Respiratory Tract Infections - EXAM 3 Flashcards
How to prevent infections
- Follow your doctor’s orders: Take medications exactly as ordered. PErform chest physiotherapy as directed. If oxygen therapy is prescribed, take it as ordered
- 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
- 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
- Avoid Air Pollution: including tobacco smoke, wood or oil smoke, car exhaust, and industrial pollution
- 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
- 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
Epiglottitis
Age Group: Children ages 2-5
Key Symptoms:
- Absence of cough
- Drooling
- Agitation
- Tripod Position
Pathophysiology: Supraglottic obstruction due to inflammation
Treatment:
- 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
Pathophysiology:
- Inflammation of tracheal and laryngeal mucosa causes narrowing of airway
Treatment:
- 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
Bronchiolitis
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
Pathophysiology:
- Caused by RSV
- Swollen bronchiole mucosa; lumens fill with mucus and exudate, leads to obstruction and emphysema
Treatment:
- 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
Pneumonia
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
Pathophysiology:
- 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
Treatment:
- 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
Goal:
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
- Inadequate ventilation
- Lack of source control: Failure to institute respiratory precautions for known or suspected cases of TB or other airborne diseases
- 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
- Recognition of symptoms, which identigy patients who may be infected with airborne pathogens
- Early triage and isolation of these patients from others including patients, staff, and visitors
- 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?
Airborne:
The patient must be in a private room with negative pressure and health care workers must wear an approved particulate matter respirator mask.
Droplet:
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
