Ch.28 concepts of care for pt. with infectious respiratory problems

Question 1

seasonal influenza

Answer 1

• highly contagious acute viral respiratory infection
• preventable with vaccination
• hand washing is critical
• antiviral agents may be effective if started within 24 to 48 hours

Question 2

seasonal flu rapid onset of…

Answer 2

severe headache
muscle ache
fever
chills
fatigue
weakness
anorexia

Question 3

pandemic influenza

Answer 3

• potential to spread globally
• avian flu, MERS, SARS
• early recognition and quarentine
• contact and airborne precautions
• antiviral drugs can be used for prevention or to shorten the duration of the infection

Question 4

pneumonia (PNA)

Answer 4

• an infection that inflames the air sacs in one or both lungs
• airsacs may fill with fluid or pus
• causing cough with phlegm pus fever chills and difficulty breathing

Question 5

what is inflammation pneumonia triggered by

Answer 5

infectious organisms and by inhaling irritating agents

Question 6

gas exchange concept for pneumonia

Answer 6

• excess fluid in lungs

- can be lobar in nature

Question 7

pneumonia health promotion and maintenance

Answer 7

• vaccination: 65 or older, immunocompromised, chronic health issues
• advoid crowded places during flu season
• cough, turn, move, deep breathe every 2 hr- helps with gas exchange and gets mucous up
• clean respiratory equipment- reduced infection
• avoid pollutants
• stop smoking
• get rest and sleep
• eat healthy diet
• drink 3l of water daily

Question 8

pneumonia assessment recognize cues: risk factors

Answer 8

risk factors:

• AGE
• no vaccination
• chronic health problems
• use of respiratory equipment
• vaccination status

Question 9

pneumonia assessment recognize cues: physical assessment and s/s: general appearance

Answer 9

• FLUSHED CHEEKS
• anxious look
• chest pain
• MYALGIA- pain in muscles
• headache
• chills
• fever
• cough
• tachycardia
• dyspna
• hemoptysis (blood sputum)
• SPUTUM- may have blood. color:yellow, green, brown, rusty, thick

Question 10

pneumonia assessment recognize cues: physical assessment and s/s: respiraotry assessment

Answer 10

• breathing pattern
• use of accessory muscles
• positioning
• cough
• sputum assessment
• lung sounds (crackles)

Question 11

pneumonia assessment recognize cues: physical assessment and s/s: vital signs

Answer 11

• increased respiration rate
• hypotension
• tachycardia
• dysrhythmias

Question 12

pneumonia assessment recognize cues: psychosocial

Answer 12

• assess for signs of anxiety
• approach the pt. calm
• if experience dyspnea, keep interview short

Question 13

pneumonia assessment recognize cues: lab assessment

Answer 13

• gram stain, culture and sensitivity of sputum- gram positive
• CBC: elevated wbc
• blood cultures: infection gone to blood stream
• ABGs: impaired gas exchange
• serum electrolytes, BUN, creatinine
• lactate level: sepsis

chest x ray
pulse ox
thoracentesis- removes fluid or air from lungs

Question 14

pneumonia: why is there a decrease gas exchange

Answer 14

due to decreased diffusion at the alveolar capillary membrane

Question 15

pneumonia: why is the a potential for airway obstruction

Answer 15

PRIORITY

- due to inflammation with excessive pulmonary secretions, fatigue, muscle weakness

Question 16

pneumonia: why is there a potential for sepsis

Answer 16

due to the presence of microorganisms in a very vascular area and reduced immunity

Question 17

pneumonia: why is there a potential for pulmonary empyema

Answer 17

• due to a spread of infectious organisms from the lung into the pleaural space

Question 18

pneumonia improving gas exchange

Answer 18

• oxygen therapy

- incentive spirometer

Question 19

pneumonia preventing airway obstruction

Answer 19

• cough and deep breath at least every 2 hr
• use incentive spirometer
• drink at least 2l of water
• monitor i&O, oral mucus membranes, skin turgor
• bronchodilators prescribed for bronchospasm
• iv steroids used to decrease inflammation and airway swelling

Question 20

pneumonia: preventing sepsis

Answer 20

• use of anti-infectices for 5-7 days for ucomplicated CAP and up to 21 days with severely impaired immunity or with HAP
• PNA caused by aspiration involves interventions that prevent lung damage and treat infection

Question 21

pneumonia: managing empyema

Answer 21

• treatment involves draining empysema cavity, re-expanding the lung and controlling infection
• antibiotics prescribed and chest tube placed, chest surgery is a possibility

Question 22

pneumonia: home care management

Answer 22

• pt. level of fatigue, dyspnea, and social support
• one level for bathroom needs and sleeping
• home nursing assessment

Question 23

pneumonia: self management education

Answer 23

• use of anti-infective therapy
• notify provider of the following symtoms: chills, fever, persistent cough, dyspnea, wheezing, hemoptysis, increased sputum production, chest discomfort, increasing fatugue
• rest is important= slowly increase activity

Question 24

health care resources

Answer 24

• smoking cessation

- immunization of appropriate persons

Question 25

pneumonia evaluating outcomes

Answer 25

- attains or maintains adequate gas exchange - maintains patent airway - free from infection - avoids empyema - returns to pre-pneumonia health status

Question 26

tuberculosis secondary tb where does bacillus multiply

Answer 26

- highly communicable caused by myocobacterium tuberculosis - transmitted via aerosolization- airborn precautions - secondary TB- reactivation of the disease in a previously infected person - bacillus multiples when it reaches areas like the bronchi or alveoli - tb consists of an inflammation and exudative response, which causes pneuomonitis - only small amount of adults infected with bacillus develip active tb

Question 27

TB health promotion and maintenance & risk factors

Answer 27

risk factors: - homelessness - living in crowded conditions - substance use with malnutrtion - avoidance of people who are ill - good handwashing - screening

Question 28

TB history

Answer 28

- past tb exposure | - BCG vaccine- may show a false postive= chest xray or bloodwork

Question 29

tb physical assessment s/s

Answer 29

- progrssive fatigue - lethargy - nausea - ANOREXIA - WEIGHT LOSS - irrgular meses - LOW GRADE FEVER - COUGH WITH BLOOD STREAKS - sptum - chest pain - night sweats with fever

Question 30

psychosocial

Answer 30

- alleviate fear - help not feel isolated - direct contact should get tested - assist with getting time off of work

Question 31

tb diagnostic test

Answer 31

- chest xray - sputum culture - NAAT - TST - IGRA (quantiferon-tb, gold in tube)

Question 32

PPD skin test

Answer 32

postive reaction of skin test does not mean that active disease is present, but does indicate that there has been exposure to tuberculosis or dormant disease

Question 33

TB: why is there a potential for airway obstruction

Answer 33

- due to thick secretions and weak cough effort

Question 34

TB: why is there a potential for developing drug resistance

Answer 34

spread of infection due to inadequate adherence to therapy regime

Question 35

TB: why is there weight loss

Answer 35

due to inadequate intake and nausea from therapy regimen

Question 36

TB: why is there fatigue

Answer 36

due to lengthy illness poor gas exchange increased energy demands

Question 37

TB: promoting airway clearance

Answer 37

- drink plenty of fluids - take a deep breath before coughing - use incentive spirometer

Question 38

TB reducing dry resistance and infection spread

Answer 38

- antimicrobial therapy - Rifampin: red ting to skin and pee, advoid alc, & extra contraceptives - pyrazinamide- pt. has gout advoid, drink with 8oz of water, look for s/s of dark urine all for 8 weeks combination drug therapy last another 18 weeks - airborne precautions - sputim specimens every 4 weeks once drug therapy has started - 3 consecutive negative sputum cultures means pt. no longer infectious

Question 39

tb improving nutrition

Answer 39

- tb drugs may cayse nausea - take once a day meds at night and order antiemetics - take with small snack - advoid alc - lack of phosphorus= lack of energy

Question 40

tb managing fatigue

Answer 40

- pt. should resume activties and get plenty of rest | - reassure pt. that fatigue will resolve with continued treatment

Question 41

tb homecare management

Answer 41

- managed outside hospital | - collab with interprofessional team

Question 42

tb self management | & how long not contangious

Answer 42

- follows medication regimen | - no longer contagious after 2 to 3 weeks of drug therapy

Question 43

TB health care resources: what should they do after treatment?

Answer 43

- pt. should follow up with primary care at least 1 year after active treatment

Question 44

Tb evaluating outcomes

Answer 44

- effective clears airways - free of active tb and does not spread infection - demonstrates improved nutrition - reports decreased fatigue and increased energy - returns to pre-tuberculosis health status