Respiratory Disorders

Question 1

Client with pneumonia

Answer 1

Infectious:
- Bacteria, viruses, fungi, protozoa, other microbes
Noninfectious:
- Aspiration of gastric contents, inhalation of toxic or irritating gases
Community- acquired:
- Streptococcus pneumoniae most common
Nosocomial (hospital acquired):
- Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginaosa, E. Coli
Opportunistic:
- Pneumocystitis carinii in immunocompromised persons

Question 2

Collaborative Care:

Answer 2

Prevention if key component, especially with vulnerable populations

Question 3

Immunization

Answer 3

Pneumococcal vaccine: antigens from 23 types of pneumococcus, imparts life-long immunity
Influenza vaccine: recommended for high-risk populations

Question 4

Medications

Answer 4

Antibiotics: initially according to gram stain, pattern of lung involvement, then according to C&S results
Bronchodilators: improve ventilation, reduce hypoxia
Sympathomimetics: albuterol, metaproterenol
Methylxanthines: theophylline, aminophylline
Expectorants: Acetylcysteine (Mucomyst) as inhalation; guaifenesin

Question 5

Respiratory Treatments

Answer 5

Incentive spirometry, suctioning

Oxygen: according to clients needs: range form cannula to intubation and mechanical ventilation

Question 6

Chest Physiotherapy

Answer 6

Percussion: rhythmic clapping on chest wall to reduce lung consolidation, prevent atelectasis
Vibration: application of pressure with repeated tensing of hand over involved areas to facilitate movement of secretions into larger airways
Postural Drainage: positioning client to facilitate drainage of secretions from lung segment

Question 7

Complementary Therapies

Answer 7

Herbs: echinacea, goldenseal, ma huang

Question 8

Nursing Care/ Health Promotion

Answer 8

Vaccinations against pneumonia
Preventive measures in high risk groups
- Increase mobility
- Good hydration, nutrition
- Prompt detection and prompt treatment of pneumonia

Question 9

Nursing Diagnoses

Answer 9

Ineffective airway clearance
Ineffective breathing pattern
Activity intolerance

Question 10

Home Care

Answer 10

Usually treated in community unless respiratory status compromised
Preventive measures
Recognition of manifestations
Supportive care to maintain clients health
Completion of any antibiotic therapy
Continue with medical appointments for follow-up

Question 11

TB: Collaborative Care

Answer 11

Significant public health threat with development of drug-resistance strains; focus includes:
- Early detection
- Accurate diagnosis
- Effective disease treatment
- Prevention of spread of TB
Non-compliance with prescribed treatment is a major problem

Question 12

TB: Treatment

Answer 12

Treatment usually lasts for many months and sometimes years
Successful treatment of TB:
- Depends on the compliance of the patient
- The failure of the patient to take the medications as prescribed is the most important cause of failure to cure TB
- Health department can demand direct monitoring of patient compliance with therapy

Question 13

TB: Medications

Answer 13

Isoniazid (INH) antibiotic to prevent TB form becoming active
Rifampin (RMP) used for active TB
Pyrazinamide (PZA) used for active TB
Ethambutol (EMB) used for active TB

Question 14

TB: Medications Prevention and Treatment

Answer 14

Prophylactic treatment to prevent active TB
- Clients with positive TB skin test
- Close contact of persons with positive sputum
6-12 months of Isoniazid orally (300 mg)
Bacilli Calmette -Guerin (BCG) vaccine given to infants
Toronto researchers (October 2013) developed a booster that will reactivate immunity (still in trials)

Question 15

TB: Treatment

Answer 15

Treatment for active disease uses 2 or more medications to prevent TB organism from mutating into drug-resistant forms
- Initial regimen is 2 months daily treatment with INH, Rifampin, Pyrazinamide, Ethambutol to kill any resistant strains
- 4 more months (or depending on compliance) of two meds depending on C&S
May use Streptomycin if compliance is an issue as it is an injection

Question 16

TB

Answer 16

Baseline testing prior to antituberculosis drug therapy

• Liver function tests before Isoniazid (INH)
• Vision examination before ethambutol
• Audiometric testing before streptomycin therapy

Question 17

TB

Answer 17

Twice weekly therapy administered under direct supervision of public health personnel if non compliant
Effectiveness of therapy assessed by repeat sputum specimens and chest x-rays

Question 18

TB

Answer 18

With adherence to treatment

- negative sputum specimens within 3 months; relapse rate with current treatment is

Question 19

Nursing Care TB: Assessment

Answer 19

Risk for infection
- Negative flow room
- HEPA-filtered respirator
- Respiratory isolation
Deficient knowledge
Ineffective therapeutic regimen management

Question 20

TB: Continuing Care

Answer 20

Teaching to reduce spread
Regular screening of high-risk individuals
Medication Administration

Question 21

COPD: Collaborative Care

Answer 21

Smoking abstinence is key to prevention and slowing progression
Treatment focuses on symptom relief, minimizing obstruction, slowing disability

Question 22

COPD: Treatment

Answer 22

Medications
Oxygen
Smoking cessation
Fluid and nutritional support
Airway clearance procedures
Breathing exercises
Lung transplant or lung reduction surgery

Question 23

COPD: Medications

Answer 23

Immunization against pneumococcal pneumonia
Antibiotics for infection
Bronchodilators: improve airflow and reduce air-trapping (Adrenergic stimulants, anticholinergics, methylxanthine)
Corticosteroids if asthma component of COPD
Alphal - antitrypsin replacement therapy, if emphysema due to genetic defect; given IV on weekly basis

Question 24

COPD: Treatment

Answer 24

Remain inside during times of significant air pollution; air filters and air conditioning
Pulmonary hygiene measures:
- Hydration
- Effective cough: “huffing” between relaxed breathing
- Percussion and postural drainage
Avoiding cough suppressants and sedations
Regular exercise program:
- Improve tolerance
- Improve ability for ADLs
- Prevent physical deterioration
Breathing exercises to slow respiratory rate and relieve accessory muscle fatigue
- Pursed lip breathing
- Abdominal breathing

Question 25

COPD: Oxygen

Answer 25

Long term therapy used for severe, progressive hypoxemia Intermittent or continuous, only at night If oxygen administered without intubation and mechanical ventilation, be cautious - Clients have chronic elevated carbon dioxide levels and do not respond to that as a stimulus to breath - Client only responds to low levels of oxygen as stimulus to breathe; giving high flow rates of oxygen will reduce stimulus to breathe

Question 26

COPD: Surgery/ Complementary Therapies

Answer 26

``` Surgery Lung transplantation may be only option if medical therapy not effective Complementary therapies: - Limit salt and dairy intake - Use of herbal teas - Acupuncture ``` Stop or never start smoking

Question 27

COPD: Nursing Care

Answer 27

``` Assessment of airway Ineffective airway clearance Imbalanced nutrition: less than body requirements Ineffective coping Decisional conflict: smoking ```

Question 28

COPD: Nursing Diagnoses

Answer 28

Ineffective Airway Clearance: prepare for intubation and mechanical ventilation, if client status is deteriorating Imbalanced nutrition: Less than body requirements - Diet high in protein and fats without excess carbohydrates to minimize carbon dioxide - Specific oral supplements Compromised family coping Decisional conflict: Smoking

Question 29

COPD: Home Care

Answer 29

Education focuses on: - Effective coughing and breathing techniques - Preventing exacerbations - Managing prescribed therapies

Question 30

COPD: Continuing Care

Answer 30

Effective coughing and breathing exercises Nutrition and fluid intake Exercise and activity Avoid crowds and infection exposure risks Stress reduction Recognition of symptoms Medication administration

Question 31

SELF DIRECTED

Answer 31

Epiglottis Croup RSV - Respiratory syncytial virus

Question 32

Asthma

Answer 32

``` Chronic inflammatory disorder Recurrent episodes of: - Wheezing - Breathlessness - Chest tightness - Coughing Common in children and adults ```

Question 33

Asthma: Treatment

Answer 33

``` Treatment goals are to control symptoms, prevent acute attacks - Teaching PEFR monitoring Medications - Anti-inflammatory agents - Rapid and long-acting bronchodilators - Leukotriene modifiers - Anticholinergic drugs Complimentary therapy Prevention ```

Question 34

Client with Asthma: Disease Monitoring

Answer 34

``` Peak expiratory flow rate (PEFR) Used on day to day basis Evaluates: - Severity of bronchial hyperresponsiveness - Severity of airway obstruction ```

Question 35

Client with Asthma: Preventive Measures

Answer 35

Avoidance of allergens and triggers - Modification of home environment (eliminate dust, install air filters) - Removal of pets - Eliminate all tobacco smoke - Wear mask during exercise in cold weather - Early treatment of respiratory infections

Question 36

Asthma: Medications

Answer 36

``` Anti-inflammatory agents - Corticosteroids: block late response to inhaled allergens, reduce bronchial hyperresponsiveness - Inhaled or systemic Non-Steroidal Anti-inflammatory Agents - Inhibit release of mediator substance - Cromolyn sodium, nedocromil ```

Question 37

Asthma: Medications (Bronchodilators)

Answer 37

Adrenergic Stimulants - Relax smooth muscle and bronchodilation - Oral or inhaled (metered dose inhaler); albuterol Methylxanthines - Theophylline (oral), aminophylline (IV) - Serum theophylline levels: Therapeutic 10-20 ug/mL Anticholinergic Agents - Ipatropium bromide (metered dose inhaler) Leukotriene modifiers - Reduce inflammatory response in asthma - Oral medications: zafirlukast, zileuton

Question 38

Asthma: Complementary Therapies

Answer 38

``` Herbal Biofeedback Yoga Breathing techniques Acupuncture Homeopathy Massage ```

Question 39

Asthma: Nursing Diagnoses

Answer 39

Ineffective airway clearance Ineffective breathing patterns Anxiety Therapeutic Regimen Management

Question 40

Asthma: Home Care

Answer 40

Educate Client to: - Promote good health - Manage acute episodes - Eliminate triggers - Use PEF meter - Followed prescribed medications

Question 41

Asthma: Nursing Care

Answer 41

``` Assessment of airway Ineffective airway clearance Fatigue Anxiety Ineffective Therapeutic Regimen Management ```

Question 42

Cystic Fibrosis: Medications

Answer 42

Dornase alfa enzyme to liquefy secretions Immunizations against respiratory infections, influenza vaccine Medications to reduce inflammation and treat infection - Bronchodilators - Antibiotics

Question 43

CF: Nursing Care

Answer 43

Similar to care of other clients with COPD DB&C exercises Percussion

Question 44

CF: Nursing Diagnoses

Answer 44

Ineffective airway clearance Imbalanced nutrition: less than body requirements Interrupted family process

Question 45

CF: Home Care

Answer 45

Extensive education and support for client and family in maintaining pulmonary function