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53 Cards in this Set
- Front
- Back
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What is pneumonia?
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An acute inflammation of the lung bronchioles and can be bacterial or viral.
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What happens when microorganisms get into the alveoli?
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The antigen-anitbody response causes an inflammatory rx which damages the alveoli. Fluids leak in, more bacteria grows, cellular debris are in the fluid and fibrin deposits form and decreases elasticity. All of these which decreases diffusion.
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Pneumonia can also have an effect on surfactant. What does this do to the lungs?
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Surfactant is decreased which can have a negative effect on lung expansion and lead to atelectisis.
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What are some of the s/sx of viral and bacterial pneumonia?
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Viral: low grade fever, nonproductive cough, normal WBC count or slightly elevated, Chest X-rays show minimal changes.
Bacterial: high fever, productive cough, infiltrates on x-ray, high WBC count. |
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What things would you want to do as a nurse for assess a patient with pneumonia?
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work/living conditions, aspiration or swallowing problems, recent illnesses, hx of URI, contact with others with pneumonia, vaccine hx, anxious or restless, resp rate, pulse rate, breath sounds, etc?
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What kinds of things can we do to manage bacterial pneumonia?
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antibiotics (rocefin), antipyretics, O2, maintain patent airway, ABC's, monitor resp. & pulse ox, address nutritional needs, encourage rest, pulmonary toilet (deep breathing, cough, chest PT, suctioning, incentive spirometer, etc.)
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What is Pulmonary Tuberculosis?
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Caused by the microbacterium tuberculosis. It's a very small airborne transmission; gram positive bacillus.
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True or False? When a person is exposed to TB they are usually asymptomatic for awhile and are not infectious until s/sx develop.
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True
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True or False? TB can not infect other body systems.
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False, it can travel to the heart and liver for example. It can be disseminated.
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What are some s/sx of TB?
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frequent cough, copious amounts of blood tinged sputum, night sweats, anorexia, positive PPD test, exposure, growth on lab culture, etc.
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How do we manage TB?
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Combo drug therapy (INH-isoniazide, rifampin, pyrozinamide, ethambutol, streptomycin, etc), monitor of LFT, sputum assessments, testing for close contacts, isolation rooms, etc.
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True or False? Drug therapy is usually short term for TB.
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False. Drug therapy for TB is long term (usually a year).
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What are some side effects of INH?
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liver problems; jaundice
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What are some side effects of Rifampin?
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Orange dis-colorization of body fluids, liver and kidney problems.
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What are some side effects of Pyrozinamide?
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Liver problems, elevations of uric acid which can lead to gout.
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What are some side effects of Ethambutol?
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visual changes such as a decrease in visual acuity. Red/green problems, etc.
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What are some side effects of Streptomycin?
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ototoxicity, nephrotoxicity and liver problems.
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How often will TB patients undergoing tx have sputum assessments done and why?
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Bimonthly or monthly to monitor if treatment is working.
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What is a pulmonary embolism?
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When a clot breaks loose and travels through the venous system typically from a DVT and ends in the lungs.
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What happens when a clot reaches the lungs?
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small clot may given some pain and dyspnea and passes on through. A large clot will cause a ventilation perfusion mismatch-an imbalance between the vol of blood and the vol of air being sent to the lungs; effects diffusion of the gases. Path of clot: RA-RV-pulmonary artery-occludes artery-possibly death.
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What are some risk factors for developing a pulmonary emboli?
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trauma, surgery, hypercoaguability, obesity, fractures, hormone replacement therapy, immobility, elderly, etc.
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What are some different types of PE's?
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Thrombo embolism, Fat embolism, Air embolism, foreign object embolism and amniotic fluid embolism.
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What is a fat embolus and how is it caused?
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A clot of fat that gets into the venous system and is usually caused by a broken leg (marrow has a lot of fat in it)
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What are some s/sx of pulmonary embolism?
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anxiety, restlessness, dyspnea, chest pain, apprehension, feeling of impending doom, bloody sputum, LOC changes, JVD, crackles, normal or infiltrates on X-ray, dark spot on pulmonary angiogram, etc.
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What is the management of PE?
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O2 therapy, anticoagulants (heparin drip), TPA, embolectomy, vena cava filter, maintain patent airway, monitor vitals and SaO2
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What is acute resp. failure?
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A sudden and life threatening deterioration of gas exchange. A decrease in PaO2 (<50) and an increase in PaCO2.
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What are two types of resp. failure?
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Ventilatory and Oxygenation failure.
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What is going on with ventilatory failure?
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Profusion is normal (blood supply is normal) but ventillation is abnormal. Movement of air in and out of the lungs is decreased. CO2 is retained but O2 is not getting in.
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What are three types of ventilatory failure?
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Mechanical, resp. center in brain, decreased fx of resp muscles.
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What can cause mechanical ventilatory failure?
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It is a problem with the lung or the chest wall. eg.: pneumothorax, kyphosis, etc.
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What can cause a problem in the resp center of the brain which leads to ventilatory failure?
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Stroke, MS, opioid overdose
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What can cause a decreased fx of resp muscles which can lead to ventilatory failure?
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Guillan-Barre, MS
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What is going on during oxygenation failure?
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There is an adequate movement of air (ventilation is normal), but perfusion is decreased. eg.: PE, foreign body
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What are some of the s/sx of respiratory failure?
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dyspnea, restlessness, anxiety, elevated pulse, LOC changes, confusion, lethargy, accessory muscle use, decreased breath sounds.
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What are some interventions for resp. failure?
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O2, ventilation, decrease anxiety, comfort, monitor resp status (ABG, SaO2), treat cause.
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What is Acute Respiratory Distress Syndrome (ARDS)?
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characterized by non-cardiac pulmonary edema and increasing hypoxemia despite treatment. Dyspnea, but O2 doesn't help.
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What are some s/sx of ARDS?
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refractory hypoxemia, decreased pulmonary compliance, dyspnea, non-cardiac bilateral pulmonary edema, pulmonary infiltrates, nonproductive cough, cyanosis, restlessness, pallor, retractions, ABG shows alkalosis or acidosis.
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What is going on in the lungs with ARDS?
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There is injury to the alveolar capillary and fluid shifts to alveoli and damage area making the lungs less compliant. The dead space increases and diffusion is decreased.
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What is the management for ARDS?
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O2 therapy, ventilation, may need fluid therapy, antibiotics (if sepsis is cause), nutritional support, steroids, monitoring of: O2, ABG, SaO2 suctioning, ventilator, lung sounds, etc.
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What is a pnuemothorax?
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A collection of air in the pleural space in which the lung starts to collapse from the apex down.
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What is a spontaneous pnuemothorax?
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The lung rupturs such as from emphysema
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What is a tension pneumothorax?
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The heart and great vessels are pushed to the other side collapsing a lung.
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What is traumatic pneumothorax?
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The lung is punctured such as from a steering wheel during a MVA.
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What is an iatrogenic pneumothorax?
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Caused by medical staff such as with a central line or punctured lung.
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What is a hemothorax?
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Blood in the pleural space. Blood goes to the base of lung and it collapses from the base up.
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What are some of the s/sx of a pnuemothorax?
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dyspnea, SOB, deviated trachea, decreased breath sounds, pain, subq emphysema, asymmetry of chest, cyanosis
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What is the management for a pnuemothorax?
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Chest tubes, pleurodises, wedge resection, lobe-ectomy, pneuomectomy,
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What is a thoracic trauma?
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Alteration in breathing mechanics or gas exchange problem caused by a traumatic event (blunt trauma or penetrating trauma)
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Explain what flail chest is.
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During a blunt trauma one or more ribs are broken in more then one spot. The pc is no longer attached to a stable bone and when the person inhales the section will be sucked in when the rest of the chest is expanding (opposite movement)
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Describe a penetrating trauma and what are some causes?
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There is a open injury to the pleura. eg.: gunshot wounds, knifings, sharp objects, etc.
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What are some s/sx of thoracic trauma?
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chest pain, shallow breathing, splinting with breathing, unequal chest expansion, paradoxical movement of chest wall, tachypnea, tachycardia, crepitous (bone to bone grinding)
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What is the management of a thoracic trauma?
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Get air or blood out (same as for pneumothorax): chest tubes, pleurodises, etc. Splints, pain management, etc.
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What are some things we can do for airway management?
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ABC's-tilt head & lift chin (if no spinal injury suspected), oropharyngeal tube (for unconscious patients), nasopharngeal tube, ET tube, Circothyrotomy (surgical opening to trachea), elevated HOB at least 45 degrees, dependant positioning with good lung down, pulmonary toilet: CDB, positioning, incentive spirometer, pursed lip breathing, adequate hydration, chest PT, vibrating vest, deep breathing, etc.
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