Management of Patients with Chest and Lower Respiratory Tract Disorders
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Questions and Answers

Which of the following could be a cause of atelectasis?

  • Hyperventilation
  • Foreign body obstruction (correct)
  • Immediate postural changes
  • Excessive physical activity
  • What is a common clinical manifestation of acute atelectasis?

  • Peripheral edema
  • Chronic cough
  • Cyanosis (correct)
  • Jaundice
  • Which of the following nursing interventions is aimed at preventing atelectasis?

  • Early mobilization of patients (correct)
  • Maintaining patients in a supine position
  • Administering antibiotics proactively
  • Limiting fluid intake
  • Which diagnostic finding is typically associated with atelectasis?

    <p>O2 saturation less than 90% (C)</p> Signup and view all the answers

    What is the primary goal of atelectasis management?

    <p>Improve ventilation and remove secretions (B)</p> Signup and view all the answers

    Which treatment may be used if a patient with atelectasis is not responding to initial management?

    <p>Bronchoscopy or CPAP (B)</p> Signup and view all the answers

    Pneumonia is primarily categorized by its inflammation of which part of the body?

    <p>Lung parenchyma (C)</p> Signup and view all the answers

    What might be a complication of untreated chronic atelectasis?

    <p>Pulmonary infection (B)</p> Signup and view all the answers

    Which of the following factors may contribute to nonobstructive atelectasis?

    <p>Prolonged supine positioning (A)</p> Signup and view all the answers

    What is a key assessment finding in a patient with atelectasis?

    <p>Decreased breath sounds (D)</p> Signup and view all the answers

    What is the primary focus of treatment for viral pneumonia?

    <p>Supportive care (C)</p> Signup and view all the answers

    Which complication is associated with pneumonia?

    <p>Septic shock (B)</p> Signup and view all the answers

    What is a primary infectious agent of pulmonary tuberculosis?

    <p>Mycobacterium tuberculosis (D)</p> Signup and view all the answers

    In the treatment of tuberculosis, what is a common duration for administering anti-TB agents?

    <p>6 to 12 months (C)</p> Signup and view all the answers

    During a tuberculin skin test, a significant reaction is indicated by what size of induration for at-risk individuals?

    <p>5 mm or greater (A)</p> Signup and view all the answers

    Which of the following is a crucial nursing management approach for patients with pneumonia and tuberculosis?

    <p>Promoting airway clearance (D)</p> Signup and view all the answers

    What does a positive skin test for tuberculosis indicate?

    <p>Previous TB infection or exposure (C)</p> Signup and view all the answers

    What is a common route of transmission for pulmonary tuberculosis?

    <p>Airborne transmission (C)</p> Signup and view all the answers

    What symptom is most likely associated with ineffective airway clearance in pneumonia patients?

    <p>Copious tracheobronchial secretions (A)</p> Signup and view all the answers

    Which of the following is considered a risk factor for TB transmission in healthcare settings?

    <p>Inadequate ventilation (A)</p> Signup and view all the answers

    What characterizes Health Care-associated pneumonia (HCAP)?

    <p>The pathogens causing HCAP are usually drug-resistant. (B)</p> Signup and view all the answers

    What is a primary risk factor for developing Hospital-acquired pneumonia (HAP)?

    <p>Impaired host defenses. (A)</p> Signup and view all the answers

    Which organism is commonly responsible for Community-acquired pneumonia (CAP) in the elderly with comorbidity?

    <p>S.pneumoniae (B)</p> Signup and view all the answers

    What is a significant characteristic of Ventilator-associated pneumonia (VAP)?

    <p>It requires a minimum of 48 hours of mechanical ventilation to develop. (B)</p> Signup and view all the answers

    Which of the following is a common cause of aspiration pneumonia?

    <p>Bacterial infection. (A)</p> Signup and view all the answers

    Which diagnostic method is NOT typically included in the assessment for pneumonia?

    <p>CT scan. (A)</p> Signup and view all the answers

    What defines clinical stability in a hospitalized pneumonia patient?

    <p>Respiratory rate less than or equal to 24 breaths/min. (D)</p> Signup and view all the answers

    Which of the following is a risk factor for infection with penicillin-resistant pneumococci?

    <p>Recent antibiotic therapy. (C)</p> Signup and view all the answers

    Which type of pneumonia is most common in patients receiving corticosteroid therapy?

    <p>Pneumonia in the immunocompromised host. (C)</p> Signup and view all the answers

    Which statement is true regarding the pathophysiology of pneumonia?

    <p>Pneumonia can have varied clinical manifestations. (A)</p> Signup and view all the answers

    Flashcards

    Atelectasis

    A collapse of the lung, either acute or chronic, often caused by blocked airways or poor breathing patterns.

    Atelectasis Causes

    Causes include foreign bodies; tumors; impaired breathing; retained fluids; pain; airway issues; prolonged lying down; or increased abdominal pressure.

    Atelectasis Clinical Manifestations

    Symptoms include increased shortness of breath, coughing, sputum, fast heart rate, rapid breathing, chest pain, and bluish skin.

    Atelectasis Assessment

    Assessment includes checking breathing effort, listening to lung sounds, and measuring oxygen levels/blood oxygen.

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    Atelectasis Prevention

    Preventative measures include turning patients frequently, moving them around, and expanding lung techniques to help manage secretions.

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    Atelectasis Management

    Treatment aims to improve breathing and remove secretions. Methods include: breathing exercises, medications, and other interventions based on severity.

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    Pneumonia

    Inflammation of lung tissue caused by various germs (bacteria, fungi, viruses).

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    Pulmonary Tuberculosis

    A chronic lung infection caused by bacteria (Mycobacterium tuberculosis).

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    Nursing Process

    A systematic approach to patient care, including assessment, diagnosis, planning, implementation, and evaluation.

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    Pulmonary Infections

    Infections in the lungs, caused by bacteria, viruses, fungi, etc.

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    Community-Acquired Pneumonia (CAP)

    Pneumonia occurring outside of hospitals or healthcare facilities, or within 48 hours of hospitalization.

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    Health Care-Associated Pneumonia (HCAP)

    Pneumonia occurring in people with recent exposure to healthcare facilities, but not in hospitals.

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    Hospital-Acquired Pneumonia (HAP)

    Pneumonia developing 48 hours or more after hospital admission, not present at admission.

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    Ventilator-Associated Pneumonia (VAP)

    Pneumonia occurring in patients needing mechanical ventilation for at least 48 hours.

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    Aspiration Pneumonia

    Pneumonia caused by substances entering the lungs, often from the mouth or throat.

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    Clinical Stability Criteria for Pneumonia

    Criteria used to evaluate the improvement of a patient with pneumonia; includes temperature, heart rate, respiratory rate, blood pressure, oxygen saturation, oral intake, and mental status.

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    Common Pathogens for HAP

    Enterobacter species, Escherichia coli, H. influenzae, Klebsiella species, Proteus, Serratia marcescens, Pseudomonas aeruginosa, methicillin-sensitive or resistant Staphylococcus aureus (MRSA), and S. pneumoniae

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    Risk Factors for Penicillin-Resistant Pneumococci

    Age over 65, alcoholism, recent beta-lactam use, immunosuppression, comorbidities, and day care exposure.

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    Risk Factors for Enteric Gram-Negative Bacteria

    Long-term care facility residents, underlying cardiopulmonary disease, comorbidities, recent antibiotic use.

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    Risk Factors for Pseudomonas aeruginosa

    Structural Lung Disease, Corticosteroid therapy, Broad-spectrum antibiotics, and Malnutrition.

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    Viral Pneumonia Treatment

    Treatment for viral pneumonia focuses on providing support to the body while it fights off the infection. This includes keeping the patient hydrated, reducing fever with medications, and using treatments like humidified air, antihistamines, and nasal decongestants to help with congestion. Oxygen therapy might also be necessary to ensure proper oxygen levels in the blood.

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    Pneumonia Complications

    Serious complications can arise from pneumonia, including septic shock (a severe infection that affects the entire body), respiratory failure (the lungs can't provide enough oxygen to the blood), pleural effusion (fluid buildup around the lungs), and empyema (pus buildup in the chest cavity).

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    Ineffective Airway Clearance

    This nursing diagnosis refers to a patient's inability to effectively move mucus and secretions out of their airways, often due to pneumonia. This can lead to difficulty breathing and increased risk of infection.

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    Pulmonary Tuberculosis Agent

    Tuberculosis (TB) is caused by a bacteria called Mycobacterium tuberculosis, which primarily affects the lung tissue.

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    TB Transmission

    Tuberculosis is spread through the air, usually when an infected person coughs, sneezes, speaks, or sings. The tiny droplets released can remain suspended in the air for hours.

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    TB Risk Factors

    People at increased risk for tuberculosis include those with weakened immune systems, those living in crowded conditions, those with close contact with someone who has TB, and those who are HIV-positive.

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    TB Assessment

    Diagnosing TB involves a combination of tests and procedures. These include: a positive skin test or blood test for TB, a sputum culture for acid-fast bacilli, a complete history focusing on exposure, a physical exam looking for lung abnormalities, and a chest x-ray to visualize the lungs.

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    Tuberculin Skin Test

    The Mantoux test, using purified protein derivative (PPD) of tuberculosis bacteria, is the standard test for TB. The test involves injecting a small amount of PPD under the skin and checking for a raised, hardened area (induration) after 48-72 hours.

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    Tuberculin Skin Test Significance

    The size of the induration determines the significance of the reaction: 0-4mm is not significant, 5mm or greater may be significant for people at risk, and 10mm or greater is considered significant. A positive reaction suggests past exposure to M. tuberculosis or BCG vaccination.

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    TB Treatment

    Treatment for tuberculosis requires a combination of antibiotics taken daily for 6-12 months. Multiple-Drug-Resistant (MDR) TB is a major concern, requiring even longer and more complex treatment regimens.

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    Study Notes

    Atelectasis

    • Atelectasis is the collapse of a lung or part of a lung.
    • Pathophysiology: Can be non-obstructive (not blocked) or obstructive (blocked). Obstructive can be from reabsorption of gas or compression. Causes include foreign objects, tumors, altered breathing, secretions, pain, airway problems, prolonged lying down, and increased abdominal pressure.
    • Clinical Manifestations: Increasing shortness of breath, coughing, sputum production. Acute atelectasis includes faster heartbeat and breathing, chest pain, and bluish skin discoloration. Chronic atelectasis can lead to lung infections.
    • Assessment and Diagnostic Findings: Increased breathing effort, low blood oxygen levels, decreased/abnormal lung sounds (crackles) in the affected area, and low oxygen saturation (less than 90%). X-rays are often used.
    • Prevention: Frequent position changes, early movement, strategies to expand the lungs, and strategies to manage secretions are all helpful. (Refer to Chart 23-1)
    • Management: Improve ventilation, remove secretions. Includes Incentive spirometry, coughing and deep breathing exercises, oral hygiene, patient and staff education, and getting out of bed several times daily.(Refer to Chart 23-2) If other methods fail, more aggressive measures like positive end-expiratory pressure (PEEP), continuous positive airway pressure (CPAP), bronchoscopy, intubation, or chest drainage may be necessary.

    Pneumonia

    • Pneumonia is lung inflammation caused by various microorganisms (bacteria, mycobacteria, fungi, viruses).
    • Types: Community-acquired (CAP), health care-associated (HCAP), hospital-acquired (HAP), ventilator-associated (VAP), pneumonia in immunocompromised hosts, aspiration pneumonia.
    • Causative Organisms (Examples): Streptococcus pneumoniae (common in some types), Haemophilus influenzae, Mycoplasma pneumoniae, viruses (especially in children). HAP can be caused by various bacteria like Enterobacter, Escherichia coli, Klebsiella, Proteus, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pneumoniae.
    • Pneumonia in Immunosuppressed Hosts: Caused by weakened immune systems due to factors like corticosteroids, chemotherapy, malnutrition, broad-spectrum antibiotics, AIDS, genetic disorders, and prolonged mechanical ventilation.
    • Aspiration Pneumonia: Pulmonary consequences from substances entering the lower airways. Primarily a bacterial infection.
    • Risk Factors: Age, alcohol use, antibiotic use, immunosuppression, comorbidities, daycare exposure, long-term care facility residence, cardiopulmonary issues, recent antibiotic use, lung conditions, corticosteroid use, broad-spectrum antibiotics.
    • Clinical Manifestations: Vary depending on the type, organism, and underlying diseases, but could include fever, cough, difficulty breathing.
    • Assessment and Diagnostic Findings: Medical history, physical examination, chest X-rays, blood cultures, sputum analysis/examination (with proper preparation techniques).
    • Medical Management: Appropriate antibiotics (IV in severe cases, oral when improving), supportive care (hydration, antipyretics, inhalations, oxygen). HAP treatment may be broad-spectrum IV antibiotics initially, followed by culture-directed therapy after 72 hours.
    • Complications: Septic shock, respiratory failure, pleural effusion, and empyema.
    • Nursing Process (Pneumonia): Focuses on ineffective airway clearance, fatigue, fluid balance, nutrition, and knowledge deficits.

    Pulmonary Tuberculosis

    • Primarily affects lung tissue.
    • Causative Organism: Mycobacterium tuberculosis.
    • Transmission: Airborne.
    • Risk Factors: (Refer to Chart 23-7)
    • Clinical Manifestations: Vary, but could include cough, chest pain, fever, fatigue.
    • Assessment and Diagnostic Findings: Positive skin test/blood test/sputum culture, complete history, physical assessment (including diminished lung sounds and crackles), tuberculin skin test, chest X-ray, drug susceptibility testing if needed.
    • Tuberculin Skin Test (Mantoux): Using purified protein derivative (PPD) injected under the skin, with size of induration determining significance (0-4mm=not significant, 5mm=possible risk, 10mm=significant).
    • Medical Management: Anti-TB medications for 6-12 months. MDR (multi-drug resistant) tuberculosis requires specialized treatment. Prophylactic Isoniazid (INH) for high-risk individuals for 6-12 months.
    • Nursing Management: Promoting airway clearance, treatment adherence, activity, nutrition, and preventing transmission. (Refer to Charts 23-7 and 23-8)

    Pleural Effusion

    • Note: This chapter covers pleural effusion in the context of broader respiratory care. The details of treatment are not fully outlined.

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    Description

    This quiz explores the critical aspects of atelectasis, including its pathophysiology, clinical manifestations, assessment techniques, and prevention strategies. Understand how atelectasis affects lung function and learn the measures to avoid it. Test your knowledge on key concepts related to this pulmonary condition.

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