The membrane between the alveolar and capillary walls where gas exchange occurs.
Name the structures of the UPPER respiratory tract.
Mouth
Nose
Pharynx
Larynx
Name the structures of the LOWER respiratory tract.
Trachea
Bronchi
Bronchioles
Alveoli
Pulmonary capillary network
Pleural membranes
What is inspiration?
Inhalation, air flows into the lungs
What is expiration?
Exhalation, air flow out of the lungs
What are the actions of inspiration?
Diaphragm and interostals contract
Thoracic cavity size increases
Volume of lungs increases
Intrapulmonary pressure decreases
Air rushes into the lungs to equalize pressure
What are the actions of expiration?
Diaphragm and intercostals relax
Volume of the lungs decreases
Intrapulmonary pressure rises
Air is expelled
When does gas exchange occur?
This takes place after the alveoli are ventilated
What affects diffusion?
Pressure differences on each side of the respiratory membranes affect this action.
When does gas exchange occur?
After the alveoli are ventilated
A patient is experiencing hypoxia. Which of the following nursing diagnoses may be appropriate?
Anxiety
Nausea
Pain
Hypothermia
Anxiety
While reading a physician's progress note, a student notes that an assigned patent is having hypoxia. What abnormal assessments would the student expect to find?
Dyspnea, Tachycardia, and Cyanosis
When a patient is described as being dyspneic, what signs/symptoms would they be showing?
C/O SOB
Nasal Flaring
Increased heart rate
What is the function of the respiratory system?
Gas exchange
How does oxygen from inspired air diffuse?
From the alveoli in the lung into the blood in the pulmonary capillaries
How does carbon dioxide, produced during cell metabolism, diffuse?
From the blood into the alveoli and it is exhaled
The nurse makes the assessment that which client has the greatest risk for a problem with the transport of oxygen from the lungs to the tissues? A client who has which of the following?
Anemia
An infection
A fractured rib
A turmor of the medulla
Anemia
What is the therapeutic effect of pursed-lip breathing?
It prolongs the expiration to reduce airway resistance
To prevent postoperative complications, the nurse assists the client with coughing and deep breathing exercises. This is best accomplished by implementing what?
Huff coughing every 2 hours or as needed.
This keeps their lungs clear
Coughing and breathing exercises are done together
Which term does the nurse document to best describe a client experienceing shortness of breath when lying down, who must assume an upright or sitting position to breathe more comfortabley and effectively?
Orthopnea
What is the reason behind using an incentive spirometer?
Expand collapsed alveoli
What is a critical factor that must be taught to an individual using prescribed oxygen at home?
The safety measures to prevent a fire
Oxygen from the alveoli goes where?
Into the pulmonary blood vessels
Carbon dioxide from the pulmonary blood vessels goes where?
Into the alveoli
Oxygen must be transported from the lungs to the ________.
Tissues
When oxygen combines with hemoglobin, what does it become?
oxyhemoglobin
What is the percentage of oxygen that combines with hemoglobin, in RBC's?
97%
Where is hemoglobin found and what does it do?
In the Red Blood Cells (RBC's)
Carries O2
Carbon dioxide must be transported from the tissues to the ______.
lungs
97% of oxygen is carried by the hemoglobin, what happens to the other 3%?
The remaining oxygen is dissolved and transported in plasma and cells
What is continually produced in teh process of cell metabolism?
Carbon Dioxide
65% of _______ _______, is carried in the red blood cells as _______.
carbon dioxide
bicarbonate
30% of _______ _______ combines with hemoglobin as _______.
carbon dioxide
carbhemoglobin
_______ of carbon dioxide is transported in solution in plasma as _______.
5%
carbonic acid
How much carbon dioxide is carried inside the red blood cells as bicarbonate?
65%
What type of patient would use a venturi mask?
A patient with COPD
The nurse ensures that the simple face mask fits snuggly over the patient's face for what reason?
To ensure they are getting the expected oxygen concentration
What is a clue that would indicate a patient might have TB?
Night sweats
What are signs and symptoms of TB?
Fatigue
Persistent cough
Night sweats
How much carbon dioxide combines with hemoglobin as carbhemoglobin?
30%
What are the factors that influence respiratory function?
Age
Environment
Lifestyle
Health status
Medications
Stress
What could low-pitched snoring sounds, during inhalation indicate?
Possible partial obstruction of the airway
Which should the patient take first, their bronchodilator or their glucocorticosteroid?
Take the bronchodilator first
What does extreme inspiratory effort with no chest movement indicate?
A complete blockage of the airway
What are some common manifestations of impaired respiratory function?
Hypoxia
Altered breathing patterns
Obstructed or partially obstructed airway
What is hypoxia?
A condition of insufficient oxygen in the body
What are the signs and symptoms of hypoxia?
Rapid pulse
Rapid, shallow respirations and dyspnea
Increased restlessness or lightheadedness
Flaring of the nares
Substernal or intercostal retractions
Cynosis
Why would you use an SCD?
To promote venous return from the legs.
What is a nursing diagnosis for COPD?
Nursing diagnosis for this disorder may include any of the following:
- - Ineffective airway clearance r/t bronchospasm and or secretion
Which inhalant requires that the client rinse their mouth after administering the medication
Powder inhaler (Advair diskus)
What are the signs and symptoms of peripheral vascular disease?
Decreased peripheral pulses
Pale skin color
Cool extremities
Decreased hair distribution
What is a cough reflex?
This is triggered by irritants in the larynx, trachea, or bronchi
What is Biot's (cluster) respirations?
This may be seen in clients with central nervous system disorders.
Shallow breaths interruped by apnea.
What are expectorants?
These medications loosen bronchial secretions, and are often found in combination with antitussives or analgesics.
Can cause nausea and vomiting (N/V)
What is Cardiac Output (CO)?
This is the amount of blood pumped from the ventricles each minute
Stroke Volume (SV) x Heart Rate (HR)
Important indicator of how the heart is functioning as a pump
What is liquid oxygen?
This is O2 delivery system has 2 parts, a large stationary container, and a portable unit.
A portable unit can weight up to 10 pounds
What is a flow meter?
This device is attached to the oxygen unit or the wall to regulate the amount of oxygen a client is to receive.
What is infiltrate?
Cloudiness seen in the lungs, on an xray
What is intrapleural pressure?
This is always slightly negative in relationship to atmospheric pressure
Prior to giving an antibiotic, what should you always get?
Always get a culture (sputum, wound, etc.) prior to giving this medication.
What are signs/symptoms of emphysema?
Loss of lung tissue elasticity
Narrowing of small airways
Hyperinflation of the alveoli (air trapping)
What are cold medications and who can use them safely?
These are generally safe for children > 6 years
May contain pseudoephedrine, analgesic antihistimine
What are the four rights of delegation?
Right Task
Right Circumstance
Right Person
Right Direction/Communication
What are some signs and symptoms of a myocardial infarction?
This condition presents with:
Chest pain
Substernal and/or radiating pain to the left arm or jaw
Nausea
SOB
Diaphoresis
What are precautionary methods used to reduce the risk of fire while O2 is in use?
Smoke only outside
Place cautionary signs on the outside of clients doors
Avoid materials that generate static electricity
What is an incentive spirometer?
These are used to:
Improve pulmonary ventilation
Loosen respiratory secretions
Expand collapsed alveoli
Facilitate gas exchange
What is TB or Tuberculosis?
Infects 1/3 of the worlds population
Pt's c/o fever, worsening cough, night sweats, and weight loss
Caused by Mycobacterium terberculosis
What is atherosclerosis?
Most common cause of impaired blood flow
Vessels narrow and become constricted
Coronary arteries are most affected
What are portable oxygen tanks?
These items should be handled with caution.
They should not be dropped or placed in high traffic areas or near heaters.
What are the medications used for TB?
TB - RIPS
Rifampin (RIF)
INH (isoniazide)
PZH (pirazinamide)
Streptomycin or Ethanbutol
What is hypoxemia?
Decreased oxygen in the blood
What are advance directives?
These documents are required to be on file and followed in regards to the patient's wishes for any resuscitation and/or life sustaining treatment
What is physical therapy?
These services are provided for the residents at Skilled Nursing Facilities to help maintain their strength and mobility or finish their rehabilitation
What are recreational activities?
These programs are designed to keep the resident active cognitively and sometimes physically
What are Long Term Care Resident's Rights?
These include the right to manage your fincances and the right to a safe, clean, comfortable, home-like environment.
Explain why a patient in hypoxic drive should not have high concentrations of O2
An individual who has COPD or Emphysema may be using their hypoxic drive for breathing.
Normally an individual breaths because the body detects the CO2 receptors in their system, which triggers the urge to exhale the CO2 and then inhale oxygen.
However, individuals who have had their alveolar sacs streched, end up retaining high amounts of CO2. The body gets used to this environment and no longer recognized CO2 as an enemy. Thus, in hypoxic drive, it is the lack of O2 that causes an individual to breath.
So, if you give high concentrations of O2 to this individual, their body will detect the O2 and will not see a need to breath. The body sees a lot of O2 and doesn't see a need for more.
If you look in your fridge and see a lot of apples, you don't see a need to get more, right!?
What are some of the early and late symptoms of hypoxia?
Early RAT2:
Restlessness
Anxiety
Tachycardia/Tachypnea
Late to BED:
Bradycardia
Extreme restlessness
Dyspnea
What are Kussmaul Respirations?
Abnormal respiratory pattern characteized by rapid, deep breathing, often seen in patients with metabolic acidosis
Abnormally deep, very rapid sighing respirations characteristic of diabetic ketoacidosis
Describe Cheyne-Stokes (chān stōks)
The pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea
Cycles ordinarily are 30 seconds to 2 minutes in duration, with 5–30 seconds of apnea
Seen with bilateral deep cerebral hemispheric lesions, with metabolic encephalopathy, and, characteristically, in coma from affection of the nervous centers of respiration.
What is tachypnea?
Fast breathing
Define bradypnea
Slow breathing
What are Biots Respirations?
Rapid, short breathing with pauses of several seconds
Indicating increased intracranial pressure (usually present due to head trauma)
What is orthopnea?
Difficulty breathing while lying down
Client may find it easier to breath in the tripod or orthopnic positions
Define dyspnea
Difficulty breathing:
Shortness of breath
Nostril flaring
Increased heart rate
NOTE: stems from cardiac or respiratory problem
What would be involved in the NURSING ASSESSMENT of respiratory issues?
Nursing history
Physical examination
Review of relevant diagnostic data
What would be involved in the physical assessment of an individual with suspected respiratory issues?
Nurse observes: rate, depth, rhythm and quality of respiration
Inspects: Variations of shape
What would be involved in the NURSING DIAGNOSIS of respiratory issues?
Ineffective Airway Clearance
Ineffective Breathing Pattern
Impaired Gas Exchange
Activity Intolerance
What would be an ETIOLOGY in the nursing diagnosis of respiratory issues?
Anxiety
Fatigue
Fear Powerlessness
Insomnia
Social isolation
What would be involved in the NURSING PLAN for an individual with respiratory issues?
Maintain a patent airway
Improve comfort and ease of breathing
Maintain or improve pulmonary ventilation and oxygenation
Improve the ability to participate in physical activities
Prevent risks associated with oxygenation problems such as skin and tissue breatkdown, syncope, acid-base balances, and feelings of hopelessness and social isolation
What would be involved in the NURSING IMPLEMENTATION for an individual with respiratory issues?
Ensure a patent airway
Positioning (semi to high Fowler's position)
Encouraging deep breathing and coughing (Huff coughing, Diaphragmatic, and pursed lip breathing)
Ensuring adequate hydration (1500 to 2500 mL/day fluids)
Medications (take bronchodialators before steroids)
Incentive spirometry
Percussion, vibration, and postural drainage
Mucus clearance device
Oxygen therapy
Oxygen delivery systems
Artificial airways
Suctioning
What do bronchodialators do?
Enhance the sympathetic nervous system
~ Increase HR
~ Increase BP
NOTE: anxiety and restlessness must be monitored
What does incentive spirometry do?
Improves pulmonary ventilation
Counteract the effects of anesthesia or hypoventilation
Loosen respiratory secretions
Facilitate respiratory gaseous exchange
Expand collapsed alveoli
What are the three main steps of PVD?
Percuss
Vibration
Drainage
Explain the percuss of PVD
Cover the area with a towel or gown to reduce discomfort
Ask the client to breathe slowly and deeply
Alternate flex and extend the wrists rapidly to slap the chest
Percuss each affected lung segment for 1-2 minutes
Explain the vibration of PVD
Place hands, palms down, on the chest are to be drained
Ask the client to inhale deeply and exhale slowly
During exhalation vibrate the hands
Vibrate during five exhalations
After each vibraation, ask client to cough and expectorate secretions
What are the various ways of delivering oxygen therapy?
Nasal cannula (25-45%, 2-6 L/min)
Simple face mask (40-60%, 5-8 L/min)
Partial rebreather (40-60%, 6-10 L/min)
Nonrebreather mask (95-100%, 10-15 L/min)
Venturi mask (25-40%, 4-10 L/min)
Face tent (30-50%, 4-8 L/min)
Noninvasive Positive Pressure Ventilation
What are the artificial airways?
Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA)
Endotracheal Tubes (Oral and Nasal)
Tracheostomy
What are the artificial airways used for?
To prevent aspiration
To keep the airway open
What is a suctioning machine?
It is used to aspirate secretions through a catheter connected to a suction machine or wall suction outlet
Used when a client is unable to cough up and expectorate secretions
Inability to clear the airway will cause respiratory distress
What would be involved in the NURSING EVALUATION for an individual with respiratory issues?
Collect data to evaluate the effectiveness of interventions
If outcomes were not achieved, explore the reasons, before modifyng the care plan
What makes up the cardiovascular system?
Heart
Blood vessels
Blood
What does the left side of the heart do?
Pumps oxygenated blood into the arteries.
How does deoxygentated blood return to the heart?
It returns via the venous system into the right side of the heart.
What does the blood do for the body?
1. Transports oxygen, nutrients, hormones to cells
2. Transports metabolic wastes from cells for elimination
3. Regulates body temperature, pH, fluid volume
4. Prevents infection, blood loss
What is Cardiac Output (CO)?
The amount of blood ejected from the heart each minute
(Stroke volume (SV) x Heart Rate (HR) = CO)
Define Stroke Volume (SV)
Amount of blood ejected from the heart with each beat
Define the Heart Rate (HR)?
Number of beats per minute
What is contractility?
Inotropic state of the myocardium
Strength of contraction
What is inotropic?
Affecting the force of muscle contraction. An inotropic heart drug is one that affects the force with which the heart muscle contracts. Ionotropic can be negative or positive.
What is myocardium?
The muscular tissue surrounding the heart
Its job is to simulate the contractions of the heart to help get blood pumped throughout the body
Define Preload
Left ventricular end diastolic volume, stretch of the myocardium
Define afterload
Resistance against which the heart muscle must pump
What type of risks are there for Coronary Heart Disease?
Modifiable Risks
Nonmodifiable Risks
Other Risk Factors
What are the nonmodifiable risk factors for Coronary Heart Disease?
Heredity
Age
Gender
What are the modifiable risk factors for Coronary Heart Disease?
Elevated serum lipid levels
Hypertension
Cigarette smoking
Diabetes
Obesity
Sedentary lifestyle
What are some of the other risk factors for Coronary Heart Disease?
Metabolic syndrome
C-Reactive Protein
Elevated Homocysteine Level
Various conditions affect the cardiovascular function, in what ways?
The function of the heart as a pump
Blood flow to organs and peripheral tissues
The composition of the blood and its ability to transport oxygen and carbon dioxide
What alterations in the cardiovascular function can cause decreased cardiac output?
Myocardial Infarction
Heart Failure
What are some factors that can cause alterations in the cardiovascular function?
Decreased cardiac output
Impaired tissue perfusion
Disorders that affect composition or amount of blood available for transport of gases
What are some of the symptoms of a myocardial infarction?
Chest pain
Substernal and/or radiating to left arm or jaw
Nausea
Shortness of breath
Diaphoresis
What are some causes of heart failure?
Can develop if heart not able to keep up with the body's need for oxygen and nutrients
Usually occurs because of an MI
May result from chronic overwork of heart
Left-sided heart failure can result in pulmonary edema
What are some conditions that increase preload?
Hypervolemia
Valvular disorders suc as mitral regurgitation
Congenital defects such as patent ductus arteriosus
Define patent ductus arteriosus
A condition in which the ductus arteriosus does not close (a hole in the heart)
The ductus arteriosus is a blood vessel that allows blood to go around the baby's lungs before birth. Soon after the infant is born and the lungs fill with air, the ductus arteriosus is no longer needed. It usually closes in a couple of days after birth.
PDA leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.
What are some conditions that increase afterload?
Hypertension
Atherosclerosis
What are some conditions that affect myocardial function?
Myocardial infarction
Cardiomyopathy (Enlarged, thick, rigid)
Coronary artery disease
What are some signs/symptoms of heart failure?
Pulmonary congestion
Adventitious breath sounds
Shorness of breath
Dyspnea on exertion
Increased HR
S3 heart sound
Increased RR
Nocturia
Othopnea
Distended neck veins
What can cause impaired tissue perfusion?
Atherosclerosis
Vessel inflammation
Arterial spasms
Blood clots
Incompetent valves of veins
Pulmonary emboli
Where can atherosclerosis occur?
Coronary arteries
Brain
Peripheral arteries
What are arterial spasms?
Coronary spasms - cause prinzmetal angina at rest
What is prinzmetal angina?
A form of chest pain, pressure, or tightness (angina) caused by spasms in the arteries that supply blood to the heart.
It is a form of unstableangina, meaning that it occurs at rest, often without a predictable pattern.
What is stable angina?
Chest pain occurs in a predictable pattern during exertion or exercise.
Why does nocturia occur in heart failure?
In cardiac failure, the heart is not able to meet the needs of organs, which include kidneys, due to failure of heart to pump out blood. Due to the failure of heart to pump out blood, it pools in the extremities leading to edema of legs and face.
At night when the patient lies down, the blood that had been accumulated in the extremities returns to the heart, hence the cardiac output during the night is slightly increased compared with during the day time.
This increased cardiac output perfuses kidneys, which in turn produces more urine to decrease the workload of the heart.
What is atherosclerosis?
Most common cause of impaired blood flow to organs and tissues
Vessels narrow and become constricted
Distal tissues receive less oxygen and nutrients
Coronary arteries most affected
Obstruction of coronry arteries leads to myocardial ischemia, which leads to angina pectoris (chest pain)
Obstruction in vessels supplying brain results in TIA or stroke
What are some complications that can occur with incompetent venous valves?
May allow blood to pool in veins
- - Edema
- - Decreased venous return to heart
Veins become inflamed
- - Reduce blood flow
- - Increased risk of thrombus formation
Thrombi may break loose
- - Emboli
- - Occlude blood supply A/C membrane
- - Acute pulmonary embolism
What are some symptoms of an acute pulmonary embolism?
Sudden onset of shortness of breath
Pleuritic chest pain
What are some symptoms of anemia?
Chronic fatigue
Pallor
Shortness of breath
Hypotension
Define anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.
What would be involved with the NURSING ASSESSMENT of an individual with a cardiac/circulation issue?
Comprehensive history
Physical examination
Review of relevant data, including cardiac monitoring
What would be some reasons that a patient would be on a cardiac monitor?
In need of continuous monitoring
Known or suspected Cardio Vascular Disease (CVD)
During and after surgery
To monitor responses to drug therapy
At risk for serious complictions such as shock
What are the blood tests that would be run and assessed for a cardiac/circulation issue?
Hemoglobin
Electrolytes
Creatine kinase (CK)
Troponin
Why is the presence of troponin important when reviewing the labs, in relation to cardiac/circulation issues?
This is an enzyme that is released during an Myocardial Infarction (MI)
Levels tell you if there is an MI as a result of cell membrane damage.
Differentiates between an MI nd angina
What are a few of the NURSING DIAGNOSIS that would be used for an individual with a cardiac/circulation issue?
Ineffective Peripheral Tissue Perfusion
Risk for Decreased Cardiac Tissue Perfusion
Decreased Cardiac Output
Activity Intolerance
What would be a sign of ineffective peripheral tissue perfusion?
Cool feet
Weak pulses
Shiny nearly hairless shins/feet
What would be involved with the NURSING PLAN (goal) of an individual with a circulation issue?
Maintain or improve tissue perfusion
Maintain or restore an adequate cardiac output
What would be involved with the NURSING INPLEMENTATION of an individual with a circulation issue?
Elecate the client's legs
Avoid placing pillows under the knees or providing more than a 15 degree flexion
Encourage leg exercises for a client on bedrest
Promote ambulation as soon as possible
Encourage or provide frequent position changes
What would be involved with the NURSING INPLEMENTATION of an individual with an impaired cardiac function?
Position the client in high Fowler's position
Monitor intake and output
Fluid restriction
What would the nurse communicate to the patient, in relation to cardiac/circulation medication?
help the client understand the purposes, effects, and side effects.
What would be involved with the NURSING ASSESSMENT of an individual with a cardiac/circulation issue, in regard to their medication?
Assess effects of medications and potential complications
Assess intake and output and potassium levels, if appropriate, for clients receiving diuretics
Assess BP, HR, peripheral pulses, and lung sounds for clients reeiving positive inotropic medications
Monitor BP (including postural blood pressure) for client receiving antihypertensive medications
How do you prevent venous stasis?
Positioning and leg exercises
Applying antiemboli stockings
Applying sequential compression devices (SCD's)
What are the three cardinal signs that a patient needs cardiopulmonary resuscitation?
Apnea
Absence of a carotid or femoral pulse
Dilated pupils
What are some stats on a cardiac arrest?
Within 20 - 40 seconds of a cardiac arrest the victim is clinically dead
After 4 - 6 minutes the lack of oxygen supply to the brain causes permanenet and extensive damage
Must initiate CPR immediately
- - - Three cardinal signs must be present
What would be involved with the NURSING EVALUATION of an individual with a circulation issue?
Collects data to evaluate effectiveness of interventions
If desired outcomes are not achieved, the nurse, client, and support person, if appropriate, need to explore the reasons before modifying the care plan
What is the smallest of all microorganisms?
A virus
What is the scope of infections that a virus covers?
Runs from the common old to AIDS
True or False
If you take an antibiotic soon enough, it can kill a virus.
False - Antibiotics have no effect on a viral infection
True or False
For some viral infections you can get an antiviral medication.
True
When is the common cold most contagious?
1-4 days before symptoms and through the first 3 days
How is the common cold transmitted?
Occurs most frequently from contact with contaminated surfaces.
True or False
Rhinorrhea, nasal congestion, and coughing can decrease mucosal secretions?
False, they increase mucosal secretions
Most cold medications are __________?
Sympathomimetic
Define Sympathomimetic
Mimicking the effects of impulses conveyed by adrenergic postganglionic fibers of the sympathetic nervous system
Denoting a drug that mimics the effects of stimulation of organs and structures by the sympathetic nervous system. The sympathetic nervous system pertains to the part of the nervous system originating in the thoracic and lumbar regions of the spinal cord.
In general, it inhibits or opposes the physiological effects of another aspect of the nervous system, as in tending to reduce digestive secretions, speed up the heart, and contract the blood vessels
What may a cold medication contain?
Pseudoephedrine
Analgesic
Antihistamine
Cold medications are safe for children of what age?
>6 years
When should you call a doctor, prior to taking a cold medication?
If you have any of the following:
Heart disease
HTN (hypertension)
Thyroid disease
What are the side effects of a sympathomimetic?
Headache
Nervousness
Increased blood pressure
Insomnia
What are the side effects of an antihistamine?
Drowsiness
List a few pieces of information about 2nd generation antihistamines.
Non-sedating antihistimines
Little to no effect on sedation
Trade names: Zyrtec and Claritin
What are two kinds of cough medications?
Antitussives
Expectorants
Define what an antitussive does
Act on medulla to suppress cough
Increased effect with other CNS depressants
Define what an expectorant does
Loosen bronchial secretions
Found in combination with antitussives, analgesics
Can cause nausea/vomiting
Define what nasal and systemic decongestants do
Produce vascular constriction within the nasal mucosa: decrease in fluid secretion
Nasal sprays and drops: can cause rebound nasal congestion
Tablet, capsule, and liguid (allergic rhinitis)
May cause the client to be "jittery" or restless: avoid caffeine
Check with a phyusician if on beta-blocker medication
What is the biological name for Valley Fever?
Coccidioidomycosis
Describe Valley Fever (Coccidioidomycosis)
Fungal: mold/spore
Grows: in the soil of the southwest
Signs/Symptoms: Often asymptomatic or symtoms similar to influenza
Treatment: usually resolves without treatment
Worst case: Pleuritic pain, arthritis of knees, ankles, systemic infetion of skin and meninges of the brain (<1%)
List a few of the lower respiratory tract disorders
Pneumonia
Pulmonary TB
What is the etiology and pathophysiology of PNEUMONIA?
Inflammation of lung tissue
Usually caused by an infectious agent (bacterial, viral, fungal, or parasitic)
Can also be caused by inhalation of chemicals and aspiration of gastric contents
What is a lifespan consideration for the elderly, when dealing with pneumonia?
Less air exchange
More air and secretions remain in the lungs
What are the subjective signs and symptoms of pneumonia?
Dyspnea
Chest pain that increases on inspriation
What are the objective signs and symptoms of pneumonia?
Fever
Chills
Increased WBCs
Cough
Purulent sputum
Crackles
Bronchial sounds
What are some diagnostics that confirm suspected pneumonia?
Positive CXR
Positive sputum culture
What is some collaborative care for pneumonia?
Drug therapy: Antibiotics based on C & S (diagnostics)
Oxygen therapy
What is involved with the Nursing Care: ASSESSMENT of pneumonia?
VS; Breathing patterns
Color, amount, consistency of sputum
Adventitious lung sounds
Mental status changes
Name a few of the Nursing DIAGNOSES for pneumonia?
Risk for deficient fluid volume r/t fever and dyspnea
What is involved with the Nursing Care: PLANNING/IMPLEMENTATION for pneumonia?
Encourage coughing & deep breathing after CPT
Splint chest as needed
Collect sputum for C & S
Increase fluid intake to 3L/day
Maintian semi-Fowler's position
Monitor for s/s respiratory distress
Plan rest periods
Administer abx (antibiotics) as ordered
What is involved with the Nursing Care: TEACH PATIENT/FAMILY with pneumonia?
Instruct pt. to cover nose and mouth when coughing
Teach preventative measures:
nutrition/fluids
Avoid respiratory irritants
Vaccinations
What is the etiology and pathophysiology of Pulmonary Tuberculosis (TB)?
Lung infection caused by Mycobacterium tuberculosisPredisposing factors include debilitating diseases like alcoholism, diabetes, and HIV infection
Causes fibrosis and calcification of lungs
Resistant strains
Define Mycobacterium tuberculosis
Acid-fast bacillus
Spread via airborne droplets
Causes pulmonary tuberculosis (TB)
What are the subjective signs and symptoms of TB?
Malaise
Pleuritic pain
Fatigue
What are the objective signs and symptoms of TB?
Fever
NIGHT SWEATS
Weight loss
Cough: becoming more persistent, productive or non-productive
Sputum: Green, purulent, yellowish mucoid or blood tinged
What are some diagnostics that confirm suspected TB?
Skin test: PPD
Chest x-ray: positive CXR
Sputum: for AFB
What is some collaborative care for TB?
Drug therapy
Long term: 6-9 months
First phase: 2 months
Second phase: 4-7 months
Combination Therapy required:
Isoniazid & rifampin or
Isoniazid, rifampin, & ethambutol or
Isoniazid, rifampin, & pyrazinamide
***********************************************
Bedrest
Isolation: Airborne precautions, specially-ventilated room, HEPA mask for staff
Prophylactic therapy for immediate contacts (6 months - 1 year)
Nutrition: high-protein, high-vitamin, supplemental B6 to counter INH side effects
NOTE: Patient MUST comply with the drug regime, avoid antacids, ETOH, and sunlight
What are the five (5) first line medications for TB?
I Refuse Every Piece of streptomycin!
INH: isoniazid (also used for prophylaxis w/exposure); Peripheral neuropathy and hepatotoxicity, visual problems, decreased food absorption rate, and may need vitamin B6 supplements
Rifampin (RIF): Hepatotoxicity, turns body fluids orange color
Ethambutol: Visual problems
PZH: Pyrazinamide
Streptomycin (possibly): Hepatotoxicity
What is involved with the Nursing Care: ASSESSMENT of TB?
Fatigue
Anorexia
Fever:NIGHT SWEATS
Color and amount of consistency of sputum
Adventitious lung sounds
Name a few of the Nursing DIAGNOSES for TB
Activity intolerance r/t impaired oxygenation
Noncompliance r/t long-term nature of therapy, medication side effects
What is involved with the Nursing Care: PLANNING/IMPLEMENTATION for TB?
Provide for rest periods
Encourage coughing/deep breathing
Dietary teaching
Teach prevention of infection
Teach s/s hemorrhage - hemoptysis
Teach importance of adhering to medication schedule and the importance of follow-up