COPD
the two thingys under COPD + patho + COPD oxygen number + is it reversible
progressive persistent airflow limitation
2
no
what do you use to check how bad your asthma is
peak flow rates
what is the patho + risk factors
acute infection of lung parenchyma (lung tissue essentially)
abdominal/chest surgery, age >65, air pollution, altered consciousness (alcoholism, head injury, stroke, seizures, overdose), bed rest/prolonged immobility
diagnosis
Skin test called mantoux test (read for the presence or absence of induration or raised, not the redness
Chest x-ray
Sputum culture
type a (severe)
type b (not as severe)
risk factors
patho
persistent airway inflammation
types of pneumonia + s/s
Community acquired (CAP, pt’s who have not resided in a hospital or long-term care facility within 14 days of onset of symptoms), hospital acquired (HAP, 48 hrs or longer after hospitalization and not present when admitted), ventilator associated (VAP, 48 hrs after endotracheal intubation), aspiration pneumonia (results from abnormal entry of secretions into lower airway), opportunistic pneumonia (caused by microorganisms that do not normally cause disease
Respiratory: cough, green/yellow/rust colored sputum, fine/coarse crackles, accessory muscles used, dyspnea, increased RR, decreased O2, pleuritic chest
Neurologic: change in mental state, lethargy, confusion
Fever, chills, HA, anorexia, diaphoresis
s/s
Low grade fever, night sweats, fatigue, cough (white/frothy sputum), dyspnea and hemoptysis, pleuritic pain, weight loss/anorexia
Immunosuppressed pt’s are less likely to have fever and other signs of an infection
when is flu season and is it contagious
sept-april
highly contagious
s/s day to day + chronic + other
day to day
prolonged expiratory phase, wheezes or decreased breath sounds, chronic cough or sputum production, dyspnea or SOB
chronic
barrel chest, underweight w/anorexia, chronic fatigue, polycythemia
other
use of accessory and intercostal muscles, tripod, pursed lip breathing
peak flow zones
green - 80-100%, keep taking meds
yellow - 50-80%,indicates exposure to trigger, use SABA inhaler, maybe oral steroids
red - <50%,indicates serious problem, go to ED
complications + diagnosis
Atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, meningitis, acute respiratory failure, sepsis/septic shock, lung abscess, emphysema, death
History, physical exam, chest x-ray (patchy areas of density), sputum analysis, CBC with increased WBC, pulse ox/ABGs, blood cultures, thoracentesis, bronchoscopy with washings
cause + patho + favorable places to grow
mycobacterium tuberculosis
Lungs most commonly affected, airborne droplets, inhaled bacilli pass down bronchial system, multiply with initial resistance, replicates slowly and spreads via the lymphatic system, favorable environments for growth is the kidneys, bones, brain and adrenal glands
s/s
high fever (3-4 days)
headache
aches/pains
fatigue/weakness
chest discomfort w/cough
stuffy nose/sneezing
sore throat
diagnostics
FEV1/FVC ratio <70%
increased residual volume
chest x-ray (flat diaphragm)
6-minute walk test (decreased SPO2)
ABGs - chronic resp acidosis w/decreased o2
echocardiogram (cor pulmonale)
sputum for culture/sensitivity
s/s (episodes of + s/s leading to exacerbation)
episodes of
wheezing, SOB, dyspnea, chest tightness, cough (at night)
leading to exacerbation
to dyspneic to speak, increased anxiety with panic/HR/BP/RR, decreased SPO2, prolonged expiration, silent chest (EMERGENCY)
treatment + nursing care
Oxygen for hypoxemia, analgesics for pain, antipyretics, individualize rest and activity, antivirals for influenza pneumonia, drug therapy is based on infecting organism, start with IV then switch to oral therapy
Elevate HOB 30 and keep up, reposition pt Q2H, prevent VAP, assess with gag reflex, early moving/ROM/turning, incentive spirometry, oral hygiene at least 2 a day, fluids, high calorie/small frequent meals, monitor for weight loss
complications + drugs (active and latent (what vitamin do you give))
Miliary TB (large amount of organisms spread via the bloodstream to organs)
TB pneumonia (large amounts of bacilli discharged from granulomas into lung or lymph nodes)
Pleural TB (s/s are chest pain, fever, cough, unilateral pleural effusion)
Pleural effusion (bacteria in pleural space which causes inflammation)
Empyema (large amount of tubercular organisms in pleural space)
Other organ involvement would be CNS (meninges), bone/joint tissue, kidneys
Active: treatment is aggressive, initial (8 weeks) and continuation (18 weeks), isoniazid, rifampin (rifadin), pyrazinamide, ethambutol
Latent: treated with INH (6-9 months, unless pt is HIV positive than than they are 9 months) (give vitamin B6 with this drug)
complications + diagnosis
pneumonia, bronchitis, acute respiratory failure
s/s, is it flu season?, rapid flu testing, viral cultures
exacerbation treatment + long-term management
exacerbation treatment
1. o2 w/SABA - albuterol via nebulizer
2. add SAMA - ipratropium via nebulizer
3. IV steroids - methylprednisolone & inhaled - budesonide
4. IV antibiotics - do not delay for sputum sample
long-term management
look at the study guide...
treatment for exacerbations
1. o2 w/ SABA (albuterol via..)
2. add a SAMA (ipratropium via..)
3. IV steroids - methylprednisolone
nutrition + shots
Hydration (loosens secretions), maintaining F&E
Prevnar 13: do not give to children <5 and adults >65 or anyone with HIV, leukemia, on immunosuppressive therapy, chronic renal failure
Pneumovax 23: do not give adults >65 or anyone with DM, heart disease, cirrhosis, conditions that weaken the immune system, pt’s on corticosteroids, chemotherapy/radiation therapy
nursing interventions
Airborne isolation (negative pressure rooms, n-95 masks?/HEPA masks, drug therapy, teach pt to cover nose/mouth with tissue when coughing/sneezing/producing sputum, pt wears mask when leaving rooms, identify/screen close contacts, monthly sputum cultures, negative cultures are needed to declare pt not infectious, notify health department, teach symptoms of recurrence, teach about what could reactivate TB, no more smoking, management of SE, monitor for hepatitis/neuro changes/rashes, monitor compliance of treatment!!, manage airway secretions, maintain nutritional status
Stay aways from foods with tyramine: anything aged, dried, fermented, salted, smoked, pickled (especially pepperoni, salami, liverwurst), soy products, nuts, seeds, alcohol or fermented beverages, sauerkraut, pickles, olives, fava or broad beans
what type of flu vaccines are there? how many times do you need flu vaccines? how long does it take before it protects you? when should you get vaccinated? what allergy should you check for?
inactivated/live vaccines
annual
takes 2 weeks to protect you
september
egg