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21 Cards in this Set
- Front
- Back
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Identify the risk factors for pneumonia
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Chronic lung disease
• Immunosupression • Smoking • ↓ LOC • Malnutrition • URI • Bedrest/inactivity • Tube feedings • Age • Tracheal intubation |
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community acquired
pneumonia, |
Community-Acquired Pneumonia
• Onset in community or during first 2 days of hospitalization • Highest incidence within the winter months • Smoking is the most common risk factor |
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hospital acquired pneumonia,
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Hospital-Acquired Pneumonia
• Occurring 48 hours or longer after admission and not incubating at time of hospitalization • Sources of infection • Grouped into classifications based on severity of symptoms |
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aspiration
pneumonia |
Aspiration Pneumonia
• Sequelae occurring from abnormal entry of secretions into lower airway • Causes • Forms of aspiration pneumonia – Mechanical obstruction – Chemical injury – Bacterial |
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and opportunistic pneumonia.
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Opportunistic Pneumonia
• Severe protein-calorie malnutrition • Immune deficiencies • Chemotherapy/radiation recipients • Transplant recipients • Insidious onset of symptoms |
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Common manifestations for person diagnosed with pneumonia?
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Cough
• Fever • Chills • Chest Pain |
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State the use of diagnostic and labratory testing in pneumonia?
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Chest x-ray
• Gram stain of sputum • Sputum culture and sensitivity • CBC with diff • Blood cultures • Pulse oximetry or ABGs |
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management of pt diagnosed with pneumonia?
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Antibiotic therapy
• Oxygen for hypoxemia • Analgesics for chest pain • Antipyretics Influenza vaccine • Fluid intake at least 3 L per day • Caloric intake at least 1500 per day |
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Goals of therapy in pt with Pneumonia?
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Clear breath sounds
• Normal breathing patterns • No signs of hypoxia • No complications |
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Describe Pathophysioly related to TB?
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Infectious disease caused by
Mycobacterium tuberculosis Inhalation of bacteria • Implanting of bacteria • Phagocytes • Slowly multiply and replicate Immunocopetent hosts – Acquired immunity develops over weeks and mImmunocompromised – Active primary disease results – Immunosuppressed and diabetic patients are at higher risk for disease – Pulmonary changes ultiplication will cease Dormant TB organisms persist for years – Few ever develop TB |
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List the diagnostic test utilized for TB?
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History
– Exposure history – Alcoholism, immunosupression – IVDA – Hepatitis B & C • Physical examination – Clinical manifestations – Respiratory assessment Manotoux Test - PPD • Intradermal injection • Results interpretation • Establishes exposure to bacteria • Response is ↓ in immunocompromised patients • DOES NOT establish a TB diagnosis Anergy Panel • Testing for immune system integrity • Multiple injections with common exposures • Establishes exposure in the immunocompromised patient. Chest X-Ray • Cannot make diagnosis solely on x-ray • Upper lobe infiltrates, cavitary infiltrates, and lymph node involvement suggest TB ONLY WAY TO DIAGNOSE Sputum C&S • Stained sputum smears examined for acid-fast bacilli (AFB) • Three consecutive sputum samples from different days • Required for diagnosis • Results take 72 hours |
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Management of active TB?
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Increased resistance to mono-therapy
• Anti-tuberculosis drugs – Isoniazid (INH) – Rifampin (Rifamate) – Pyrazinamide – Streptomycin – Ethambutol (Myambutol Length of therapy – 6 to 9 months – Immunosuppressed population • Effectiveness of pharmacological management • Compliance of medication regimen |
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Latent TB Management?
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Isoniazid (INH) is indicated to latent TB
treatment – 6 month versus 9 month course of treatment – HIV population needs a longer course of therapy (9 months) |
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Treatment for Head and Neck Cancer and thier side effects?
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Radiation
-Stage 1 or 2 can be curative -Can be used as palliative • Side Effects – Dry mouth – Stomatitis – Burns |
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Types of surgery for head and neck pt and post op care?
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Surgical Interventions
• Hemilaryngectomy – one vocal cord • Total Laryngectomy- both cords (and epiglottis) • Total Laryngectomy with Radical Neck Dissection – to decrease lymphatic spread. Immediate Post-op management – Airway – Communication issues – Nutrition – Oral care –Wound and drain – Edema – Pain – Shoulder immobility – Psychosocial issues |
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Identify the most common cause of lung cancer?
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Most important risk factor in 80% to 90%
of all lung cancers is smoking |
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Describe the pathophysiolgy of lung cancer?
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90% of cancers originate from epithelium
of bronchus • It takes 8 to 10 years for a tumor to reach 1 cm – Smallest lesion detectable on x-ray • Chronic irritation of the lung tissue resulting in hyperplasia and metaplasia Occur primarily in segmental bronchi and upper lobes • Pathologic changes in bronchial system – Hypersecretion of mucus – Desquamation of cells Pathologic changes in bronchial system – Reactive hyperplasia of basal cells – Metaplasia of normal respiratory epithelium to stratified squamous cells Primary lung cancers categorized into two subtypes – Non–small cell lung cancer (NSCLC) • 25% – Small cell lung cancer (SCLC) • 75% Common sites for metastatic growth – LIVER – Brain – Bones – Scalene lymph nodes – Adrenal glands |
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Common most clinical manifestations of lung cancer?
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Symptoms appear late in disease and
dependant on Clinical Manifestations • Pneumonitis • Persistent cough with sputum* • Hemoptysis • Chest pain • Dyspnea • Later manifestations – Anorexia – Fatigue – Nausea/vomiting – Hoarse voice – Unilateral paralysis of diaphragm |
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Describe Staging for NSCLC
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Staging (NSCLC)
– T denotes tumor size, location, and degree of invasion – N indicates regional lymph node invasion – M represents presence/ |
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Describe staging for SCLC
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Staging (SCLC)
– Not been useful because cancer metastasized before diagnosis is made – No current recommendations exist – No difference in deaths between screened and those who were not |
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Treatments for pt diagnosed with Lung cancer?
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Surgical therapy
– Surgical resection is contraindicated for small cell carcinomas – Squamous cell carcinomas are likely treated with surgery Collaborative Care • Radiation therapy – Curative approach in individual with resectable tumor and poor surgery risk – Some cancer cells are more radiosensitive than others – Used in combination with chemotherapy Chemotherapy – Treatment of non-resectable tumors or adjuvant to surgery in NSCLC with distant metastases Collaborative Care • Chemotherapy – Used in combination with multi-drug regimen – Improved survival rate with NSCLC and SCLC |
