Lower Respiratory System (Nac 1)

Front 1

Pneumonia
(def)

Back 1

Acute inflammation of lung caused by microbial organisms

Front 2

The leading cause of death in the United States from infectious disease

Back 2

Pneumonia

Front 3

Discovery of ______ and ______ drugs decreased morbidity and mortality rates

Back 3

sulfa drugs and penicillin

Front 4

Etiology of Pneumonia

Back 4

1-Decreased defense mechanisms
2- Decreased cough and epiglottis reflexes allow aspiration
3- Mucociliary mechanisms impaired

Front 5

Causes of decreased defense mechanisms that lead to Pneumonia

Back 5

1- Viral or bacterial infections (bacteria grows in mucous)
2- Respiratory irritants

Front 6

Causes of aspiration that lead to Pneumonia

Back 6

1- Decreased LOC
2- Tracheal Intubation

Front 7

Causes of impaired mucociliary mechanisms that lead to Pneumonia

Back 7

1-Pollution
2-Cigarette Smoking
3- Upper respiratory infections (viral)
4- Tracheal intubation
5- Aging
6- Malnutrition

Front 8

Three ways organisms reach the lungs

Back 8

1- Aspiration from nasopharynx or oropharynx
2- Inhalation of microbes such as Mycoplasma Pneumoniae
3- Hematogenous spread from primary infection elsewhere in the body ( Staph auresus)

Front 9

(5) Types of Pneumonia

Back 9

1- Community acquired (CAP)
2- Hospital acquired (HAP)
3- Fungal
4- Aspiration
5- Opportunistic

Front 10

Community acquired pneumonia
(CAP)

Back 10

Lower respiratory infection of the lungs

Front 11

Onset of CAP occurs during the first _____ days of hospitalization

Back 11

2 days

Front 12

_____ million U.S. adults diagnosed with CAP yearly

Back 12

4 million

Front 13

The highest incidence of CAP occurs

Back 13

midwinter

Front 14

An high risk factor for CAP

Back 14

smoking

Front 15

HAP occurs ______ hours or longer after admission and NOT incubating at time of hospitalization

Back 15

48 hours or longer

Front 16

(True or False)
HAP is the second most common nosocomial infection

Back 16

True

(UTI is the first)

Front 17

_______ is the most common cause of pneumonia

Back 17

bacteria (comes from the oropharynx)

Front 18

Ways to prevent bacteria from the oropharynx

Back 18

1- oral care
2- cough and deep breathing

Front 19

(True or False)
Fungal pneumonia is transmitted from patient to patient

Back 19

False

Fungal pneumonia is not transmitted from person to person and the patient does not need to be placed in isolation

Front 20

Aspiration pneumonia
(def)

Back 20

Sequelae occurring from abdominal entry of secretions into lower airway

Front 21

Aspiration pneumonia usually occurs in pts with a history of

Back 21

loss of consciousness

Front 22

Diminished _______ and _______ reflexes often cause aspiration pneumonia

Back 22

Gag and Cough reflexes

Front 23

Prevention of Aspiration Pneumonia following procedures involving the throat

Back 23

Use a tongue depressor to check the gag reflex prior to feeding the pt

Front 24

Precautions to prevent aspiration with tube feedings

Back 24

-raise hob 30-40 degrees
-check residual and keep up to 100 ml of fluid in stomach (anything above 100 ml remove)

Front 25

Pathology of Pneumonia

Back 25

1-Inflammation
2-Red Hepatizitation
3-Gray Hepatizitation
4-Resolution

Front 26

Inflammatory response occurring with pneumonia

Back 26

Attract neutrophils, release mediators, exudate collects RBC's and bacteria

Front 27

Red Hepatiziation

Back 27

Capillaries dilate, more congestion of exudate- lungs appear red and granular (looks like the liver)

Front 28

Gray Hepatiziation

Back 28

Blood flow decreases, leukocytes and fibrin consolidate affected part of the lung- looks gray

Front 29

Resolution of Pneumonia

Back 29

Exudate lysed and removed by macrophages, normal tissue restored and normal gas exchange returns

Front 30

Clinical Manifestations of Pneumonia

Back 30

1- Changes in mental status
2- Confusion or stupor in older or debilitated patients
3- Restlessness (lack of O2)
4- Tachycardia (compensation to move O2)
5- Muscle Aches (overworked)
6- Sudden onset of fever and chills
7- Nasal congestion/ sore throat
8- Cough
9- Pleuritic chest pain
10- Dyspnea/SOB/Tachypnea
11- Asymmetric chest movements
12- Use of accessory muscles
13- Crackles
14- Fremitus/ Bronchial breath sounds

Front 31

Changes in mental status in Pneumonia occur due to

Back 31

Hypoxia from impaired gas exchange

Front 32

Characteristics of cough occurring with pneumonia

Back 32

-productive of purulent sputum (rusty colored)

-dry cough

Front 33

Implementation to prevent chest pain while coughing

Back 33

Splinting

Front 34

Implementation for conscious pt unable to cough

Back 34

Incentive spirometer
*Improves gas exchange
*10 x per hour

Front 35

Pneumonia Diagnostic Tests

Back 35

1- History
2- Physical exam
3- Chest x-ray/ Bronchoscopy
4- Gram stain of sputum (+/-)
5- Sputum culture sensitivity
6- Pulse Ox or ABG
7- CBC, differential, chemistries
8- Blood cultures

Front 36

Information to determine with pt history

Back 36

-How long fever has lasted
-How long cough has lasted
-Color, sputum with cough

Front 37

Sputum and Blood cultures take ______ hours to grow

Back 37

24
*Treat with antibiotics immediately after the culture sample is taken

Front 38

If non-invasive Chest x-ray does not give a clear enough picture of pneumonia, the next diagnostic test to perform is___________

Back 38

bronchoscopy: gives the clearest picture of the lungs
-scope from trachea to the lungs

Front 39

History for Pneumonia Pt

Back 39

1- Use of antibiotics, corticosteroids, chemotherapy, immunosuppressants
2- Recent abdominal or thoracic surgery/intubation/general anesthesia/sedation
3- Smoking
4- Alcoholism
5- Respiratory infections/Poor oral hygiene
6- Prolonged bed rest/TCDB
7- Lung cancer
8- COPD
9- DM
10- Debilitating disease
11- Malnutrition
12- AIDS

Front 40

Nursing Diagnoses R/T Pneumonia

Back 40

1- Ineffective breathing pattern r/t impaired gas exchange
2- Ineffective airway clearance r/t fluid
3- Acute pain r/t coughing
4- Imbalanced nutrition: less than required
5- Activity intolerance r/t to SOB

Front 41

Goals/Outcomes for Pneumonia

Back 41

1- Clear or improve breath sounds
2- Improved breathing patterns
3- No signs of hypoxia, monitor O2 stat
4- Improved chest x-ray
5- No complications r/t pneumonia

Front 42

Nursing Implementation for Pneumonia

Back 42

1- Antibiotic therapy
2- O2 for hypoxemia
3- Analgesics for pain
4- Antipyretics (tylenol)
5- Flu drug (tamiflu) and flu vaccine
6- 3L fluids daily (thin mucous)
7- 1500 calories daily
8- Prompt treatment of UTI's
9- Strict asepsis
10- Assist pt's at risk for aspiration with eating, drinking, taking meds
11- Assist immobile pt's with TCDB q2h

Front 43

Start antibiotic therapy within _____ hours of pneumonia diagnosis

Back 43

4 hours
*Evidence shows that early antibiotic therapy is imperative for effective treatment

Front 44

What must be checked prior to administration of antibiotics?

Back 44

Check for ALLERGIES

Front 45

Influenza Teachings

Back 45

Nutrition
Hygiene
Rest
Regular exercise
Flu and Pneumonia vaccine

Front 46

High risk groups suggested for pneumonia vaccine

Back 46

-Chronic illness (heart, lung disease and DM)
-Recovering from severe illness
-65 or older
-Long term care facilities

Front 47

Evaluation/Outcomes for Pneumonia

Back 47

1- Breathing improved
2- SpO2 >95
3- Free of adventitious breath sounds
4- Clear sputum from airway
5- Pain controlled
6- Verbalizes causal factors
7- Adequate fluid and caloric intake
8- Performs ADL's

Front 48

Complications of Pneumonia

Back 48

1- Pleurisy
2- Pleural Effusion
3- Atelectasis
4- Bacteremia

Front 49

Pleurisy
(def)

Back 49

Inflammation of the pleural space

Front 50

Pleural Effusion
(def)

Back 50

Fluid in the pleural space
-causes crackles
-Usually sterile

Front 51

Pleural Effusion is usually reabsorbed within

Back 51

1 to 2 weeks
-If not may require thoracentesis

Front 52

Thoracentesis
(def)

Back 52

drawing of fluid off the lungs with a needle

Front 53

Atelectasis
(def)

Back 53

Collapsed alveoli
-Usually clears with cough and deep breathing

Front 54

Treatment for atelectasis

Back 54

Incentive spirometer

Front 55

Bacteremia
(def)

Back 55

Bacterial infection in the blood

Front 56

(True or False)
Breath sounds are present with pleural effusion

Back 56

False-
Breath sounds are typically nor present with pleural effusion

Front 57

In assessing a patient with pneumcoccal pneumonia, the RN recognizes that clinical manifestations include:

A- Fever, chills and productive cough with rust colored sputum
B- a non-productive cough and night sweats that are self-limiting
C- A gradual onset of nasal stuffiness, sore throat and purulent productive cough
D- abrupt onset of fever, non-productive cough and formation of lung abscess

Back 57

Answer needed

Front 58

Pneumothorax
(def)

Back 58

Air surrounding in the pleural space causing the lung to collapse

Front 59

Tuberculosis (TB) is an infectious disease caused by

Back 59

Mycobacterium tuberculosis

Front 60

TB involves

Back 60

Lungs
Larynx
Kidneys
Meninges
Bones
Adrenal glands
Lymph nodes

Front 61

TB is the _____ most common cause of death from infectious disease

Back 61

2nd most common
(behind HIV/AIDS)

Front 62

__ _____ of the world's population is estimated to be infected with TB

Back 62

2 Billion (one third of the population)

Front 63

Resurgence of TB involves

Back 63

-high rates of TB with HIV infection
-Multidrug-resistant strains of M. tuberculosis

Front 64

TB is often disproportionate in:

Back 64

1- Poor, homeless, elderly
2- Underserved
3- Minorities-Native Americans, Asian, Hispanics
4- Foreign Born
5- Immunosuppressed
6- LTC facilities
7- Prisoners
8- IV drug abusers

Front 65

TB is spread via airborne droplet when infected pt:

Back 65

-coughs
-sneezes
-speaks
-sings

Front 66

(True or False)
TB is not spread by hands or objects

Back 66

True
TB is spread by airborne droplet
-brief exposure rarely causes infection
-requires close, frequent, prolonged exposure

Front 67

A pt with TB should wear a ______ mask when coming in contact with others

Back 67

N-95

Front 68

(True or False)
Cellular immunity limits further multiplication and spread of TB infection

Back 68

True

Front 69

After the cellular immune system is activated _______ _______ is formed to prevent the further spread of infection

Back 69

tissue granuloma

Front 70

After tissue granuloma formation, it may take __ to ___ weeks for the person to have a positive TB test.

Back 70

2-10 weeks
(this person is infected but doesn't have the disease)

Front 71

Characteristics of TB without sufficient immune response

Back 71

-Organism is not contained
-Active primary disease results

Front 72

Groups at high risk for getting TB disease

Back 72

1- Immunosuppressed
2- Diabetics
3- HIV
4- Chemo pt's
5- Long term steroid use

Front 73

Dormant TB organisms can exist for

Back 73

years

Front 74

(True or False)
Few ever develop TB

Back 74

True
*reasons for reactivation are not well understood

Front 75

Clinical manifestations of Active TB

Back 75

1- Fatigue
2- Malaise
3- Anorexia
4- Weight Loss
5- Low-grade fevers
6- Night sweats
7- Frequent cough with white frothy sputum

Front 76

(True or False)
Early stages of active TB are usually free of symptoms

Back 76

True

Front 77

Acute S/S of active TB

Back 77

1- High fever
2- Chills
3- Pleuritic pain
4- Productive cough

Front 78

Complications of TB

Back 78

1- Miliary TB
2- Pleural effusion and empyema
3- TB pneumonia

Front 79

Miliary TB
(def)

Back 79

Large numbers of organisms invade the bloodstream and spread to all organs
*Acute or chronic symptoms

Front 80

Pleural Effusion and Empyema associated with TB

Back 80

-Caused by bacterial in pleural space
-Inflammatory reaction with plural exudates of protein rich fluid

Front 81

TB Pneumonia
(def)

Back 81

Large amounts of bacilli discharging from granulomas into lung or lymph nodes
*S/S similar to bacterial pneumonia

Front 82

TB Skin Test (TST)
(Mantoux test)

Back 82

-Injection of purified protein derivative (PPD)
-Mark site of injection on pt
-Check within 48-72 hours

Front 83

_______ not ______ at the injection site 48-72 hours indicates exposure to TB and development of antibodies to the disease

Back 83

Induration (raised) NOT redness

Front 84

Reaction to exposure to TB can occur ____ to ____ weeks after exposure

Back 84

2 to 12 weeks

Front 85

(True or False)
Sensitivity remains for life and the individual should not be tested again

Back 85

True

Front 86

TB Skin test reaction > or = 5mm induration

Back 86

considered positive in the immunocompromised

Front 87

TB skin test reaction > or = 10mm

Back 87

considered positive in the high risk groups
*prison, shelter, HCP

Front 88

TB skin test reaction > or = 15mm

Back 88

considered positive in the low risk groups

Front 89

TB test method for HCP and those with decreased response to allergens

Back 89

Two-Step testing is recommended

Front 90

Two-Step testing

Back 90

GIve TB test and read results then give another TB test b/c the body may be getting used to getting tested so frequently

Front 91

Classification of TB

Back 91

Class 0: No exposure
Class 1: TB exposure, no infection
Class 2: Latent TB infection, no disease
Class 3: TB clinically active
Class 4: TB, but not clinically active
Class 5: TB suspect

Front 92

(True or False)
TB cannot be diagnosed solely on a chest x-ray

Back 92

True

Front 93

X-ray results that suggest TB infection

Back 93

-Upper lobe infiltrates
-Cavitary infiltrates
-Lymph node involvement

Front 94

Bacteriologic studies for TB

Back 94

-Stained sputum smears examined for acid-fast bacilli (AFB) test
-Required for diagnosis

Front 95

AFB Test

Back 95

3 Sputum specimens collected on 3 different days
AFBx3

*Required for diagnosis

Front 96

Sputum samples for an AFB test should be taken

Back 96

in the morning when pt first wakes up

Front 97

When having trouble collecting a sputum sample for a pt

Back 97

call respiratory therapy

Front 98

AFB culture can take up to ___ ______ to grow

Back 98

8 weeks

Front 99

QuantiFERON -TB (QFT)

Back 99

-New Test
-Rapid blood results (few hours)
-Does not replace cultures

Front 100

(True or False)
Hospitalization is not necessary for most TB patients

Back 100

True:
Hospitalization is not usually necessary unless severely ill

*Treatment is often done as an outpatient

Front 101

_________ is a major issue with TB care

Back 101

Compliance

Front 102

Drug Therapy is used to ________ or _______ active TB disease

Back 102

prevent or treat

Front 103

Directly observed therapy (DOT) for TB

Back 103

-Noncompliance is a major issue
-Requires watching pt swallow drugs
-Preferred to ensure adherence
-Pt should be taught @ side effects and when to seek med assistance

Front 104

_______ function should be monitored when taking TB drugs

Back 104

Liver

Front 105

Latent TB infection (LTBI)

Back 105

-Individual is infected with M. tuberculosis but does NOT have the disease
-Can be used to prevent a TB infection from developing into active disease

Front 106

LTBI is usually treated with ______ for ______ months

Back 106

INH for 9 months

Front 107

HIV patients should take INH for ______ months

Back 107

9 months

Front 108

Vaccine to prevent TB

Back 108

Bacille Calmette-Guerin (BCG)

*Can result in a positive TB reaction

Front 109

Assessment for TB

Back 109

-Productive cough
-Night sweats
-Afternoon temperature elevation
-Weight loss

Front 110

Nursing Diagnoses for TB

Back 110

1- Ineffective breathing pattern
2- Imbalanced nutrition: less than body requirements
3- Noncompliance
4- Ineffective health maintenance
5- Activity intolerance

Front 111

Patient Goals with TB

Back 111

1- Compliance with therapeutic regimen
2- Have no recurrence of disease
3- Have normal pulmonary function
4- Take appropriate measures to prevent spread of disease
5- No damage to liver functioning

Front 112

Acute Intervention for TB

Back 112

1- Airborne isolation
2- Drug therapy
3- Immediate medical workup: CXR, sputum cultures

Front 113

Airborne Infection Isolation
(def)

Back 113

isolation of patients infected with organisms spread by the airborne route.
*Should be placed in a single occupancy room with negative pressure and an airflow of 6-12 exchanges per hour.
*An N-95 mask should be worn when taking care of this patient

Front 114

Isoniazid (INH) Drug Therapy

Back 114

Monitor liver function

Front 115

Rifampin (Rifadin) & Rifabutin (Mycobutin) Drug Therapy

Back 115

turns urine, sweat and tears orange

Front 116

Ethambutol (Myambutol)
Drug Therapy

Back 116

Obtain baseline them monthly snellen test and color discrimination

Front 117

Patient teaching with TB

Back 117

1- Cover nose and mouth with tissue when coughing, sneezing, or producing sputum
2- Hand washing after handling sputum-soiled tissues

Front 118

Ambulatory and Home Care TB Implementation

Back 118

1- Ensure pt can adhere to treatment (Rx etc.)
2- Teach symptoms of recurrence
3- Must notify public health dept

Front 119

TB Goals/Outcomes

Back 119

1- Complete resolution of disease
2- Normal pulmonary function
3- Absence of any complications
4- No transmission of TB

Front 120

A patient with TB has a nursing diagnosis of noncompliance. The nurse recognizes that a common etiological factor for this diagnosis is:
A- Fatigue and lack of energy to manage self care
B- Lack of knowledge about disease transmission
C- Little/No motivation to adhere to drug regimen
D- Feelings of shame and the response of the social stigma of TB

Back 120

D. Feelings of shame and the response of the social stigma of TB

Front 121

Pulmonary Fungal Infections

Back 121

-Increasing incidence
-Found frequently in seriously ill patients that are being treated with corticosteroids, antineoplastic and immunosuppressive drugs and multiple antibiotics

Front 122

(True or False)
Fungal infections are transmitted from person to person

Back 122

False

Front 123

Drug of choice for serious systemic fungal infections

Back 123

Amphotericin B

Front 124

Amphotericin B is given

Back 124

IV

Front 125

Side effects from Amphotericin B can be avoided by taking

Back 125

Benadryl 1 hour before infusion

Front 126

Amphotericin B requires monitoring of

Back 126

renal function
*Check BUN and Creatinine before giving

Front 127

Total treatment with Amphotericin B may be up to

Back 127

12 weeks

Front 128

Oral antifungal medications

Back 128

-Nizoral
-Diflucan
-Sporanox

Front 129

Lung Cancer

Back 129

Leading cause of cancer-related deaths (28%)

Front 130

Lung cancer most commonly occurs in individuals over_____ with a history of _________

Back 130

50
smoking

Front 131

Prescreening for Lung cancer

Back 131

There is NO prescreening for lung cancer.
*No annual sputum test can be done
* No meds can be given to stop inflammation or growth

Front 132

The most important risk factor for Lung Cancer is

Back 132

Smoking

Front 133

Lung Cancer risk related to smoking is measured by

Back 133

1. Total # cigarettes smoked
2. Age of smoking onset
3. Depth of inhalation
4. Tar and nicotine content
5. Use of unfiltered cigarettes

Front 134

Occupational and Environmental Carcinogen exposures that cause risk for lung cancer

Back 134

-Asbestos
-Radon
-Nickel
-Iron/iron oxides
-Uranium

Front 135

Primary Lung cancer divided into 2 groups

Back 135

1. Non-small cell lung cancer
(NSCLC) 80%
2. Small cell lung cancer (SCLC) 20 %

Front 136

Lung Cancers metastasize by

Back 136

Direct extension via:
-Blood Circulation (i.e. have lung cancer now bone cancer)
-Lymph system (i.e. have lung cancer now Lymphoma)

Front 137

Common sites for metastatic growth

Back 137

-Liver
-Brain
-Bones
-Lymph nodes
-Adrenal glands

Front 138

Paraneoplastic syndrome
(def)

Back 138

various systemic manifestations caused by factors produces by tumor cell enzymes

-Inflammatory response r/t lung cancer

Front 139

Paraneoplastic syndrome is most often associated with

Back 139

SCLC

Front 140

(True or False)
S/S of Lung Cancer appear late in the disease process

Back 140

True:
S/S often appear late in the process because there is no screening process

Front 141

S/S of Lung Cancer

Back 141

1- Pneumonitis (inflammation)
2- Persistent cough with sputum
3- Hemoptysis
4- Chest pain
5- Dyspnea

Front 142

The most common S/S of lung cancer

Back 142

Persistent cough with sputum

Front 143

Late S/S of lung cancer

Back 143

1- Anorexia/weight loss
2- Fatigue
3- Nausea/Vomiting
4- Hoarse voice
5- Unilateral paralysis of diaphragm (decreases chest movement)

Front 144

Diagnostic Studies for Lung Cancer

Back 144

1- Chest x-ray (non invasive)
2- CT scan (most accurate)
3- MRI
4- PET
5- Malignant cells detected from sputum sample
6- Biopsy

Front 145

(True or False)
A biopsy is necessary for a definitive Lung Cancer diagnosis

Back 145

True

Front 146

SCLC

Back 146

-Cancer is typically very aggressive and metastasized before diagnosis made
-Can't stage
-Poor prognosis

Front 147

Surgical Therapy for Lung Cancer

Back 147

-Surgical resection has limited success for SCLC

-NSCLC more likely to be treated with surgery

Front 148

Radiation Therapy

Back 148

-Curative approach for individuals with resectable tumor and poor surgery risk

-Used in combination with chemotherapy

-Adjuvant after tumor resection

Front 149

Chemotherapy

Back 149

Treatment of nonresectable tumors or adjuvant to surgery in NSCLC with distant metastases

-Used in combination with multidrug therapy

-Improved survival rate with NSCLC and SCLC

Front 150

Assessment with Lung Cancer

Back 150

-Assess pt and family's understanding of treatment, diagnosis, testing, options and prognosis
-Anxiety

Front 151

Nursing Diagnoses with Lung Cancer

Back 151

1- Ineffective airway clearance
2- Anxiety
3- Acute pain
4- Imbalanced nutrition: less than required
5- Ineffective health maintenance
6- Ineffective breathing pattern

Front 152

Overall Goals for Lung Cancer

Back 152

1- Effective breathing pattern
2- Adequate airway clearance
3- Adequate oxygenation of tissues
4- Minimal to no pain
5- Realistic attitude toward treatment and prognosis

Front 153

Teachings for Lung Cancer Pt's

Back 153

1- Avoid Smoking and
Promote smoking cessation

Front 154

Acute intervention for lung cancer

Back 154

-offer support during diagnostic testing
-nutritional evaluation
-provide comfort
-teach methods to reduce pain
-educate indications for hospitalization

Front 155

Ambulatory and home care for lung cancer

Back 155

-follow up for s/s of metastasis
-education on s/s

Front 156

Expected Outcomes for Lung Cancer

Back 156

1- Adequate breathing pattern
2- Minimal to no pain
3- Realistic attitude about prognosis