Lower Respiratory Problems

Front 1

What is acute bronchitis?

Back 1

Inflammation of the bronchi in the lower respiratory tract

Front 2

What causes acute bronchitis?

Back 2

Usually occurs during or after a viral infection (influenza).

Front 3

What are the symptoms of acute bronchits?

Back 3

Cough lasting for 10 to 20 days.
Clear, mucoid sputum or purulent sputum.
Headache, SOB on exertion, and sometimes a low grade fever.

Front 4

What objective data may the nurse observe when someone has acute bronchitis?

Back 4

Elevated temperature, pulse and respiratory rate.
Normal breath sounds or wheezes, usually with expiration and exertion.

Front 5

What is the treatment for acute bronchits?

Back 5

Supportive, fluids, rest, and antiinflammatory agents.
Cough suppresants or bronchodilators for nocturnal cough or wheezing.
Antiviral drugs such as zanamivir (Relenza) or oseltamivir (Tamiflu) initiated within 48 hours of the onset of symptoms

Front 6

What is pertussis?

Back 6

It is a highly contagious infection of the lower respiratory tract with a gram-negative bacillus, Bordella Pertussis

Front 7

What are the symptoms of pertussis?

Back 7

Whooping cough.
More frequent at night.
Cough may last for 6 to 8 weeks.

Front 8

What is the treatment for pertussis?

Back 8

Treatment is antibiotics, usually macrolides (erythromycin, azithromycin).
No cough suppression.
Booster.

Front 9

What is pneumonia?

Back 9

An acute inflammation of the lung parenchyma (alveoli) that is mostly caused by a microorganism.

Front 10

What are risk factors for pneumonia?

Back 10

Aging, air pollution, smoking, tracheal intubation, depressed consciousness, immunocompromised, URI, immunosuppressive drugs, inhalation or aspiration of noxious substances

Front 11

What three methods can organisms that cause pneumonia reach the lungs?

Back 11

Aspiration, Inhalation, and hematogenous?

Front 12

What are the types of pneumonia?

Back 12

CAP, HAP (VAP and HCAP), aspiration and opportunistic.

Front 13

What is the critera for HAP?

Back 13

Pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.

Front 14

What is the criteria for CAP?

Back 14

Lower respiratory tract infection with onset in the community or during the first 2 days of hospitalization.

Front 15

What is the criteria for VAP?

Back 15

Pneumonia that occurs more than 48 hours after endotracheal intubation.

Front 16

What is the criteria for HCAP?

Back 16

New onset pneumonia in a patient who was hospitalized in an acute care hospital for 2 days or longer within 90 days of infection, resided in long term care facility, received recent intravenous antibiotic therap, chemotherapy, or wound care within the past 30 days of the current infection, or attended a hosptial or hemodialysis clinic

Front 17

What are the three distinct forms of aspiration pneumonia?

Back 17

Inert substance (barium) leading to mechanical obstruction, gastric juices leads to chemical injury within 48 to 72 hours, and bacterial infection.

Front 18

What is a cause of pneumonia for individuals with HIV?

Back 18

Pneumocystis jiroveci (PCP)

Front 19

What are the symptoms of PCP?

Back 19

It is slow in onset.
Fever, tachypnea, tachycardia, dyspnea, nonproductive cough, and hypoxemia.
Diffuse bilateral alveolar pattern of infiltration, massively consolidated.

Front 20

What is the treatment of PCP?

Back 20

Trimethoprim/sulfamethoxazole (Bactrm, Septa) IV or orally

Front 21

What is a cause viral pneumomia in the immunocompromised patient?

Back 21

Cytomegalovirus (CMV).
Treatment antiviral medications.

Front 22

What is the pathological course of pneumococcal pneumonia?

Back 22

Entry of organism, release of bacterial endotoxin (congestion), Inflammatory response (red hepatization), leukocytes infiltrate and neutrophils and macrophages, consolidation of leukocytes and fibrin in the affected part (gray hepatization), and macrophages clean house (resolution)

Front 23

What are the clinical manifestations of pneumonia?

Back 23

Sudden onset of fever,shaking, chills, SOB, cough productive of purulent sputum (may be rust colored), and pleuritic chest pain.

Front 24

What will you find on physical examination for pneumonia?

Back 24

Signs of pulmonary consolidation, such as bronchial breath sounds, crackles, dullness to percussion, and increased fremitus.
Associated with S pneumoniae and Haemophilus influenzae.

Front 25

What are atypical clinical manifestations of pneumonia?

Back 25

Fever, headache, dry cough, myalgias, fatigue, sore throat, nausea, vomiting, and diarrhea.

Front 26

What will you find on physical examination if person with pneumonia presents atypically?

Back 26

Crackes.
Associated with M. pneumoniae, Legionella, and Chlamydia pneumoniae.

Front 27

What can cause primary viral pneumonia?

Back 27

Influenza virus, measles, varicella-zoster, and herpes simplex virus.

Front 28

What are complications of pneumonia?

Back 28

Pleurisy, meningitis, pleural effusion, empyema, lung abcess, bactercemia, atelectasis, endocarditis, and pericarditis.

Front 29

What diagnostic tools will be used for pneumonia?

Back 29

Chest x-ray will show consolidation and infiltrates.
Sputum specimen.
ABG to assess hypoxemia.

Front 30

What interventions are done for the patient with pneumonia?

Back 30

Pneumococcal vaccine.
Antibiotic treatment.
Oxygen therapy.
Analgesics.
Individualize rest and activity.
Hydration if able to tolerate.
Nutritional meals.
Reposition every 2 hours.
Educate about antibiotics, vaccines
Deep breathing.
Improvement should be noticed within 3 to 5 days

Front 31

What are some overall goals for pneumonia?

Back 31

Clear breath sounds, normal breathing patterns, no signs of hypoxia, normal chest x-ray, and no complications related to pneumonia.

Front 32

What is tuberculosis?

Back 32

It is an infectious diease caused by Mycobacterium tuberculosis.

Front 33

How does tuberculosis spread to others?

Back 33

By repeated close contacts within 6 inches of the person's mouth that is infected.

Front 34

What are the clinical manifestations of active TB?

Back 34

Fatigue, malaise, anorexia, unexplained weight loss, low grade fevers, and night sweats.
Cough that becomes frequent and may produce mucoid or mucopurulent sputum.
Hemoptysis in late stages (movie Tombstone)

Front 35

What are complications of TB?

Back 35

Miliary TB, plerual effusion and empyema, TB pnuemomia, and other organ involvement (CNS, bone joints, adrenal glands, kidneys, lymph nodes, and genital tracts)

Front 36

What is the tuberculin skin test?

Back 36

PPD
0.1 intradermal
48-72 hours rechecked for induration
Test positive should not be tested again.

Front 37

What will chest x-ray show for TB?

Back 37

Upper lobe infiltrate, cavitary infiltrates, and lymph node involvement.

Front 38

What are some bacteriological and other tests for TB?

Back 38

AFB test and quantiferon-TB.
AFB need three consecutive sputums on three different days, may take 8 weeks.
Quantiferon-TB takes a few hours.

Front 39

What are the interventions for TB?

Back 39

Four drug cocktail for 6 months (INH, rifampin, pyrazinamide and ethambutol)
Direct observe therapy.
INH for 6-9 months or rifampin for 4 months for LTB.
Vaccination BCG.
Airborne isolation.
Cover mouth and nose during cough, sneeze, or produce sputum.
Adverse effects of treatment.
Compliance.
Rest.
Follow up exams.
Balanced meals.

Front 40

What are some nursing diagnoses for TB?

Back 40

Ineffective breathing pattern.
Imbalanced nutrition: less than body requirements.
Noncompliance.
Ineffective self-health managment.
Activity intolerance.

Front 41

What are some goals for a patient with TB?

Back 41

Comply with therapeutic regimen, have no recurrence of disease, have normal pulmonary function, and take appropriate measures to precent the spread of the disease.

Front 42

What are risk factors for lung cancer?

Back 42

Smoking and inhaled carcinogens.

Front 43

What is the pathogenesis of primary lung cancer?

Back 43

Grows slowly, 8-10 years to grom 1 cm.
Hypersecretion of mucous, desquamation of cells, reactiver hyperplasia of the basal cells, and metaplasia of normal respiratory epithelium to stratified squamous cells.

Front 44

What are the two broad sub-types of primary lung cancers.

Back 44

Non-small cell lung cancer and small cell lung cancer.

Front 45

What are the common sites for mestatic growth of lung cancer?

Back 45

Liver, brain, bones, scalen lymph nodes, and adrenal glands

Front 46

What is paraneoplastic syndrome?

Back 46

A consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells or direct invasion, obstruction, or metastsis of the cancer.

Front 47

What are examples of pareneoplastic syndromes?

Back 47

SIADH, hypercalcemia, anemia, leukocytosis, hypercoagulable disorders, and neurological syndromes.

Front 48

What are the clinical manifestations of lung cancer?

Back 48

Depends on type of lung cancer.
Persistent cough that produces sputum.
Blood tinged sputum.
Chest pain.
Dypsnea.
Wheezes.
Nonspecific symptoms in later staged cancer.
Anorexia.
N/V.
Fatigue.
Weight loss
Hoarseness.
Unilateral paralysis of diaphragm.
Dysphagia.
SVC obstructions.
Palpable lymph nodes in the neck and axilla.

Front 49

What are diagnostic tools to identify lung cancer?

Back 49

Chest x-ray.
CT scan-single most important tool. If mass are easy to see fine-needle biospy technique or bronchoscopy.
MRI.
PET.
Sputum cytology.
Mediastinoscopy.
VAT,

Front 50

What is the TNM staging for NSCLC?

Back 50

T for the tumor size, location,and degree of invasion, N indicates regional lymph node involvement, and M represents the presence or absence of distant metastases.

Front 51

What are the therapies for lung cancer?

Back 51

Surgical therapy, radiation therapy, steretactic radiotherapy, chemotherapy, biological and targeted therapy, prophylactic cranial therapy, bronchoscopic therapy, photodynamic therapy, airway stenting, and cryotherapy.