Respiratory Tract Infections - EXAM 3 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Respiratory Tract Infections - EXAM 3 > Flashcards

Flashcards in Respiratory Tract Infections - EXAM 3 Deck (28):

How to prevent infections

  1. Follow your doctor's orders: Take medications exactly as ordered. PErform chest physiotherapy as directed. If oxygen therapy is prescribed, take it as ordered
  2. Take care of yourself every day: drink at least 6 glasses of water daily (unless dr. tells differently). Eat a nutritious, well-balanced diet. Sleep 7 or 8 hours every night. Take several short rests during the day. Learn to conserve your energy and avoid getting too tired
  3. Stay away from people who have colds and flu: if this cannot be avoided, wear a dispoable mask when around people with colds or flu
  4. Avoid Air Pollution: including tobacco smoke, wood or oil smoke, car exhaust, and industrial pollution
  5. Take special precautions with your personal hygiene: wash hands before taking medicaitons or handling oxygen equipment, wash hands after handling soilded tissues and before and after using the bathroom. Always rinse your oral inhaler after each use
  6. Ask your Dr. about flu and pneumonia vaccinations


Symptoms of respiratory infections

  • Fever, chills
  • Increased coughing, wheezing, or trouble breathing
  • Mucus changes in any of these ways:
    • Thicker
    • Amount is either more or less than usual
    • Foul odor
    • Color is green, yellow, brown, pink, or red
  • Stuffy nose, sneezing, or sore throat
  • Increased fatigue or weakness
  • Weight gain or loss of more than 5 pounds within a week
  • Swollen ankles or feet
  • Confusion, memory loss, or persistent drowsiness



Age Group: Children ages 2-5

Key Symptoms:

  • Absence of cough
  • Drooling
  • Agitation
  • Tripod Position

Pathophysiology: Supraglottic obstruction due to inflammation


  • Antibiotics
  • Corticosteriods
  • Airway Protection
  • Emergency Situation
  • Droplet Precautions

Nursing Considerations:

  • Do no use tongue depressor for throat insepction unless immediate intubation/tracheostomy can be performed if nessed (can cause bronchospasms)
  • Education regarding avialable HIB vaccine
  • Act quicky and calmly


Laryngotracheobronchitis (LTB or Croup)

Age Group Affected: Less than 5 years

Key Symptoms:

  • Inspiratory stridor
  • Substernal retractions
  • Barking cough


  • Inflammation of tracheal and laryngeal mucosa causes narrowing of airway


  • High humidity with cool mist
  • Nebulized (racemic) epinephrine
  • Corticosteriods
  • Maintain airway

Nursing Considerations:

  • Allow for rest
  • Maintain adequate fluids
  • Provide reassurance for family and child
  • Vigilant observation of respiratory status



Age Group Affected: children ages 2 months-12 months, rare after age 2

Key Symptoms:

  • URI symptoms with mild fever
  • Paroxysmal cough
  • Copious secretions
  • Can lead to respiratory distress - tachypnea or apnea


  • Caused by RSV
  • Swollen bronchiole mucosa; lumens fill with mucus and exudate, leads to obstruction and emphysema


  • High humidity
  • Adequate fluids
  • Rest
  • O2 for hospitalized child
  • Aerosolized Ribavarin for severe infections

Nursing Considerations:

  • If hospitalized with RSV, assign separate rooms
  • Good handwashing
  • Contact precautions
  • Avoid aerosolized Ribavarin if pregnant



Age Group Affected: most frequent in infancy and early childhood, also occurs in adults

Key Symptoms:

  • Fever (usually high)
  • Productive/unproductive cough
  • Rhonchi/crackles
  • Retractions/nasal flaring
  • Irritability or lethargy


  • Classficiation if based on causative agent
  • Can be precipitated by RSV, influenza, or a bacterial organism
  • Inflammatory process in which exudate forms patches in lung lobules


  • Antibiotics if bacterial
  • Oxygen administration with cool mist
  • Fluids
  • Rest
  • Chest physiotherapy
  • Antipyretics for fever

Nursing Considerations:

  • Close monitoring of VS and respiratory status
  • Avoid aspiration with frequent coughing
  • May require suctioning
  • Encourage caregiver presence to reduce anxiety


isoniazid (INH)

Classification: antitubercular

Mechanism of action: Interferes with synthesis of bacteria proteins, lipids, and nucleic acid

Use: Primary antitubercular - used in combination therapy for TB, prevention of Tb, and patients with latent TB infection

Side/Adverse Effects:

  • Fever
  • H/A
  • Weakness
  • Tinnitus
  • Halluncinations
  • Opticneuritis
  • N/V
  • Hepatoxicity
  • Aplastic anemia
  • Pancytopenia
  • SOB

Nursing Implications:

  • Limit foods containing tyramine: aged cheeses, red wine, chocolate
  • May take with food
  • Avoid aluminum based antacids within 1 hour of INH
  • Avoid ETOH
  • Report s/sx of hepatitis
  • Visual changes
  • Peripheral neuropathy
  • Vitamin B6 may be used to lessen CNS side effects
  • Directly observe therapy. DOT is used for issues with noncompliance


Mist Tent Therapy


This intervention moistens airways, minimizes fluid loss from the lungs, liquefies secretions, reduces bronchial edema, mobilizes respiratory secretions and allows for small-to-moderate oxygen administration as indicated. Note that this intervention is different from the use of an oxygen tent. An O2 tent provides oxygen, and is not necessarily humidified; by the same token, mist tents can be ordered with room air or with O2. They always provide humidification.

Indications: Mist tent therapy is utilized for a variety of acute and chronic respiratory problems of children, such as croup, asthma, epiglottitis, pneumonia, bronchiolitis, and bronchitis

Nursing Interventions: Nurses must perform a complete respiratory assessment and assist the child to semi-fowler's position to facilitate chest expansion. The child should receive psychological support, since this can be a frightening and isolating procedure. In addition to ongoing respiratory assessments, the child's temperature should be monitored, as it may decrease an average of two degree Fahrenheit. The presence of a dense fog within the plastic canopy indicates an effective degree of moisture. Excess condensation collects in a chamber, which should be emptied when full. Frequent linen and pajama changes will facilitate the child's comfort and safety.


Circumstances which increase opportunistic for exposure to airborne pathogens

  1. Inadequate ventilation
  2. Lack of source control: Failure to institute respiratory precautions for known or suspected cases of TB or other airborne diseases
  3. Failure to consider the diagnosis of TB or other airborne disease, resulting in delayed recognition, isolation, and treatment of cases


Source Controls for Airborne Pathogens

  1. Recognition of symptoms, which identigy patients who may be infected with airborne pathogens
  2. Early triage and isolation of these patients from others including patients, staff, and visitors
  3. Teach source (patient) to cover mouth when coughing or sneezing, to appropriately discard tissues, and to wear a mask when trasnported to other areas


Engineering Controls of Airborne Pathogens

  • Appropriate Air Exchange
  • Minimum six air exchanges per hour are required in rooms housing patients with known or suspected TB or other airborne diseases
  • Air from these rooms must be exhausted to the outside, or appropriately filtered (HEPA filtration) before re-circulation
  • Negative-pressure room (airborne infection isolation room)
    • Special isolation rooms, which have airflow from corridor into the room, preventing flow of contaminated air out into the corridor. Doors to these rooms must be closed at all times.
  • HEPA Filters
    • Highly efficiency particulate air filters remove infectious particles from the air



PFR 95 (N-95 NIOSH Approved) HEPA Filter Masks

These masks are also called personal respirators. They are mandated in the care of tuberculosis patients in situations where there is potential for great concentration of infectious aerosol (bronchoscopy, pentamidine, administration, sputum induction). These masks must be fitted to each individual


What is the difference between Airborne Infection Precautions and Droplet Precautions?


The patient must be in a private room with negative pressure and health care workers must wear an approved particulate matter respirator mask.


The patient can be in a regular private room and health care workers can wear a regular surgical mask


How often does OSHA/PESH require TB testing?

Every three months for workers in high risk categories

Every six months for workers in intermediate risk categories

Annually for all low risk personnel


What is the difference between TB infection and TB disease?

TB Infection:

The presence of M. tuberculosis. It occurs when M. Tuberculosis bacilli enter the body and multiply. The body's immune system usually responds by containing the infection. The boyd's immune system attacks the TB organisms by surrounding them with macrophages. These organisms are walled off and enclosed in hard capsules called tubercules. People with TB infection cannot transmit M. tuberculosis bacilli unless the infection develops into active TB disease.

TB Disease:

Illness from the presence of the M. Tuberculosis bacillius in the body when TB infection progresses to TB disease. The individual becomes clinically ill, with symptoms such as prolonged cough productive of sputum and/or blood (hemoptysis), pain in the chest, fever, weight loss, anorexia, and night sweats


How is pulmonary TB transmitted?

TB is transmitted VIA airborne particles known as droplet nuclei. These particles are exprelled when persons with TB disease cough, sneeze, laugh, sing, or talk. When other individuals inhale droplet nuclei containing m. tuberculosis, they become infected with TB.


What is the screening test for TB and what does a positive test indicate?

The tuberculin skin test (TST) (Mantoux test) using Purified Protein Derivative (PPD) is the best screening test for TB. A positive response (induration or "wheal" not redness) means that infection with TB has occurred and therapy might be required. It does not mean that active TB disease is present, but more studies need to be done. Positive reactions do not occur until 3-10 weeks after the initial infection.


What is the size of induration for a positive reaction in an immunocompromised patient compared to a low risk patient?

A positive reaction in an immunocompromised patient is an induration of greater than 5mm. A positive reaction in a low risk patient is an induration of greater than 15mm.


What is anergy and its relation to TB skin testing?

Anergy is the inability of a person to react to skin test antigens because of defects in or severe depression of the immune system, even if the person is infected with the organisms in question.

To determine the presence of anergy, Candida and mumps (90% of people react) are administered intradermally. If the patient does not react, it may be due to an impaired immune response. Anergy is more common in the geriatric, HIV, and steroid dependent population.


What is the booster phenomenon (also known as 2 step PPD) in relation to TB testing?

In some individuals, espeically those over 55, the cell-mediated immune response (which is what causes the reaction in a skin test) may be reduced. In these circumstances, absence of a reaction to a 1st skin test does not exclude the presence of TB infection or disease. A 2nd TB test may stimulate the body's ability to produce a positive reaction to a PPD skin test. For this reason, many nursing homes administer a 2nd PPD skin test if the 1st test was negative.


Miliary TB

TB infections involving nonpulmonary sites are referred to as miliary TB. Other areas of the body affected by miliary TB include the kidneys, bones, adrenal glands, lymph nodes, and meninges


How would interventions for infection control differ between pulmonary TB and miliary TB?


Pulmonary TB is transmitted by aerosol droplet. Gown, gloves, and HEPA filter mask should be worn if TB is suspected. The patient should be placed in an isolation room, preferably negative pressure where the exhaust air is filtered and the exchanged rate is at least 6X per hour. Miliary TB is not contagious VIA airborne spread and requires only the standard universal precautions.


When is TB no longer contagious?

Pulmonary and laryngeal TB are no longer considered contagious after approximately two weeks of appropriate medication, 3 consecutive negative AFB sputum smears, and a reduction in symptoms


What is the length of time that antimycobacterial medications should be taken?

At leaast 6 months. Administration may vary from daily to 2-3 times per week.


What is the most common problem with treatment of TB?

Noncompliance. If there is a chance that the prescribed drug regimen will not be followed, the patient should be observed taking all medication doses. This is known as "directly observed therapy" or "DOT" and is carried out by the local health Department.


Describe the pathophysiology of bronchiolitis

Bronchiolitis from RSV is an acute viral infection of the bronchioles. The bronchiole muscosa swells and fills with muscus and exudate. Inflammation and obstruction occur in the smaller airways causing hyperinflation and air trapping (obstructive emphysema). This infection is rare in children over age 2.


What are the key clinical features in bronchiolitis?

  • Initially child exhibits symptoms of a URI with coughing, sneezing, intermittent fever, and possibly otitis media or conjuctivitis
  • As the disease progresses, tachypnea (can be greater than 70 breaths per minute), pronounced retractions, cyanosis, poor breath sounds, and listlessness develop
  • Key clinical feature that requires nursing interventions is the presence of copious secretions.
  • Hypoxemia and respiratory acidosis can develop in severe disease


What should the RN do incase of desaturation without an obvious increase in respiratory distress?

  • Perform a quick assessemnt - color, WOB, general appearance, counting RR for 1 full minute
  • Check that equipment is working accurately
  • Arouse the child, stimulate if sleepy
  • Reposition with HOB elevated 90 degrees if needed
  • Consider suctioning and/or use of saline bullets
  • Anticipate MD order for Albuterol or Saline nebs
  • Increase O2 to return SpO2 to prescribed parameter (not 1st TNI)
  • Notify MD if desaturation recorrus or persists or if Respiratory status worsens

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