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Flashcards in Respiratory Diseases Deck (144):
1

ARDS

Adult Respiratory Distress Syndrome
- Sudden onset of progressive pulmonary disorder
- REDUCED PERFUSION TO THE LUNGS caused by different factors
- Caused by LUNG FLUID and leads to EXTRAVASCULAR LUNG FLUID
- FLUID BUILD UP in ALVEOLI when surfactant production falls causing collapse of alveoli

2

Causes of Adult Respiratory Distress Syndrome

- Aspiration of gastric contents
- Chest ( VIRAL and BACTERIAL PNEUMONIA)
- Fractured bone with emboli
- Smoke and chemical inhalation
- O2 toxicity
- Drug overdose
- Shock
- Trauma
- DIC
- Burns
- Neuro injuries

3

Signs/Symptoms of ARDS and Care Mgmt

- Dyspnea and Tachypnea
- RAPID/SHALLOW BREATHING
- Restlessness/Apprehension
- Increased pCO2 and Decreased SpO2

Care Mgmt:
- SEDATIVES to REDUCE RESTLESSNESS
- May need mechanical vent with PEEP ( Positive End Expiratory Pressure) for severe hypoxemia
PEEP may cause DECREASE CARDIAC OUTPUT, HYPOTENSION, and TACHYCARDIA

4

Date Collection for ARDS

- Tachypnea
- Dyspnea
- Decreased breath sounds
- Deteriorating ABG levels
- Hypoxemia despite high concentrations of delivered oxygen
- Decreased pulmonary compliance
- Pulmonary infiltrates

5

Asthma

- Known as Respiratory Airway Disease (RAD)
- Narrowing/inflammation of airway (bronchi or bronchioles)
- Respiratory disorder characterized by wheezing, chest tightness, dyspnea and cough with recurrent episodes of precipitated allergens, infections, strenuous exercise, and exposure to cold environment or emotional stress
- No CURE can only be controlled

6

Treatment for Asthma (meds) and side effects

- Bronchodilators ( inhaler or nebulizer)
- S/E
Jittery, nervousness, tachycardia, palpitations, nausea, diarrhea

7

Acute Bronchitis

- An inflammation of the bronchi resulting from BRONCHIAL TISSUE IRRITATIONS secondary to smoking, chemicals, and pollens
- Often follows a cold or URTI ( Upper Respiratory Tract Infection )
- Viral or bacterial
- Radiology film reveals no infiltrates or consolidation

8

Signs and Symptoms of Acute Bronchitis

- Productive cough ( clear to purulent )
- Fever ( Mild to Moderate )
- Dyspnea

9

Diagnostic Tests for Acute Bronchitis/ Treatments

- Chest X Ray
- CBC
- Pulse Ox
- Pulmonary function test using PEAK FLOW

10

Chronic Bronchitis

- Inflammation or irritation of one or more bronchial tubes
- Productive cough for at least 2-3 continuous months for 3 years
- CIGARETTE SMOKING is the the MAIN CAUSE of chronic bronchitis

11

Signs and Symptoms of Chronic Bronchitis

-Chest tightness
- Exertional dyspnea
- Diminished breath sounds with wheezing
- Activity intolerance
- Recurrent respiratory infection

12

Acute Bronchitis (Meds)

Benzonatate ( Tessalon Perles ), Guaifenesin ( Robitussin) , Promethazine ( Phenergan)

( These are cough and antihistamines )

13

Cor Pulmonale

- CHANGE IN STRUCTURE OF HEART as a result of respiratory disorder
- COPD PRODUCES PULMONARY HYPERTENSION
- RIGHT SIDED HEART FAILURE ( enlargement of the right ventricle due to high BP in the lungs usually caused by chronic lung disease

14

Signs and Symptoms of Cor Pulmonale

- Shortness of breath on exertion
- Easy fatigability, chest pain, palpitations, ankle, leg, and abd swelling

15

Emphysema

- Chronic obstructive disease of the lungs with significant over distention of the alveoli
- Bronchitis and Emphysema = COPD

16

Primary factors of Emphysema

- SMOKING
- Air pollution
- Environmental exposure
- Allergy
- Infection
- AGING and GENETIC PREDISPOSITION

17

Signs and Symptoms of Emphysema/COPD

- Dyspnea, worse on exertion ( prolonged exertion )and exercising
- Coughing
- Excessive mucous production
- Shortness of breath and tightness of chest
- Wheezing
- Use of accessory muscles
*Tripod posture
* Barrel chest
- Inward movement of the lower chest with inspiration ( associated with severe hyperinflation)
- PROLONGED EXPIRATORY PHASE
- PULSUS PARADOXUS may be present ( Heart sounds heard precordium when radial pulse is not felt )

18

Nursing Interventions for Emphysema/COPD

- VS
- OXYGENATION USUALLY BY NASAL CANNULA at 1-2 L,
- VENTURI- MASK ALLOWS MORE PRECISE O2 ADMINISTRATION ( maintain PaO2 between 55- 65

19

MEDS on COPD/ EMPHYSEMA

BRONCHODILATORS
*Aminophylline
*Terbutaline ( Brethine )

INHALED ANTICHOLINERGIC
* Ipratroprium ( ATROVENT)

INHALED BETA AGONISTS
* ALBUTERTOL
* METAPROTERENOL ( Alupent )

CORTICOSTEROIDS
* Inhaled or Oral ( Prednisone )

BROAD SPECTRUM ANTIBIOTICS

INCREASE IN FLUID INTAKE to 3 L A DAY TO THIN SECRETIONS or give MUCOLYTICS

PURSE- LIP BREATHING


20

Nursing Alert/Pt Teaching (COPD)

- NO CURE
- Ensure adequate rest periods
- Monitor pulse ox ( continuous or periodically)
- Teach Pt. how to control breathing pattern and PURSE LIP EXHALATION to AVOID TACHYPNEA and EXCESSIVE HYPERVENTILATION
- TRIPOD POSITION to maximize respiratory muscles
-TEACH AND ENSURE CORRECT USE OF BRONCHODILATOR INHALERS TO PROMOTE BRONCHODILATION
- O2 inhalation usually by NASAL CANULA at (1-2 L) USE VENTURI ALLOWS MORE PRECISE O2
- AVOID IRRITANTS ( CIG SMOKE, PERFUMES) might trigger BRONCHOSPASM
-USE OF INHALED or ORAL PREDNISONE corticosteroid as prescribed. TEACH PURSE-LIP BREATHING

QUIT SMOKING by using prescribed
- Zyban ( buproprion) or Chantix ( varenicline) or Nicotine patch

21

Pursed- Lip Breathing

Pursed- lip breathing works by helping your air passages STAY OPEN LONGER ( lengthening expiration ) to allow for more normal oxygen exchange. PROMOTES CARBON DIOXIDE ELIMINATION (prevents early airway collapse)

22

How to do Purse- Lip breathing ?

1. Relax your neck and shoulder muscles and inhale slowly through your nose for at least 2 counts

2. Pucker your lips as if to blow out a candle
Exhale slowly and gently through your pursed lips for at least twice as long as you inhaled ( count to 4 )

23

Histoplasmosis

- SYSTEMIC FUNGAL INFECTION
- Inhalation of dust contaminated by Histoplasma capsulatum ( transmitted through bird manure )
- Lungs almost infected but can affect other internal organs
- Fungus is found in Southern parts of the US and South America

24

Signs and Symptoms of Histoplasmosis

- Similar to pneumonia or TB ( Cough, fever, chills)
- Anorexia, nausea, vomiting, generalized weakness, body aches, and joint pains

- Amphoterecin B ( Fungizon ) administration
- Meds: Tylenol, steroids, antiemetic
- Monitor BUN and Creatinine

25

Aspergillosis

- Caused by opportunistic fungal infection called aspegillus causing pulmonary infection when inhaled
- Aspergullius LIVES IN SOIL, AIR, and WATER

26

Aspergillosis Pt Teaching

Avoid cool and wet places and household dust

27

Aspergillosis
Symptoms/ Treatment/ Nursing considerations

- Fever, cough, chest pain, and hemoptysis
- Systemic Antifungal Fungizone
- Premedicate with Benadryl and Tylenol 30 min prior to the start of Amphotericin B IV treatment

28

Pneumonia

- An infection of the pulmonary (lung) tissue including interstitial spaces, the alveoli, and the bronchioles
- Caused by viruses bacteria, Protozoa, mycobacterium, mycoplasma, and rickettsia

29

Right middle lobe lung is the most common site of what ?

Aspiration pneumonia as the right main bronchus is shorter and wider ( easily catching foreign body or patient’s own secretions)

30

What type of isolation and PPE does pneumonia require

- DROPLET
- Surgical mask, gloves, and gown

31

How long can a surgical mask be worn ?

20-30 minutes (if greater), moisture will build up and make the mask ineffective against maintaining sterility

32

Data Collection for Pneumonia

1. Fever
2. Chills
3. Headache
4. Muscle pain
5. SOB
6. Non- productive cough to productive cough
7. Use of accessory muscles for breathing
8. Rhonchi and wheezes
9. Mental status changes
10. Sputum production

33

Diagnostic Tests for Pneumonia

- Chest x- ray
- Blood tests ( CBC and basic metabolic panel )
- Sputum culture and sensitivity

34

Diet for Pneumonia/ Interventions

- Admin O2
- Provide CPT
- Semi Fowler’s position
- Monitor/record color, consistency, and amount of sputum
- Provide a balance of rest and activity, increasing activity gradually
- High protein
- High calorie ( unless overweight )
- Increase fluid intake ( Avoid milk because it thickens secretions)
- Fluids ( up to 3 L) such as
Water
Cranberry
Pineapple
Grapefruit juice
If not contraindicated because it may help cut mucus

35

Pulmonary Edema

- ACCUMULATION OF EXTRAVASCULAR FLUID IN THE LUNG OFTEN CAUSED BY CHF (Fluid build up in alveoli, fluid leakage into lungs )
- FLUID BACK UP INTO PULMONARY VEINS when the heart’s pumping power on LEFT SIDE is weaker that normal
- May cause respiratory failure

36

Signs/Symptoms of Pulmonary Edema

- Dyspnea
- SOB
- Gasping for air
- Restlessness
- Anxiety Tachycardia
- Tachypnea
- Pink-tinged frothy phlegm
- Sweating
- Inspiratory and expiratory wheeze
- Neck vein distention ( RIGHT SIDE HF)


37

Diagnostic Test for Pulmonary Edema

- Chest radiograph
- Electrocardiogram
- CBC
- CMP ( comprehensive metabolic panel)
- Echocardiogram

38

Nursing Management for Pul Edema

M(orphine sulfate)

A(minophylline)

D(igitalis)


D(iuretics)


O(xygen)


G( ABG )

Monitor response to therapy

39

Why do you give morphine in Pulmonary edema ?

- Promotes venous pooling
- Reduces oxygen demand due to anxiety
- Conserves oxygen to the myocardium
- DO NOT GIVE TO STROKE PT WITH HEAD INJURY ( pupils constrict )
- COPD
- CARDIOGENIC SHOCK
- There is NO CONSTIPATION when taking for FIRST FEW DAYS
- MONITOR FOR RESPIRATORY DEPRESSION AND DROP IN BP

40

What does Aminophylline do for Pulmonary Edema ?

- May prevent bronchospasm associated with pulmonary congestion
- Relax bronchospasm when if wheezing
- SHOULD BE ATTACHED TO HEART MONITOR WHEN INFUSING THIS MED
- MONITOR FOR TACHYCARDIA AND DYSRHYTHMIAS

41

Why do you give Digoxin to Pulmonary edema ?

- It improves cardiac contractility increasing the output of left ventricle
- Hold if pulse is <60/min
- ASSESS FOR TOXICITY

42

What Diuretics do you give to pulmonary edema ?

- Lasix (furosemide) This causes vasodilation and peripheral venous pooling
- Bumex (bumetanide)
- Demadex (torsemide)
- Edercin (ethacrynic)
- Loop diuretics in acute pulmonary edema (given IV)
- Indwelling cath may be inserted in acute condition
- Upon discharge oral form is administered by LVN or RN

43

Causes for Pulmonary Edema

CARDIOGENIC
- Congestive Heart Failure
- Myocardial Infarction
- Abnormal Heart Valves

NONCARDIOGENIC
- Rapid infusion
- Fluids or blood ( TRALI ) transfusion-related acute lung injury
- cocaine
- smoking
- lung infection
- trauma
- severe infection
- ARDS
- kidney failure

44

Pleural Effusion

- Abnormal collection of fluid in the pleural space between the visceral and parietal pleura
- 5-15 ml to prevent friction if greater than 25ml it is considered effusion
- 300ml or more before becoming symptomatic
- Thoracentesis is performed for therapeutic and diagnostic test

45

Causes for pleural effusion

- CHF
- Pneumonia
- Pulmonary embolism
- Liver disease
- ESRD
- Cancer
- Nephrotic syndrome

46

Data Collection

- Pleuritic pain that increases with inspiration
- DYSPNEA
- DECREASED MOVEMENT OF CHEST WALL ON AFFECTED SIDE
- DRY NON- PRODUCTIVE COUGH CAUSED BY BRONCHIAL IRRITATION
- TACHYCARDIA
- INCREASE TEMP
- DECREASED BREATH SOUNDS ON AFFECTED SIDE
- CHEST X-RAY FILM SHOWS PLEURAL EFFUSION AND MEDIASTINAL SHIFT AWAY FROM FLUID IF EFFUSION GREATER THAN 250 mL

47

(Pleural Effusion) Pt. Teaching/Post procedure

- Explain
- POSITION SEMI- FOWLERS
- CHEST X-RAY REQUIRED BEFORE PROCEDURE

POST
- Monitor for signs of respiratory distress
- Obtain a chest X-Ray Film

48

Pleurectomy

- Surgically stripping the parietal pleura away from the visceral pleura
- Produces strong inflammatory reaction that promotes adhesion formation between the two layers during healing

49

Pleurodesis

- Involves the instillation of a sclerosing substance into the pleural space via thoracotomy tube
- Creates an inflammatory response that scleroses tissues together

50

Empyema

- COLLECTION OF PUS WITHIN PLERAL CAVITY
- THICK, OPAQUE, FOUL SMELLING
- Common cause is PULMONARY INFECTION and LUNG ABSCESS caused by thoracic surgery or chest trauma ( Bacteria introduced into pleural space)

51

Treatment ( Empyema)

- Focuses on treating the infection and emptying empyema cavity
- reexpanding the lung
- Controlling infection

52

Data Collection ( Empyema)

- Recent febrile illness or trauma
- CHEST PAIN
- COUGH
- DYSPNEA
- Anorexia weight loss
- Malaise
- Night sweats
- Pleural exudate on chest x- ray

53

Interventions ( Empyema)

- Monitor breath sounds
- SEMI- FOWLERS or HIGH
- Coughing/Deep breathing
- Antibiotics as prescribed
-Thoracentesis or chest tube insertion to promote drainage and lung expansion

54

Pulmonary Embolism

- OBSTRUCTION TO PULMONARY ARTERY BY BLOOD CLOT
- Blood is usually in the PERIPHERAL DEEP VEINS OF THE LEG
- Blood is DISINTEGRATE AND CIRCULATED TO THE LUNG CAUSING OBSTRUCTION
- Thrombus forms Detaches and travels to right side of heart and then lodges in branch of pulmonary artery

55

Risk Factors for Pulmonary Embolism

- PROLONGED INACTIVITY or BED REST
- CHF
- MI
- RECENT SURGERY
- LEG INJURY
- TRAUMA TO PELVIS
- MALIGNANT DISEASE
- CLIENT ON BC PILLS
- HYPERCOAGULABLE CONDITION
- OBESITY
- PREGNANCY
- HISTORY OF THROMBOEMBOLISM
- FAT EMBOLI AFTER LONG BONE FRACTURE

56

Signs/Symptoms ( Pulmonary Embolism)

- DYSPNEA
- TACHYPNEA/TACHYCARDIA
- SHORTNESS OF BREATH/ANXIETY
- HYPOTENSION
- HYPOXEMIA
- FEVER
- DECREASE Pa02 (partial pressure of 02 in ABG)
- INCREASE Pc02 ( partial pressure in carbon dioxide in blood)
- WEAKNESS/RESTLESSNESS
- ALTERED LOC
- CRACKLES/WHEEZES
- BLOOD TINGED SPUTUM
- DISTENDED NECK VEINS
- CYANOSIS

57

Diagnostic Tests for Pulmonary Embolism

- Chest X- Ray
- Lung Scan ( V/Q scan )
- ABG
- D-Dimer ( < 250)
- EKG
- Pulmonary angiogram

58

Treatments for Pulmonary Embolism

- OXYGEN THERAPY
- ANTICOAGULANTS (HEPARIN BOLUS AND DRIP)
- TRAP EASE VENA CAVA FILTER or GREENFIELD VENA CAVA FILTER for recurrent pulmonary embolism

59

Protime




10.6 - 12.9 seconds

60

INR



2.0 - 3.0 Prophylaxis/ Treatment venous thrombosis, Pulmonary embolism

61

On Heparin PTT or APTT



24 -37 seconds

62

Surgical intervention for blood clot

- Intraluminal
- Vena Cava Filter (Garfield or Trap- Ease filter
- Ligation
- Plication
- Clipping of vena cava and embolectomy

63

What is the therapeutic time for prothrombin ?



1.5 - 2 times

64

What does heparin do ?

It STOPS FURTHER THROMBUS FORMATION and EXTENDS the CLOTTING TIME of the blood

65

What is S T A I R and what does this stand for ?

Thrombolytics

Streptase (streptokinase)

T-pA (Tissue plasminogen activator) * Must be stored in refrigerator*

Abbokinase (urokinase)

Integrilin (eptifibatide)

Retavase (retaplase)

Nurse Alert* Administer initial intravenous bolus over 1 min, follow by prescribed drip. Monitor for any bleeding

DO NOT INSERT after Clot buster has been given
Foley Cath
NGT
Digital exam



66

Low- Molecular weight Heparin

Lovenox (Inoxaparine)

1mg/kg SubQ BID

Arixtra (fonduparanux)

SubQ ONCE DAILY

67

Other Blood Thinners (PET PAX)

Pradaxa (Dibigatron) - PREVENT STROKE & BLOOD CLOTS WITH A-FIB. NO NEED TO MONITOR INR

Eliquis (Apixaban) - PREVENT DVT

Ticlid (Ticlopidine)


Plavix (Clopidrogel)

Aggrenox (Dipyridamole/ASA)

Xarelto (Rivaroxaban)

68

Side Effects of Anticoagulants/Thrombolytics

- Bruising
- Hematoma
- Gum bleeding
- Epistaxis
- Hemoptysis or Hematemesis
- Back pain
- Stomach pain
- Increased abd girth
- Black Tarry stools
- Heavy periods
- Vaginal bleeding
- Internal Bleeding
- Decreased BP
- Altered Breathing

69

Risk Factors for DVT

- Venous Injury
Surgery Trauma

- Poor Blood Circulation
HF
Increased blood thickness
Small blood clots
Prolonged immobilization

Increased Blood Clotting
Anticlotting factor deficiencies
Autoimmune disorders
Certain cancers
Platelet disorders

70

Is VENOUS OCCLUSION RED or BLUE ?

RED

71

Arterial is ?

BLUE/COLD

72

Why is Venous more common to have clots ?

- Have Valves
- Can NOT FLOW BACK
- MOVE SLOW

73

When it is WARM, RED, and/or pain in leg is this Arterial or Venous ?

Venous

74

Majority of DVTs occurs in only one leg at a time. TRUE or FALSE

TRUE

75

Can DVT in the thigh cause symptoms in both the thigh and leg ?

Yes

76

What are the Diagnostic Tests for the Leg (DVT)

- Doppler Ultrasound
- Venogram
- Impedance Plethsmography (IPG)

77

How do you assess DVT ?

- PAIN & TENDERNESS IN CALF of affected extremity
- Pain ESPECIALLY ON DORSOFLEXION of FOOT also called HOMAN’S SIGN
- Extremity will appear larger than the other caused by edema
- Affected extremity will be WARM TO TOUCH

78

Warfarin interaction with Herbals ( Can Increase INR )

- Garlic
- Ginger
- Ginseng
- Ginkgo
- Guarana
- Chamomile
- St. John’s Wort

79

What decreases INR ?

- Antacids
- Barbiturates
- Corticosteroids
- Grapefruit/ grapefruit juice
- Oral contraceptives and estrogen
- Quinidine ( this is an antiarrhythmic drug)
- Rifampin (Antibiotic)
- Tamoxifen ( Treats breast cancer )
- Vitamin K rich foods

80

What are substances that can increase INR ?

- Alcohol
- Aspirin
- Cephalosporins (Antibiotic)
- Fluconazole (Anti-Fungal)
- GARLIC
- GINSENG
- GINGKO BILOBA
- GINGER
- GUARANA
- Heparin
- Macrolides (Antibiotics)
- Penicillins ( HIGH DOSE)
- Sulfa Compounds
- Thyroxin (Synthroid)
- Ticlopidine (Ticlid)
- Clopidrogel (Plavix)

81

How many days does it take before the therapeutic effect of warfarin is exhibited ? What should should you monitor ?

3-4 Days and monitor the INR

82

What are the safety precautions when administering heparin ?

- Convenient sites are the lower abd fat pad ( to avoid inadvertent intramuscular injection, injection near an incision and hematoma formation)

- Common location site is the fatty area anterior to either iliac crest
- *AVOID INJ SITES WITHIN 2 IN. OF UMBELLICUS BECAUSE OF POSSIBILITY OF ENTERING A LARGER BLOOD VESSEL*
- AVOID THIN LAYERS OF SKIN
- **ALERT** - Elderly begin to lose SubQ fat padding ( EXAMINE FOR SAFE SITES ON SKIN)

83

Is Heparin safe in pregnancy ?

YES

84

MNEUMONIC: COUMADIN

Contraindicated in lactating women, hemophilia, dyscrasias, active bleeding

Oral anticoagulant

Usual side effect is BLEEDING

Monitoring of PT/INR

AVOID GREEN LEAFY VEGGIES AND FRUITS WITH GREEN SKIN

DRUG ANTIDOTE IS VIT K

INSTITUTE BLEEDING PRECAUTIONS

NO TO MANUAL RAZOR

85

What is the antidote for Heparin overdose ?

Protamine Sulfate

86

How can Heparin be administered ?

SubQ, Bolus, IV Drip

87

Is aPTT obtained before initiation of Heparin ?

YES, Every 6 hours thereafter until stable, the daily

88

Pulmonary Hypertension

- Abnormally high blood pressure in the arteries of the lungs
- It makes the right side of the heart work harder than normal when blood is pumped through arteries in the lungs

89

What may cause Pulmonary Hypertension ?

- Autoimmune diseases that damage the lungs ( such as scleroderma and RA
- Birth defects of the heart
- PULMONARY EMBOLISM
- CHF
- HEART VALVE DISEASE
- HIV
- COPD
- Pulmonary fibrosis (scarring of lungs)
- Obstructive sleep apnea

90

Signs and symptoms of Pulmonary Hypertension

- SOB
- Light-headedness during activity is OFTEN FIRST SYMPTOM
- Palpitations may be present
- Over time, symptoms OCCUR with LIGHT ACTIVITY OR EVEN REST
Other symptoms:
- Swelling of ankle and leg
- Cyanosis of lips or skin
- Chest pain ( Usually front of chest)
- Dizziness or fainting
- Fatigue
- Weakness

91

Patient Teaching for Pulmonary Hypertension

- QUIT SMOKING
- AVOID PREGNANCY
- AVOID HEAVY PHYSICAL ACTIVITIES AND LIFTING
- Avoid traveling in HIGH ALTITUDES
- Keep up to date with yearly flu and pneumococcal vaccines every 5 years

92

Treatments for Pulmonary Hypertension

- AmbrisenTAN( Letairis ); Prevents thickening of blood vessels ESPECIALLY THOSE IN LUNGS AND HEART, also LOWERS BP IN LUNGS
- BosenTAN (Tracleer)
- Calcium Channel Blockers AmlodiPINE (Norvasc), FelopiDINE (Plendil),
NicardiPINE (Verapamil)
- Diuretics
- Prostacyclin or similar medicines ( Prostaglandin)
- Sildenafil (Viagra) or other erectile dysfunction medications

93

Sarcoidosis

-An IMMUNE DISORDER AFFECTING ANY ORGAN
- MAINLY LUNG CAUSING SCARING OF LUNG TISSUES
- Bacteria produce VIT D and this condition may suffer VIT D TOXICITY

94

What should you avoid in Sarcoidosis ?

- AVOID BEING IN SUN ALOT
- AVOID VIT D FORTIFIED MILK

95

Symptoms of Sarcoidosis

- Cough that does NOT go away
- Fever
- Weight loss
- reddish bumps or patches on the skin or under the skin
- Swollen painful joints
- Kidney stones

96

Systemic or topical steroids for 1 - 2 years or life long

Symptomatic Sarcoidosis

97

No Treatment Required

Asymptomatic

98

Obstructive Apnea

- WHEN MUSCLES AT THE BACK OF THROAT RELAX causing airways to NARROW or COLLAPSE
- Oxygen levels DECREASED during DEEPER SLEEP causing apnea
- CHOKING OR GAGGING
- Being overweight can cause sleep apnea

99

What are 3 non invasive breathing machines that deliver positive airway pressure support ?

- APAP (Automatic)

- BiPAP (BiLevel)

-CPAP (Continuous)

100

APAP

- A machine that automatically adjusts the amount of pressure into the airway on a breath-by-breath basis
- Allows least amount of pressure to keep the airway open while the user sleeps
- this machine “SENSES” the amount of pressure needed per breath
- Can also function as a CPAP machine with a preset pressure per breath

101

BiPAP

- Delivers TWO DIFFERENT PRESSURES
- INSPIRATORY & EXPIRATORY ARE DIFFERENT AS MACHINE ALTERNATES BETWEEN PRESSURES
- Able to provide DUAL PRESSURES INSPIRATORY AND EXPIRATORY

102

What are common side effects with the BiPAP machine ?

- THROAT/NASAL IRRITATION
- Skin lesion
- bloated stomach
- Ear discomfort can lead to hearing difficulties or disrupt ability to sleep at night

103

CPAP

- Allows airways pressure to REMAIN OPEN while the person is sleeping to prevent apneic episodes
- Most commonly used in to treat OBSTRUCTIVE APNEA
- DELIVERS CONSISTENT PRESET PRESSURE BASED ON MD’S PRESCRIPTION, AFTER SLEEP APNEA STUDY

104

What are common side effects of the CPAP machine ?

- Dizziness
- Nasal congestion
- Runny nose
- Worsening headache if with sinusitis and deviated septum
- Noisy and uncomfortable

105

Tuberculosis

- HIGH CONTAGIOUS
- ACUTE or CHRONIC disease caused by mycobacterium tuberculosis
- An aerobic bacterium that PRIMARILY AFFECTS PULMONARY SYSTEM
- ESPECIALLY HIGHER LOBES WHERE OXYGEN CONTENT IS
HIGHEST
- Radiograph film shows pulmonary infiltrates

106

Can TB Effect other parts of the body ?

YES
- Brain
- Intestines
- Peritoneum
- Kidney
- Joints
- Liver

107

What type of transmission precaution is used for TB

- AIRBORNE BY DROPLET INFECTION
- When an infected individual coughs, sneezes, laughs, or sings TB ENTERS AIR, MAY BE INHALED BY OTHERS

108

How do you determine weather someone is infected with TB

X-RAY

109

Disease progression (TB)

- DROPLETS ENTER THE LUNGS, BACTERIA FORMS TUBERCLE LESION
- Defense system encapsulate the tubercle, leaving a scar
- If no encapsulation, bacteria may ENTER LYMPH NODES and CAUSE INFLAMMATORY RESPONSE (Granulomatous inflammation)
- IF ACTIVE PHASE, TB can cause necrosis and cavitation in the lesions, leading to rupture, the spread of necrotic tissue, and damage to various parts of the body

110

Client History (TB)

- Past Exposure to TB
- CLIENT’S COUNTRY OF ORIGIN AND TRAVEL TO FOREIGN COUNTRIES IN WHICH INCIDENCE OF TB IS HIGH
- RECENT HISTORY OF FLU, PNEUMONIA, FEBRILE ILLNESS, COUGH, OR FOUL-SMELLING SPUTUM PRODUCTION
- PREVIOUS (+) TESTS FOR TB
- RECENY BACILLE CALMETTE-GUERIN VACCINE, THIS IS GIVEN TO PEOPLE IN FOREIGN COUNTRIES TO PRODUCE RESISTANCE TO TB

111

If an individual who has received a bacilli Calmette Guerin vaccine what will their skin test result be ?

- POSITIVE
- INDIVIDUAL WILL NEED A CHEST X-RAY

112

When do individuals with TB begin to feel symptoms ?

Individuals will not feel symptoms until disease is well advanced

113

Signs/Symptoms of TB

- Fatigue/Lethargy
- Weight loss
- Anorexia
- After rise of fever
- Cough
- Night sweats
- Hemoptysis (Bloody Sputum)
- Low- Grade Fever
- PERSISTENT COUGH AND PRODUCTION OF MUCOID AND MUCOPURULENT SPUTUM ( BLOOD STREAKED SPUTUM)
- CHEST TIGHTNESS
- DULL, ACHING CHEST PAIN THAT MAY ACCOMPANY COUGH

114

Does a physical exam of the chest provide conclusive evidence of TB ?

NO

115

Does a chest X-RAY provide a definitive presence of TB ?

NO, But the presence of multinodular infiltrates with calcification in the upper lobes suggests TB

116

If the disease is active, what may be seen on the chest x-ray ?

Caseation and inflammation

117

How can you determine weather TB disease is in the advanced stage ?

- Bronchial breath sounds
- Dullness with percussion over involved parenchymal areas
- RHONCHI
- CRACKLES (ADVANCED)
- Partial obstruction of a bronchus caused by endobronchial disease or compression by lymph nodes maybe produce localized wheezing and dyspnea

118

Isolation Precaution

-AIRBORNE ( once inhaled, the TB bacilli will begin to multiply in 18-24 hrs)

119

What PPE is used for TB ?

- N-95 or called particulate mask

120

What is HEPA Filtration ?

-High- Efficiency Particulate
- Negative Air Flow (NAF) room >12 of air changes per hour (ACH)
- Usually 6-12 air exchange every hour

121

Diagnostic Test for TB

- Mantoux Test (PPD); A standard Tests for TB
- Tine Test
- QuantiFERON- TB Gold test
- Sputum cultures

122

Explain what is done in a Mantoux Test (PPD)

- Administer 0.1 of 5 units tuberculin units PPD INTRADERMALLY
- REACTIVE OR RAISED SKIN RAISED SKIN GREATER THAN 10mm AFTER (48-72 hrs) MEANS STRONG INDICATION OF TB
- Looking for thickness and hardening of tissues ( NOT ERYTHEMA)

123

What gauge needle is used for a PPD, what degree of angle, and how many inches ?

- 26 60 27 gauge needle is used
- 5 - 15 Degree angle INTRADERMAL
- 1/4 - 1/2- inch needle with BEVEL UP

124

Is redness without induration considered negative for a PPD test ?

YES

125

How many mm of induration is considered POSITIVE in people with HIV, RECENT CONTACT WITH ACTIVE TB, ORGAN TRANSPLANTED, and IMMUNOCOMPROMISE ?

5mm or greater is CONSIDERED POSITIVE

126

How many mm of induration is CONSIDERED POSITIVE for IV DRUG USERS, SUBSTANCE ABUSE, ALCOHOL, LEUKEMIA ?

10mm or more

127

How many mm of induration is considered POSITIVE REGARDLESS OF MEDICAL CONDITION ?

15mm or more is POSITIVE

128

If no induration, how will you record it ?

0mm
DO NOT RECORD AS “POSITIVE or “NEGATIVE”
ONLY RECORD MEASUREMENT IN MM

129

Can anyone have a TB Test ?

YES
CAN BE GIVEN TO
- Infants
- Pregnant women
- HIV Infected people with no potential problem

130

How many months to treat uncomplicated TB ? And what kind of drugs are used ?

- 2 Months
- Using BACTERIAL DRUGS such as:
ISONIAZID
ETHAMBUTOL
RIFAMPIN
PYRAZINAMIDE

131

How many times are Sputum smears done ?

- EVERY 2 WEEKS until NEGATIVE
- DOES NOT become NEGATIVE IN 3-5 months

132

Tine Test

- MULTIPLE PUNCTURE TEST
- USED FOR SCREENING ONLY to detect if someone is infected

133

Is a small reaction (5mm of firm swelling at site) considered to be positive ?

- YES
- POSITIVE IN PEOPLE WHO ARE HIGH RISK WITH:
HIV
RECEIVED AN ORGAN TRANSPLANT
SUPPRESSED IMMUNE SYSTEM
TAKING STEROID THERAPY ( about 15 mg of prednisone per day for 1 month)
CLOSE CONTACT WITH PERSON WHO HAS ACTIVE TB
CHANGES ON X-RAY THAT LOOK LIKE PAST TB

134

10mm or greater is considered positive in ?

- Known NEGATIVE TEST IN THE PAST 2 YEARS
- Diabetes
- Kidney failure
- Or other conditions that increase their chance of getting active TB
- Health care workers
- Injection drug users
- IMMIGRANTS who moved from a country (Latin America, Asia, Africa) with HIGH TB RATE in the PAST 5 YEARS
- Students/Employees working in certain group living settings
PRISONS
NURSING HOMES
HOMELESS SHELTERS
- Children younger that 4 years ( Infants, children, adolescents exposed to adults in high risk categories

135

15mm or greater is considered positive in ?

- ANY PERSON
- PERSONS WITH NO KNOWN FACTORS FOR TB

136

What are standard precautions when transporting patient with TB?

- Patient MUST WEAR A MASK ( DROPLET OR AIRBORNE)

137

PRECAUTION FOR AIRBORNE( DOORS ) for TB

- Doors CLOSED AT ALL TIMES
- May COHORT WITH SAME MICROORGANISM

138

PRECAUTION FOR DROPLET (DOORS) for TB

- Door MAY REMAIN OPEN
- SPACE BETWEEN PTs , Visitors, and staff
- 3 FT or GREATER

139

Latent TB Infection

- A condition in which TB BACTERIA ARE ALIVE, BUT INACTIVE IN THE BODY
- NO SYMPTOMS
- DON’T FEEL SICK
- CAN’T SPREAD TB TO OTHERS
- USUALLY HAVE POSITIVE TB TEST
- MAY DEVELOP TB IF NO TREATMENT IS GIVEN FOR TB INFECTION

140

PATIENT TEACHING FOR LTBI

- After taking medicine for about (2-3 WEEKS), you may NO LONGER BE ABLE TO SPREAD TB BACTERIA TO OTHERS
- BE ABLE TO GO BACK TO DAILY ROUTINE
- MAY RETURN TO WORK or SCHOOL

141

QuantiFERON- TB TEST (QFT)

- QFT MEASURES IMMUNE REACTIVITY TO MYCOBACTERIUM TB ( Bacterium that causes TB)
- WHOLE BLOOD TEST for DIAGNOSING LTBI
- If NOT DETECTED and TREATED, LTBI may later DEVELOP into TB DISEASE

142

AIRBORNE PRECAUTIONS

- KEEP DOOR CLOSED AT ALL TIMES
- NEGATIVE AIRFLOW ROOM (NAF)
- Airborne Infection Isolation Room (AIIR)
- MAY COHORT ( SAME MICROORGANISM )
- Transport ONLY WHEN NECESSARY
- PLACE MASK WHEN TRANSPORTING
Also for Measles
TB
Varicella (CHICKEN POX) until lesions are crusted

143

DROPLET PRECAUTIONS

- PRIVATE ROOM
- CLOSE ASAP
- May COHORT SAME MICROORGANISM
- WEAR MASK WITHIN 5Ft of client
- APPLY MASK WHEN TRANSPORTING
- SPATIAL BETWEEN CLIENTS, VISITORS, STAFF
3Ft or greater

144

Sputum Cultures

- SPUTUM SPECIMENS ARE OBTAINED FOR AN ACID FAST SMEAR
- SPUTUM CULTURE IDENTIFYING TB (CONFIRMS) THE DIAGNOSIS!
- AFTER MEDS ARE STARTED SPUTUM SAMPLES ARE TAKEN AGAIN TO DETERMINE EFFECTIVENESS OF THERAPY
- Most clients have NEGATIVE CULTURES AFTER (3 Months)