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NUR 317 Respiratory

TB, Lung Cancer, COPD

What is the infectious agent involved in Tuberculosis? TB is an infectious disease caused by a gram positive, acid fast bacillus: Mycobacterium tuberculosis
What is the pathophysiology of Tuberculosis? TB usually spreads from person to person via airborne droplets produced by speaking or coughing. It is more commonly spread by repeated close contact (6 in) because it is not highly infectious. Droplet particles can remain airborne for minutes/hours
There are 2 classifications of TB: Latent TB infection and TB disease. describe the difference. Latent TB infectino is when the bacteria are inhaled, but there is an effective immune response and the bacteria become inactive. TB disease is when the immune response is not adequate and cannot gain control of the m/o and therefore causes active diseas
What are the manifestations of early TB? usually symptom free
What are the manifestations of latent TB? During the latent phase, there is a positive skin test, but the pt is asymptomatic.
what treatment occurs during the latent phase of TB? describe the treatment. During latent TB, isoniazid is administered, this is Oral, effective, and inexpensive. it is administered 1x/day for 6-9 months.
What manifestations are exhibited during Active TB? Active TB disease may initially manifest in FATIGUE, MALAISE, ANOREXIA, UNEXPLAINED WEIGHT LOSS, LOW GRADE FEVER AND NIGHT SWEATS. A characteristic pulmonary manifestation is a COUGH that becomes FREQUENT and may produce MUCOID OR MUCOPURULENT SPUTUM
What are 5 complications associated with Tuberculosis? Miliary TB, Pleural Effusion, Empyema, Tuberculosis pneumonia, Other organ involvement.
What is Miliary TB? Miliary TB is when the m/o invades the bloodstream and spreads to all the body organs.
What is Pleural effusion? Pleural effusion is caused by bacteria inb the pleural space which triggers an inflammatory rxn and a pleural exudate of protein rich fluid.
What is Empyema? Empyema is less common that effusion, but may occur from large numbers of tubercular organisms in the pleural space.
What is Tuberculosis pneumonia? Tuberculosis pneumonia may result when large amounts of tubercle bacilli are discharged from granulomas into the lugn or lymph nodes. manifestations are similar to bacterial pneumonia.
What other organs can TB affect? Serious complications involve the CNS (meninges). other organs include bone, joints, kidneys, adrenal glands, lymph nodes, genital tracts
How is TB diagnosed? Skin test -> Chest xray ->bacteriologic studies
What might you find upon assessment of a TB pt? A TB patient may present with a productive cough, night sweats, afternoon temperature elevation, weight loss, pleuric chest pain, crackles over the apices of the lungs
What are the goals of treatment for TB? comply with therapeutic regimen, have no recurrence, have normal pulmonary function, take appropriate measures to preent the spread of disease.
What must occur for a TB pt to be deemed noninfectious? Effective drug therapy, clinical improvement and 3 NEGATIVE AFP SMEARS
what precautions must be taken in a TB patient? Airborne droplet precautions: single occupancy room, negative pressure and airflow of 6-12 exchanges per hour, respirator!
What is important to teach a TB patient? It is important to teach a TB patient to cover nose and mouth with paper tissue every time they cough, sneeze or produce sputum. they should wear an isolation mask when exiting the negative pressure room
what puts a pt at risk for getting Lung Cancer? Smoking is the MOST IMPORTANT RISK FACTOR. tobacco smoke contains 60 carcinogens. other risks include inhaled carcinogens (asbestos, radon, nickel, iron etc.)
what are the 2 types of lung cancer? Small cell lung cancer (20%) and non-small lung cancer. (80%)
what are some common metastasis sites for lung cancer? the common metastasis sites for lung cancer include the liver, brain, scalene lymph nodes, adrenal glands
What are the clinical manifestations of Lung Cancer? Silent disease. It is generally found on routine chest x-rays. Some early manifestations would include: persistent pneumonitis dt obstructed bronchi (fever, chills, cough). Later manifestations are nonspecific (anorexia, fatigue, weight loss, n/v)
How is Lung Cancer diagnosed? Lung cancer is diagnosed by chest x-ray, Sputum cytology that IDs malignant cells and a mediastinoscopy(insertion of a scope via small anterior chest incision into the mediastinum)
What is the staging technique for Lung Cancer? TNM - T: (Tumor size, location, degree of invasion) N: (degree of NODAL invasion) M: (Presence/absence of METASTASIS
What is the treatment of choice for lung cancer? Surgical resection for stages I and II.
What is radiation therapy used for in Lung cancer? Radiation therapy is used as a curative, palliative or as adjunctive therapy in combo with surgery or chemo. This is the PRIMARY therapy in those who could not tolerate surgery. It may also relieve symptoms.
What should the assessment entail in a new Lung Cancer pt? Determine understanding of pt/caregiver on: diagnosis, treatment options, prognosis. Assess level of anxiety.
What are the goals of care in a lung cancer patient? The goals in a lung cancer patient include: effective breathing patterns, adequate airway clearance, adequate oxygenation of tissues, minimal to no pain, realistic attitude toward treatment and prognosis.
What is involved in health promotion for prevention of lung cancer? preventing smoking beginning. and smoking cessation.
What is your job once the pt is diagnosed with Lung cancer? Initially, you must support and reassure the pt during the diagnostic evaluation. You can help by identifying multiple stressors and helpint with stress mgmt.
What must you teach a patient with lung cancer for discharge? a lung cancer patient should be aware of what s/s to report: Hemoptysis, Dysphagia, chest pain, hoarseness. Teach the safe use of O2 (NO O2 while smoking!!! explosive)
How much O2 can COPD patients generally tolerate? 2 L
what is the etiology of COPD? Cigarette smoking is the major risk factor. Occupational chemicals and dust, air pollution, infection, genetics, Alpha 1-Antitrypsin (AAT) deficiency, Aging
What is the pathophysiology of COPD? COPD is a chronic inflammation found in the airways, bronchioles/alveoli, and pulmonary vessels. COPD is characterized by an inability to expire air. Gas exchange abnormalities result in hypoxemia and hypercarbia
What are the clinical manifestations of COPD? COPD generally develops slowly (over 50 years). s/s include a COUGH, SPUTUM PRODUCTION, DYSPNEA. Dyspnea is progressive usually occuring upon exertion (in late stages, it may occur at rest). Advanced COPD - weight loss, anorexia.
COPD patients may exhibit a bluish-red color of the skin. what is this related to? Over time, hypoxemia may develop with hypercapnia. The bluish-red color of the skin is related to polycythemia and cyanosis. This patient may not respond well to too much O2
What are some complications associated with COPD? Cor Pulmonale, COPD exacerbations, acute respiratory failure, depression and anxiety
How is COPD diagnosed? COPD is confirmed by pulmonary function tests (Spirometry).
What are some typical lab findings in a patient with COPD? Reduced FEV1, FEV1/FVC ratio (the ratio <70% in COPD pts.), Diffusi9ng capacity for Carbon Monoxide, increased residual volume, functional residual capacity (FRC)
What is the goal of Drug therapy in a COPD pt? what drugs are used? The goal of Drug therapy in a COPD patient is to improve the quality of life. Bronchodilators are used (B@ adrenergic agonists, anticholinergic agents, methylxanthines)
What surgical therapy is used in COPD pts? Lung volume reduction surgery
What breathing techniques should be taught to a COPD pt? pursed lip and diaphragmatic breathing
What are 8 airway clearance techniques? Coughing, Chest physiotherapy, postural drainage, percussion, vibration, airway clearance devices, high frequency chest wall oscilliation, O2 therapy
what is chest physiotherapy? postural drainage, percussion and vibration
what is postural drainage? postural drainage is the use of positioning to drain secretions from specific segments of the lung and bronchi into the trachea
what is the vibration technique that is used for airway clearance? the vibration technique is the tensing of the hands and arm muscles repeatedly and pressing mildly with the flat of the hand on the affected area whild the pt slowly exhales and deep breathes.
what is High Frequency Chest wall Oscilliation? Used to vibrate the chest
what is the goal of nutritional therapy in a COPD pt? COPD pts are often underweight. the goal of nutritional therapy is to get the pt to a healthy weight in a healthy way
O2 therapy (pg 619-620) has low flow and high flow. what are the 4 LOW flow O2 therapy devices? Nasal canula, simple face mask, low flow delivery device, O2 conserving cannula.
What is the most common O2 delivery device? who is this most effective for? nasal cannula. it is used for pts who require low O2 concentration.
Which is the O2 delivery system that has a mask attached to a bag? low flow delivery device
What is the delivery system of choice for long term therapy? how much can this deliver? what's the downside to this? The O2 conserving cannula. This device can deliver up to 8L O2. The downsides to this delivery system is that it cannot be cleaned, it must be changed out every week. It is more $ and requrires ABG eval/oximeter
What are the 3 HIGH flow O2 administers? Tracheostomy Collar, Tracheostomy T-Bar, Venturi Mask
What must be monitored/done for a pt on a tracheostomy collar? secretions collect inside the collar and around the tracheostomy and should be removed and cleaned q4 hours to prevent aspiration of fluid/infection. Condensation occurs in tubing and needs to be periodically drained distally to tracheostomy
What must be monitored/done for a pt on a Tracheostomy T-bar? Similar to tracheostomy collar. secretions collect inside the collar and around the tracheostomy and should be removed and cleaned q4 hours to prevent aspiration of fluid/infection. Condensation occurs in tubing and needs to be periodically drained
which mask is especially useful for administering low constant O2 for COPD pts? the Venturi mask is especially helpful for administering low constant O2 for COPD pts. Applicators can be applied to increase humidification.
what is a CON of the Venturi Mask? mask is uncomfortable and must be removed for the pt to eat
What are 4 complications for O2 therapy? Combustion, CO2 narcosis, O2 toxicity, Absorption atelectasis
What is CO2 narcosis? CO2 narcosis is the lack of a drive to breathe related to increased O2 than used to
What is O2 toxicity? O2 toxicity is a severe inflammatory response leading to severe pulmonary edema, shunting of blood and hypoxemia.
what is Absorption atelectasis? absorption atelectasis results from too much O2 flushing out the nitrogen that is normally present in the alveoli. Nitrogen prevents atelectasis. without this nitrogen, the alveoli collapse.
look at notes for assessment of COPD
What are some possible diagnostic findings of COPD? decreased PaO2, increased PaCO2, Polycythemia, pulmonary functiontests showing expiratory airflow obstruction (Low FEV1, FEV1/FVC, large RV), chest x-ray showing flattened diaphragh amd hyperinflation
how should a COPD pt be instructed on exercise? sex? coping? a COPD pt should be instructed to start small and build up with exercise. walk 10-15 minutes 3x per week. modify sexual activity and promote healthy coping
Look at picture you drew about COPD.
Created by: 1398660434