Clinical Manifestations
characteristic manifestations of asthma?
wheezing, cough, dyspnea, chest tightness, (air trapping), hyperinflation of the lungs
The amount of fluid recommended for patient intake for Asthma?
Encourage the patient to maintain a fluid intake of 2 to 3 L/day
First-line treatment for Asthma?
Bronchodilators (B2 adrenergic agonists) and Corticosteroids (anti-inflammatory drugs)
The best way to promote health teaching in a patient with Asthma?
Teach the patient to identify and avoid known personal triggers
Diagnostic testing for Asthma?
Spirometry, Peak Expiratory flow rate (PEFR), Chest XR, Pulse Ox, allergy skin testing, eosinophils and IgE (if indicated)
Common triggers for Asthma exacerbations?
Air pollutants, allergen inhalation, drugs, occupational exposure, pulmonary, stress, hormones, environment (cold, dry air)
What kind of retraining exercises are recommended for COPD patients?
pursed-lip breathing and diaphragmatic breathing
First-line treatment for COPD?
Bronchodilators for most patients; SABA (short acting B2 adrenergic) -- main one Albuterol!
What is a good goal to promote during an asthma attack?
decrease the patient's anxiety and sense of panic
What test is used to confirm the diagnosis of COPD and its severity?
Spirometry!!
characteristic manifestations of Tuberculosis?
primary manifestation: initial dry cough (often becomes productive with mucoid or mucopurulent symptoms)
Latent TB: asymptomatic
Active TB: fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats; dyspnea and hemoptysis -- late symptoms
Renal TB: dysuria and hematuria
Bone and Joint TB: severe pain
TB meningitis: headaches, vomiting, lymphadenopathy
What form of nutrition therapy is typically recommended for patients presented with pneumonia?
Hydration!! -- important to prevent dehydration and thin and loosen secretions; carefully monitor fluid intake.
If patient is an older adult, has heart failure (HF), or has a known pre-existing respiratory condition, administer IV fluids carefully to avoid fluid overload -- monitor fluid intake and output
What is the mainstay treatment of TB?
Drug therapy! including:
plan with 4 drugs: isoniazid, rifampin, pyrazinamide, and ethambutol
Isoniazid -- monitor for liver toxicity -- teach patient to avoid drinking alcohol
Directly observed therapy (DOT) -- providing the antitubercular drugs directly to patients and watching as they swallow the drugs -- to ensure adherence, nonadherence is a major factor in the emergence of MDR-TB and treatment failures!
What kind of things would you implement for health promotion of COPD patients?
Stop smoking!! and, influenza and pneumococcal vaccine; COVID vaccine
Chest XR -- is important in diagnosing pneumonia!
Arterial blood gases (ABG's), leukocytosis present, WBC count (typically elevated greater than 15,000 uL
Sputum culture for gram stain to identify the organism before starting antibiotic therapy
blood cultures for severe cases!
characteristic manifestations of COPD?
expiratory phase prolonged, chronic cough (intermittent, can be productive), decreased breath sounds, wheezing, fatigue, weight loss, anorexia (advanced COPD), "barrel chest", sitting in "tripod position"
Common interventions for pneumonia patients?
monitor respiratory status
keep head of bed elevated at least 30 degrees
turn and reposition that patient every 2 hours to promote lung expansion and mobilize secretions
encourage the patient to cough, deep breathe, and use incentive spirometer
Common drug treatment for pneumonia?
appropriate antibiotic therapy -- determined based on culture/gram stain
antipyretics (fever reducers)
analgesics (pain relievers)
NSAIDS (if no contraindications)
Teach early recognition of the 3 main manifestations of COPD exacerbations which include: ?
dyspnea, increased sputum volume, increased sputum purulence
Common tests used to confirm/diagnose/manage TB?
Mantoux Test (PPD skin test) -- read 48 to 72 hours later for presence or absence of induration
IGRA -- Quantiferon TB Gold Test (blood) and the T Spot TB test
Sputum culture is the gold standard for diagnosing TB!!! -- need 3 consecutive sputum specimens, each collected at a 8 to 24 hour intervals, with at least 1 early morning specimen
Chest XR --- not used to diagnose but to see progression of TB
characteristic manifestations of pneumonia?
most common: cough, fever, chills, dyspnea, tachypnea, and pleuritic chest pain, sputum (may be green, yellow, or even rust colored (bloody)); older adult -- typically confusion or stupor; nonspecific manifestations: diaphoresis, anorexia, fatigue, myalgias, and headache
Breath sounds: fine or coarse crackles; if consolidation is present, bronchial breath sounds, egophony (increase in the sound of the patient's voice) and increased fremitus
Common interventions for Tuberculosis?
Placed on airborne isolation precautions -- negative pressure room and airflow of 6 to 12 exchanges per hour
receive a medical work up including chest XR and sputum smear and culture
start appropriate drug therapy
For COPD patients using O2 therapy, what is the recommended maximum L/min?
Max 3L/min on COPD patients.
More than this can cause a decrease in respiratory drive
Common health promotion teachings for patients with pneumonia?
Practice good health habits -- hand washing!
good nutrition, adequate rest, regular exercise, coughing or sneezing into elbow rather than hands
avoid smoking!
avoid exposure to people with URI's!
pneumococcal and influenza vaccines!
Teach importance of taking every dose of the prescribed antibiotic!
Explain the need for adequate rest to promote recovery
plenty of fluids (at least 6 to 10 glasses/day)
cool mist humidifier or warm bath may help the patient breathe easier
minimize exposure to close contacts and household members -- homes should be well ventilated -- patient should sleep alone and spend as much time outdoors as possible
minimize time in congregate settings and public transportation
What are two methods used to assess the effectiveness of gas transfer in the lungs and tissue oxygenation?
Oximetry and Arterial Blood gases (ABG's)