Tuberculosis
An infectious disease that may affect almost all tissues of the body, especially the lungs.
-Negative pressure private room
- Always wear N95 mask.
s/s: Blood in sputum
latent TB
refers to an infection with mycobacterium tuberculosis but no current active disease.
-may lead to active TB if the immune system
-HIV or advanced age are examples
Tuberculin skin test
�is considered positive if the swelling after 48-72 hours is:
-5mm for people who have a history of contact with infectious TB or are immunocompromised
- 10mm in recent immigrants, or homeless
-15mm for those who are at a low risk.
Rifampin
administered for TB
-can cause orange secretions
Pursed lip breathing
a technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping
-done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure.
"Sit up tall, close
COPD
-Includes related diseases such as emphysema, chronic bronchitis, and chronic obstructive asthma.
-Bronchodilators and anti-inflammatory agents are used to stable condition. O2 should be maintained between 88%-92% with low level of supplemental oxygen
increases risks for developing COPD
-smoking (90% of risk)
-ATT deficiency, biomass fuels use
-occupational exposure
-increase in air pollution.
Asthma
-Chronic lung disease characterized by reversible airway obstruction, airway edema, or swelling from inflammation, and increased airway hypersensitivity.
Cough
usually indicates obstruction of lager airways and dyspnea normally indicates inflammation of the airways, mucosal edema, and excessive secretion of mucus, which causes a plugging of the small airways.
~asthma~
respiratory distress
During ____________ apply high-flow 02 and monitor via pulse oximeter
~asthma~
Goals for asthma
manage under lying symptoms and include:
-minimizing irritation of the airway passage
-relieving obstruction by secretions
-edema, or bronchospasm.
-Preventing or controlling infection or allergy.
-Increasing tolerance for activity.
-Determining best drug
Intermittent Asthma
symptoms less than once a week, short lasting only a few hours, present at night no more than twice a month.
-Treated with as needed low dose inhaled corticosteroids (ICS)-formoterol.
-Low dose ICS taken whenever inhaled short acting beta agonist (SABA) i
Mild Asthma
symptoms occur more than twice a week but not daily, and at night three to four times per month.
- Treated with daily dose ICS, or as needed low dose ICS-formoterol.
-LTRA or low dose ICS taken whenever SABA is taken
Moderate Asthma
symptoms occur daily and cause limitation to activity and are present at night at least once a week.
-Treated with low dose ICS-LABA.
-Medium dose ICS, or low dose ICS+LTRA.
Severe Asthma
episodes are frequent and severely limit physical activity, also frequently present at night.
-Step 4 treated with medium dose ICS-LABA, high dose ICS, add-on tiotropium or add-on LTRA.
-Step 5 treated with high dose ICS-LABA, add low dose oral corticoste
influenza
There are 4 types (A,B,C, and D).
-type A and B are responsible for the seasonal disease epidemics
-C causes a mild respiratory illness
-D affects cattle.
Influenza S/S
occur 2 to 3 days after exposure and include:
headache, fever, child, and muscle aches,sore throat, hacking cough, runny nose, nasal congestion, sensitivity to light, nausea, vomiting, and diarrhea can occur.
Influenza VS and Tests
-WBC is normal or slightly below normal.
-Chest x-ray is normal
-Viral culture, serology, rapid molecular assays, or rapid influenza diagnostic tests may be used.
Influenza Management
-Increase fluid intake to at least 3000ml per 24 hours
-saline gargles for sore throat
-cough suppressant at night time
-mouth care every 4 hours
-manage fever
-cater to patients food and drink preferences within limits
-humidify inhaled air
-apply emolli
Pneumonia
Is extensive inflammation of the lungs with either consolidation of the lung tissue as it fills with exudate or interstitial inflammation and edema"
-Can be caused by a virus or bacteria.
-Bacterial tends to be more common with worse symptoms
-Can also o
Pneumonia prevention
includes people over 65 getting a pneumonia vaccine
-ensuring frequent turning coughing with deep breathing for postop patients,
-aspiration prevention and avoiding infection.
pneumonia S/s
-a high fever
-chills
-a cough with rusty or blood-flecked sputum
-sweating
-chest pain
-feeling of weakness (malaise)
Walking pneumonia S/S
tend to be systemic
-body temperature could be normal
-breath sounds may be normal or a few crackles or wheezes heard
-headache
-abdominal pain
-diarrhea
-myalgias are common
Pneumonia treatment
Usually treated with antibiotics:
first signs of decreasing oxygenation
may be restlessness or confusion.
-Patient should breathe deeply and cough 5 to 10 times each hour while awake
~pneumonia~
Sinusitis
Is inflammation of the mucosal lining caused by infection or allergies.
-Rhinosinusitis is the preferred term.
-Most commonly caused by viral infection.
-Often occurs after colds.
-Nasal passage may be blocked by deviated septum, injury to the nose, or po
sinusitis S/S
-tenderness over the sinuses,
-purulent drainage from the nose
-nasal obstruction
-sometimes a nonproductive cough
-The upper teeth may become painful also.
sinusitis treatment
can include:
-relieving pain
-promoting drainage
-controlling bacterial infection
-reducing inflammation
-preventing reoccurrence
-Hot moist packs over the sinus area or inhaling moist steam may be helpful.
-Medications are prescribed to promote the decon
Epistaxis
nosebleed"
Can be caused by decreased humidity, excessive nose blowing, allergy with inflammation, nose picking, trauma, hypertension, leukemia, overuse of nasal spray, tumors, and street drug use.
epistaxis management
the patient should sit forward and apply direct pressure by pinching the nose just below the bone close to the face for 10 to 15 minutes.
-Cold compress or ice may be applied to the nose to constrict the blood vessels.
*If there is still bleeding at the e
Surfactant
A lipoprotein produced by cells lining the alveoli, which lowers surface tension within the alveoli.
-It prevents collapse of the lungs by stabilizing the alveoli and decreasing capillary pressures
Mucous
The mucus membrane secretes mucus, which traps dust particles and bacteria
Cilia
Are small hair like projections that propel the mucus forward in the larynx, so that the person can swallow or expectorate it (cough up and spit out)
Oxygen flow through the body
Air passes through the nose, pharynx, larynx, and the trachea of the upper respiratory system, air enters the left and right bronchi, which branch off the trachea.
-The bronchi carry air into the lungs.
-The main bronchi divide into smaller and smaller br
Coughing deep breathing
-Deep breathing and coughing maneuvers helper move sputum and decrease the likelihood of complications.
-Instruct the patient to cough at least three times to be effective
Deep breathing exercises
exercises sit up and away from mattress, take a deep breath in through nose, hold for a few seconds, and slowly exhale, repeat 4 more times.
-Preform every 2 hours during the day and when awakened at night for vital signs.
Bacterial infections
gonorrhea, syphilis, chlamydia
-can be treated with antibiotics
Viral infections
cannot be treated by antibiotics
Pharyngitis
inflammation of the pharynx usually called a sore throat. -May be caused by a virus, bacteria, or fungus.
-Most cases are viral.
In-fection may progress into the larynx causing laryngitis with diminished voice or hoarseness.
*If inflammation extends to th
pharyngitis S/S
-dry scratchy feeling in the back of the throat
-mild fever
-headache
-malaise.
-The throat, tonsils, pallet, and uvula may be involved and will be red and this may cause dysphasia.
Pharyngitis management
*Uncomplicated pharyngitis usually responds to rest, warm saline gargles, throat lozenges, antiseptic spray, plenty of fluids, and mild analgesic for aches and pains
Bacterial Pharyngitis
requires antibiotic therapy
chronic pharyngitis
may require diagnostic procedures to determine the underlying cause and therapeutic measures such as humidification and filtering of environmental air.
jungle pharyngitis
treated with an antifungal agent but may be difficult to control in immunocompromised individuals.
Cancer of the larynx risk factors
-smoking
-excessive use of alcohol
-lack of fruits and vegetables in diet
-gastroesophageal reflux
-immunosuppression
-environmental exposures
-HPV
Cancer of the larynx S/S
-hoarseness that lasts over 3 weeks
-sore throat that lasts more than two weeks
-difficulty swallowing
-pain in or around the ear when swallowing
-dry persistent cough for no known reason
-blood in phlegm or saliva that last more than a few days
-lumps or
Restrictive pulmonary disorders
caused by decreased plasticity or compliance of the lungs or decreased ability of the chest wall to expand. --Disorders of the central nervous system or the neuromuscular system can cause a restrictive lung disorder.
Examples: asbestosis, sarcoidosis and
Obstructive pulmonary disorders
characterized by problems with moving Air out of the lungs, contributing to air trapping, thus making exhalation difficult.
examples:
Obstructive pulmonary disorders medications
Formoterol (Foradil)
Ipratropium (Atrovent)
Tiotropium (Spiriva)
Albuterol (Ventolin HFA, Proventil HFA, ProAir HFA, AccuNeb)
Salmeterol (Serevent)
Theophylline (Theo-Dur, other brand names) taken as an oral tablet (rarely used)
Combined medicines like Du
Restrictive pulmonary disorders medications
Cyclophosphamide
Corticosteroids
Methotrexate
Azathioprine
Emphysema
Destruction of the alveolar and alveolar-capillary walls producing emphysematous blebs.
-This leads to large, permanently inflated alveolar airspaces, making exhalation harder than inhalation, thus leading to trapped air
Emphysema S/S
-Dyspnea is an early symptom.
-Coughing that is more present in the morning.
*As the disease progresses dyspnea worsens and eventually interferes with activities of daily living,-A barrel chest is common to see in these patients.
-The skin has a pink tone
Emphysema treatments
-treated with inhaled bronchodilators and steroids.
-Oxygen is given for hypoxia.
Status asthmatics
-Unrelieved asthma attacks that are very serious
Pulmonary embolism
-This happens when a pulmonary vessel is plugged with a mass or a clot. The obstruction causes shunting, and blood is blocked from flowing past alveoli.
-Which prohibits receiving O2 or giving up CO2.
-The consequences of a PE can be minor or life threate
Pulmonary embolism S/S
-respiratory distress with dyspnea
-chest pain
-cough
-hemoptysis
-anxiety
-Hypertension
-tachycardia
-confusion
- A sudden onset of dyspnea and a drop in SpO2 in a patient at risk of thrombosis formation is very suggestive of PE.
Pulmonary embolism diagnosis
is made by ruling out other health problems, such as heart failure.
-Plasma D-dimer testing is recommended when a PE is initially suspected.
-CTPA Is ordered unless contradicted
Pulmonary embolism management
Oxygen therapy is initiated to decrease hypoxemia and intravenous heparin is normally started.
-Thrombolytic therapy may be needed for a large clot
Priorities in blunt chest injuries
-Maintenance of airway
-ensure adequate ventilation
-treatment of circulatory problems to ensure circulation of oxygenated blood.
Pneumothorax
a threat in chest injury and usually present in the period after thoracic surgery
-
Pneumothorax management
-may require nothing more than rest in administration of O2 to relieve discomfort.
*If the amount of air in the pleural space is minimal, a large bore needle may be used to aspirate it, or a one-way chest valve device may be placed.
-For greater amounts o
Hemothorax
presence of blood within the pleural cavity caused by laceration of the heart, lung, or blood vessels within the thorax.
-The blood is removed with a thoracostomy and chest drainage
Pneumothorax and hemothorax
These often occur as a result of a blunt non penetrating or penetrating injury to the chest wall.
-They cause partial or total collapse of one or both lungs.
Nasal canula
low concentrations.
-1-6L/min at 24-44% O2.
-Risk of skin irritation, humidified O2 may be required.
-The curve of the prongs should be pointed down.
Simple face mask
low to medium concentration.
-6-16L/min at 35-50% O2.
-Short term therapy, requires at least 5L/min, wipe out mask q1-2h.
Partial nonrebreather
-high concentration.
-10-20L/min at 80-90% O2.
-Cannot be used with humidity and risk of tissue pressure injury with long term use.
Venturi Mask
-24- 60% O2.
-Good for COPD patients.
-Very precise oxygen levels can be maintained.
Bronchoscopy
visual examination of the bronchi
-When a tumor is suspected, a lung biopsy may be obtained by a ______
-Monitor for bleeding and vital signs.
-Nothing given by mouth until gag reflex returns.
Contact Isolation Precautions
used for infections, diseases, or germs that are spread by touching the patient or items in the room
-examples: MRSA, VRE, diarrheal illnesses, open wounds, RSV
-PPE: gown and gloves
droplet isolation precautions
used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing
-examples: pneumonia, influenza, whooping cough, bacterial meningitis
Airbourne Precautions
We as a nurse N95 mask + contact precautions;
-are measures that reduce the risk for transmitting airbourne infectious agents
-Examples: TB, Rubella, Shingles, SARS.
needs private room, door must remain closed, confined client to room, negative air pressu
Direct Contact
exposure or transmission of a communicable disease from one person to another by physical contact
indirect contact
Exposure or transmission of disease from one person to another by contact with a contaminated object.
Labored breathing
Breathing that requires greater than normal effort; may be slower or faster than normal and usually requires the use of accessory muscles.
Clubbing of the fingers
Which finding in a female patient should indicate to the LPN/LVN that the patient is likely to have a respiratory problem?
Blood-tinged sputum
A patient is to have a bronchoscopy. The LPN/LVN should expect which finding in the postprocedure period?
Alveoli
What structure allows for gas exchange with the pulmonary capillaries during respiration?
Tobacco use, Compromised immune response, Group living conditions, Chronic renal disease
The school nurse is teaching a group of older adults about maintaining a healthy respiratory system. Which risk factor(s) for respiratory disease should the nurse include? (Select all that apply.)
I need to get enough rest and eat a balanced diet."
"I should be sure to practice good handwashing."
"It's a good idea to stay away from crowds during cold and flu season."
"I need to stop smoking.
The nurse is teaching the patient about ways to prevent inflammation in the respiratory tract. Which patient statement(s) demonstrate(s) knowledge of this subject? (Select all that apply.)
Do not suction the patient for more than 10 to 15 seconds.
The nurse is suctioning a patient who is unable to expectorate respiratory secretions from his tracheotomy. How can the nurse avoid the serious consequences of removing oxygen when suctioning this patient?
You should see your primary health care provider.
The patient tells the LPN/LVN that she has been hoarse for the past 2� weeks. Which response by the nurse is most appropriate?
Rest assists in keeping the immune system healthy.
It is appropriate to teach patients to obtain sufficient rest to help decrease the frequency with which they contract upper respiratory infections. How does rest help prevent respiratory infections?
Cilia
To defend against exposure to foreign particles, the mucous membrane of the respiratory tract contains tiny, hairlike projections. What are these called?
Sitting, facing the side of the bed
The nurse is caring for a patient who is going to have a thoracentesis performed. How should the nurse position the patient for this procedure?
Glomerulonephritis
A patient with a sore throat is to have a throat culture to establish whether the infection is being caused by Streptococcus. If it is a streptococcal infection and the patient is not treated, what may the patient be at risk for?
Antihistamines, corticosteroids, and decongestants
What are some commonly prescribed drugs used for allergic rhinitis and sinusitis?
Perform tracheostomy care, Maintain aspiration precautions, Develop an alternate communication method
The nurse is caring for a patient following a total laryngectomy. Which interventions should the nurse anticipate will be needed? (Select all that apply.)
Compressing the bleeding nostril against the septum and applying ice, Monitoring airway patency, Keeping the patient sitting forward
The nurse is caring for a patient with epistaxis who is to be taken for x-rays of the skull and face. What nursing intervention(s) will be necessary? (Select all that apply.)
They are more susceptible to upper respiratory infections.
For which of these reasons is it particularly important for older adults to receive influenza immunizations?
Aspiration
The nurse is caring for a patient who has had a partial laryngectomy and is experiencing difficulty swallowing. For which complication is this patient most at risk?
Have the patient apply direct pressure by pinching his nose for 10 to 15 minutes.
A patient's nose begins to bleed. Which action should the LPN/LVN take?
Inserting a tube for breathing
The nurse is caring for a patient going to surgery for a tracheostomy. What is the purpose of a tracheostomy?
Increase fluid intake.
A patient presents at the emergency room complaining of severe throat pain "that's so bad I can hardly swallow. It feels like there's a huge lump in my throat." The patient is diagnosed with severe pharyngitis. What would the nurse include in patient teac
Persistent hoarseness
The nurse is performing an admission assessment on a patient who is scheduled for several diagnostic respiratory procedures. Which symptom(s) reported by the patient would make the nurse suspect the patient may have laryngeal cancer?
Hyperinflation of the lungs
The nurse assesses a patient with emphysema and notes a barrel chest. What is the reason for this patient's chest anomaly?
The patient will need his aminophylline dosage adjusted.
A patient taking aminophylline tells the nurse that he is going to begin a smoking cessation program when he is discharged from the hospital. Why should the nurse tell this patient to notify his physician if his smoking pattern changes?
The disease is characterized by decreased lung expansion.
The student nurse is caring for a patient with a restrictive respiratory disease. Which description demonstrates the student's knowledge of the disease?
Providing oral hygiene before and after meals
Maintaining adequate fluid intake
Providing adequate rest periods
Monitoring vital signs and respiratory status
The nurse is caring for a patient with viral pneumonia. Which intervention(s) should the nurse expect to be included in the care plan? (Select all that apply.)
Chronic bronchitis
Emphysema
The student nurse is preparing a report about COPD. The student would be correct in including which disease(s) in the report? (Select all that apply.)
Extra protein is required to repair damaged tissues.
The nurse notes that the respiratory symptoms of the patient with chronic obstructive pulmonary disease (COPD) have affected his nutrition. Which would most help improve the patient's nutrition?
Oxygen is titrated to maintain saturation levels.
A patient with COPD asks the nurse to turn his oxygen up from 3 L/min via nasal cannula to 5 L/min. The nurse assesses the patient and finds that the oxygen saturation level is at 91%. The nurse explains to the patient that she cannot turn his oxygen up t
Increase calories, protein, vitamins, and minerals.
A patient with emphysema may lose weight despite having an adequate caloric intake. What advice should the nurse give the patient regarding ways to maintain an optimal weight?
Pneumonia.
A patient who experienced high fever and chills, a productive cough, chest pain, general malaise, and aching muscles during the past week is admitted to the hospital. The nurse realizes these symptoms correspond most closely with which disease?
Albuterol
A patient with asthma is suddenly experiencing difficulty breathing, tachypnea, and wheezing. Which medication listed on the medication administration record, administered through an inhaler, should the nurse administer to this patient?