Test #4 - COPD, Pneumonia, TB Flashcards Preview

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Flashcards in Test #4 - COPD, Pneumonia, TB Deck (67):
1

What are some Epidemiology & Etiology for COPD?

More than 40 million Americans

4th leading cause of death & illness

Estimated $18 Billion annually in direct care costs

Specific causes are not clearly understood

2

COPD refers to several disorders affecting airflow, what are the three?

They may occur alone or coexist
 

Bronchitis

Emphysema

Asthma

3

What are some risk factors for COPD?

SMOKING
Stimulates excess mucous production
Decreases Ciliary function
Inflames and damages bronchiolar & alveolar walls

CHRONIC RESPIRATORY INFECTIONS

HERDITY/GENETIC PREDISPOSITION

4

What is the pathophysiology of Bronchitis?

Increased mucous production due to:
- inflammation of bronchi
- Inc size & # of submucousal glands
- Inc number of goblet cells

Impaired ciliary function and dec mucous clearance

Obstruct airway = airway collapse = air trapping

Dec Alveolar ventilation = dec PO2 & inc PCO2 = polycythemia

5

What is the pathophysiology of Emphysema?

Aveolar walls damaged 

Partial airway collapse

Loss of elastic recoil

Formation of blebs and bullae

Inc Ventilatory dead space
(Amt of lungs inflated but not being used for gas exch)

Overdistension of alveoli

6

What is the pathophysiology for asthma?

Chronic inflammatory response to allergens

Occurs in 2 phases by release of chemical mediators
Lukatrine & Hystamine

Inc Mucosal edema, Inc Mucous secretion, Inc airway inflammation

Leads to airway constriction

Self-sustaining cycle of inflammation and obstruction

Airway responds to antigens and stimuli by constricting
(Exercise, Cold air, dry air, emotional stress, chemical exposure ie paint fumes)

 

7

What are some assessments for Bronchitis?

Blue Bloater

Productive cough with copious amounts of sputum

Dec exercise tolerance

Wheezing in lungs

Short of Breath

Prolonged expiration

Chronic hypoxemia (low oxygen in blood) & hypercapnia (High CO2 in blood)

Cyanosis

Inc anteroposterior diameter

8

What are some assessments for Emphysema?

Pink Puffer

Progressive DOE = dyspnea at rest

Tachypnea (small volume)

Chest X-Ray=Overinflation & flattened diaphragm

Diminished breath sounds

Clubbing of fingers

Use of accessory muscles
especially expiration

Generally pink color

Inc anteroposterior diameter (Barrel Chest)

 

9

What are some assessments for Asthma?

Dyspnea

Marked Respiratory Effort during episodes:
-Nasal Flaring
-Pursed-lip breathing
-Use of accessory muscles

Wheezing (No wheezing=ominous sign)

Bronchospasm = Almost continuous coughing

Dec Peak expiratory flow rate (PEFR) & forced expiratory volume (FEV)

Dec O2 Sat, Dec PO2, Inc PCO2

10

What are some complications that occur to the pt body if we fail to treat the primary problem COPD?

Respiratory Infections

Respiratory Failure (Deadly)
(Lungs are no longer effective in meeting your oxygen need or the acid base balance)

Pneumothorax (Deadly)
(When a hole is generated in the aveoli as a result from excessive coughing)

Status Asthmaticus (Deadly)
(Specific to asthma form of COPD-Bronchoconstriction continues to the point of 

Cor Pumonale
(Form of right sided heart failure-Pulmonary artery pumps blood into lungs to pick up oxygen and drains back into left side.)

 

11

What are some diagnostic tests for COPD?

Chest X-Ray
-Reveals lungs, calcified casculature & skeletal structure
-Reveals pneumothorax, hemothorax, masses, or parenchymal changes (ie: blebs, bullae, consolidation, infiltrates, etc)

 Sputum Culture & Sensitivity
(Bc they are prone to infection-Can identify if there is one there, what it is, and what drug is effective in killing it)

Pulmonary funtion test P.606
(Measures various lung volumes to assess ventilation)
- Peak Expiratory Flowmeter - Measures flow rate
-Peak Expiratory Volume 
(Check these on routine basis so they can tell when they are gettin close to have an episode)

Arterial Blood Gases (ABG's)
When you see PO2, it is not the same as O2 or SPO2
- PO2-Measures total volume of oxygen in their arterial blood

12

What are some Lab work for COPD? (Deals more with complications than with COPD)

Complete Blood Count (CBC)
-Red Blood Cells
-Hemoglobin
-Hematocrit

Normals for males are slightly higher than females

 

 

13

What is the purpose of Oxygen and what are some considerations pertaining to COPD?

Relieve Hypoxemia

Used cautiously in COPD - Bc their respiratory drive may be prompted by low oxygen levels

Typical Range - 1-3L/min per NC

Can use Venturi mask if higher O2 needed; doesn't promote retention of CO2

May place NC in mouth if mouth breather

Pursed-lip breathing promotes o2/co2 diffusion in alveoli by prolonging expiration

It's unethical to withhold a higher oxygen level when needed even if you are afraid of causing respiratory issues for raising oxygen over 3L.

14

What do Bronchodilators (Beta2 Agonists-more effective for Chronic Bronchitis or Asthma form) do and what are some considerations, ex, and side effects for COPD pt?

Stimulates beta2 receptors in the lungs

May also enhance  mucous clearance by creating a larger airway

Inhaled, parenteral, & oral form

Rapis onset; peak=60-90 mins; duration=3-4 hours

Examples: Albuterol, metaproterenol, levalbuterol

Side Effects: Tachycardia, tremors, nervousness, nausea

These are relief or rescue meds (inhalers)

15

What are some considerations for Bronchodilators (Anticholinergic Agents)?

Greater effect and fewer side effects

Blocks cholinergic receptors in larger airways

Inhaled form

Peak=1-2 hours ; Duration=4-5 hours

Examples: Ipratropium Bromide (Atrovent), Atropine

Side Effects: Dry mouth, nervousness, dizziness, fatigue, headache

16

What are some considerations for Bronchodilators (Methylxanthines)?

Produce bronchodilation

Enhance mucociliary clearance

Stimulate central respiratory drive
(Help pt breath deeper)

Dec pulmonary vascular resistance
Help heart circulate blood through lungs

Increases lung function in sleep

Oral and Parenteral forms

Toxicity may occur; blood levels need to be monitored

Examples: Theophylline, aminophylline
Theophylline level=5-20mcg/ml 

Coffee, chocolate, tea or cola may interact with these meds, and increase blood levels of theyophylline levels (Do these in moderation)

 Side Effects: gastric upset, tachycardia, tremors, nervousness, N/V

 

17

What are some considerations for Corticosteroids?

Reduce airway inflammation & edema

Inhibits breakdown of epinephrine which creates bronchodilation

Inhaled, Oral and Parenteral forms

Dose should be tapered as clients improve
Chronic use leads to complications such as fat metabolism, immune responses, and changes physical appearance

Examples: Hydrocortisone sodiumsuccinate(Solu-Cortef), methylprednisolone sodium succinate (Solu-Medrol)

Side Effects: hypertension, peptic ulcer, dysphoria, hyperglycemia, cough, oral thrush, fragilie skin, thinning hair, delayed would healing and a hump between scapula

18

What are mast cell stabilizers used for and what do they do, side efgfects and examples?

Used for asthma

Supppress the release of brochoconstrictive substances during antigen-antibody reactions

Inhaled, oral, nasal & opthalmic forms

Examples: Cormolyn (intal) and Nedocromil (Tilade)

Side Effects: Sneezing, cough, throat & tracheal irritation & nausea

19

Leuokotriene Recepter Antagonists

Decrease effects of leukotrienes released into the airways
(Leukotrienes cause smooth muscle constriction, Inc vascular permeability, edema of airway mucosa, mucous release, inhibit mucous clearance, and attract eosinophils that promote inflammation) BREAK THE PROCESS AT THE FRONT DOOR (Maintenance med that helps prevent asthma attacks from occuring)

Oral form

Examples: Montelukast (Singulair) and Zafirlukast (Accolate)

Side Effects: HA, liver failure, fever, muscle aches

20

What are some nursing interventions for COPD?

HT assess with focused resp assess

Assess VS & Pulse Ox

 Provide O2 as needed
-Requires PCP order
-Standing Orders

BiPAP or CPAP may be used
Continual Postitive Airway Pressure-When they exhale they have to exhale against oxygenated air, helps keep airway open to prolong expiration
Biphasic Airway Pressure-Certain pressure when they breath in and lower pressure when they exhale (Better for Emphysema)

Allow position of comfort; High Fowler's (HOB ^) position is usually best

Instruct in pursed-lip breathing

Proved meds promptly, esp bronchodilators, as ordered

Collect sputum & send for testing; monitor amount, color & consistency

Provide oral care every 2-4 hours

Assess and treat nutritional deficits

Promote clearing of secretions

21

What are some interventions to promote the clearing of secretions?

Increase fluid intake 2-3L to thin secretions

Humidify Room and or O2

Frequent position changes
The secretions go where gracity takes it so you want to move it around

Instruct in deep breathing and coughing

Huff coughing - Series of small coughs and then one BIG cough - which is better for COPD pt

Give chest physiotherapy
Percussional vibrations to break up mucous

Suction if indicated

22

What are some O2 safety teaching/health promotion for COPD patients?

No smoking or sources of ignition

No petroleum based products

Conventrator vs. tank-based

Always ground self before touching client

23

What are some nutritional teaching/health promotions for COPD patients?

Frequent small meals

Inc Calories, Inc fats & proteins, Dec Carbs

Liquids & soft foods easier to handle

If supplements used, use those designed for pulmonary clients

Encourage easy food prep or prepared foods

Work with resources & preferences

24

What are some Energy/O2 conservation teching/health promotions for COPD pt?

Diary of activity

Help client prioritize

Use inhalers before activities

Plan activites in small steps

Plan frequent rest periods

25

What are some exercise teaching/health promotions for COPD?

Doesn't improve lung function but can strenthen respiratory muscles

Progressive walking is most common
Walk/Rest/Walk/Rest/Walk/Rest

O2 may be needed

Remind to deep breathe and use pursed-lip breathing

26

What are some socialization and sexuality teachings/health promotion?

Encourage Socialization
During meals & exercise=good time
Use technology (Email  & chat rooms)

Sexuality
Assume passive positions
Use massage as part of foreplay
Have partner play more active role

27

What are some teachings as to how to minimize infections?

Proper hand hygeine

Identify allergens & avoid (may require lifestyle change)

Avoid contact w/ those who have coughs or fevers

Notify PCP quickly: Changes in sputum, level of dyspnea, fever develops

Encourage influenza and pneumoccoccal vaccinations

28

What are some teachings for Peak Flow?

Values drop ~24 hrs before acute asthma attack manifests

Monitor daily and record

Follow designated action plan

Use HEPA filter system, esp in sleeping areas
(Very effective in minimizing allergic responses)

29

What are some inhaler/nebulizer use teachings?

Cleaning of Equipement

Rinse mouth after corticosteroid/anticholinergic use

30

What is Pneumonia?

An inflammatory process within the lungs, in response to injurty or organism, that results in a marked increase in interstitial and alveolar fluid.

Pneumonia & influenze are the 6th leading cause of death

2nd most common hospital-acquired infection (Highest mortality)

31

What causes pnemonia (Infectious agents, aspiration, inhalation of toxic or caustic agents) Give examples of each?

Infectious:
Bacteria
Viruses
Mycoplsmas
Fungal Agents
Protozoa

Aspiration:
Food
Fluids
Vomit

Inhalation of toxic or caustic agents:
chemicals
smoke
dust
gses

32

What are some risk factors for pneumonia?

Smoking History

Advanced Age
Changes in anatomy and ability to resist process

Upper Respiratory Infection

Immobility

Immunocompromised
Chemotherpy, HIV, etc

Tracheal Intubation
Just like foley catheter - Can carry bacteria

Malnutrition
This is where you get all essential chemicals for all processes in the body and to help w/ energy to repair

Dehydration
Makes the secretions thick

Chronic Disease
Resp, Cardiac, Diabetes, Kidney, Cancer
Effect on Nutrition nd Life of tissues round Cancer

Air Pollution

Dec LOC
Drugs, ETOH, anesthesia, disease, diability

Residence in institution

Difficulty swallowing

 

33

What are the steps or process  of Pnemonia?

Agen or organism produces inflammatory response of lower airways

Dec cough and or ciliary activity leads to colonization; infection develps

Fluid in alveoli consolidates (difficult to expectorate)

O2/CO2 exchange is impaired

34

What are some signs and symptoms of Pneumonia?

Fever, chills, sweats

Pleuritic chest pain

Productive cough

Hymoptysis
Blood streaking/tinting in the sputum

Dyspnea

Headache

Fatigue
Immune system activated and their immune system is focusing on fixing the infection

Altered mental status/confusion & dehydration
(OFTEN 1ST SIGN IN OLDER ADULTS)

Diminished BS, crackles or rhonchi

Tachypnea & Orthopnea

Dec Bowel sounds if resp distress is signifigant
B/c your immune system is focusing on breathing it can cause an ileus

Dec O2 stat possible

35

What happens to the client if they fail to get treatment, prolong treatment or don't respond to treatment of pnemonia?

Respiratory Failure
Become Hypoxemic; Usually people who have COPD to being with

Pneumothorax
Coughing too much and too hard

Fractured Rib

Sepsis
Infection in the blood
(Inflammatory process didn't keep infection and it released into blood)
 

36

What are some diagnostics and labs for pneumonia?

Chest X-Ray

Sputum for Gram Stain and a culture & sensitivity

Bronchoscopy (to remove foreign material or for a sample)

Aterial Blood Gases (ABGs)
Level of gas exchange and their pH level

CBC - esp WBC count with differential
When they move from pneu to sepsis -WBC could be normal and there is an absent of fever

Blood Cultures

37

What is some pharmacology for Pneumonia?

Oxygen:
May or may not be required
Hypoxemia will guide PCP decisions

Bronchodilators

Antibiotics

38

What are some Antibiotic considerations, examples and nursing implications?

Broad spectrum antibiotics; Does not treat viral

Different types; Some interfere w/ replication of invading organism

IV, IM, and oral form

Examples: Cefazolin Sodium (Ancef), Ceftriaxone Sodium (Rocephin)

Nursing Implications: 
- Assess for allergies
- Watch for S&S of nephrotoxicity
- Collect sputum prior to starting, if possible
- Complete dosing regiment

39

What are some Expectorants considerations, examples and nursing implications?

Reduces adhesiveness and surface tension of secretions; making them easier to cough up

Liquid and tablet form

Example: Guaifenesin (Robitussin or Humibid)

Side Effects: 
Nausea or Drowsiness

Nursing Implications:
Inc fluid intake to help loosed secretions (at least 2-3L/day)
May interact with Heparin & inc risk of hemorrhage

40

What are some Antitussives considerations, examples and nursing implications?

Act on cough center of medulla to Dec cough reflex

Not Desirable with pneumonia but may see used if client's cough is non-productive and depriving of sleep

Liquid, capsule, and lozenge

Example: Codeine, dextromorphan hydrobromide (Robitussin DM)

Side Effects: 
dizziness, drowsiness, N/V, constipation

Nursing Implication:
Insure safety with ambulation
Instruct to cough intentionally every hour to clear secretion

41

What are some nursing interventions for pneumonia?

HT assess with focuse resp assess

Assess VS & pulse ox
Focus on temp, pulse and Respiration

O2 if needed

Allow position of comfort; High Fowlers is usually best

Pursed-Lip breathing (If COPD is present)

Provide meds promptly, esp bronchodilator, as ordered

Collect sputum & send for testing; monitor amount, color and consistency

Provide oral care

Assess and treat nutritional deficits
No carb restriction if no COPD

Promote clearing of secretions

O2 Safety

Nutrition

Energy/O2 conservation

Encourage socialization

42

What are some room assignment considerations with a pneumonia client?

Private room if available

Cohort with similar diagnosis

Keep clients 3-6 feet apart

43

What are some infection control considerations?

Droplet Precautions

Mask on client if transported

Stay 3-6 feet away from other people until cough has subsided or few days of antibiotics

44

What are some Bronchoscopy interventions?

Requires permit

NPO

IV sedation & topical anesthesia to throat; gag reflex

Aspiration precautions; side-lying position

Observe for Complications: 
Stridor from laryngeal edema
Frank bleeding from lungs

45

What are some teaching and health promotions for pneumonia?

Instruct in infection control:
- Avoid close contact w/ those who have cough/fever
- Cough & sneeze into tissue; dispose promptly
- Proper Hand Hygeine

Encourage Vaccinations: 
-Influenza yearly
-Pneumococcal for high-risk clients (q5Years)

Maintain appropriate rest & exercise: 
- 6-8 hrs nightly
-30-60 min's aerobic exercise most days/week

Eat balanced diet w/ adequate hydration

Support smoking cessation

46

What are some alternative therapies for pneumonia?

Apples & Pears
Protect lungs

Vitamin A 
Promotes healthy lining of lung

Mullein
Dec cough, kills bacteria & viruses, and aids in expectoration

47

What is tuberculosis and what is the epidemiology?

An infection by the organism, mycobacterium tuberculosis

May occur in lungs (Pulmonary TB) or various other organs

Epidemiology:
- Estimated 8 mil new cases yearly
- ~3 mil people dying annually
- Cases have been identified in Payne County
- Multiple drug resistant strains now

48

What is the etiology for TB?

It is caused by inhaled organism that reached the aveoli

Organism  very small (1-5mm) and is actively airborne during coughing, talking, laughing, sneezing or singing (Any form of exhalation)

Brief exposure doesn't usually cause infection

Organism must resis body's defenses and penetrate lung issues.

49

What are some risk factors for TB?

Immunocompromise
HIC, Cancer tx, malnourished

Manutrition
Poverty, ETOH abuse, drug abuse

Freq contact with medically underserved
low-income, homeless, foreign-born, drug abusers

Close confinement in a residential facility or institution

Occupational Exposure
HEALTHCARE WORKERS

50

How does TB develop?

Airnborn TB bacilli are inhaled

Inflammatory process develops pneumonia

WBCs ingest bacilli but don't kill them

Infected WBC carry bacilli to lymph system and other organs

Primary infection site may cause active or dormant TB

Body develops an allergic response(cell mediated immune response) to TB bacilli or their proteins
- Takes 2-6 weeks
-Occurs in all the body's cells
- Inhibits further growth and bacilli and dev of active TB
- Maintained as long as living bacilli is in body

 

51

What happens during Active TB?

- Process of necrotic degeneration (caseation) produces cheese-filled cavities of TB bacilli, dead WBCs and necrotic lung tissue

-Liquifies, drains and is coughed up

- Air-filled cavities remain

52

What happens during dormant TB?

Process of forming scars & calcified lesions (Ghon tubercles) that "wall-off" and contain living bacilli, even for many years

53

What are some S&S of TB?

Dormant TB may be asymptomatic and only diagnosed by skin testing and chest x-ray

Cough - Productive and nonproductive
Color of sputum

Fatigue

Anorexia and weight loss

Low grade fever

Chills & night sweats

Dyspnea

Hemoptysis

 Chest tightness or pleurisy

Crackles or friction rub

54

What happens if TB is not treated?

Respiratory Failure

Infection of other organs
Brain, liver, kidney's and bone

55

What are some diagnostic and labs for TB?

Tuberculin Skin Test

Acid-fast bacillus smear and culture

Chest X-Ray
(May see Ghon tubercles or air-filled cavities)

Liver Function Tests

 

56

What is and what are some considerations for the TB skin test?

uses purified protein derivative (PPD)

0.1ml injected intradermally on L forearm

Examined in 48-72 hours

Induration >5mm (hardening of tissue), not erythema, = positive (Anergy=Inadequate immune response)

False positive and false negatives can occur

Tuberculin converter = someone with documented neg TB skin test but now shows positive results

57

What is and what are some considerations for Acid-Fast bacillus smear and culture test for TB?

3 sputum samples collected on 3 consecutive mornings

Acid-fast smear on each sample

Positve results = active TB disease

Culture done on each sample
-Pos for active TB if mycobacterium tuberculosis is grown

58

What are a couple of the liver function tests for TB?

AST (SGOT)

ALT (SGPT)

Liver enzymes released when liver cells are damaged

59

What is some pharmacology general information for TB?

Drug resistant strains have developed

Multi-drug approach recommended by CDC
- Induction phase: 2 months of 4 meds
- Continuation phase: 4 month-2years of 2 meds

Compliance= MAJOR problem
- Cost and Side Effects
-Client Population
-Various health initiative to address (free meds and follow up, Directly observed therapy= healthcare personnel observe or administer client's meds daily for 6 months

60

What are 5 first line Antituberculosis Agents?

Isoniazid (INH)

Rifampin (RIF)

Pyrazinamide

Ethambutol

Streptomycin

(Oral form is most common)

(Some inhibit growth and some kill bacteria)

61

What are some side effects of Antituberculosis Agents for TB?

Hepatoxicity
(Inc liver enzymes, N/V, anorexia, fatigure, jaundice)

Streptomycin
May be ototoxic and nephrotoxic

RIF
Colors body fluids orange (urine, sweat, salive, aputum & tears), GI upset, renal failure

Pyrazinamide
May cause Gout

Ethambutol
May be ocular toxic, causing multiple visual changes

INH
May causeperipheral neuritis (Paresthesias of feet and hands)
 

62

What are some nursing interventions for Antituberculosis Agents for TB?

Instruct in importance of completion of drug regimen

May divide RIF dose in half and take twice daily with meals

Monitor liver function tests

INH may cause Vit B6 deficiency; supplementation usually encouraged

63

What are some things to avoid with INH TB meds?

Thyamine-Containing = Palpitations, flushing & BP
-Beer, wine, processed meats, yeast, aged cheese, smoked fish

Histamine-containing = HA, Inc BP, palpitations, sweating, itching, flushing and diarrhea
-Tuna, Sauerkraut, Yeast

64

What are some nursing interventions and considerations for TB?

HT assess with focused resp assess

Assess VS & pulse ox

Collect putum & send for testing; 3 samples, 3 consec mornings

Assess and treat nutritional deficits

Room Assignment = PRIVATE

65

What are some infection control precautions for TB?

Airborn Precautions: 
- N95 fit-tested respirator for all staff entering room
-Neg airflow room with at least 6 air exchanges/hr
- HEPA filter
-Ultraviolet lights (proven to kill mycobacteria) OPEN WINDOWS

Contact List: 
-All close contacts identified and screened with TB skin test

66

What are some teachings and health promotions for TB?

Emphasize significance of completeing drug regimen as ordered

Promote high calorie, high protein, well balanced diet (Teach regarding thyramin & histamine containing foods)

Encourage yearly TB skin testing for high-risk client group

Teach client with dormant TB when to see PCP
- Review S&S of active TB
-Esp. productive cough of blood-tinged sputum, fever, wt loss & night sweats

67

What are some cultural considerations for TB?

Certain traditions of native Americans may increase risk for TB (Sharing of ceremonial pipes) and COPD (Smoking)

Chronic, debilitating illnesses (Ie: COPD) may precipitate spiritual distress for some clients (bargaining, blaming, repenting, evaluating life choices)