The Mycobacteria we care about (other than leprosy)
These are risk factors for M. tuberculosis...
What are low socioeconomic status, substance use, incarceration, closely confined living conditions, Health Care Workers!
These are expected s/s of pneumonia...
What are sharp pleuritic chest pain, fever, tachypnea, tachycardia, fatigue, myalgia, fever, productive cough, crackles (from the fluid) and wheezes (from the inflammation of the bronchi)
Environmental risks for asthma include...
What are pollution, 2nd hand smoke, pollen, chemicals, strong perfumes, cold weather, dander from pets, dust mites, fumes from fireplaces, aerosol sprays?
These later findings of hypoxia are often experienced by pts w COPD...
What are clubbing of the fingernails, bradycardic, shallow breathing, confusion, cyanosis, hypotension, dysrhythmias
The RN knows CF is not a respiratory disease, but a disorder of this system...
What is an exocrine disorder related to a gene mutation that must be inherited from both parents and affects glands that secret hormones into ducts (pancreas, GI, reproductive)
When educating a pt about inhaled Glucocorticoids , the RN knows...
What are glucocorticoids reduce airway inflammation but DO NOT act as bronchodilators and DO suppress immune response which reduces risk of exacerbations?
Signs and Symptoms of TB include...
What are night sweats, unexplained weight loss (anorexia), persistent cough w hemoptysis
The RN knows a sputum collection should be collected at this time but after doing this...
What is first thing in the morning and after the mouth has been rinsed to reduce normal flora?
Bonus Knowledge: a sputum culture may be collected from a trach
After administration of an inhaled bronchodilator, what would the RN expect to hear?
What is decreased wheezing!
This is the biggest risk factor for COPD...
What is smoking!
Bonus Knowledge: will stopping smoking reverse damage? No but it will slow down further disease progression
The RN knows the primary problem with cystic fibrosis is the production of this...
What is a thick sputum that may coat and clog the respiratory system, pancreatic and reproductive ducts, the bowel, and any other tube system in the body?
Think green Slime!!!!
The RN knows that this pt past medical history event is an indicator that the pt has increased risk of intubation and is a red flag...
What is past history of intubation related to exacerbations?
TB pts will be in this type of isolation and staff will wear this type of mask...
What is airborne isolation and what is a fitted N95 mask?
For a pt with pneumonia, pt teaching will include...
What is HH, rest as needed, DC tobacco, respiratory etiquette, increase fluids to thin mucous, encourage pneumonia vaccine (q 3- 5y depending on manufacturer) and flu vaccine (annually), when to call the physician (worsening change in sputum), frequent ambulation to mobilize fluid in lungs
Common side effects of bronchodilators include...
What are feeling n/v, jittery, heart racing, headache?
Per ATI, this mask should be used with COPD when a more precise O2 delivery method is preferred...
What is a venturi mask?
Signs and symptoms of CF may include...
What is foul smelling greasy stools (because pancreas is blocked and not able to break down fats adequately), poor weight gain due to malabsorption, severe constipation/intestinal blocks related to mucous build up, increased sodium excretion (you taste EXTRA salty)
The RN knows these medications relax large airways/bronchi providing bronchodilation and improving airflow overtime; these are a maintenance med...
What are inhaled anticholinergics?
Bonus Knowledge: do not thin mucous, long acting
Ipratropium bromide (Atrovent), Tiotropium bromide (Spiriva), Umeclidinium bromide (Incruse), Glycopyrronium bromide (Seebri), and Oxitropium bromide
Mantoux/PPD/Tuberculin skin test is read after this many hours in order to allow time for antibodies to respond...
What is 48 to 72 hours
Plan of care for pt with pneumonia should include...
What is ambulate frequently, encourage fluids and rest, oral hygiene at least per shift
If pt experiencing peak flow readings lower than normal, the nurse should do this...
What is have the pt use his/her rescue inhaler and retest?
This is program is recommended for COPD patients and is a structured program designed to help individuals with chronic lung diseases improve their quality of life through education, exercise, and support
What is a pulmonary rehab program?
These meds are specific to CF and correct the function of the defective protein related to the CF gene...
What are CFTR modulators?
Cystic Fibrosis Transmembrane Conductance Regulator (a protein made by the CF gene)
These types of inhalers are used for quick relief and termed a "rescue inhaler"...
What are short acting beta2 agonists, albuterol?
Latent TB is when a person tests positive to the skin test but has no active signs of infection, but the TB may become active if the person experiences...
What is chronic renal disease, diabetes, malnutrition or anything that puts them in an immunocompromised or weakened state (kind of like shingles!)
The RN knows dyspnea, particularly at rest, is an indication of this...
What is deteriorating respiratory status?
The RN knows these are signs of worsening respiratory distress/increased hypoxia...
What are cyanosis, use of accessory muscles, change in level of consciousness (confusion), restlessness, agitation
RATT r/t hypoxia: restlessness, agitation, tachypnea, tachycardia
This position is often preferred by COPD patients to decrease the work of breathing...
What is tripod positioning?
These enzymes may be needed for the pt with CF to aid in the breakdown and absorption of food because the pancreatic ducts get blocked with thick mucous and are not chewed...
What are pancreatic enzymes?
This device is used with an MDI and will make a whistling noise if the pt breathes in too quickly...
What is an aerochamber or a spacer?
If a pt is suspected of having TB, it is most important to take this action first...
What is place pt on Airborne isolation!
The RN knows s/s of pneumonia include...
What are fever, chills, productive cough, tachypnea, tachycardia, pleuritic pain & fatigue, myalgia?
These are the expected breath sounds related to an asthma exacerbation...
What are wheezes?
The RN educates the COPD pt to get these vaccines...
What is flu vaccine annually and what is pneumonia vaccine x 1 or per manufacturers recommendations?
The RN teaches the pt these types of medications are used to thin and loosen mucous...
What are mucolytics?
The RN knows pt teaching regarding inhaler use includes...
What is rinsing mouth after inhaler use (not necessary to rinse between each puff) especially with steroid inhalers to reduce risk of developing thrush?
These indurations are considered positive for these populations:
5mm or greater
10mm or greater
15mm or greater
What are:
5mm: immunocompromised, HIV+, recent exposure
10mm: recent immigration from endemic area, IV drug abusers, employees of high risk settings, kids of high risk adults
15mm: positive in ANYONE even without risk factors
Before administering antibiotics these 2 actions are high priority...
What are verify the pts allergies and ensure cultures have been collected if ordered?
The RN knows these are expected findings with an acute asthma exacerbation...
What is dry, hacking cough, tachycardia, may have tenacious sputum, inability to speak in complete sentences (red flag!)?
The RN teaches the COPD pt that first line treatment for smoking cessation are these...
What is 1st line is nicotine patches and bupropion?
Chest physiotherapy (CPT) may be performed to help loosen and expectorate thick sputum; related teaching includes...
What is should be performed at least daily to be effective, may be performed by family members, should be performed 1 h before meals or 3 h after meals, should not be performed over zippers or buttons r/t risk of skin breakdown?
The RN knows absent breath sounds are a huge red flag because...
What is the airways have closed off so NO air is moving?
Bonus Knowledge: Prepare to intubate!
This vaccine is administered in areas where TB is endemic and if administered, the pt will then test positive to the PPD/Mantoux skin test related to antibody reaction...
What is the BCG (Bacilli Calmette-Guerrin) vaccine?
This position helps the lungs expand and may ease work of breathing...
What is high fowler's?
The RN teaches the pt that the purpose of inhaled corticosteroids is...
What is to decrease inflammation & suppress the immune response?
The RN teaches the pt that LONG-acting beta 2 adrenergic agonists maintain bronchodilation and SHORT-acting beta 2 adrenergic agonists provide rapid relief by relaxing the muscles in the airway; the most common short acting beta 2 is...
What is albuterol as a rescue inhaler?
Long acting beta 2s are most commonly used with COPD-
Because CF may affect the airways, these inhaled medications that are used with asthma and COPD may be used...
What are beta 2 adrenergic agonists? (relax smooth muscle of the airways)
The RN knows priority action for any pt experiencing respiratory distress is...
What is to sit the pt up in low or high fowler's to activate and elongate the core to facilitate better ventilation?