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Influenza | infectious disease caused by ribonucleic acid (RNA) viruses that can affect humans, birds, and other mammals
A, B, and C can infect humans |
Avian Influenza | infected migratory & domestic birds shed virus in saliva, nasal secretions, feces
Strain: H5H1
Transmission limited to people and some animals |
Influenza
Signs & Symptoms | fever, cough, sore throat, muscle aches
also eye infections, PNA, acute respiratory distress
diarrhea, vomiting, and abd pain may occur |
Influenza
Diagnosis | chest xray - may show PNA, infiltrates, or consolidations
sputum gram stains & culture isolate virus |
Influenza
Treatment | Neuraminidase inhibitor - oseltamivir (Tamiflu), peramivir (Rapivab), and sanamivir (Relenxa) can reduce severity & duration
M2 inhibitors - amantadine & rimantadine (Flumadine) for pandemic (resistance may develop)
maintain fluid/electrolyte balance |
Influenza
Nursing Interventions | standard and contact precautions, fit-tested ventilator, hand hygiene
eye protection within 3' of patient
maintain patent airway, suctioning |
Pleural Effusion | accumulation of fluid in pleural space
occurs secondary to other disease states
empyema - accumulation of pus & necrotic tissue in pleural space; blood (hemothorax) and chyle (chylothorax) may also collect in this space |
Exudative Pleural Effusion | caused by inflammation of pleura
causes - bacterial or fungal empyema or pneumonitis, chest trauma, collagen disease, malignancy, myxedema, pancreatitis, PE, subphrenic abcess, and TB |
Transudative Pleural Effusion | caused by excessive hydrostatic pressure or decreased osmotic pressure
causes - HF, hepatic disease with ascites, hypoalbuminemia, and peritoneal dialysis |
Pleural Effusion
Signs and Symptoms | most common - pleuritic pain and dyspnea
decreased chest wall movement, decreased breath sounds over affected area, dullness on percussion
infection from empyma may cause - cough, fever, night sweats |
Pleural Effusion
Diagnosis and Treatment | chest xray can diagnose
CT of chest, bronchoscopy, pleurocentesis, US
underlying cause should be treated
thoracentesis - remove fluid (chest tube for continued drainage)
thoracotomy if thoracentesis ineffective
abx for empyema (depends on organism) |
Pleural Effusion
Nursing Intervention | watch for respiratory distress or pneumothorax after thoracentesis
encourage deep breathing and IS
maintain integrity of chest tubes; monitor amount, color, consistency of drainage; check for air leaks |
Pneumonia | acute lung infection with inflammation accompanied by accumulation of exudate in the alveoli
major cause of morbidity and mortality among elderly and chronically ill |
Pneumonia
Risks | risk increases with aspiration, CNS depression, chronic illness, COPD, dehydration, trach, immobility, immunosuppression, intubation, pain in thoracic cavity, anesthesia
may result from bacterial, fungal, or viral infection; exposure to chemical irritan |
Pneumonia
Signs and Symptoms | common - dyspnea, tachypnea, fatigue, & fever
cyanosis/hypoxia in advanced disease
cerebral hypoxia - irritability or restlessness
crackles, rhonchi, bronchial breath sounds over consolidation; wheezes over affected areas; decreased in advanced disease |
Pneumonia
Diagnosis | chest xray, ABG, sputum culture (bacterial), serologic testing (viral)
needle or open biopsy to obtain lung tissue specimen (fungal) |
Pneumonia
Treatment and Nursing Intervention | antibiotics to eradicate infecting organisms
bronchodilator to open narrowed airways
teach effective coughing/deep breathing, hydration, pain management, hand hygiene |
Pulmonary Edema | the collection of fluid in the interstitium and alveoli of the lungs as pressure rises in pulmonary vessels
can result from ARDS, fluid overload, left-sided HF, mitral stenosis, MI, PE |
Pulmonary Edema
Effect on Left Ventricle | L ventricle can't pump blood from heart; increased resistance = fluid backs up into lungs; surface tension increases, alveoli shrink, lungs become stiff = diff breathing; hypoxemia/altered V/Q ratio; fluid moves into larger airways -> pink, frothy sputum |
Pulmonary Edema
Signs and Symptoms | tachycardia & -pnea, hypoTN; 3rd & 4th heart sounds; skin cold & clammy; dysp, pulm HTN; distended jugular veins; blood-tinged or pink, frothy sputum
lung auscultation = dependent crackles
confusion, decreased urine output, diaphoresis, lethargy |
Pulmonary Edema
Diagnosis and Treatment | CXR, ABG
diuretic; inotropic drugs = increase myocardial contractility, nitro = reduce pre & afterload, and vassopressor; morphine = decrease preload, RR, anxiety
if no response = intra-aortic balloon pump or surgery (angioplasty, bypass, valve repair) |
Pulmonary Edema
Nursing Intervention | semi-Fowlers to maximize oxygenation and reverse hypoxemia
strict I/O to assess effectiveness of diureti |
Pulmonary Embolism | blockage in pulm vasculature; bone, air, fat, amniotic fluid, thrombus, foreign object
lung isnt perfused = altered V/Q ratio = alveolar collapse -> atelectasis & hypoxemia; pulm infarction may occur
can cause pulm HTN, right HF, ventricular hypertrophy |
Pulmonary Embolism
Risk Factors | afib, COPD, family hx of PE, birth control, prior embolism, venous injury or stasis |
Pulmonary Embolism
Signs and Symptoms | dyspnea with CP; pleuritic CP may be pulm infarction; hemoptysis, anxiety, restlessness, hypoTN, tachycardia; crackles, pleural friction rub, wheezes; lowgrade fever
may have arrhythmia, cyanosis, diaphoresis
fat embolism - confusion, dyspnea, petechiae |
Pulmonary Embolism
Diagnosis and Treatment | ABG, CXR, ECG, lung scintigraphy, MRI, pulm abgiography, V/Q lung scan
DVT - contrast venography, Doppler
heparin gtt; warfarin
embolectomy; vena cava filter; diuretic (for fat em); abx (for septic em); anti-arrhythmic for arrhythmia with ischemia |
Pulmonary Embolism
Nursing Intervention | cough/deep breath; hydration; ambulation, ROM; TED hose; don't raise knees (obstructs venous flow); elevate legs |
Severe Acute Respiratory Syndrome
(SARS) | life-threatening viral infection believed to be coronavirus (mutated from animals)
incubation period - 2-7 days
risk factors - close contact/contact with exhaled droplets/bodily secretions from infected person, or travel to endemic area |
Severe Acute Respiratory Syndrome (SARS)
Signs and Symptoms | early stages - nonproductive cough, rash, high fever, headache, body aches, PNA
later stages - SOB and respiratory distress |