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35 Cards in this Set
- Front
- Back
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What are some key characteristics of pneumonia?
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- acute inflammation of lung caused by microbial organism
- leading cause of death in US from infectious disease - defense mechanisms become incompetent or overwhelmed: viral or bacterial infections, respiratory irritants, decreased cough and epiglottal reflexes may allow aspiration, may occur in clients with decreased level of consciousness - tracheal intubation |
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What is the etiology of pneumonia?
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- mucociliary mechanism impaired d/t pollution, cigarette smoking, upper resp infections (viral), tracheal intubation, aging, malnutrition
- Organisms reach lungs through aspiration from nasopharynx or oropharynx, inhalation of microbes, hematogenous spread from primary infection elsewhere in body |
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What is community-acquired pneumonia (CAP)?
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- lower respiratory infection of lung
- onset in community or during FIRST 2 DAYS OF HOSPITALIZATION - highest incidence midwinter - smoking important risk factor |
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What is hospital-acquired pneumonia (HAP)?
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- occurs 48 hrs or longer after admission and not incubating at time of hospitalization
- 2nd most common nosocomial infection after UTI - usually bacterial, comes from own oropharynx |
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What is aspiration pneumonia?
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- occurs from abnormal entry of secretions into lower airway
- usually occurs with history of loss of consciousness (gag and cough reflexes are diminished) - tube feeding is a risk factor |
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What is opportunistic pneumonia?
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- occurs most commonly in patients with altered immune response (HIV, chemo)
- bacterial and viral causative agents |
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What are some clinical manifestations of pneumonia?
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- changes in mental status (decreased LOC d/t lack of oxygen to brain)
- confusion or stupor may manifest in older or debilitated adult - restlessness - tachycardia - muscle aches - sudden onset of fever/chills - nasal congestion/sore throat - cough productive of purulent sputum - pleuritic chest pain/splinting - dyspnea/SOB/tachypnea - asymmetric chest movements - use of accessory muscles - crackles - fremitus/bronchial breath sounds |
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What are some diagnostic tests for pneumonia?
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- History (smoking, recent abdominal surgeries, work conditions, resp infections, poor oral hygiene)
- physical exam - chest x-ray/bronchoscopy - Gram stain of sputum - culture and sensitivity of sputum - CBC, blood cultures - pulse oximetry or ABG's |
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What are treatments for pneumonia?
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- antibiotic therapy (early antibiotic therapy is imperative for effective treatment)
- oxygen for hypoxemia - analgesics for chest pain - antipyretics - influenza drugs and vaccine - fluid intake at least 3 liters per day - caloric intake at least 1500 cal/day |
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What are some complications of pneumonia?
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- pleurisy (inflammation of pleurae, causes pain)
- pleural effusion (usually reabsorbed within 1-2 weeks) - pneumothorax (air or gas in cavity b/w chest and lungs, causes collapse) - atelactasis (usually clears with cough and deep breathing) - bacteremia |
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What are some key characteristics of tuberculosis?
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- infectious disease caused by Mycobacterium tuberculosis
- involves lungs, larynx, kidneys, meninges, bones, adrenal glands, lymph nodes - 2nd most common cause of death from infectious disease - high rates of TB with HIV infection - common in poor, homeless, elderly, minorities, foreign-born, immunosuppressed, institutionalized, IV drug abusers |
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What is the etiology of tuberculosis?
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- spread via airborne droplets
- NOT spread by hands or objects. - brief exposure rarely causes infection - transmission requires close, frequent, or prolonged exposure - infected person may take 2-10 weeks to have positive TB skin test (person is infected, but doesn't have the disease) - without sufficient immune response, organism is not contained and primary disease results |
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What are some clinical manifestations of tuberculosis?
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- fatigue
- malaise - anorexia - weight loss - low-grade fevers - night sweats - frequent cough with white frothy sputum (hemoptysis usually seen in advanced disease) - acute symptoms (flu-like symptoms): high fever, chills, pleuritic pain, productive cough |
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What are some complications of TB?
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- miliary TB (large # of organisms enter bloodstream and infect all organs)
- pleural emphysema - TB pneumonia (similar to bacterial pneumonia) |
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What are the diagnostic tests for TB?
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- Skin test using purified protein - induration indicates sensitivity and patient does not have to be tested again (sensitivity remains for life)
- chest x-ray - sputum specimens - QuantiFERON-TB (QFT): new, rapid blood test - does not replace cultures |
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What are some treatments for TB?
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- hospitalization not necessary for most patients
- tx done as outpatient, noncompliance is biggest issue - latent TB usually treated with INH for 6-9 months - some meds make turn urine orange |
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What are some nursing implementations for TB?
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- airborne isolation (surgical mask for patient, n95 mask for nurse)
- notify public health program |
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What are some key characteristics of lung cancer?
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- leading cause of cancer-related deaths
- no pre-screening for lung CA - no annual sputum culture that can be done - no meds that can be given to stop formation of tumor growth - most important risk factor is smoking. other risk factors include asbestos, radon, nickel, iron/iron oxides, uranium |
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What is non-small cell lung cancer?
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- 80% of lung cancers
- adenocarcinoma/squamous cells |
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What is small-cell lung cancer?
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- 20% of lung cancers
- oat cells - pareoplastic syndrome: various systemic manifestations caused by factors produced by tumor cell enzymes |
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What are some clinical manifestations of lung cancer?
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- occur late in disease and are non-specific
- pneumonitis - persistent cough with sputum - hemoptysis - chest pain - dyspnea Later: - anorexia/weight loss - fatigue - n&v - hoarse voice - unilateral paralysis of diaphragm |
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What are some diagnostic tests for lung cancer?
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- chest x-ray
- CT scan - MRI - PET - malignant cells via sputum cytology - biopsy necessary for definitive diagnosis |
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What is TNM?
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- staging for NSCLC
- T: tumor size, location, and degree of invasion - N: regional lymph node invasion - M: presence/absence of distant metastases (staging not useful for SCLC because cancer is very aggressive and metastasized before diagnosis is made) |
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What are some treatments for lung cancer?
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- surgery for squamous (NSCLC)
- radiation used with chemo after tumor resection |
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What is COPD?
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- group of diseases including chronic bronchitis, emphysema, and asthma
- the presence of a productive cough that lasts 3 months a year for 2 years - primarily associated with cigarette smoking or air pollution - chronic irritation of airways |
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What are some key characteristics of bronchitis?
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- BLUE BLOATERS
- polycythemia: occurs as an attempt to compensate for chronic hypoxemia (levels reach 20g/dl or more) - |
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What are some clinical manifestations of bronchitis?
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- use of accessory muscles
- dyspnea - orthopnea - pulmonary function test (PFT) - decreased vital capacity - decreased forced expiratory volume - abnormal ABG's - restlessness - irritability - confusion - dusky, cyanosis - right ventricle enlarges (heart is pumping thick blood thru narrow vessels) --> right sided HF - increased weight, decreased activity level |
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What are some key characteristics of emphysema?
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- PINK PUFFERS: predominant symptom of dyspnea, which can be present at rest and become more severe with exertion
- chronic obstruction to inflow and outflow of air from lungs - lungs are in a state of chronic hyperexpansion - breakdown of alveolar and supporting tissue - inflammation of bronchioles - excessive mucus - loss of elastic recoil of airways |
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What is the pathology of emphysema?
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- alveolar tissue is destroyed, air is trapped in alveoli
- dead space - O2 diffusion - barrel chest and respiratory changes - deficiency of AAT (genetic and smoking inactivates AAT) |
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What are the clinical manifestations of emphysema?
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- dyspnea is earliest sign
- barrel chest - nonproductive cough, minimal sputum - respiratory changes - anorexia and weight loss - loss of muscle mass and fat - weakness - flattened diaphragm and hyperinflation |
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What are some key characteristics of asthma?
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- chronic inflammatory disorder of the airways, inflammation causes obstruction
- episodes of wheezing, breathlessness, chest tightness, and cough - hyperresponsiveness of airways - reactive airway disease (RAD) - causes increased airway resistance over time and damages airways |
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What is the pathology of asthma?
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- airway inflammation
- hyperirritability and hyperresponsiveness of tracheobroncial tree - constriction of bronchial smooth muscle - hypersecretion of mucus and mucosal inflammation - edema - inflammatory response to allergens/irritants |
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What are the signs/symptoms of asthma?
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- respiratory changes
- wheezing - nonproductive cough - abnormal ABGs - peak expiratory flow rate (PEFR) - eosinophilia increases with allergic responses |
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What are leukotriene modifiers?
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- drugs that have bronchodilator and anti-inflammatory effects
- interfere or block the action of leukotrienes, which cause airway edema, bronchoconstriction, and inflammation |
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What can be done to improve respiratory function with regard to asthma?
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- drug therapy
- effective coughing - pursed-lip breathing - respiratory therapy - O2 adm - semi to high fowlers position - control anxiety - fluid balance - monitor cardiac status |
