Podcast
Questions and Answers
A patient prescribed warfarin is also prescribed levofloxacin. What potential interaction should the healthcare provider be most concerned about?
A patient prescribed warfarin is also prescribed levofloxacin. What potential interaction should the healthcare provider be most concerned about?
- Decreased effectiveness of levofloxacin due to warfarin interference.
- Increased risk of nephrotoxicity due to combined drug effects.
- Increased risk of bleeding due to enhanced warfarin effect. (correct)
- Reduced anticoagulant effect of warfarin, increasing clotting risk.
Which assessment finding would be most concerning in a patient receiving vancomycin?
Which assessment finding would be most concerning in a patient receiving vancomycin?
- A decrease in blood pressure following administration.
- Mild rash on the upper extremities.
- Slight redness at the IV insertion site.
- Complaints of tinnitus and decreased hearing acuity. (correct)
A patient is prescribed azithromycin and reports taking antacids regularly. What education should the nurse provide regarding this combination?
A patient is prescribed azithromycin and reports taking antacids regularly. What education should the nurse provide regarding this combination?
- Antacids may reduce the absorption of azithromycin, decreasing its effectiveness. (correct)
- Antacids will increase the absorption of azithromycin, enhancing its effect.
- Antacids should be taken at the same time as azithromycin to reduce GI distress.
- There is no known interaction between antacids and azithromycin.
Why is clavulanic acid often combined with amoxicillin?
Why is clavulanic acid often combined with amoxicillin?
Which of the following is the MOST important to monitor in a patient receiving imipenem?
Which of the following is the MOST important to monitor in a patient receiving imipenem?
A patient with seasonal allergies is prescribed cromolyn spray. What is the MOST important instruction the nurse should provide regarding its use?
A patient with seasonal allergies is prescribed cromolyn spray. What is the MOST important instruction the nurse should provide regarding its use?
What is the primary mechanism of action of mast cell stabilizers?
What is the primary mechanism of action of mast cell stabilizers?
A patient is prescribed both cromolyn spray and a nasal decongestant. What instruction should the nurse include related to administration?
A patient is prescribed both cromolyn spray and a nasal decongestant. What instruction should the nurse include related to administration?
When are mast cell stabilizers typically considered as a treatment option?
When are mast cell stabilizers typically considered as a treatment option?
A patient reports mild nasal irritation after starting cromolyn spray. What is the MOST appropriate nursing action?
A patient reports mild nasal irritation after starting cromolyn spray. What is the MOST appropriate nursing action?
Which of the following structures is primarily responsible for gas exchange in the respiratory system?
Which of the following structures is primarily responsible for gas exchange in the respiratory system?
A patient's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 50 mm Hg, and HCO3 of 24 mEq/L. How should the nurse interpret these results?
A patient's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 50 mm Hg, and HCO3 of 24 mEq/L. How should the nurse interpret these results?
A patient with suspected tuberculosis is scheduled for sputum collection. When is the MOST appropriate time for the nurse to collect the sputum specimen?
A patient with suspected tuberculosis is scheduled for sputum collection. When is the MOST appropriate time for the nurse to collect the sputum specimen?
During a bronchoscopy, what nursing intervention is MOST important to implement before the procedure?
During a bronchoscopy, what nursing intervention is MOST important to implement before the procedure?
Which of the following factors can interfere with the accuracy of a pulse oximetry reading?
Which of the following factors can interfere with the accuracy of a pulse oximetry reading?
Which intervention is MOST appropriate when caring for a patient under airborne precautions?
Which intervention is MOST appropriate when caring for a patient under airborne precautions?
A patient with a respiratory condition has collapsed alveoli. Which substance is the patient MOST likely deficient in?
A patient with a respiratory condition has collapsed alveoli. Which substance is the patient MOST likely deficient in?
A Gram stain of a sputum sample reveals the presence of gram-negative bacteria. What is the significance of this finding?
A Gram stain of a sputum sample reveals the presence of gram-negative bacteria. What is the significance of this finding?
A patient with a history of smoking is diagnosed with lung cancer. What percentage range does smoking contribute to lung cancer cases?
A patient with a history of smoking is diagnosed with lung cancer. What percentage range does smoking contribute to lung cancer cases?
A patient is diagnosed with Potts disease secondary to long-term tuberculosis. Which area of the body is primarily affected by this condition?
A patient is diagnosed with Potts disease secondary to long-term tuberculosis. Which area of the body is primarily affected by this condition?
A patient has a chest tube inserted after a pneumothorax. Which assessment finding would indicate the chest tube is effectively resolving the pneumothorax?
A patient has a chest tube inserted after a pneumothorax. Which assessment finding would indicate the chest tube is effectively resolving the pneumothorax?
A patient is admitted with a flail chest after a motor vehicle accident. What is the most concerning physiological consequence associated with flail chest?
A patient is admitted with a flail chest after a motor vehicle accident. What is the most concerning physiological consequence associated with flail chest?
A patient is diagnosed with acute respiratory distress syndrome (ARDS). What is a key characteristic of the pathophysiology of ARDS?
A patient is diagnosed with acute respiratory distress syndrome (ARDS). What is a key characteristic of the pathophysiology of ARDS?
A patient with ARDS is exhibiting refractory hypoxemia. What does this indicate about the patient's response to oxygen therapy?
A patient with ARDS is exhibiting refractory hypoxemia. What does this indicate about the patient's response to oxygen therapy?
A patient receiving amoxicillin reports developing a vaginal yeast infection. What is the most likely explanation for this occurrence?
A patient receiving amoxicillin reports developing a vaginal yeast infection. What is the most likely explanation for this occurrence?
A patient is prescribed cephalexin (a first-generation cephalosporin) for a skin infection. Which type of bacteria is this medication most effective against?
A patient is prescribed cephalexin (a first-generation cephalosporin) for a skin infection. Which type of bacteria is this medication most effective against?
A patient with a known penicillin allergy is prescribed cefazolin, a first-generation cephalosporin, postoperatively for infection prophylaxis. What is the most important nursing action?
A patient with a known penicillin allergy is prescribed cefazolin, a first-generation cephalosporin, postoperatively for infection prophylaxis. What is the most important nursing action?
When teaching a patient about taking penicillin, what instruction should the nurse include regarding meal times?
When teaching a patient about taking penicillin, what instruction should the nurse include regarding meal times?
A patient on mechanical ventilation exhibits signs of increased agitation and restlessness. Which nursing intervention is the INITIAL priority based on the provided information?
A patient on mechanical ventilation exhibits signs of increased agitation and restlessness. Which nursing intervention is the INITIAL priority based on the provided information?
A patient receiving oxygen therapy at 6L/min via nasal cannula complains of a dry nasal passage. What nursing intervention is MOST appropriate?
A patient receiving oxygen therapy at 6L/min via nasal cannula complains of a dry nasal passage. What nursing intervention is MOST appropriate?
A patient with a tracheostomy is being prepared for discharge. Which teaching point is MOST important for the nurse to emphasize to the patient and family?
A patient with a tracheostomy is being prepared for discharge. Which teaching point is MOST important for the nurse to emphasize to the patient and family?
A patient is prescribed pseudoephedrine for nasal congestion. Which of the following conditions should the nurse recognize as a contraindication or reason for caution when administering this medication?
A patient is prescribed pseudoephedrine for nasal congestion. Which of the following conditions should the nurse recognize as a contraindication or reason for caution when administering this medication?
A patient is receiving mechanical ventilation and the nurse observes a sudden decrease in cardiac output. Which of the following ventilator-related complications should the nurse suspect?
A patient is receiving mechanical ventilation and the nurse observes a sudden decrease in cardiac output. Which of the following ventilator-related complications should the nurse suspect?
A patient receiving fluticasone nasal spray for allergic rhinitis reports experiencing frequent nosebleeds. What should the nurse recommend?
A patient receiving fluticasone nasal spray for allergic rhinitis reports experiencing frequent nosebleeds. What should the nurse recommend?
A patient taking diphenhydramine (an antihistamine) for allergic symptoms reports feeling excessively drowsy. What nursing intervention is MOST appropriate?
A patient taking diphenhydramine (an antihistamine) for allergic symptoms reports feeling excessively drowsy. What nursing intervention is MOST appropriate?
Following endotracheal intubation, the nurse auscultates the patient's lungs and hears diminished breath sounds on the left side. What immediate action should the nurse take?
Following endotracheal intubation, the nurse auscultates the patient's lungs and hears diminished breath sounds on the left side. What immediate action should the nurse take?
A patient is prescribed oseltamivir (Tamiflu) for influenza symptoms. The nurse should emphasize which of the following points regarding medication administration?
A patient is prescribed oseltamivir (Tamiflu) for influenza symptoms. The nurse should emphasize which of the following points regarding medication administration?
A patient has been on long-term mechanical ventilation and is now being weaned. Which assessment finding would indicate that the weaning process should be slowed or temporarily stopped?
A patient has been on long-term mechanical ventilation and is now being weaned. Which assessment finding would indicate that the weaning process should be slowed or temporarily stopped?
Which intervention is MOST appropriate for a patient experiencing acute bronchitis with a persistent, disruptive cough, especially at night?
Which intervention is MOST appropriate for a patient experiencing acute bronchitis with a persistent, disruptive cough, especially at night?
A patient is diagnosed with pneumonia after presenting with fever, productive cough, and coarse crackles in the lower lobes. Which of the following actions should be prioritized by the nurse based on the potential complications of pneumonia?
A patient is diagnosed with pneumonia after presenting with fever, productive cough, and coarse crackles in the lower lobes. Which of the following actions should be prioritized by the nurse based on the potential complications of pneumonia?
A patient who is immunocompromised is suspected of having an opportunistic pneumonia. Which of the following factors is MOST critical in determining the course of treatment?
A patient who is immunocompromised is suspected of having an opportunistic pneumonia. Which of the following factors is MOST critical in determining the course of treatment?
A client with a persistent cough, night sweats, and recent weight loss is being evaluated for tuberculosis (TB). Which initial nursing intervention is MOST important while awaiting diagnostic confirmation?
A client with a persistent cough, night sweats, and recent weight loss is being evaluated for tuberculosis (TB). Which initial nursing intervention is MOST important while awaiting diagnostic confirmation?
A patient is prescribed acetylcysteine via nebulizer as part of their treatment for a lower respiratory infection. What should the nurse emphasize when educating the patient about this medication?
A patient is prescribed acetylcysteine via nebulizer as part of their treatment for a lower respiratory infection. What should the nurse emphasize when educating the patient about this medication?
A patient with a history of asthma is admitted with acute bronchitis and is experiencing significant wheezing. Which class of medication would be MOST appropriate to administer FIRST?
A patient with a history of asthma is admitted with acute bronchitis and is experiencing significant wheezing. Which class of medication would be MOST appropriate to administer FIRST?
A patient is being discharged after treatment for community-acquired pneumonia. Which discharge instruction is MOST important to prevent recurrence or complications?
A patient is being discharged after treatment for community-acquired pneumonia. Which discharge instruction is MOST important to prevent recurrence or complications?
A nurse is caring for a patient with a nursing diagnosis of impaired gas exchange related to tuberculous infection. What focused assessment should the nurse prioritize?
A nurse is caring for a patient with a nursing diagnosis of impaired gas exchange related to tuberculous infection. What focused assessment should the nurse prioritize?
Which statement BEST describes the rationale for using empiric antibiotic therapy in the treatment of pneumonia?
Which statement BEST describes the rationale for using empiric antibiotic therapy in the treatment of pneumonia?
A patient with a history of heavy alcohol use is admitted with aspiration pneumonia. What is the MOST important nursing intervention to prevent recurrence?
A patient with a history of heavy alcohol use is admitted with aspiration pneumonia. What is the MOST important nursing intervention to prevent recurrence?
A patient presents with increased fremitus on the left side during a respiratory assessment. What physiological change is most likely causing this finding?
A patient presents with increased fremitus on the left side during a respiratory assessment. What physiological change is most likely causing this finding?
During percussion of a patient's chest, a nurse notes a hyperresonant sound. Which condition is most consistent with this finding?
During percussion of a patient's chest, a nurse notes a hyperresonant sound. Which condition is most consistent with this finding?
A patient with suspected pneumonia is auscultated. Which adventitious breath sound is most closely associated with pneumonia?
A patient with suspected pneumonia is auscultated. Which adventitious breath sound is most closely associated with pneumonia?
What is the underlying mechanism for the clinical manifestation of cyanosis in a patient with inadequate oxygenation?
What is the underlying mechanism for the clinical manifestation of cyanosis in a patient with inadequate oxygenation?
A patient with rhinitis is prescribed a nasal corticosteroid. What is the primary mechanism by which this medication alleviates symptoms?
A patient with rhinitis is prescribed a nasal corticosteroid. What is the primary mechanism by which this medication alleviates symptoms?
A patient with acute sinusitis is prescribed a topical decongestant nasal spray. What is an important teaching point regarding the use of this medication?
A patient with acute sinusitis is prescribed a topical decongestant nasal spray. What is an important teaching point regarding the use of this medication?
A patient diagnosed with influenza is prescribed an antiviral medication. When should the nurse administer antiviral medications for influenza to be most effective?
A patient diagnosed with influenza is prescribed an antiviral medication. When should the nurse administer antiviral medications for influenza to be most effective?
Which physiological process is the primary cause of morning headaches in patients with sleep apnea?
Which physiological process is the primary cause of morning headaches in patients with sleep apnea?
During assessment of a patient with a suspected airway obstruction, the nurse notes suprasternal and intercostal retractions. What do these findings indicate?
During assessment of a patient with a suspected airway obstruction, the nurse notes suprasternal and intercostal retractions. What do these findings indicate?
A patient is diagnosed with rhinitis following exposure to a known allergen. Which assessment finding is most consistent with this condition?
A patient is diagnosed with rhinitis following exposure to a known allergen. Which assessment finding is most consistent with this condition?
A patient with chronic sinusitis reports persistent nasal congestion, facial pain, and headache for over 12 weeks. What is the most likely underlying cause of these symptoms?
A patient with chronic sinusitis reports persistent nasal congestion, facial pain, and headache for over 12 weeks. What is the most likely underlying cause of these symptoms?
A nurse is educating a community group about influenza prevention. What should the nurse emphasize regarding the timing of influenza vaccination?
A nurse is educating a community group about influenza prevention. What should the nurse emphasize regarding the timing of influenza vaccination?
A patient undergoing polysomnography is found to have apneic episodes with a cessation of respiratory airflow lasting more than 10 seconds. Based on this finding, how should the nurse interpret this result?
A patient undergoing polysomnography is found to have apneic episodes with a cessation of respiratory airflow lasting more than 10 seconds. Based on this finding, how should the nurse interpret this result?
A patient with a complete airway obstruction is unresponsive. What intervention should the nurse prioritize to establish a patent airway?
A patient with a complete airway obstruction is unresponsive. What intervention should the nurse prioritize to establish a patent airway?
Which assessment finding would indicate that a patient is experiencing early inadequate oxygenation?
Which assessment finding would indicate that a patient is experiencing early inadequate oxygenation?
A patient who recently underwent a mediastinoscopy should be closely monitored for which of the following potential complications?
A patient who recently underwent a mediastinoscopy should be closely monitored for which of the following potential complications?
Before a patient undergoes a VATS (video-assisted thoracic surgery) lung biopsy, which nursing action is the MOST important?
Before a patient undergoes a VATS (video-assisted thoracic surgery) lung biopsy, which nursing action is the MOST important?
Following a thoracentesis, a patient reports sudden onset sharp chest pain and increasing shortness of breath. What is the priority nursing intervention?
Following a thoracentesis, a patient reports sudden onset sharp chest pain and increasing shortness of breath. What is the priority nursing intervention?
A patient is scheduled for pulmonary function tests (PFTs). Which instruction should the nurse provide to the patient prior to the test?
A patient is scheduled for pulmonary function tests (PFTs). Which instruction should the nurse provide to the patient prior to the test?
A patient with no known risk factors for tuberculosis (TB) has a tuberculin skin test (TST) administered. Forty-eight hours later, the nurse assesses the injection site and notes an area of induration measuring 12 mm. How should this result be interpreted?
A patient with no known risk factors for tuberculosis (TB) has a tuberculin skin test (TST) administered. Forty-eight hours later, the nurse assesses the injection site and notes an area of induration measuring 12 mm. How should this result be interpreted?
When taking a respiratory history, which question would be most important to ask to assess a patient's health perception-health management pattern?
When taking a respiratory history, which question would be most important to ask to assess a patient's health perception-health management pattern?
A patient with chronic obstructive pulmonary disease (COPD) reports experiencing increased dyspnea and has thick, tenacious secretions. Which intervention is MOST important to include in the patient's plan of care?
A patient with chronic obstructive pulmonary disease (COPD) reports experiencing increased dyspnea and has thick, tenacious secretions. Which intervention is MOST important to include in the patient's plan of care?
An elderly patient is admitted with pneumonia. Knowing the effects of aging on defense mechanisms, which nursing intervention is most important to include in the patient's care plan?
An elderly patient is admitted with pneumonia. Knowing the effects of aging on defense mechanisms, which nursing intervention is most important to include in the patient's care plan?
During the physical assessment of an elderly patient, the nurse observes a barrel chest and kyphotic posture. What is the best explanation for these findings, regarding the aging process?
During the physical assessment of an elderly patient, the nurse observes a barrel chest and kyphotic posture. What is the best explanation for these findings, regarding the aging process?
The nurse is assessing a patient's respiratory status and notes an increased respiratory rate, use of accessory muscles, and nasal flaring. What is the priority nursing intervention?
The nurse is assessing a patient's respiratory status and notes an increased respiratory rate, use of accessory muscles, and nasal flaring. What is the priority nursing intervention?
When auscultating a patient's lungs, the nurse hears high-pitched, musical sounds primarily during expiration. How should the nurse document these sounds?
When auscultating a patient's lungs, the nurse hears high-pitched, musical sounds primarily during expiration. How should the nurse document these sounds?
The nurse is palpating the chest wall to assess for fremitus. What does increased fremitus indicate?
The nurse is palpating the chest wall to assess for fremitus. What does increased fremitus indicate?
A patient reports a history of seasonal allergies. Which question is most important for the nurse to ask to assess the patient's respiratory health?
A patient reports a history of seasonal allergies. Which question is most important for the nurse to ask to assess the patient's respiratory health?
A patient with COPD reports feeling full quickly and experiencing weight loss. What dietary modification should the nurse suggest?
A patient with COPD reports feeling full quickly and experiencing weight loss. What dietary modification should the nurse suggest?
An older adult patient is being discharged home after treatment for pneumonia. Which statement indicates a need for further teaching regarding respiratory health?
An older adult patient is being discharged home after treatment for pneumonia. Which statement indicates a need for further teaching regarding respiratory health?
A 52-year-old female presents to the emergency department experiencing a severe asthma exacerbation. Which assessment finding would be most indicative of impending respiratory failure?
A 52-year-old female presents to the emergency department experiencing a severe asthma exacerbation. Which assessment finding would be most indicative of impending respiratory failure?
A patient with a known history of asthma is prescribed both albuterol (Proventil) and fluticasone (Flovent Diskus). What instructions should the nurse give the patient regarding the use of these medications?
A patient with a known history of asthma is prescribed both albuterol (Proventil) and fluticasone (Flovent Diskus). What instructions should the nurse give the patient regarding the use of these medications?
A patient with COPD is being discharged home on oxygen therapy. Which statement indicates that the patient understands the safety precautions associated with oxygen use?
A patient with COPD is being discharged home on oxygen therapy. Which statement indicates that the patient understands the safety precautions associated with oxygen use?
A 68-year-old patient with COPD is admitted to the hospital with increased dyspnea and productive cough. The patient's ABG results are: pH 7.30, PaCO2 60 mm Hg, PaO2 55 mm Hg, HCO3 30 mEq/L. Which intervention is most appropriate for this patient?
A 68-year-old patient with COPD is admitted to the hospital with increased dyspnea and productive cough. The patient's ABG results are: pH 7.30, PaCO2 60 mm Hg, PaO2 55 mm Hg, HCO3 30 mEq/L. Which intervention is most appropriate for this patient?
A patient with a history of exercise-induced asthma (EIA) is preparing to participate in a 5K run. What is an important recommendation the nurse should provide to prevent bronchospasm during the event?
A patient with a history of exercise-induced asthma (EIA) is preparing to participate in a 5K run. What is an important recommendation the nurse should provide to prevent bronchospasm during the event?
A patient with COPD has developed cor pulmonale. Which assessment finding is most closely associated with this complication?
A patient with COPD has developed cor pulmonale. Which assessment finding is most closely associated with this complication?
A patient is prescribed montelukast (Singulair) for long-term asthma control. Which statement indicates the patient needs further teaching regarding this medication?
A patient is prescribed montelukast (Singulair) for long-term asthma control. Which statement indicates the patient needs further teaching regarding this medication?
A 45-year-old patient with asthma is admitted for an elective surgery. Which medication should be continued throughout the perioperative period unless otherwise directed by the anesthesia provider?
A 45-year-old patient with asthma is admitted for an elective surgery. Which medication should be continued throughout the perioperative period unless otherwise directed by the anesthesia provider?
A patient with COPD is being evaluated for pulmonary rehabilitation. Which assessment finding would be most indicative of their suitability for this program?
A patient with COPD is being evaluated for pulmonary rehabilitation. Which assessment finding would be most indicative of their suitability for this program?
A patient with a history of asthma and allergic rhinitis reports increased symptoms during the spring. Which intervention would be most appropriate to recommend at this time?
A patient with a history of asthma and allergic rhinitis reports increased symptoms during the spring. Which intervention would be most appropriate to recommend at this time?
A 30-year-old female with asthma reports increased symptoms during her menstrual cycle. Which factor likely contributes to this phenomenon?
A 30-year-old female with asthma reports increased symptoms during her menstrual cycle. Which factor likely contributes to this phenomenon?
A patient with COPD is being assessed for the effectiveness of their bronchodilator therapy. Following administration of a bronchodilator, which objective finding indicates a positive response?
A patient with COPD is being assessed for the effectiveness of their bronchodilator therapy. Following administration of a bronchodilator, which objective finding indicates a positive response?
A patient with COPD and a history of smoking asks about ways to prevent further lung damage. Which recommendation is most important for the nurse to emphasize?
A patient with COPD and a history of smoking asks about ways to prevent further lung damage. Which recommendation is most important for the nurse to emphasize?
A construction worker with no prior history of respiratory illness develops occupational asthma. Which measure would be most effective in preventing further exacerbations?
A construction worker with no prior history of respiratory illness develops occupational asthma. Which measure would be most effective in preventing further exacerbations?
A nurse is teaching a patient about the appropriate use of a peak flow meter. Which statement by the patient indicates a correct understanding of the procedure?
A nurse is teaching a patient about the appropriate use of a peak flow meter. Which statement by the patient indicates a correct understanding of the procedure?
Flashcards
Primary purpose of the respiratory system?
Primary purpose of the respiratory system?
Exchange of gases (O2 and CO2).
Alveoli
Alveoli
Tiny air sacs in the lungs where gas exchange occurs.
Surfactant
Surfactant
Lipoprotein that reduces surface tension in the alveoli, preventing collapse.
Atelectasis
Atelectasis
Collapsed alveoli.
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Anatomic dead space
Anatomic dead space
Airways where no gas exchange occurs (trachea and bronchi).
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PaO2
PaO2
Partial pressure of oxygen in arterial blood.
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SaO2
SaO2
Oxygen saturation in arterial blood.
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Sputum Studies
Sputum Studies
Used to diagnose lung infections and abnormal cells. Collected in sterile container.
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Lung Cancer: Late Symptoms
Lung Cancer: Late Symptoms
Lung cancer often presents late due to nonspecific symptoms that can be masked by smoking or other respiratory conditions.
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Pneumothorax
Pneumothorax
Air in the pleural space leading to a collapsed lung.
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Iatrogenic Pneumothorax
Iatrogenic Pneumothorax
A pneumothorax caused by a medical procedure.
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Tension Pneumothorax
Tension Pneumothorax
Air enters the pleural space but cannot escape, compressing the lung and mediastinum.
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Hemothorax
Hemothorax
Blood in the pleural space.
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Flail Chest
Flail Chest
Two or more adjacent ribs are fractured in multiple places, leading to instability of the chest wall.
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Pleural Effusion
Pleural Effusion
Fluid accumulation in the space between the lungs and the chest wall.
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ARDS
ARDS
A severe lung condition caused by widespread inflammation & damage to alveoli. Common cause is sepsis.
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Refractory Hypoxemia
Refractory Hypoxemia
Severe hypoxemia that does not improve with supplemental oxygen.
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Acute Bronchitis
Acute Bronchitis
Inflammation of the mucous membrane of the bronchial tree.
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Bronchitis Symptoms
Bronchitis Symptoms
Cough, sputum, headache, fever, malaise, dyspnea, chest pain.
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Bronchitis Treatment Goals
Bronchitis Treatment Goals
Symptom relief and prevention of pneumonia.
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Pneumonia
Pneumonia
Acute infection of the lung parenchyma.
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Pneumonia Symptoms
Pneumonia Symptoms
Cough, fever, chills, dyspnea, tachypnea, chest pain, crackles.
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Pneumonia Treatment
Pneumonia Treatment
Broad-spectrum antibiotics, supportive care.
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Empiric Antibiotic Therapy
Empiric Antibiotic Therapy
Started before culture results return.
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Hospital-Acquired Pneumonia
Hospital-Acquired Pneumonia
Infection acquired in a non-intubated patient 48 hours after hospital admission.
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Aspiration Pneumonia
Aspiration Pneumonia
Entry of substances from the mouth or stomach into the trachea and lungs.
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Tuberculosis Symptoms
Tuberculosis Symptoms
Initial dry cough, fatigue, malaise, night sweats, fever.
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Vancomycin
Vancomycin
Inhibits bacterial cell wall synthesis; used to treat MRSA.
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Macrolides
Macrolides
Broad-spectrum antibiotic; watch for liver and kidney toxicity.
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Beta-lactam combinations
Beta-lactam combinations
Added to broad-spectrum penicillin to boost antibacterial action.
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Monobactams
Monobactams
Narrow-spectrum antibiotic for respiratory, urinary, and abdominal infections.
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Carbapenems
Carbapenems
Broadest spectrum antibacterial; lower resistance, but watch for superinfections.
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Tracheostomy
Tracheostomy
Surgically created opening in the trachea to establish an airway, bypass obstruction, remove secretions, allow long-term ventilation, and facilitate weaning.
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Endotracheal Tube
Endotracheal Tube
Flexible tube inserted through the mouth into the trachea, connected to a ventilator to assist breathing during anesthesia, trauma, or illness.
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Antihistamines
Antihistamines
Medications that bind to H1 receptors, blocking histamine release to relieve allergy symptoms like itching and sneezing.
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Non-Opioid Antitussives
Non-Opioid Antitussives
Medications that act on the central nervous system (CNS) to increase the cough threshold, reducing the urge to cough.
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Nasal Glucocorticoids
Nasal Glucocorticoids
Medications that inhibit the inflammatory response in the nasal passages, reducing congestion and facilitating sinus drainage.
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Oral Decongestants
Oral Decongestants
Medications that stimulate adrenergic receptors, causing vasoconstriction in the nose to reduce nasal congestion.
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Antivirals (for Flu)
Antivirals (for Flu)
Medications that reduce the duration of flu symptoms and the risk of complications when started within 2 days of symptom onset.
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Venturi Mask
Venturi Mask
Oxygen delivery system that can deliver oxygen concentrations from 24% to 60% with flow rates of 4 to 12 L/min, via a specific color-coded adapter.
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Absorption Atelectasis
Absorption Atelectasis
High concentrations of oxygen can lead to alveolar collapse due to nitrogen being replaced. Signs are cough, chest pain, and crackles.
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Oxygen Toxicity
Oxygen Toxicity
Damage to the lungs due to prolonged exposure to high concentrations of oxygen. The patient may experience cough, chest pain, dyspnea, and pulmonary congestion.
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Increased Fremitus
Increased Fremitus
Increased fremitus indicates fluid or denseness in the lungs.
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Dull Percussion Sound
Dull Percussion Sound
Dull sounds during percussion may indicate a mass or pneumonia.
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Hyperresonance
Hyperresonance
Hyperresonance indicates overinflation, commonly found in COPD.
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Crackles
Crackles
Fine or coarse crackles can be an indication of pneumonia.
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Inadequate Oxygenation
Inadequate Oxygenation
Early signs include accessory muscle use, shortness of breath, and pallor. Late signs include cyanosis and poor capillary refill.
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Rhinitis
Rhinitis
Inflammation of the nasal mucosa in response to antigens.
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Rhinitis Treatments
Rhinitis Treatments
Topical corticosteroids, antihistamines, decongestants.
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Sinusitis
Sinusitis
Inflammation of sinus mucosa; can be acute, subacute, recurrent, or chronic.
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Sinusitis Treatment
Sinusitis Treatment
Decongestants, intranasal corticosteroids, analgesics.
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Influenza
Influenza
Highly contagious viral infection with subtypes A, B, C, D.
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Influenza Symptoms
Influenza Symptoms
Abrupt onset of fever, myalgia, headache, cough, sore throat, and fatigue.
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Influenza Management
Influenza Management
Vaccination, rest, fluids, antipyretics, and analgesics.
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Sleep Apnea
Sleep Apnea
Repeated upper airway obstruction during sleep.
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Sleep Apnea Risk Factors
Sleep Apnea Risk Factors
Obesity, age over 65, neck circumference greater than 16 inches.
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Airway Obstruction Interventions
Airway Obstruction Interventions
Heimlich maneuver, cricothyroidotomy, ET intubation, tracheostomy.
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Post-Sedation Monitoring
Post-Sedation Monitoring
NPO until gag reflex returns post-sedation.
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Mediastinoscopy
Mediastinoscopy
Examines the mediastinum (space behind the breastbone).
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Lung Biopsy - Nursing Care
Lung Biopsy - Nursing Care
Obtain consent, monitor distress/bleeding, chest X-ray, incision care, monitor breath sounds, encourage deep breathing.
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Thoracentesis Use
Thoracentesis Use
Obtain fluid for diagnosis, remove fluid, or instill medication.
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Thoracentesis - Nursing
Thoracentesis - Nursing
Upright, elbows on table, no talk/cough during procedure; observe for hypoxia/pneumothorax post-procedure.
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Pulmonary Function Test
Pulmonary Function Test
Measures lung volumes and airflow to diagnose disease and assess bronchodilator response.
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PFT Prep & Care
PFT Prep & Care
Avoid bronchodilators/smoking before; deep breathing instruction; rest after.
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TB Skin Test - Positive
TB Skin Test - Positive
≥15mm is positive in all individuals.
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Respiratory History - Past
Respiratory History - Past
Respiratory issues, allergies, other diseases.
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Respiratory History - Lifestyle
Respiratory History - Lifestyle
Smoking, travel and immunizations.
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Respiratory - Genetic Risks
Respiratory - Genetic Risks
COPD, asthma, cystic fibrosis.
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Respiratory Objective Data
Respiratory Objective Data
Rate, depth, rhythm, O2 sat.
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Aging - Respiratory Structure
Aging - Respiratory Structure
Calcification, stiffening cause reduced expansion.
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Aging - Respiratory Defense
Aging - Respiratory Defense
Reduced immune response, less cough force increases risk of aspiration or infection.
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Respiratory - Inspection
Respiratory - Inspection
Position, shape, symmetry, and respiratory rate.
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Bronchodilators
Bronchodilators
Medications like albuterol that relax bronchial smooth muscle, opening airways.
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Corticosteroids (for Respiratory Issues)
Corticosteroids (for Respiratory Issues)
Medications, like prednisone, that reduce inflammation in the airways.
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Mast Cell Stabilizers
Mast Cell Stabilizers
Medications suppressing histamine release which reduces inflammation.
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Cromolyn (spray)
Cromolyn (spray)
Reduces inflammation by stopping histamine release, preventing allergy symptoms.
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Cromolyn - Nursing Actions
Cromolyn - Nursing Actions
Prevents allergy symptoms, start 1 week before pollen season, use prophylactically before allergen exposure, can use with antihistamines and/or nasal decongestants.
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Anaphylactic Reaction
Anaphylactic Reaction
A severe, life-threatening allergic reaction.
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Antituberculars/Antimycobacterials
Antituberculars/Antimycobacterials
Medications used to treat tuberculosis and other mycobacterial infections.
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Mucolytics
Mucolytics
Medications that help loosen and clear mucus from the airways.
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Asthma
Asthma
A chronic inflammatory disease characterized by hyperresponsiveness and reversible airflow limitation.
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Asthma Symptoms
Asthma Symptoms
Shortness of breath and chest tightness, potentially progressing to severe hypoxemia and respiratory arrest.
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Asthma Triggers
Asthma Triggers
Air pollutants, allergens, drugs, food additives, occupational exposure, and viral infections.
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Clinical Manifestations of Asthma
Clinical Manifestations of Asthma
Wheezing, cough, dyspnea, and chest tightness.
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Asthma Complications
Asthma Complications
Pneumonia, tension pneumothorax, status asthmaticus, and acute respiratory failure.
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Status Asthmaticus
Status Asthmaticus
A life-threatening asthma exacerbation unresponsive to usual treatments.
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Asthma Medications
Asthma Medications
Bronchodilators (short-acting beta 2 agonists, anticholinergics) and anti-inflammatory drugs (corticosteroids, leukotriene modifiers).
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COPD
COPD
A progressive lung disease characterized by persistent airflow limitation.
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COPD main causes
COPD main causes
Cigarette smoking and exposure to noxious particles and gases.
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COPD Pathophysiology
COPD Pathophysiology
Chronic inflammation, loss of elastic recoil, and airflow obstruction.
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COPD Complications
COPD Complications
Pulmonary hypertension, cor pulmonale, and acute respiratory failure.
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COPD treatment goals
COPD treatment goals
Relieve bronchospasms, decrease edema, improve ventilation and prevent/treat infections.
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- The primary purpose of the respiratory system is gas exchange.
Upper Respiratory Tract Structures
- Nose
- Mouth
- Pharynx
- Epiglottis
- Larynx
- Trachea
Lower Respiratory Tract Structures
- Bronchi
- Bronchioles
- Alveolar ducts
- Alveoli
Lower Airways
- Trachea and bronchi constitute the anatomic dead space, where no gas exchange occurs.
- Bronchioles have smooth muscle that constricts and dilates.
- Alveoli are the terminal part of the respiratory tract where gases are exchanged.
- Surfactant, a lipoprotein secreted by alveoli when stretched, reduces surface tension, preventing alveolar collapse.
- Atelectasis refers to collapsed alveoli.
Nursing Process & Respiratory Defense Mechanisms
- Strategies should be developed to enhance normal respiratory system defense mechanisms.
- Nursing diagnoses should relate to abnormalities of the respiratory system.
Precautions
- Droplet precautions require a mask.
- Airborne precautions require an N95 respirator.
- Contact precautions require gloves and a gown.
Diagnostic Studies & Nursing Interventions
- Hemoglobin: Normal range is 12-18.
- Hematocrit: Normal range is 36-52.
Arterial Blood Gases (ABGs)
- pH: Normal range is 7.35-7.45.
- PaO2: Normal range is 80-100 mmHg.
- SaO2: Normal range is >95%.
- PaCO2: Normal range is 35-45 mmHg.
- HCO3: Normal range is 22-26 mEq/L.
- ABGs indicate respiratory or metabolic acidosis/alkalosis.
Pulse Oximetry
- Normal range is 94-99%.
- Factors affecting accuracy: anemia, cold extremities, IV dyes, thick nails.
PaO2 and SaO2
- PaO2: Partial pressure of oxygen in arterial blood, obtained via ABG analysis.
- SaO2: Oxygen saturation, also obtained via ABG analysis.
Sputum Studies
- Culture and Sensitivity: Diagnoses bacterial infection, selects antibiotics, and evaluates treatment.
- Gram Stain: Classifies bacteria as gram-positive or gram-negative to guide initial therapy.
- Acid-Fast Smear and Culture: Identifies Mycobacterium tuberculosis.
- Cytology: Detects abnormal cells, possibly indicating cancer.
Sputum Studies: Nursing Implications
- Obtain the specimen in the early morning after mouth care, as secretions accumulate overnight.
- Collect the specimen in a sterile container.
- Send the specimen promptly to the laboratory.
Endoscopic Testing
- Bronchoscopy: Direct visualization of bronchi using a scope to obtain specimens or remove mucus/foreign bodies.
- Before: Verify consent, NPO status ensured, patient sedated.
- After: NPO until gag reflex returns, monitor for hemorrhage or pneumothorax.
- Mediastinoscopy: Examines the mediastinum, the space behind the breastbone between the lungs containing lymph nodes, heart, and great vessels
Lung Biopsy
- Verify consent.
- Types include transbronchial, percutaneous/transthoracic needle aspiration (TTNA), video-assisted thoracic surgery (VATS), and open lung biopsy.
- Nursing Implications: monitor for distress, pneumothorax, or bleeding. Obtain chest X-ray. Incision or chest tube care. Monitor breath sounds. Encourage deep breathing.
Thoracentesis
- Used to obtain pleural fluid for diagnosis, remove pleural fluid, or instill medication.
- Explain procedure and confirm signed consent; perform a time-out.
- Position patient upright with elbows on overhead table and feet supported; instruct patient not to talk or cough during the procedure.
- Observe for signs of hypoxia or pneumothorax.
- Encourage deep breaths to expand lungs.
- Send labeled specimen to the lab.
Pulmonary Function Studies
- Measures lung volumes and airflow to diagnose pulmonary disease, assess response to bronchodilators, and evaluate disability.
- Avoid bronchodilator administration or smoking 6 hours before the exam.
- Assess height and weight.
- Instruct on deep breathing exercises.
- Encourage rest after testing to alleviate fatigue.
Tuberculin Skin Testing
- 0-4 mm: Negative.
- 5-9 mm (Category 1) Positive for people: HIV+, recent TB exposure, fibrotic lung lesions, immunosuppressed, recent organ transplants, or taking ≥15 mg prednisone daily.
- 10-14 mm (Category 2) Positive when: diabetes mellitus, end-stage renal disease, recent immigrants, homeless, institutionalized, or IV drug abusers.
- ≥15 mm (Category 3) Positive for all!
Respiratory History: Subjective Data
- Past health history of respiratory conditions, allergies, and other relevant body systems.
- Current medications, including prescription, OTC, illicit drugs, and oxygen.
- Surgical or other treatments received.
- Health perception and health management patterns, including smoking history, changes in respiratory status, characteristics of cough and sputum, and international travel.
- Immunization status.
- Family history of cystic fibrosis, COPD, and asthma.
Respiratory History: Objective Data
- Vital signs with pulse oximetry.
- Assess the nose for patency, inflammation, deformity, symmetry, and discharge.
- Assess the mouth and pharynx for color, lesions, masses, gums, and dentition.
- Assess the neck for symmetry, tenderness, and swollen nodes.
- Examine the thorax and lungs by inspection, palpation, percussion, and auscultation.
Factors Influencing Respiratory Health
- Current medications (OTC, prescribed, doses, frequency, side effects, overuse of bronchodilators).
- Past health history (colds, sore throats, sinus issues, allergies, asthma, COPD, pneumonia, TB).
- Past surgical history related to respiratory problems, dates, therapies, nebulizer/humidifier use.
- Nutrition: weight loss, fatigue, feeling full quickly, common in TB, COPD, lung cancer. Avoid fluid overload.
- Elimination: activity intolerance from dyspnea, limited mobility, and constipation.
- Sleep patterns: waking due to lung problems, asthma, COPD; chest tightness, wheezing, coughing.
- Activity patterns: dyspnea limiting activity; stress and coping levels.
Gerontological Considerations
Structural Changes
- Reduced chest expansion due to calcification of costal cartilages.
- Stiffening of the chest wall.
- Barrel chest appearance and kyphotic posture.
- Decreased chest wall movement and less deep breathing.
- Breath sounds may be decreased at the bases.
Defense Mechanisms Changes
- Immune function is reduced with decreased ability to produce antibodies.
- Less forceful cough and decreased functional cilia.
- Decreased sensation in the pharynx.
- Decreased cough effectiveness.
- Thickened mucus, increasing the risk for aspiration and infection.
Respiratory Control Changes
- Responses to changes in O2 and CO2 levels are more gradual, increasing risk of hypoxemia and hypercapnia from minor incidents.
- Decreased ability to maintain acid-base balance.
- Slight PaO2 and PaCO2 changes may occur before changes in RR.
Physical Assessment Techniques
- Inspection: Appearance, position, signs of respiratory distress, shape, symmetry, movement, respiratory rate, depth, and rhythm.
- Examine skin & nails for cyanosis and clubbing.
- Palpation: Tracheal position, expansion, fremitus (vibration of chest wall). Increased fremitus indicates fluid or denseness.
- Percussion: Assesses density and aeration of lungs.
- Dull: mass, pneumonia.
- Flat: soft, high-pitched.
- Hyperresonance: loud, low pitch (COPD).
- Tympany: pneumothorax.
- Resonance: normal sound.
- Auscultation: Listen to anterior, lateral, and posterior aspects for at least one complete respiratory cycle.
Abnormal Breath Sounds
- Crackles: Fine and coarse (pneumonia).
- Wheezes.
- Stridor.
- Pleural friction rub.
- Abnormal voice sounds: Egophony, bronchophony, whispered pectoriloquy.
Signs of Inadequate Oxygenation
- Use of accessory muscles.
- Cyanosis.
- Pallor.
- Shortness of breath.
- Poor capillary refill.
Rhinitis
- Inflammation of the nasal mucosa in response to an antigen.
- Sneezing, watery/itchy eyes and nose, congestion, and decreased smell.
- Pale, boggy, swollen turbinates.
- Headache, nasal congestion, sinus pressure, hoarseness, and cough due to nasal polyps/postnasal drip.
- Management: avoid triggers, reduce inflammation.
- Medications: Corticosteroids, antihistamines, decongestants, leukotriene receptor agonists (LTRAs), immunotherapy (allergy shots).
- No Antibiotics Listed
Sinusitis
- Inflammation of the sinus mucosa resulting in blockage and accumulated secretions.
- Risk for viral, bacterial, or fungal infection.
- Acute (1-4 weeks), subacute (4-12 weeks), recurrent (4+ infections/year), chronic (more than 12 weeks).
- Treatment: decongestants, intranasal corticosteroids, analgesics, increased fluid intake, hot showers, saline nasal sprays/lavages, warm/moist applications to the face.
- Monitor temperature and assess for bacterial changes to determine if antibiotics are needed.
Influenza
- Highly contagious viral infection with increased morbidity and mortality.
- Peak season is December to February.
- Classified by stereotypes (A, B, C, D).
- Influenza A is the most common and virulent.
- Transmission: infected droplets (1 day before symptoms to 5-7 days after).
- Abrupt onset (chills, fever, myalgia, headache, cough, sore throat, fatigue).
- Complications: pneumonia, ear/sinus infections. Older adults may experience weakness and lethargy.
- Prevention: vaccine (inactivated or live attenuated). Annual vaccination is needed, takes 2 weeks for antibody production.
- Symptom relief: rest, fluids, antipyretics, analgesia.
- Antivirals shorten the duration of symptoms and reduce the risk of complications.
Sleep Apnea
- Partial or complete upper airway obstruction during sleep, usually during REM cycle.
- Apnea: Cessation of respiratory airflow lasting more than 10 seconds.
- Hypopnea: 30-90% decrease in airflow.
- Risk factors: obesity, age over 65, neck circumference ≥16 inches, male gender, postmenopausal women.
- Frequent arousals, insomnia, daytime sleepiness, witnessed apneic episodes, snoring, morning headache, irritability.
- Hypertension, type 2 diabetes, dysrhythmias, CHD, arteriosclerosis, heart failure.
Airway Obstruction
- Medical emergency. Partial or complete.
- Choking, stridor, use of accessory muscles, suprasternal/intercostal retractions, nasal flaring, wheezing, restlessness, tachycardia, cyanosis, altered LOC.
- Immediate assessment and treatment (brain damage or death in 3-5 minutes).
- Interventions: Heimlich maneuver, cricothyroidotomy, ET intubation, tracheostomy. Partial Symptoms Intervention: chest X-ray, laryngoscopy, bronchoscopy
Oxygen Therapy: Expected patient outcomes
- Improved oxygenation
- Decreased hypoxemia
- Improved gas exchange
- Decreased workload of breathing
- Decreased myocardial stress
Oxygen Therapy: Nursing Implications
- Assess the need for oxygen therapy and obtain an order.
- Properly set up the equipment and apply devices, humidifying if needed.
- Prevent infection and decrease the risk of fires.
- Assess for complications and client response.
- Perform patient/family teaching, and document interventions.
Oxygen Therapy Complications
- Combustion
- CO2 narcosis
- Absorption atelectasis
- Oxygen toxicity
- Infection
Complications of Mechanical Ventilation
- Decreased cardiac output
- Barotrauma
- Gastrointestinal distress
- Fluid volume excess
- Alteration in acid/base balance
- Airway obstruction
- Neurological complications such as increased intracranial pressure
- Infections such as ventilator-associated pneumonia
- Musculoskeletal and integumentary complications of immobility
- Psychosocial needs
Nursing Care of Mechanical Ventilation
- Respiratory assessment
- Assess ventilator settings
- Assess patient's response to treatment
- Emergency equipment at bedside
- Maintain patency of airway
- Monitor vital signs
- ROM exercises
- Proper humidification
- Cardiovascular assessment
- Monitor lab results
- Assess GI System
- Nutritional support
- Measures to decrease anxiety
- Establish communication system
- Emotional support and teaching
Artificial Airway: Tracheostomy
- Surgically created stoma to:
- Establish a patent airway
- Bypass an upper airway obstruction
- Facilitate secretion removal
- Permit long-term mechanical ventilation
- Facilitate weaning from mechanical ventilation.
Artificial Airway: Endotracheal Tube
- Flexible plastic tube placed through the mouth and into the trachea.
- Can be connected to a ventilator.
- Inserted when receiving general anesthesia, trauma or during a serious illness.
Antihistamines
- Prototype: Brompheniramine / diphenhydramin.
- Binds with H1 receptors on target cells, blocking histamine release. Relieves acute symptoms of allergic responses (itching, sneezing, rhinorrhea).
- Side effects: sedation, somnolence, paradoxical stimulation, palpitations, dry mouth, constipation, urinary hesitancy.
- Nursing implications: warn against operating machinery, report palpitations, do not use alcohol.
Nasal Glucocorticoids
- Prototype: Budesonide, ciclesonide, fluticasone mometasone.
- Mechanism of action: inhibits inflammatory response, decreases mucosal inflammation, and facilitates drainage of sinus.
- Side effects: mild nasal irritation, mucosal dryness, nosebleed, localized fungal infection.
- Nursing implications: adherence, use on regular basis not pRn, reinforce that spray acts to decrease inflammation and it may take several days to 1-2 weeks to achieve max effect.
- Stop if infection develops
Decongestants
- Oral - pseudoephedrine.
- Mechanism of action - stimulates adrenergic receptors and promotes vasoconstriction of superficial vessels of the nose, reduces nasal congestion.
- Side effects - CN stimulations, headache, hypertension, dysuria.
- Nursing implications - tolerance variable, hypertension, DM, Glaucoma, liver, kidney, rebound congestion with overuse.
- Nasal spray- oxymetazoline: same as above
Antivirals
- Antivirals shorten the duration of flu symptoms and reduce risk of complications.
- Oseltamivir (Tamiflu) - oral med
- Zanamivir (Relenza) - oral med.
- Begin within 2 days of onset of symptoms.
Influenza Vaccine Implications
- Know the vaccine, assess the patient, administer the vaccine, monitor patient (at least 15 mins), document.
Complementary/Alternative Therapies Implications
- Zinc - May reduce duration of the cold virus
- Echinacea - may affect the immune system and anti-inflammatory effects.
- Golden Seal.
Acute Bronchitis
- Inflammation of the mucous membrane of the bronchial tree.
- Acute = up to 3 weeks Chronic = 2-3 months of the year for at least 2 consecutive years
- Self-limiting inflammation of the bronchi, usually caused by viruses.
- Symptoms: cough, clear/purulent sputum, headache, fever, malaise, dyspnea, chest pain.
- Breath sounds may reveal crackles or wheezes.
- Supportive treatment to relieve symptoms and prevent pneumonia.
- Medications:
- Beta 2 adrenergic agonists (if wheezing): Short acting inhaler (albuterol).
- Antitussives: swallowed without water and allowed to coat throat for soothing effects, then followed with increased fluid intake 30 to 60 minutes later.
- Opioids (codeine).
- Non-opioids (dextromethorphen).
- Expectorants to thin and loosen secretions.
- Guaifenesin (oral: liquid and tabs).
- Mucolytic agents to thin secretions.
- Acetylcysteine inhalation with nebulizer.
Pneumonia
- Acute infection of the lung parenchyma (fluid in lungs)
- Etiology - occur when defense mechanisms become incompetent or are overwhelmed by the virulence or infectious agents.
- Weakened cough or epiglottal reflex may allow aspiration of the oropharyngeal contents into the lungs.
- Symptoms: cough, fever, chills, dyspnea, tachypnea, pleuritic chest pain, unproductive cough, confusion secondary to hypoxia, fine coarse crackles
- Complications: multidrug resistant pathogens (MDR), MRSA and gram negative bacilli, advanced age, immune suppression, history of abx use, prolonged mechanical ventilation
- Empiric antibiotic therapy- broad spectrum abx, started before culture and sensitivity returns
- Risk factors:
- Aspiration of normal flora from the nasopharynx or oropharynx
- Many organisms that inhibit the mouth or pharynx in health adults
- Hospital acquired - nosocomial - in a non-intubated patient that begins 48 hours or longer after admission to hospital and was not present when they were admitted.
- Community acquired - occurs who have not been hospitalized or lived in a long-term facility within 14 days of infection
- Aspiration - results from the abnormal entry of material from the mouth or stomach into the trachea and lungs, seizure, anesthesia, head injury, stroke, etoh use, decrease loc
- Opportunistic - inflammation and infection of the lower respiratory tract in the immunocompromised community. at risk altered immune fx
Tuberculosis
Symptoms do not develop for 2-3 weeks after infection or deactivation. - Main: initial dry cough, fatigue, malaise, anorexia, night sweats, fever, dry cough that becomes productive and effects other organs. Bone and joint TB can cause pain dysaria and hematuria.
- Complications- scarring and residual, significant lung damage, can be fatal if untreated
- Complications of long term TB- spine Potts disease- destruction of intervertebral disc and adjacent joint, CNS- bacterial meningitis, abdomen peritonitis, kidney adrenal, lymph.
Lung Cancer
- Smoking the biggest cause
- Arise from mutated epithelial cells
- Nonspecific and appear late in the disease process
- Complications Lobar pneumonia that does not respond to treatment, masked by cough.
- Spread location depends on cancer, location, and metastatic, persistent cough with sputum.
Chest Trauma
- Pneumothorax: Air in the pleural space, leading to a collapsed lung, dyspnea, decreased chest wall movement and breath sounds, and hyperresonance to percussion.
- Requires chest tube insertion.
- Spontaneous can happen randomly
- Iatrogenic can occur due to laceration or lung procedure
- Tension occurs when air enters but cannot escape, compressing the lung.
- Hemothorax: Blood in the pleural space.
- Dyspnea, decreased/absent breath sounds, dullness to percussion, decreased hemoglobin, and shock.
- Requires chest tube insertion/drainage, autotransfusion, and treatment for hypovolemia.
- Fractures
- Signs and symptoms: paradoxical movement of chest wall, respiratory distress
- Intraprofessional care: O2 needed to maintain saturation, analgesia, positive pressure mechanical ventilation for acute respiratory distress, will also help stabilize flail segment, treat associated injuries
Restrictive Disorders
- Pleural Effusion: Fluid in the pleural space. Requires aspiration via thoracentesis.
- Atelectasis: Absence of gas or air in the lungs. Possible symptoms include SOB and chest pain
- Acute Respiratory Distress Syndrome: Sudden and progressive form of acute respiratory failure with damage to the alveolar-capillary membrane, increasing permeability to the intravascular fluids.
- Etiology sepsis, or multisystem organ dysfunction, from acute respiratory sounds of direct injuries.
- Refractory hypoxemia: Getting worse despite receiving higher concentrations of O2
Antibiotics/Antibacterials
- Penicillins (amoxicillin, ampicillin): Effective against gram-positive bacteria.
- Target areas: pneumonia, meningitis, skin, bone, joint, and GI infections.
- Nursing education: Monitor superinfection and anaphylactic, monitor bleeding, increase fluids, take 1h before or 2H after meal.
- Cephalosporins (monitor potential allergy with patients who are allergic to PCN 1-7% chance there is also an allergy)
- Generations (Cephalexin, cefazolin, Cefaclor etc...)
- Side effects: Gi distress, weakness, itching, high Dose, nephrotoxicity, bleeding, seizures can increase effect of warfarin can't mix with nephrotoxic drugs.
- Respiratory Fluoroquinolones (levofloxacin and moxifloxican): GI problems, neuralgic effects, rash
- Vancomycin (treatment of MRSA, alternative to PCN): Bacteriocidal, inhibits bacterial cell wall synthesis. Side effects: kidney/hearing toxicity IV site monitoring, skin irritation, thrombophlebitis red man
Mucoltytics
Asthma
- Diverse: characterized by bronchial hyperactivity and reversible expiratory airflow limitation. Signs and symptoms: varied Genetic Environmental Air pollution: Pathophysiology Clinical manifestations: Wheezing, diminished breath sounds Cough Dyspnea Chest tightness
- Complications Treatment: Albuterol rescue.
COPD
- Destruction of alveoli and connective tissue of the lung that gets trapped affecting gas exchange
- Vascular networks fuse together Progressive lung disease characterized by persistent airflow limitations. Cigarette smoke is the biggest cause
- Complications: o Pulmonary hypertension o Cor pulmonale o Acute respiratory failure o Depression/ anxiety
- Goals: adequate hydration, relieve bronchiospasm, mucolytics, prevent infection and psycho social needs.
Mast Cell Stabilizers
Cromolyn (spray): suppresses the release of histamine and other inflammatory mediators from mast cells Side effects: minimal, occasional irritation. Nursing Action : spray prevents the symptoms begin 1 week before pollen season starts through out, isolated use prophylactic, may use antihistamine or decongestant.
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