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medsurg exam 2
respiratory tract disorders
| Question | Answer |
|---|---|
| indicators of respiratory distress | increased RR upright position talks in whispers using accessory muscles to breathe retractions in intercostal space stridor !!!silent chest pneumonia |
| What causes acute dyspnea? | Asthma COPD Airway inflammation Pneumonia Pleural effusion Spontaneous pneumothorax Heart failure |
| influenza is a | Highly contagious viral respiratory infection |
| influenza strains | A, B, C |
| who is more susceptible to illness and death from the flu | older adults |
| vaccine is updated yearly based on | strains that are expected to occur |
| influenza is transmitted by | airborne droplet and direct contact |
| diagnosis are influenza | Patient history Clinical symptoms Rapid influenza diagnostic tests (RIDTs) |
| Rapid influenza diagnostic tests (RIDTs) | through throat and nasal swab or wash, will be done in 30 min some can tell you if it is strain A or B, some can't |
| influenza symptoms are primarily | respiratory |
| influenza symptoms examples | ever, chills body aches (myalgia), cough (productive or non-productive) flushing, sweating, anorexia, chest pressure or pain, runny nose, sneezing, headache, sore throat, swollen lymph nodes, fatigue |
| Vaccination of High Risk Groups | Adults 50 or older Children 6 – 59 months People with chronic conditions Women who are pregnant People who are immunocompromised Indigenous peoples Residents of long-term care facilities People with BMI > 40 |
| why are Indigenous peoples at higher risk | they do not have access to healthcare |
| treatment of influenza | Fluids Antipyretics (acetaminophen) If hospitalized (droplet isolation) Antiviral Medications |
| Antiviral Medications for influenza | Tamiflu, Rapivab, Relenza, Xoluza |
| Tamiflu | oral (5 day course) |
| Rapivab | IV |
| Relenza | Inhalation (5 day course) |
| Relenza should not be given to | people with chronic lung problems |
| Xoluza | oral (single dose) |
| Xoluza should not be given to patients who are | under 12 years or older, women who are pregnant or breastfeeding, people who are severely immunocompromised, people with complicated illness |
| single best way to prevent influenza according to CDC | vaccine |
| CDC Recommendations for Influenza Vaccine | All persons aged 6 months and older are recommended for annual vaccination, with rare exception |
| CDC contraindications for the influenza vaccine | anaphylaxis, live vaccine should NOT go to older adults or pregnant mothers |
| CDC precautions for the influenza vaccine | moderately to severe pts - hold off guillain barre syndrome within 6mo - precaution egg allergies - no longer an issue |
| side effects of influenza injection | redness, swelling, pain at injection site low grade fever and aches |
| side effects of influenza nasal spray | live vaccine so more likely to cause flu like symptoms |
| who should not receive the influenza nasal spray | under 2, over 50, history of hypersensitivity, immunocompromised pts or ppl who care for immunocompromised pts |
| RSV = | Respiratory Syncytial Virus |
| possible modes of transmission for RSV | An infected person coughs or sneezes Direct contact with the virus, like kissing the face of a child with RSV Touching a surface that has the virus on it and then touching your face before washing your hands |
| how long can people with RSV be contagious | 3-8 days |
| how long can people with RSV be contagious prior to symptoms | 1-2 days |
| infants and people with weak immune systems can be contagious for how long | 4 weeks |
| symptoms of RSV | Runny nose Decrease in appetite Coughing Sneezing Fever |
| who is at highest risk for severe RSV infections | Older adults Adults with chronic heart or lung disease Adults with weakened immune systems Adults with certain other underlying medical conditions Adults living in nursing homes or long-term care facilities |
| RSV treatment that is not routinely recommended | antiviral medication |
| steps to relieve symptoms of RSV | Fever and pain-over the counter medication such as acetaminophen and ibuprofen Fluids to prevent dehydration |
| pneumonia occurs when | the alveoli of the lungs fill with fluid or pus |
| cause of pneumonia | Microorganisms enter the lungs and overwhelm the lung’s normal defense mechanisms, causing infection and inflammation of the alveoli |
| how do organisms enter the lungs | inhalation, aspiration, hematogenous (bloodstream) |
| types of organisms that enter the lungs causing pneumonia | Bacterial Viral Fungal (immune system compromise) Chemical (rare) |
| types of pneumonia | Community Acquired Pneumonia(CAP) Health-Care Associated Pneumonia (HCAP) Hospital acquired (nosocomial) (HAP) |
| Community Acquired Pneumonia (CAP) | acquired in the community, either in a community setting or <48 hrs after admission |
| Health-Care Associated Pneumonia (HCAP) | Not hospitalized but healthcare contact either in nursing home, dialysis center, or IV home care |
| Hospital acquired (nosocomial) (HAP) | > 48 hrs after admission no evidence on admission |
| factors that increase risk of pneumonia | age, immune system dysfunction, medications that increase GI pH, aspiration risk |
| immune system dysfunction affects on pneumonia | Disease: chronic diseases Medications: steroids, chemotherapy, transplant (rejection) |
| medications that increase GI pH affects on pneumonia | Proton pump inhibitors (PPI) |
| why do proton pump inhibitors increase risk of pneumonia | PPIs increase risk because they remove the stomach’s acid barrier which allows more bacteria to survive and reach the lungs |
| why do aspiration risk pts increase risk for pneumonia | fluids and airway secretions, swallowing dysfunction |
| Ventilator-associated (VAP) is a type of | HAP that develops > 48 hours after endotracheal intubation |
| Videofluoroscopic Swallowing Study is done by which member of the interdisciplinary team | SLP |
| Videofluoroscopic Swallowing Study is known as | modified barium swallow or cookie swallow |
| Videofluoroscopic Swallowing Study is used to determine | swallowing dysfunction and helps determines ways to prevent aspiration |
| ways to prevent aspiration | types of foods and liquids, positioning and techniques |
| pneumonia nursing management | promote adequate oxygenation |
| goal SPO2 for pneumonia | 92-95% |
| bacterial pneumonia nursing management | control infection |
| how do you work to control infection in pneumonia | culture and sensitivity (C&S) test antibiotics |
| culture and sensitivity (C&S) test | identifies the specific bacteria causing a lung infection and determines the most effective antibiotic for treatment |
| antibiotics are supposed to be started when | bacterial pneumonia is suspected |
| types of antibiotics for bacterial pneumonia | target and empiric (BSA) |
| pneumonia nursing management | promote secretion clearance |
| promote secretion clearance through | flutter valve, incentive spirometer, PEP therapy, ambulation, chest PT (back massage that she did on brian bogert in class) |
| pneumonia nursing management | promote adequate hydration: IV or oral do this to keep sputum liquified, ideally PO but can be done through duotube or IV |
| pneumonia nursing management: provide rest and comfort | Position with HOB elevated Improves gas exchange Prevents aspiration |
| pneumonia nursing management: decrease risk factors | Vaccination – Influenza Pneumovax Pneumococcal conjugate vaccines (PCV13, PCV15, or PCV20) Smoking cessation |
| Gerontological Considerations | Elderly are at greater risk |
| why are elderly at greater risk | Likely to have comorbidity Changes due to aging More difficult to detect early |
| elderly symptoms are more difficult to detect early because | Classic sxs not present Low rather than high fever |
| Gerontological Considerations prevention | Education Vaccination – Influenza, Pneumovax |
| pleurisy cause | inflammation of layers of the pleura - visceral/parietal |
| pleural friction rub | inflamed layers of the pleura rub together and cause pain |
| what can be used to treat pleurisy | pain meds (NSAIDs), splint when coughing |
| pleural effusion | collection of fluid in pleural space due to another disease |
| Normal pleural fluid | 5-15 mL |
| pleural effusion volume can increase to | several liters |
| what happens if pleural space fills with fluid | lungs can not expand so breath sounds are diminished or absent |
| pleural effusion fluid can be | Clear, bloody, purulent Transudate (from vascular system) Exudate (inflammation, cancer) Layered, loculated |
| respiratory assessment for pleural effusion | Decreased or absent breath sounds Dull, flat to percussion over fluid Dyspnea, cough, fever, chills Pleuritic chest pain Large effusion – acute respiratory distress |
| why would someone have decreased or absent breath sounds | because that is the area where the lung is unable to expand |
| may have a fever with pleural effusion if | infection is present |
| large pleural effusion like ascites leads to | acute respiratory distress |
| common causes of pleural effusion | CHF, pneumonia, cancer |
| hemothorax | blood enters pleural cavity |
| pneumothorax | air enters pleural cavity, but still not going to expand |
| simple (small) | may resolve without treatment |
| where does fluid in the lungs typically accumulate | at the base! |
| simple pneumothorax may resolve | on own without TX |
| large pneumothorax requires | chest tube to drain |
| hemothorax treatments | are the same as pneumothorax |
| assessment of pleural effusion | CXR thoracentesis |
| CXR reveals | that the lung isn't expanding and fluid is present |
| thoracentesis is used to | drain fluid |
| management of pleural effusion depends on | accumulation |
| management of pleural effusion options | Repeat thoracentesis In-dwelling pleural catheter Pleurodesis (irritant instilled) |
| when would it be appropriate to use an In-dwelling pleural catheter | if recurring |
| when would it be appropriate to use Pleurodesis (irritant instilled) | if the pt has cancer and has recurring fluid build up |
| what is Pleurodesis | it it when you inject sterile talc in the pleural space, clamp the chest tube, which causes irritation leading to scar tissue and prevents further occurances |
| causes of a pneumothorax | Trauma Preexisting lung disease Spontaneously, no apparent cause Iatrogenic |
| spontaneous pneumothorax | young men who are tall and thin, and have a rupture which leads to a lung collapse |
| signs and symptoms of Simple pneumothorax | anxiety, increase RR, HR, pain with deep breath Physical exam Decreased breath sounds Decreased chest expansion right side |
| tests to diagnose a simple pneumothorax | chest xray |
| Decision insert a chest tube is based on | amount of collapse which is revealed through the insertion of a catheter |
| !!! tension pneumothorax | air enters, gets trapped which causes intrathoracic pressure to increase and prevent the inflow of blood |
| tension pneumothorax is essentially caused by a | 'flap' that allows entry of air but no exit |
| tension pneumothorax causes | pressure on vessels and heart which makes it an emergent case!! |
| respiratory distress symptoms | increased RR, decreased O2 SPO2 is going to tank because the body cannot keep up with high RR |
Created by:
leh195