ASSESSMENT! Aggressive breathing treatments, and medications ,
Medications for Asthma inflammatory drugs Corticosteroids – inhaled or oral Leukotriene modifiers Anti- IgE Bronchodilators Long acting B2 –adrenergic agonists Long acting oral B2- adrenergic agonist Methylxanthines ( rarely used) Bronchodilators Short acting inhaled B2 a
COPD cause? Occupational chemicals and dust, air pollution, infection, genetics, AAT deficiency. Cigarette smoking #1!!
COPD Clinical Manifestations •Develops slowly •Chronic intermittent cough may develop first •Dyspnea is progressive , occurs with exertion •Inability to take a deep breath •Gradually symptoms interfere with ADL •When COPD is advanced : •Frequent experiences weigh
COPD Exacerbation Acute event •Assess – increase in dyspnea, sputum volume, sputum purulence, malaise, insomnia, fatigue, depression, confusion, decrease exercise tolerance, confusion, increased wheezing, may have fever . •Increase in exacerbation → poor outcomes â
COPD Respiratory Failure COPD patients who have had exacerbations are @ risk to develop respiratory failure. •Use of B- adrenergic blockers (atenolol)-may improve survival rate & ↓ risk of exacerbations. •If patient retains CO2 – carefully monitor when on oxygen or durin
COPD Diagnostic testing •Spirometry – must confirm airflow obstruction (PFT) •Chest x-ray- usual findings- flat diaphragm hyper inflated lungs •Serum ᾁ antitrypsin levels •ABG •6 minute walk test •COPD assessment test
Collaborative Care COPD cessation •Drug therapy – reduce symptoms •Bronchodilators •LABA •Inhaled corticosteroids •Long acting bronchodilators •Oxygen therapy •Goal to maintain O2 > 90% •Always start with a low liter flow •Breathing Retraining •Purse lipped
COPD Nursing Management Heath promotion •Smoking cessation •Early diagnosis and treatment →decrease in progression of disease •Family with history of COPD need to be aware of possible genetic link •Acute intervention •Bronchodilators, corticosteroids •Position to m
Tuberculosis Infectious disease •Caused by mycobacterium tuberculosis •Usually involves lungs •Leading cause of mortality in patients with HIV •Worldwide problem •Occurs more in the underserved, poor, and minorities •Population @ risk in the US : •Prison
Risk Factor fo Tuberculosis Latent TB vs TB disease •Latent •No symptoms •Does not feel sick •Cannot spread TB •Skin test or blood test = positive •Normal chest x-ray •Needs treatment to prevent active TB •TB Disease •Symptoms present: bad cough >3week duration, pa
Diagnostic testing for Tuberculosis Skin test – mantoux is done •Interferon –y release assays •Chest x-ray Bacteriologic studies •sputum collection •3 specimens must be taken on different days – usually first morning sputum .
Tuberculosis Treatment Usually as an outpatient •If patient has positive sputum – they are considered infective for the first two weeks after starting treatment- •Advise these patients to avoid travel, public transportations, limit visitors • TB treatment involves medic
Tuberculosis Drug Therapy Initial phase •4 drug regimen – INH, rifampin (Rifadin), pyrazinamide(PZA), ethambutol(Myambutol) – given daily for 8 weeks. Continuation phase •INH and rifampin or INH and Rifapentine daily for 4 or 7 months.
TB Nursing Management •Health Promotion •Ultimate goal wipe TB off the globe •Screening programs for high risk populations •Acute intervention •Placed on air borne precautions (HEPA mask ) •Chest x-ray, sputum collection, receive correct drug therapy •Teach patie
TB Discharge teaching Teach patient •to minimize exposure to close contacts •Homes should be well ventilated •If still infectious – they should sleep alone •Spend as much time outside •Limit time in areas where people congregate. •Teach importance of adherence to
Pulmonary Emboli Obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombus •Inflammatory process obstructs area, results in diminished or absent blood flow •Bronchioles constrict, further increasing pulmonary vascular resist
Risk Factors for Pulmonary Emboli Immobility, venous stasis •Hypercoagulability •Venous endothelial disease •Heart disease, trauma, postoperative/postpartum, diabetes, COPD •Obesity, oral contraceptive use •Previous history of thrombophlebitis
Preventions and treatment for pulmonary emboli Prevention •Exercises to avoid venous stasis •Early ambulation •Sequential compression devices (SCDs) •Anti embolism stockings •Treatment •Anticoagulation, thrombolytic therapy
Atelectasis Airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression ■Postoperative patients at high risk ■Symptoms: insidious, include cough, sputum production, low-grade fever ■Respiratory distress, anxiety, hypoxia occur
Atelectasis Nursing Management Prevention ■Turn, cough, deep breathe –Early mobilization –Incentive spirometer –Judicious administration of opioids and sedatives
Atelectasis Collaborative Care ■Remove secretions: coughing exercises, suctioning, aerosol therapy, chest physiotherapy •Oxygen therapy –Endotracheal tube intubation Mechanical ventilation Bronchoscopy to remove obstruction to relieve compression
Pulmonary Infections ■Severe acute respiratory syndrome (SARS)—viral, no cases reported since 2004, CDC ■Lung abscess ■Tuberculosis ■Tracheobronchitis ■Pneumonia
Pulmonary infection lung abscess ■Most are a complication of bacterial pneumonia ■Drainage achieved through postural drainage and chest physiotherapy ■IV antibiotic therapy for 3 to 5 days, followed by oral antibiotics for 4 to 12 weeks ■Diet high in protein to facilitate healin
Pneumonia Facts Community acquired pneumonia (CAP) sixth leading cause of death for people over 65. Risk factors: abdominal or thoracic surgery > 65 years old air pollution altered LOC chronic disease immunosuppressed resident of long term ca
Types of Pneumonia ■Community acquired (CAP) –Acute infection of the lung, patients who have not been hospitalized or resided in a long-term care facility with 14 Days of onset. ■Medical care- associated pneumonia –Hospital acquired- occurs 48 hours or longer after
Pneumonia Collaborative Care ■Vaccination – for patients > 65 years. Old. ■Prompt treatment ■Supportive measures – like bronchodilators, corticosteroids ■Rest but not too much – WHY? Improved diaphragm movement, chest expansion, mobilization of secretions & prevention
Nursing care for pneumonia Assessment : –Past history –Medication history –Potential Objective finding– ■ fever, lethargy , ■Tachypnea, ↑ work of breathing, crackles , production of sputum ■Tachycardia ■Changes in mental statusGoal – reduce risk of pneumonia –
Evaluation for Pneumonia Patient has received antibiotics – finished course of treatment ■Respiratory pattern has returned to normal ■Lungs are clear ■Fatigue has decreased ■Lab studies have improved ■No further need for oxygen
Aspiration ■Risk factors ■Can cause pneumonia ■Nursing interventions: –Keep HOB elevated >30 degrees –Avoid stimulation of gag reflex with suctioning or other procedures –Check for placement before tube feedings –Thickened fluids for swallowing problem
Pleural issues Pleurisy: inflammation of both layers of pleurae –Inflamed surfaces rub together with each respiration, causes sharp pain intensified with inspiration ■Pleural effusion: fluid collection in pleural space usually secondary to pneumonia –Large effusio
Pleural infection Empyema: accumulation of thick, purulent fluid in pleural spaces –Acutely ill patient; fibrin development loculated (walled-off) impairing lung expansion –Chest tube for drainage –Resolution is a prolonged process, 4 to 6 weeks of antibiotic therapy
Created by: feliciachoyce46