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lower AD
Bronchitis, other lung disorders in lower airway
| Question | Answer |
|---|---|
| Acute Bronchitis, Legionaires, Anthrax, TB, pneumonia, age alterations, Antitussive agents, Pleurisy, Pleural Effusion, Empyema, Chest Tube Management, Atelectasis include a four step process of medical treatment: | Etiology, S/S, DX test, Medical/Surgical MGM, Nursing MGM |
| Explain the different types of Chest tubes: | |
| Bronchitis | Secondary to an upper respiratory infection, exposure to inhaled irritants, inflammation of the mucous membranes of the major bronchi and their branches |
| signs of Broncitis | productive cough, low grade fever, diffuse rhonchi/whezzes, dyspnea, chest pain, malaise, H/A |
| DX test | chest x ray, sputum culture |
| treatment | bronchodilators, antibiotics, cough suppressants, antipyretics, nursing-facilitate recovery and prevent secondary infections |
| Nursing Diagnosis | infection, risk for, related to retained pulmonary secretions; Airway clearance, ineffective, related to tenacious pulmonary secretions, |
| interventions for airway clearance | bed rest, humidifier, encourage increased fluid intake, teach/assess understanding signs that may indicate worsening infection |
| interventions for risk for infection | assess for signs of infection, admin ABX, frequent VS, Encourage adequate PO intake |
| other bronchitis interventions | teach/assess importance of prescribed medication regiment, understand importance of limiting exposure to others, avoid smoking or other irritating fumes |
| Legionaires Etiology | Legionella pneumophila, gram neg bacillus, Airborne, two courses of infection influenza and legionella disease(life threateninng pneumonia |
| patho phisiology of Legionaires | Pneumonia cause by Legionaella pneumophila, lung consolidation, alveolar necrosis, may result in resp/renal failure and bacteremic shock and death |
| S/S of Legionnaries | elevated temp (102-105), h/a, nonproductive cough, diarrhea, general malaise, pt's complaints of dyspnea, h/a, and chest pain on inspiriation, crackles/wheezes, hematuria indication remal failure |
| diagnostic tests | blood culture, sputum, pulmonary tissue, chest xray (patchy infiltrates and small pleural effusions) |
| medical management | observation for disease progression, o2 support and possible mechanical ventilation,possible temporary dialysis due to accute kidney failure, IV therapy |
| meds | ABX-erythromycin IV, then po (rifampin), Antipyretics, vasopressors/inotropes, analgesics |
| nursing diagnosis | tissue perfusion, ineffective cardiopulmonary or renal , related to lack of oxygen |
| tissue perfusion interventions | monitor and report any s/s of impending shock, administer vasopressors and closely monitor VS, maintain hydration and urinary output (30ml/hr)assess for changes in loc |
| breathing patter, ineffective, related to respiratory failure | assess for S/S of resp failure, be alert for cynaosis/dyspnea, assist with o2 therapy or mechanical ventilation, facilitate optimal ventilation- place patient in semi-fowlers, suction as needed, have patient CDB every 2 hrs |
| Etiology | spore-forming bacterium bacillus antrhacis, anthrax most commonly infects wild and domestic hhoofed animals, spread through direct contact with bacteria and its spores, it is not contatious by person-to person |
| Antrhax Patho | direct contact with bacillus anthracis and its spores that lie dormant and become active when contact is made with a living host, |
| Anthrax patho part 2 | macule or papule occurs as an insect bite, black eschar formation and edema to the site, bacterial toxins> hemorrhage, necrosis , lymph edema |
| initial symptoms of inhalational anthrax resemble those of the common cold or inluenza except, infected persons will not develop nasa secreions | hemorrhage, tissue necrosis, and lymph edema, death usually results due to blood loss nd shok |
| diagnostic test | chest x-ray, inhalation anthrax vs pneumonia(infiltrates,no single reliable screening avail, rapid dna test available to id antrax in people and the environment, culture most reliable for cutanious and intestinal anthrax |
| Med mgm | abx-cipro 60 day course, anthrax vaccine-30 days antibiotic and 3 doses of anthrax vaccine |
| TB etiology | chronic pulmonary and extra pulmonary infectious disease, acquired by inhalation, most commoly, affects the lungs, results in inflammatory infiltrations, characterized by stages of early infection, latency and potential for recurrence |
| TB | transmitted yto host by airborne droplets during cough or sneeze, host inhales infected droplets, infection spreads to susceptivle organs sites via blood &lymphatic system |
| TB infection | always precipitates active disease, mycobacteria in the tissue, only about 10% of infections progress to active disease, those infected but not converted will have a positive skin test and a negative chest x-ray |
| TB Disease | destructive activity of mycobacteria in host tissue |
| predisposing factors | family history of TB, low income populations- crowding |
| predisposing factors conitued | immunosuppression (HIV +), increased resk of develop |
| TB stats | 15 mil American are infected, 5.8 cases per 100,000 in 2002, incidence of usborn active TB is decreasing, but foreign born us residents has increased 65j% since 1986 |
| s/s | fatique, anorexia, productive cough, fever, weakness, daily reoccurring fever with chills night sweats hemoptysis, |
| note reports loss of muscke strenght and weight loss, report characteristics of sputum (amount & color) | DX mantoux TB skin test, sputum culture-acid fast bacillus (AFB)to confirm the dx of active TB, chest x ray, all patients with TB must be reported to the appropriate public health authority, |
| medical managemnt | isolation, resp isolation, neg pressure room, particulate matter mask, infants and chilren do not requre isolation |
| nursing diagnosis | infection, risk for, related to viable M tuberculosis in resp secretions |
| rifampin(rifadin) | preventionf ro those exposed to isniazid restiatnt MTB (meningocci) |
| rifampin action | inhibit protein synthesis |
| monitor for in rifampin | hepatitis, hematologic, c/o red-orange-brown urin, tears, sweat sputum |
| important considerations in rifampin- | beta blocker increased metabolism of beta blockers and anticoagulants, increase bleeding tendancies |
| 2nd line antitubercular drugs | amikacin, capreomycin, cyloserine, ethionamide, levoflaxacin, ofloxacin, Para-aminosalicylic acid (PAS) |
| labs | Anemia: HCT, HGB and fatigue; Hepatic q week: ALT, AST, bilirubin; Renal : BUN, creatinin, I&O specific gravity, urinalysis |
| Pneumonia susceptible patients | disease affectivng antibody response, alchoholics, delayed WBC reaction ito infection, mode of transmission dependant on infectiv organism, classfied according to organism, |
| causes of pneumonia | bacterial, aspiration, viral, fungal, chemical |
| patho of pneumonia | cillia cannot remove secretions, retained secretions become infected, inflammation, edema leads to decreased oxygen-carbon dioxide exchange, |
| S/S of pneumonia | sudden onset of peurisy, severe chills, elevated temperature and night sweats, paiful productive cough, increased heart rate, tachypn3ea with difficult expiration |
| streptocoocal | rust colored sputum, possible friction rub |
| staphylococcal | same step and copious salmon colored sputum |
| Klebsiella | gradual onset more inflamma of the terminal bronchioles and alvioli, if reatment delayed bedyond second, day critically ill pt wi/ increased risks |
| Hemophilu | commonly follows URI, croupy cough, arthralgias, yello or green sputum, |
| mycoplasmal | gradual onset, cough severe & son productive, deceased breath sounds, crackles, cxr-clear, wbc normal |
| viral | generaly mild s/s, cold symptoms, irritating cough produces mucopurulent or bloody sputum bronchopeumonic tuype on cxr, wbc usually normal increase in antibody |
| subjective; | description of onset, duration, and history of cough, complaints of fever and night sweats, |
| objective | loc, vs, monitor sputum, observe resp effort, crackles |
| Diagnostic tests | pt history and physical exam, blood and sputum cultures, chest xray, CBC PFT ABG oximetry |
| med management | aBX therapy (pcn, e-mycin, ceph, tetracyclin)O2 thereapy, analgesics/antipyretics, expectorants, brochodilators, vaccine, physiotherapy, humidifacation |
| nursing diagnosis | breathing patern ineffective,related to th inlmmatory process, --assess ventilation to include respiratory effort and sighs of resp distreess, elevate HOB |
| pneumonia nursing interventions | auscultate breath sounds, instruct patient on importance of consuming large quantities of fluid, encourage patient to conserve energy, admin abx encourage deep breaything and couging |
| s/s of pneumonia | atypical fever, sputum cough often absent |
Created by:
redhawk101
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