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wvc 33 resp. disord
| Question | Answer |
|---|---|
| Pathophysiology of pneumonia | excess of fluid in lungs from inflammatory process. Inflammation triggered by microbes or other agents; WBC migrate to area of irritation, causing capillary leak, edema & exudate; fluids reduce gas exchange around alveoli & lung tissue becomes stiff |
| Two classifications of pneumonia | CAP (community acquired pneumonia) HAP/ HAI (Hospital acquired pneumonia. |
| CAP | (community acquired pneumonia) |
| HAP/ HAI | (Hospital acquired pneumonia. |
| Consolidation | a condition associated with pneumonia where air spaces in the lungs are replaced by areas filled with fluid or sputum these hard areas can be heard on palpation and are known as consolidations. |
| Pneumonia often affects people who are | immune compromised …mostly effecting people who are living in LTC facilities. |
| Risk factors for CAP | Older adult; never received pneumococcal vaccination; no flu vaccine; chronic health condition; recently been exposed to respiratory viral or influenza infections; abuses tobacco or alcohol. |
| Risk factors for HAP | Older adult; chronic lung disease; presence of gram negative colonization; altered LOC; recent aspiration event; has endotracheal, tracheostomy or nasogastric tube; poor nutritional status; immunocopromised; on a ventilator. |
| Oral care and pneumonia prevention | perform frequent oral care to help prevent pneumonia (q12hrs). |
| Prevention of pneumonia | strict hand washing; avoid large gatherings; visit health care provider if a fever last more than 24 hours; pneumococcal vaccine; flu vaccine; adequate nutrition. |
| Physical assessment manifestations associated with pneumonia | cough, flushed cheeks; bright eyes; anxious expression; chest pain or discomfort; headache; fever; chills; tachycardia; dyspena; tachypnea; sputum production, muscle weakness; crackles, wheezing, tactile fremitus. |
| tactile fremitus | is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat a phrase while the examiner feels for vibrations by placing a hand over the patient's chest or back. |
| Considerations for the older adult in pneumonia signs and symptoms | weakness, fatigue; lethargy; and confusion are often their presenting s/s…cough a fever can be absent in this population. Hypoxia will be present. |
| Laboratory assessment associated with pneumonia | ID by gram stain & then culture & sensitivity; CBC for elevated WBC count; blood cultures to see if organism has invaded the blood. ABG’s in severly ill patients. |
| Interventions for pneumonia | oxygen therapy via nasal cannula to prevent hypoxic condition; incentive spirometry as a type of bronchial hygiene; drug treatment of eradicate infectious organism. |
| DRSP | drug resistant streptoccus pneumonia is becoming increasingly common. |
| Assessment questions/ findings for a patient recovering from pneumonia | new onset of confusion; chill; fever; persistent cough; dyspena; wheezing; hemoptysis; increased sputum production; chest discomfort; increased fatigue; diaphoresis; cyanosis; dyspena; abnormal breath sounds; weakness. |
| Tuberculosis is transmitted via | aerosolization (ie. Airborne route) when a person infected with TB laughs, coughs, whistles, sings or sneezes droplets become airborne and are inhaled by others. |
| TB infection | once airborne droplet enters a host it resides bronchi or alveoli; body mounts defense & this INITIAL INFECTION normally does not result in symptoms nor is the person contagious to others. A 2nd TB REACTIVATION occurs when host defenses are diminished |
| TB pathophysiology | Necrotic TB masses surrounded by collagen, fibroblast & lymphocyte granulation; these nodules are distributed throughout the lungs & represent active phase of disease. TB microbes dividing & body is responding by surrounding these areas w/ granulation. |
| Assess the patient's past exposure to TB. | Ask about his or her country of origin and travel to foreign countries where incidence of TB is high. It is important to ask about the results of any previous tests for TB. |
| The patient with TB has | progressive fatigue, lethargy, N&V, anorexia, , irregular menses, and a low-grade fever, night sweats. Assess for cough & mucopurulent sputum, which may be streaked with blood. Chest tightness and a dull, aching chest pain occur with the cough. |
| A diagnosis of TB is suggested by the manifestations and a positive smear for acid-fast bacillus. | The acid-fast bacillus test is not specific for TB (other organisms are also acid-fast), but it is used as a quick method to determine whether TB precautions should be started until more definitive testing can be completed |
| TB Sputum culture confirms the diagnosis. | Enhanced TB cultures and automated mycobacterial cultures require 1 to 4 weeks to determine a positive or negative result. |
| Nursing diagnoses and collaborative problems that may apply to patients with TB include: | Impaired Gas Exchange/ Deficient Knowledge (Infection Control, Therapeutic Regimen, Nutrition)/ Fatigue related to poor tissue oxygenation/ Imbalanced Nutrition: Less Than Body Requirements/ Social Isolation. |
| Combination drug therapy is the most effective method of treating TB and preventing transmission. | Active TB is treated with a combination of drugs. Multiple-drug regimens destroys organisms as quickly as possible & reduces emergence of drug-resistant organisms. rifampin & isoniazid & pyrazinamide & Ethambutol |
| Current first-line drug therapy for TB uses: (RIPE) | rifampin & isoniazid (INH) throughout the therapy; pyrazinamide is added for the first 2 months Ethambutol is the recommended fourth drug in first-line therapy. rifampin & isoniazid & pyrazinamide & Ethambutol |
| Strict adherence to the prescribed drug regimen is crucial for suppressing the disease. | Thus your major role is teaching the patient about drug therapy and stressing the importance of taking each drug regularly, exactly as prescribed, for as long as it is prescribed. |
| The TB drugs may cause the patient to have nausea. | Teach him or her to prevent nausea by taking the daily dose at bedtime. Antiemetics may also prevent this problem. Instruct him or her about the need for a well-balanced diet to promote healing. |
| With current resistant strains of TB, | emphasize that not taking the drugs as prescribed could lead to an infection that is difficult to treat or has total drug resistance. |
| Multidrug-resistant TB (MDR TB) strains | are emerging as are strains that are considered extensively drug-resistant (XDR TB), especially among patients who have HIV disease |
| The hospitalized patient with active TB is placed on | Airborne Precautions. The room should have at least 6 exchanges of air per minute and should be ventilated to the outside. All health care workers must wear a N95 or HEPA respirator when caring for the patient. |
| Pulmonary Empyema | is a collection of pus in the pleural space. |
| The most common cause of empyema | is pulmonary infection, lung abscess, or infected pleural effusion. Pneumonia or lung abscess can spread across the pleura. Lymph node obstruction can cause a retrograde (backward) flood of infected lymph into the pleural space. |
| Thoracic surgery and chest trauma can introduce bacteria directly into the pleural space, leading to empyema. | Blood from trauma may collect in the pleural space. Poor drainage of this blood promotes infection & empyema |
| Rhinitis, | an inflammation of the nasal mucosa, is the most common problem of the nose and sinuses. Inflammation can be caused by infection (viral or bacterial) or contact with allergens. |
| Often an allergic rhinitis will | make the mucous membranes more susceptible to invasion, and an infection will accompany the allergy. Regardless of the cause, rhinitis is uncomfortable. |
| Rhinitis | does not interfere with the person's ability to meet the human need for oxygenation and tissue perfusion because the nose is not the only respiratory passageway. |
| Allergic rhinitis, | often called hay fever or allergies, is triggered by hypersensitivity reactions to airborne allergens, especially plant pollens or molds. Some episodes are “seasonal” in that they tend to recur at the same time each year and last only a few weeks. |
| Chronic rhinitis | occurs either intermittently with no seasonal pattern or continuously whenever the person is exposed to allergens such as dust, animal dander, wool, and foods (e.g., seafood). |
| Acute viral rhinitis (coryza, or the common cold) is caused | by any one of at least 200 viruses. Spreads by droplets from sneezing/ coughing. Colds are most contagious in the first 2 to 3 days after symptoms appear. Teach patients to avoid spreading infection at this time. |
| In both acute and chronic allergic rhinitis | presence of allergen causes a release of histamine, from WBCs in the nasal mucosa. These chemicals bind to blood vessel receptor sites, causing local blood vessel dilation & capillary leak, leading to edema & swelling of the nasal mucosa. |
| Signs and symptoms of allergic rhinitis | Head Ache, nasal irritation, sneezing, nasal congestion, rhinorrhea, & watery eyes. |
| Drug therapy for rhinitis | |
| Antihistamines block the | chemicals released by white blood cells from binding to receptor sites on blood vessels and nasal tissues, preventing local edema and itching. |
| Decongestants work by | constricting blood vessels, thus decreasing edema. |
| Antipyretics are given if | fever is present. |
| Antibiotics are prescribed only for | bacterial infections. |
| Rhinitis caused by overuse of nose drops or sprays is treated by | discontinuing the offending drug. |
| Humidifying the air helps | relieve congestion. Using a room humidifier, inhaling steam from a pan of boiled water after removing it from the heat, or breathing steamy air in the bathroom after running hot shower water. |
| Sinusitis is an inflammation of | the mucous membranes of one or more of the sinuses. Swelling can obstruct the flow of secretions from the sinuses, which may then become infected. The disorder often follows rhinitis. |
| Diagnosis of sinusitis is made on the basis of the | patient's history and manifestations. Transillumination affected sinus is decreased. |
| Transillumination | can be assessed by having the patient place a lighted penlight tip into the mouth and closing the lips around it in a darkened room. Non-swollen sinuses reflect light through the skin as seen as a red glow on the cheek between the eye and the lip. |
| Bacterial sinusitis requiring antibiotic therapy is usually indicated by | purulent drainage from one or both nares and lack of response to decongestant therapy |
| Assess for the manifestations of sinusitis including | nasal swelling & congestion, HA, facial pressure, pain (worse when head is tilted forward), tenderness to touch over involved area, low-grade fever, cough, and purulent or bloody nasal drainage. |
| Treatment of sinusitis includes the use of | broad-spectrum antibiotics, analgesics , decongestants (phenylephrine), steam humidification, hot over sinus area, and nasal saline irrigations. Teach the patient to increase fluid intake to more than 10 glasses / day |
| Surgical management of sinusitis | Antral irrigation, AKA maxillary antral puncture & lavage, a large-gauge needle inserted into maxillary sinus & fluid/ pus drained. Sinus is then irrigated w/ saline &/or antibiotic solution. |
| Pharyngitis, or “sore throat,” is a common inflammation of the | mucous membranes of the pharynx. It accounts for more than 15 million office visits each year in the United States. This condition often occurs with acute rhinitis and sinusitis. |
| Acute pharyngitis can be caused by | bacteria, viruses, other organisms, trauma, dehydration, irritants, tobacco use, and alcohol consumption. The most common bacterium causing pharyngitis is group A beta-hemolytic Streptococcus, but most adult cases are caused by a virus. |
| The patient with pharyngitis has | throat soreness & dryness, throat pain, pain on swallowing (odynophagia), difficulty swallowing (dysphagia), and fever. |
| Viral and bacterial pharyngitis are often difficult to distinguish on physical assessment. | When inspecting a throat infected w/ either virus or bacteria, mild to severe hyperemia (redness) may be seen w/ or w/out enlarged tonsils & w/ or w/out exudate. Ask about nasal discharge (can vary from thin and watery to thick and purulent) |
| Bacterial infections in pharyngitis are more often associated with | enlarged red tonsils, exudate, purulent nasal discharge, and local lymph node enlargement. |
| Bacterial pharyngitis, such as group A streptococcal infection, can lead to | acute glomerulonephritis & rheumatic fever carditis. Glomerulonephritis may occur 7- 10 days after infection, & rheumatic fever may develop 3- 5 weeks after infection. Cultures important in distinguishing viral from bacterial |
| Complications of Group A Streptococcal Infection | Rheumatic fever; Acute glomerulonephritis; Peritonsillar abscess; Retropharyngeal abscess; Otitis media; Sinusitis; Mastoiditis; Bronchitis; Pneumonia; Scarlet fever |
| Most sore throats in adults are viral, do not require | antibiotic therapy, & respond to supportive interventions. Teach patients to rest, increasefluids; humidify air, use analgesics for pain, gargle with warm saline, & throat lozenges containing mild anesthetics. |
| For streptococcal infection treat with | oral penicillin or cephalosporin. Drugs from macrolide class (e.g., azithromycin or erythromycin if allergic to penicillin). Stress the importance of completing the entire antibiotic prescription, even when symptoms improve or subside. |
| The patient should be re-evaluated if | no improvement in 3 days or if manifestations are still present after completion of the antibiotic course. Persistent bacterial pharyngitis may occur with immunosuppression. Consider testing for HIV. |
| Any patient with pharyngitis who has stridor or indications of airway obstruction should be | immediately evaluated by a health care provider in a setting in which intubation or tracheostomy can be performed quickly and safely |
| Tonsillitis is an inflammation and infection of the tonsils and lymphatic tissues | located on each side of the throat, tonsils are lymphatic tissue shaped like a small almond. Each tonsil is covered by a mucous membrane. Tonsils filter organisms and protect the respiratory tract from infection |
| Tonsillitis is a | contagious airborne infection. Acute or chronic tonsillitis can occur in any age-group, but it is less common in adults. The infection is usually more severe when it occurs in adolescents or adults. |
| Acute tonsillitis usually lasts | 7 to 10 days & often is caused by bacteria (Streptococcus. Other bacterial causes include Staphylococcus aureus, Haemophilus influenzae, and Pneumococcus. Viruses also cause tonsillitis). |
| For bacteria caused tonsillitis the health care provider prescribes | antibiotics (penicillin or azithromycin 7 -10 days). Teach patient supportive care & completing antibiotic therapy. Teach: rest, increase fluids, humidify the air, use analgesics for pain, gargle, use lozenges. |
| Surgical intervention for tonsillitis may be needed for recurrent acute infections | (especially group A betahemolytic streptococcal infections), chronic infections that have not responded to antibiotic therapy, a peritonsillar abscess, & enlarged tonsils or adenoids that obstruct the airway. |
| Acute Tonsillitis | Sudden onset; Fever; Muscle aches; Chills; Dysphagia, Pain in ears; HA; Anorexia; Malaise; Tonsils swollen &red with pus; Tonsils may be covered w/ a white or yellow exudate; Purulent drainage; Uvula inflamed; cervical lymph nodes tender & enlarged. |
| Peritonsillar abscess (PTA), or quinsy, is a complication of | acute tonsillitis. Infection spreads from the tonsil to the surrounding tissue, which forms an abscess. The most common cause of PTA is group A beta-hemolytic streptococcus. |
| Peritonsillar Signs of infection are pronounced on examination | Pus forms behind tonsil & causes one-sided swelling with deviation of the uvula, swelling may cause the patient to drool, severe throat pain radiating to the ear, voice change, difficulty swallowing, difficulty breathing. |
| Peritonsillar Outpatient management | antibiotics & needle aspiration of the abscess. Opioid analgesics given for pain, & IV steroids may be prescribed to reduce the swelling The PT. usually improves in 36 hrss. GO to ER if S/S of obstruction appear (drooling and stridor). |
| Laryngitis is an | inflammation of the mucous membranes lining the larynx and may or may not include edema of the vocal cords. It can occur as a single problem or occur with upper respiratory infections. |
| Laryngitis also can be a manifestation of a related disease process, such as | throat or lung cancer. Common causes include exposure to inhalants & pollutants (e.g., chemical agents, tobacco, alcohol, smoke), overuse of voice. |
| Nursing management of laryngitis is aimed toward symptom relief and prevention | Treatment consists of voice rest, steam inhalations, increased fluid intake, & throat lozenges, prescribe antibiotics & bronchodilators when sinusitis, bronchitis, or other bacterial infection is also present. |
| Influenza, or “flu,” is a highly contagious acute viral respiratory infection that | occur in adults of all ages. Epidemics are common & lead to complications of pneumonia or death, especially in older adults or debilitated or immunocompromised patients. |
| The patient with influenza usually has | severe headache, muscle aches, fever, chills, fatigue, weakness, and anorexia, sore throat, cough, and rhinorrhea |
| Adults with the flu are contagious from | 24 hours before symptoms occur and up to 5 days after they begin. Patients who are immunosuppressed may remain contagious for several weeks. |
| Vaccinations for the prevention of influenza | are widely available; changed every year; Usually, the vaccines contain three antigens for the three expected viral strains |
| attenuated virus | live virus has been altered to reduce its ability to cause infection. The intranasal vaccine is live, & some people develop influenza symptoms after its use. For this reason, its use is recommended only for healthy people up to 49 years of age. |
| People recommended to be flu vaccinated each year include | those older than 50 years, people w/ chronic illness or immune compromise, those living in institutions, people living with or caring for adults with health problems, & healthcare personnel providing care to patients. |
| Teach the patient who is sick to reduce the risk of spreading the flu by | washing hands after sneezing, coughing, rubbing the eyes, or touching the face. Other precautions include staying home from work, school, or places where people gather. |
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