Upper Respiratory
What tests and labs do you use to diagnose pneumonia
Diagnostic test
-chest xray
-ct scan
Lab studies
-WBC
-C reactive Protein
-ABG
-Sputum culture
Key points for activity tolerance for a pneumonia patient
assessment, schedule activities/rest periods, self care and ROM, assistive devices
What is chronic obstructive pulmonary disease?
a common preventable and treatable disease characterized by persistent airflow limitation
Compare and contrast clinical manifestations:
Lung sounds:
CB vs E
CB: wheezing and rhonchi w/ normal percussion
E: distant, diminished, may have expiratory wheezes w/ hyperresonance with percussion
List the possible complications of living with COPD
anxiety and depression, acute respiratory failure, pulmonary hypertension, pulmonary heart disease, pulmonary edema, pneumothorax, malnutrition, secondary polycythemia
Pneumonia Core Measures
-Blood cultures within 24 hrs of hospital arrival or prior to arrival
-blood cultures performed before first dose of antibiotics
-Broad spectrum antibiotic given within 4-6 hours after arrival
-smoking cessation counseling
-influenza and pneumococcal vaccine status documented (given, refused, or exempt)
Key points for safety with a pneumonia patient
infection, fall risk
What part of the lungs does emphysema effect and how
Aveoli and destroy walls of alveoli resulting in enlargment of abnormal air spaces
Compare and contrast clinical manifestations:
Respiratpry pattern:
CB vs E
CB: dyspnea
E: dyspnea, accessory muscle use, prolonged expiratory phase, tripod position
what diagnostic studies are used to diagnose COPD
Medical H&P, laboratory test (sputum cultures, ABG, CBC), radiology (CXR, nuclear imaging), echocardiogram, 6-minute walk test, pulmonary function test (PFT)
When is the pneumococcal vaccine intially given? are there special circumstances
initial vaccine given at 65 y.o.
special situations for person 19-64
Key points for nutrition with a pneumonia patient
kilocalorie requirement (>1500), small meals, fluids, IV fluids
How does chronic bronchitis affect the lungs and how long does it have to last to be considered chronic bronchitis
Chronic bronchitis is the excessive production of bronchial mucus and the productive cough must last 3 or more months in 2 consecutive years
Compare and contrast clinical manifestations:
Appearance:
CB vs E
CB: obese, peripheral edema, cyanotic, distended neck veins
E: cachexia (very thin), barrel chested
What are the 4 measurements taken when performing a PFT
total lung capacity (TLC)
residual volume (RV)
forced vital capacity (FVC)
forced vital capacity in 1st second of exhalation (FEV1)
When do you give the subsequent dose of the pneumoccal vaccine? whats the procedure for immunocompromised?
1 year after first
immunocompromised
-8 weeks in between doses for immunocompromised
-Q5 years
Preventative measures for pneumonia
hand washing, balanced diet, adequate rest, regular exercise, avoid smoking, avoid exposure to URI, immunizations
What are the clinical manifestations of COPD
Bonus if you know the earliest manifestation and initial presenting symptom
cough, progressive dyspnea, sputum production, ausculatory findings, respiratory patterns, weight changes, anorexia, fatigue, changes in oxygenation, chest shape, exacerbation and frequent respiratory infections
earliest manifestation: cough
initial presenting symptom: progressive dyspnea
Compare and contrast clinical manifestations:
Oxygenation:
CB vs E
Bonus if you know the possible ABG results of each
CB: Hypoxemia, hypercapnia
-Bonus: respiratory acidosis
E: Mild hypoxemia
-Bonus: normal to low CO2, normal pH
How do you determine persistent airflow limitations using the results of a PFT
FEV1/FVC < 0.7
Key points to rememeber when caring for a pneumonia patient
oxygenation, vitals, medication administration, mental status, positioning, ABGs, therapies for improvement
Compare and contrast clinical manifestations:
Signs and Symptoms:
CB vs E
CB: persistent with copius sputum
E: mild with scant sputum
Compare and contrast clinical manifestations:
Primary affected area:
CB vs E
CB: bronchi
E: alveoli
What would you find on a CXR of a patient with suspected COPD
the images may show enlarged lungs, air pockets (bullae) or a flattened diaphragm*
*Flattened diaphragm is usually a sign of hyperinflation lungs, most commonly found on emphysema patients*