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Med Surg > Lower / Upper Respiratory Problems > Flashcards

Lower / Upper Respiratory Problems Flashcards

1
Q

What is pneumonia?

A

Infection of lung parenchyma

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2
Q

Which pneumococcal vaccines does the CDC recommend for adults?

A

1 dose PCV15 or PCV20 then 1 yr later, 1 dose PPSV23 (pneumovax 23)

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3
Q

Who does the CDC recommend should get the pneumococcal vaccine?

A

Adults 19-64 with chronic diseases
All adults > 65 yrs

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4
Q

Ways organisms reach the lungs to cause pneumonia

A

1 - aspiration (from nasopharynx or oropharynx)
2 - inhalation (of microbes in air from sick person)
3 - hematogenous (spread from primary infection elsewhere in body)

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5
Q

Major risk factors for developing aspiration pneumonia

A

Decreased LOC
Difficulty swallowing
NG tube w/ or w/o tube feeding

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6
Q

Clinical classifications of types of pneumonia

A

Community acquired
Hospital acquired
- ventilator associated
- nonventilator associated

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7
Q

What are the parameters for pneumonia to be considered community acquired vs hospital acquired?

A

Community = not hospitalized on in LTC within 14 days of onset of symptoms

Hospital = occurs 48+ hours after hospitalization

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8
Q

Main type of pathogen that causes community acquired pneumonia

A

*Streptococcus pneumonae (G+)

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9
Q

Types of pathogens usually causing hospital acquired pneumonia

A

Pseudomonas aeruginosa
E. coli
Staph aureus
(Usually worse pathogens acquired in hospital)

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10
Q

Pathogen that is multi-drug resistant and causes a lot of problems for pts with pneumonia

A

*Staphylococcus aureus

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11
Q

Who is most at risk for multi drug resistant pneumonia?

A

Advanced age
Immunosuppression
Hx of antibiotic use
Prolonged mechanical ventilation

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12
Q

Symptoms of pneumonia

A

Cough
*Fever, chills
Dyspnea, tachypnea
Hypoxemia
*Pleuritic chest pain (different from angina, will hurt to take deep breath or cough)
Green, yellow, or rust-colored sputum

Change in mentation for older* or debilitated pts (restless, lethargic, or confusion)

Tachycardia, fatigue, headache, poor appetite

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13
Q

What will you find on assessment of a pt with pneumonia?

A

Fine or coarse crackles
Bronchial breath sounds (in areas other than bronchi)
Pleural friction rub
Increased fremitus
Dullness to percussion if pleural effusion
Splinting
Use of accessory muscles

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14
Q

Complications a pt with pneumonia may have

A

Atelectasis (seen on X-ray)
Pleurisy (inflammation)
Pleural effusion
Bacteremia (bacteria in blood stream)
Pneumothorax (collapsed lung)
Acute respiratory failure (usually if they have other pulmonary disorders)
Sepsis/septic shock (if blood stream infection gets worse)
Lung abscess (from infection)
Empyema (infection in pleural space)

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15
Q

Diagnostic tests done for pts who may have pneumonia

A

CXR
Sputum analysis (to determine pathogen)
CBC w/ diff (WBC count)
Pulse ox, ABGs (monitor)
Blood cultures (if infection suspected)
Thoracentesis (to get specimen of drainage)
Bronchoscopy w/ washings (to see if situation is worsening)
C-reactive protein - PNA v/s HF, RF (to look for inflammatory markers to determine what’s going on)

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16
Q

Nursing actions for pts with pneumonia

A

Supplemental O2
C/DB, IS
BID oral hygiene
Therapeutic positioning
Rest & activity, early ambulation
RT: postural drainage and chest percussion
Adequate hydration
High calorie, small, frequent meals

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17
Q

Medications nurses can expect pts with pneumonia to be administered

A

Analgesics (Tylenol)
Antipyretics
Expectorants
Antivirals/antibiotics

18
Q

Antibiotics used for pneumonia

A

Vancomycin (Macrolides)
Levofloxacin (Levoquin) (fluroquinolone *tendon ruptures possible)
Ceftriaxone (Rocephan) (cephalosporin)
- if pt allergic to penicillin, but could have cross allergy

19
Q

What does prompt tx of pneumonia look like?

A

Should see response in 48-72 hours
- decreased temp
- improved breathing
- decreased chest discomfort

Repeat chest X-ray in 6-8 days

20
Q

Nursing diagnoses for pneumonia

A

Impaired gas exchange
Ineffective breathing pattern
Acute pain in chest
Activity intolerance

21
Q

Two main kinds of lung cancer

A

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

22
Q

Characteristics of small cell lung cancer

A

Aggressive
Always systemic/metastasis

23
Q

Types of non small cell lung cancer

A

Squamous cell
Adenocarcinoma
Large cell

24
Q

Screening recommendations for lung cancer

A

Annually for high risk pts >55
(Using low dose CT)

25
Q

Diagnostic studies for person suspected of having lung cancer

A

Chest X-ray
Biopsy
Cytology of early morning sputum
CT scan, MRI
PET scan (to look for metastasis)

26
Q

Ways to obtain a biopsy of possible lung cancer

A

Bronchoscopy
CT guided needle biopsy
Thorocosopy (video assisted)
Thoracentesis

27
Q

Typical metastasis of lung cancer

A

Liver
Brain
Bones
Adrenal glands

28
Q

Assessment cues of lung cancer

A

Persistent cough not responsive to treatment
Blood-tinged sputum
Dyspnea
Wheezing
Chest pain

Late, non-specific s/s:
Fatigue, weight loss, N/V
Dysphagia
Superior vena cava syndrome

29
Q

Small cell lung cancer treatment

A

(Aggressive = poor prognosis)
Chemotherapy
Prophylactic cranial radiation

30
Q

Treatment for non-small cell lung cancer

A

Surgery
Radiation
Chemotherapy
Immunotherapy
Targeted therapy

31
Q

What is paraneoplastic syndrome?

A

Lung cancer complication where hormones secreted by certain tumor cells cause endocrine problems
(Most often caused by small cell lung cancer)

32
Q

Types of endocrine problems that can be caused by paraneoplastic syndrome

A

Hypercalcemia
SIADH

33
Q

Emergency warning signs for Covid or Flu

A

*Hypoxia - need oxygen or Ventilatory support
Severe dyspnea at rest
SoP2 <94% on RA
RR >30

34
Q

Covid PPE requirements

A

Isolation & PPE
Contact & Droplet precautions (+ airborne precautions if aerosolized procedure/treatment)
N-95
Face shield
Gown
Shoe covers
Gloves
Goggles

35
Q

Which admission labs indicate a poor prognosis for covid patients?

A

C-reactive protein (CRP) - due to inflammation
D-dimer - checked when worried about clotting (risk for covid pt)

36
Q

Most common flu test and why

A

Rapid influenza diagnostic test (RIDT)
- antigen swab
- only takes 15-30 min for results
(RT-PCR takes days for results, Viral cultures take 3-10 days for results)

37
Q

Types of flu vaccines:

A

High-dose - 4x antigen (65 yrs and older)
Inactivated (IIV4) - quadrivalent
Recombinant (RIV4) - egg free (18 yrs and older)
Live attenuated (LAIV4) - nasal spray influenza

38
Q

Who should not be given the live attenuated nasal spray flu vaccination?

A

Adults 50+
Pregnant women
Hx severe allergic reaction to flu vaccine
Immunocompromised
People who have taken influenza antivirals w/in 48 hrs
Caregivers for immunocompromised pts

39
Q

Recommendations for flu vaccinations for pts with special considerations

A

Egg allergy, hives only: 1 flu vaccine per year
Egg allergy more severe than hives: only 1 vaccine per year in medical setting where allergic reaction can be managed
Hx of Guillain-Barré syndrome w/in 6 weeks of previous flu vaccine: should not be vaccinated

40
Q

Medications for pts with the flu

A

Antivirals: within 24-48 hrs of symptoms
Tamiflu - oral, IV
Relenza - inhaled

Med Surg (12 decks)

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