PATHO
Inflammation of the mucous membranes lining the airways
Causing bronchoconstriction, mucus production and edema leading to decreased airflow and gas exchange
ASTHMA
S/S OF ASTHMA
Feeling of chest tightness
Shortness of breath
Prolonged exhalation
Retractions
Tachypnea
Dry cough -productive
Wheezing
Hypoxia
Silent chest
Tachycardia
Restlessness
Anxiety
Difficulty sleeping
Unable to speak a few words
Exercise intolerance
Pallor
Cyanosis
RF FOR ASTHMA
Genetic factors
Environment (allergens, air pollutants)
Exercise
Medication
Stress
GERD
NURSING INTERVENTIONS FOR RESPIRATORY ALKALOSIS
•Correcting the underlying cause
•Fear, anxiety—anxiety reduction, antidepressants
•Oxygen therapy, rebreathing techniques
•Teach stress relieving techniques and identify causes of anxiety
WHAT IS A NORMAL PH?
7.35-7.45
DRUGS FOR ASTHMA
- BRONCHODILATORS : SABA'S & LABA'S
SABA'S (ALBUTEROL & LEVABUTEROL)
LABA'S (SALMETEROL)
- CHOLINERGIC ANTAGONISTS (SHORT-ACTING)
(IPRATROPIUM)
- ANTI-INFLAMMATORIES : CORTICOSTEROIDS
(FLUTICASONE - LONG-ACTING & PREDNISONE)
COMPLICATION OF ASTHMA
STATUS ASTHMATICUS
•Results from early acute pulmonary problems that presents with hyperventilation, fear, anxiety
RESPIRATORY ALKALOSIS
S/S OF RESPIRATORY ALKALOSIS
•tachypnea, inability to concentrate
RF OF PNEUMONIA
older adults, has not received pneumococcal/COVID-19/flu vaccines, chronic health problems, low immunity health problem, just had the flu or other respiratory infections, smoking, endotracheal or NG tube, chronic lung disease
NURSING INTERVENTIONS FOR RESPIRATORY ACIDOSIS
•Improving ventilation and oxygenation
•Oxygen therapy, ventilator, positioning, breathing techniques
•Bronchodilators (breathing treatments)
•Assessing breathing and respiration status hourly
•Abnormal signs—wheezing, use of accessory muscles, cyanosis
measure the maximum flow velocity during forced exhalation
Green, Yellow, Red Zone
PEAK EXPIRATORY FLOW METER
DRUGS FOR COPD
•Short-acting bronchodilators
•Corticosteroids
•Antibiotics
•Mucolytics
•Supplemental oxygen therapy
COMPLICATIONS OF STATUS ASTHMATICUS
- PNEUMOTHORAX
- CARDIAC OR RESPIRATORY ARREST
- Sudden absence of wheezing and decreased oxygen saturation
- Prepare for emergency intubation
•Results from: hypoventilation
RESPIRATORY ACIDOSIS
S/S OF RESPIRATORY ACIDOSIS
•confusion, coma, tachycardia, variable respirations, pale to cyanotic and dry skin
RF FOR TUBERCULOSIS (TB)
HOMELESS
RESIDENTS OF INNER-CITY NEIGHBORHOODS
FOREIGN-BORN PERSONS
LIVING OR WORKING IN INSTITUTIONS (INCLUDING HEALTHCARE WORKERS)
IV INJECTING DRUG USERS
POVERTY, POOR ACCESS TO HEALTH CARE
IMMUNOSUPPRESSION
HOME MANAGEMENT FOR ASTHMA
Control and prevent episodes
Avoidance allergens
Self-management education
Personal asthma action plan
Drug therapy
Control therapy drugs
Rescue/Reliever drugs
Exercise and activity
Rest and sleep
WHICH DIAGNOSTIC EXAMS ARE USED FOR ASTHMA?
Pulmonary function tests
Peak expiratory flow rates (PEFR)
Forced vital capacity (FVC)
Forced expiratory volume (FEV1)
ABGs
Initially decrease in CO2 and later increase in CO2
Sputum collection
Elevated eosinophils serum
Skin testing (for allergy)
DRUGS FOR SEASONAL INFLUENZA
ANTIPYRETICS
ANALGESICS
ANTIVIRALS (TAMIFLU)
COMPLICATIONS OF COPD
Respiratory infections (pneumonia)
Cardiac failure, especially cor pulmonale
(Right sided heart failure)
Cardiac dysrhythmias
(Atrial fibrillation)
Polycythemia
Respiratory failure
(Hypoxemia--Oxygen: PaO2 <60mmHg)
(Hypercapnia-Carbon dioxide: PCO2 >50mmHg)
Respiratory Acidosis
- DOES NOT RESPOND TO COMMON THERAPY
STATUS ASTHMATICUS
S/S OF COPD
Prolonged expiratory phase
Wheezes
Decreased breath sounds
↑ Anterior-posterior diameter (barrel chest)
Tripod position
Pursed lip breathing
Dyspnea
Cough
Sputum production
Chronic fatigue
Weight loss
May experience chest tightness with activity
Cyanosis to blue-tinged, dusky appearance
NURSING INTERVENTIONS FOR ACUTE ASTHMA
Improve airway clearance and gas exchange
Focused Assessment
Oxygen
Medications
Position and breathing
WHICH 2 DISORDERS ARE UNDER THE COPD UMBRELLA?
EMPHYSEMA & CHRONIC BRONCHITIS
DRUGS FOR PNEUMONIA
Antibiotics
- (Broad spectrum: Rocephin, Levaquin, and Zosyn)
Bronchodilators nebulizers
IV steroids
Expectorants
COMPLICATIONS OF SEASONAL INFLUENZA
pneumonia, ear or sinus infections; Older adults—weak and lethargic
Loss of lung elasticity and hyperinflation of lung
Air trapping and overstretching and enlargement of alveoli, collapse of small airways
EMPHYSEMA
S/S OF SEASONAL INFLUENZA
Abrupt onset—~ 7 days: chills, fever, myalgia, headache, cough, sore throat, fatigue
NURSING INTERVENTIONS FOR STATUS ASTHMATICUS
Oxygen keep sats above 92
Inhaled nebulizers short acting B2 agonists
Systemic corticosteroid
Epinephrine nebulizer or injection
IV access for fluids
Frequent ABGs, electrolytes
WHAT ARE LABORATORY ASSESSMENTS FOR COPD?
ABG values (hypoxemia and hypercapnia)
Sputum samples
CBC
Hemoglobin and hematocrit
Serum electrolytes
Chest x-ray
Pulmonary function test
DRUGS FOR TUBERCULOSIS (TB)
Combination drug therapy with strict adherence: (Table 25.4)
(Isoniazid)
(Rifampin)
(Pyrazinamide)
(Ethambutol)
PREVENTION OF PNEUMONIA
know risk factors, flu/COVID-19/pneumococcal vaccines, turn & cough, clean respiratory equipment, avoid pollutants, no smoking, get enough sleep, increase fluids (water), eat healthy
Inflammation of bronchi and bronchioles caused by chronic exposure to irritants affects only airways
Production of large amounts of thick mucus
CHRONIC BRONCHITIS
S/S OF PNEUMONIA
Cough
Fever, chills
Dyspnea, tachypnea
Pleuritic chest pain
Green, yellow, or rust-colored sputum
Confusion or stupor
Fine or coarse crackles
Bronchial breath sounds
NURSING INTERVENTIONS FOR COPD
Monitor respiratory status Q2 hours and PRN
Oxygen to keep O2 sats 88% or higher
BIPAP (Non-invasive ventilation)
Breathing techniques
Positioning
Coughing
Nutrition
WHAT KIND OF DIET SHOULD COPD PATIENTS BE ON?
High-calorie, high-protein diet is recommended.
PREVENTION OF PNEUMONIA IN ADULTS OVER 65 YEARS OF AGE OR CHRONIC HEALTH PROBLEMS
VACCINES (PCV13 & PPSV23)
Exposed not active disease
No symptoms
No transmission
Treatment, must be compliant to adhere to month long prescriptions
LATENT TUBERCULOSIS (TB)
S/S OF SEPSIS
Changes in level of consciousness (metabolic encephalopathy)
Low urine output
Tachycardia
Increased respiratory rate
Low blood pressure
NURSING INTERVENTIONS FOR SEASONAL INFLUENZA
Prevention: Vaccine
- Inactivated or live attenuated
- Takes 2 weeks for antibody production
Symptom relief and prevent secondary infection: rest, fluid, antipyretic, analgesia
Antivirals: shorten duration of symptoms and reduce risk of complications
- Oseltamivir (Tamiflu) 24-48 hours of symptoms
NUTRITION THERAPY/MANAGEMENT FOR COPD PATIENTS
Weight loss and malnutrition are common.
- Pressure on diaphragm from a full stomach causes dyspnea.
- Difficulty breathing while eating leads to inadequate consumption.
To decrease dyspnea and conserve energy
- Rest at least 30 minutes before eating.
- Use bronchodilator.
Avoid :
- Foods that require a great deal of chewing
- Exercises and treatments 1 hour before and after eating
- Gas-forming foods
PREVENTION OF SEASONAL INFLUENZA
VACCINE (SEASONALLY)
HAND-WASHING
MASKS
NOT GETTING AROUND INFECTED PEOPLE
Exposed developed disease immediately or latent TB disease became active because of weakened immune
disease can spread to others
Symptoms
Patient with active symptoms are considered contagious until test results are returned
- Isolate
ACTIVE TUBERCULOSIS (TB)
S/S OF TUBERCULOSIS (TB)
Progressive fatigue
Lethargy
Nausea
Anorexia
Weight loss
Low-grade fever, night sweats
Cough, mucopurulent (mucus and pus) sputum, blood streaks (hemoptysis)
NURSING INTERVENTIONS FOR PNEUMONIA
Antibiotics
Broad spectrum: Rocephin, Levaquin, and Zosyn
Oxygen Therapy
Adequate hydration (IV fluids and electrolytes)
Incentive spirometer
Bronchodilators nebulizers
IV steroids
Expectorants
WHICH DIAGNOSTIC TESTS ARE USED FOR SEASONAL INFLUENZA?
- H&P, PREVALENCE IN COMMUNITY
- Rapid influenza diagnostic tests (RIDTs)
TEACHINGS FOR ISONIAZID (ANTITUBERCULAR DRUG)
take 1-2 hours after meals, take a B complex multi-vitamin, AVOID alcohol, report dark urine
WHAT ARE THE 3 TYPES OF PNEUMONIA?
Community-acquired pneumonia
Hospital-acquired/healthcare required pneumonia
Aspiration pneumonia
TEACHINGS FOR RIFAMPIN (ANTITUBERCULAR DRUG)
expect reddish-orange skin or urine, soft contact lenses will become permanently stained, use alternative contraceptive, AVOID alcohol, report dark urine
WHAT ARE DIAGNOSTIC TESTS/LABORATORY ASSESSMENTS FOR PNEUMONIA?
Gram stain, culture and sensitivity of sputum
CBC
ABGs
Blood cultures
Chest x-ray
Pulse oximetry
TEACHINGS FOR PYRAZINAMIDE (ANTITUBERCULAR DRUG)
ask if they ever had gout, drink 8 oz. of water when taking tablets, wear protective clothing & sunscreen when outdoors, AVOID alcohol, report dark urine
WHICH 4 TYPES OF INFECTIONS IS SEPSIS SECONDARY TO?
LUNG
URINARY TRACT
SKIN
GI TRACT
TEACHINGS FOR ETHAMBUTOL (ANTITUBERCULAR DRUG)
report any vision changes, AVOID alcohol, drink 8 oz. of water when taking this drug
WHAT ARE DIAGNOSTIC TESTS/LABORATORY ASSESSMENT FOR SEPSIS?
Elevated serum procalcitonin level
Increased serum lactate level
Increased band neutrophils level (Left shift)
NURSING INTERVENTIONS FOR TUBERCULOSIS (TB)
3 Negative sputum culture = no longer infectious
Directly observed therapy (DOT) for noncompliance
Exposure
Transmission
Sputum specimens 4 weeks
WHAT ARE DIAGNOSTIC TESTS FOR TUBERCULOSIS (TB)?
Tuberculin (Mantoux) test—PPD given intradermally in forearm
- Induration of 10 mm or greater diameter = positive for exposure 48-72 hours after
- Elderly and immunocompromised is 5 mm
QuantiFERON-TB (blood test)
- Positive results do not confirm disease!!
WHAT ARE DIAGNOSTIC TESTS FOR TUBERCULOSIS (TB)?
Manifestation of signs/symptoms
Chest X-ray
Sputum smear for acid-fast bacillus
Definitive: Sputum culture of M. tuberculosis!!