Pneumonia and Respiratory Assessments Quiz

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Questions and Answers

Which of the following is the most common cause of death from infectious diseases in the U.S.?

  • Staphylococcal pneumonia
  • Mycoplasma pneumonia
  • Pneumonia (correct)
  • Influenza

A patient is admitted to the hospital with severe pneumonia. The onset of symptoms occurred 72 hours after admission. This is most indicative of:

  • Community-acquired pneumonia
  • Viral pneumonia
  • Hospital-acquired pneumonia (correct)
  • Mycoplasma pneumonia

Which of the following is a common cause of pneumonia in older children and adults, which is spread by respiratory droplets causing earache?

  • Pneumococcal pneumonia
  • Viral pneumonia
  • H. influenza pneumonia
  • Mycoplasma pneumonia (correct)

Which type of pneumonia is most commonly seen in infants and children, and in immunocompromised adults, with cytomegalovirus being a common cause?

<p>Viral pneumonia (B)</p> Signup and view all the answers

Which of the following is most likely to be associated with pneumonia in debilitated patients with altered mental status, and who have had prolonged intubation or tracheostomy?

<p>Pseudomonas pneumonia (B)</p> Signup and view all the answers

Which of the following is NOT typically assessed during a physical assessment of the respiratory system?

<p>Pain level (C)</p> Signup and view all the answers

A prolonged expiratory phase is MOST associated with what aspect of respiratory assessment?

<p>Lower respiratory system (B)</p> Signup and view all the answers

Which of the following is primarily used to evaluate the effectiveness of gas exchange in the lungs?

<p>Pulse oximetry (B)</p> Signup and view all the answers

Which of the following would be classified as an 'endoscopic study' of the respiratory system?

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

Which of the following is a primary cause of atelectasis?

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

Which patient is at MOST risk for developing atelectasis?

<p>A patient on bedrest with an impaired cough (D)</p> Signup and view all the answers

Which symptom is more closely associated with acute tracheobronchitis than with atelectasis?

<p>Night sweats (B)</p> Signup and view all the answers

What nursing intervention is MOST important for a patient suffering from acute tracheobronchitis?

<p>Encouraging fluid intake (C)</p> Signup and view all the answers

Which of the following is a primary nursing intervention for a patient with a respiratory disorder?

<p>Encouraging activity as tolerated (B)</p> Signup and view all the answers

A patient with a respiratory disorder is experiencing ineffective airway clearance. Which nursing diagnosis is most directly related to this?

<p>Activity intolerance (D)</p> Signup and view all the answers

What is the primary mode of transmission for pulmonary tuberculosis?

<p>Airborne via droplet nuclei (B)</p> Signup and view all the answers

Which of the following is a typical clinical manifestation of pulmonary tuberculosis?

<p>Low-grade fever, night sweats, and fatigue (C)</p> Signup and view all the answers

A Mantoux PPD test result is considered positive and significant in a patient with normal immunity if the induration is:

<p>10mm or greater (C)</p> Signup and view all the answers

Which of the following is NOT a typical characteristic of Klebsiella-related pneumonia?

<p>MRSA resistance (B)</p> Signup and view all the answers

What does a positive Mantoux PPD test indicate?

<p>Initial exposure to TB, not necessarily active disease (B)</p> Signup and view all the answers

A patient with a history of long-term steroid use and nutritional depletion is at an increased risk for which type of pneumonia?

<p>Pneumocystis jirovecii pneumonia (PCP) (A)</p> Signup and view all the answers

Which of the following best describes the primary mechanism of aspiration pneumonia?

<p>Growth of bacteria from normal upper airway flora in the lungs (D)</p> Signup and view all the answers

What does the QuantiFERON-TB Gold test indicate?

<p>The person has been infected with TB (D)</p> Signup and view all the answers

Which of the following is a risk factor associated with the development of tuberculosis?

<p>Overcrowded living conditions and malnutrition (C)</p> Signup and view all the answers

Which of the following is NOT a common risk factor for developing pneumonia?

<p>Regular exercise and balanced diet (D)</p> Signup and view all the answers

What is one of the primary clinical manifestations of pneumonia as it relates to the breathing pattern?

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

What is often the initial diagnostic step to determine which antibiotic is needed for pneumonia?

<p>Gram Stain (B)</p> Signup and view all the answers

Besides antibiotic resistance patterns, what is another important consideration for antibiotic selection in pneumonia?

<p>Cost and availability of the antibiotic (C)</p> Signup and view all the answers

Which vaccine is specifically recommended for pneumonia prevention in certain at-risk populations?

<p>Pneumovax vaccine (A)</p> Signup and view all the answers

A patient's sputum sample is being tested for tuberculosis. When is the ideal time to collect the sample?

<p>First thing in the morning. (B)</p> Signup and view all the answers

Which of the following is NOT typically used to classify TB?

<p>Blood culture results. (A)</p> Signup and view all the answers

A patient is classified as having 'latent TB infection, no disease'. Which TB classification category does this belong to?

<p>Class 2 (B)</p> Signup and view all the answers

How long is the typical duration for the initial treatment phase with multiple medications for TB?

<p>8 weeks (D)</p> Signup and view all the answers

What vitamin is typically administered with isoniazid (INH) to prevent peripheral neuropathy?

<p>Vitamin B (C)</p> Signup and view all the answers

When is a patient with TB considered non-infectious after starting continuous medication therapy?

<p>After 2-3 weeks of continuous therapy. (C)</p> Signup and view all the answers

Which of the following precautions are not required for airborne isolation of a patient with active TB?

<p>Positive pressure room (A)</p> Signup and view all the answers

Which nursing management action is NOT a priority for a patient with TB?

<p>Increased fluid intake (D)</p> Signup and view all the answers

Flashcards

Pneumonia

Inflammation of the lungs often caused by infections or inhaled toxins.

Community-Acquired Pneumonia

Pneumonia acquired in the community, outside of a hospital setting. Common causes include pneumococcal infection, mycoplasma pneumonia, H. influenza, and viral pneumonia.

Hospital-Acquired Pneumonia

Pneumonia acquired in a hospital setting, usually more than 48 hours after admission. Common causes include VAP (ventilator-associated pneumonia) and infections from bacteria like Klebsiella, Pseudomonas, and MRSA.

Pseudomonas Pneumonia

A type of hospital-acquired pneumonia caused by the bacterium Pseudomonas, often affecting debilitated or intubated patients.

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Staphylococcal Pneumonia

A type of hospital-acquired pneumonia caused by the bacteria Staphylococcus, commonly associated with bacteremia (bacteria in the blood) and positive blood cultures.

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What is atelectasis?

A condition where alveoli in the lungs collapse due to reduced ventilation. This can happen because of excess airway secretions, abnormal breathing patterns, pain, or any condition that affects airway function.

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What are the symptoms of atelectasis?

Signs and symptoms of this condition are: difficulty breathing, coughing, sputum production, rapid heart rate, rapid breathing, chest pain, anxiety, and decreased or absent breath sounds.

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Who are at risk for atelectasis?

Patients who are post-operative, immobilized, or have a compromised cough due to bronchial obstruction are at increased risk for atelectasis.

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What is acute tracheobronchitis?

This respiratory condition refers to inflammation of the mucous membranes in the trachea and bronchial tree, often caused by an upper respiratory tract infection.

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What are the symptoms of acute tracheobronchitis?

Symptoms of acute tracheobronchitis include cough, fever, chills, night sweats, headache, weakness, and in severe cases, shortness of breath and noisy respirations.

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How is acute tracheobronchitis treated?

Medical management for acute tracheobronchitis involves medications to address symptoms like cough, fever, and inflammation.

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What are the nursing interventions for patients with acute tracheobronchitis?

Nursing interventions for acute tracheobronchitis include encouraging fluid intake to thin secretions, advising patients not to overexert themselves to avoid fatigue, and encouraging rest for recovery.

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What is the primary goal of nursing management in respiratory disorders?

The primary goal of nursing management for respiratory disorders is to improve ventilation and clear airway secretions.

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MRSA

A common bacterial infection that is resistant to many antibiotics, often found in hospital settings and can be fatal if left untreated.

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Immunocompromised Host Pneumonia

A type of pneumonia that affects individuals with weakened immune systems, often caused by opportunistic infections.

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Aspiration Pneumonia

A type of pneumonia that develops in individuals who aspirate (breathe in) foreign substances, such as food, vomit, or saliva, into their lungs.

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Pathophysiology

The study of how diseases develop and progress.

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Risk Factors

Factors that increase the risk of developing a particular disease.

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Clinical Manifestation

The physical signs and symptoms that a person experiences when they are ill.

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Broad Spectrum Antibiotics

A type of antibiotic that is effective against a wide range of bacteria.

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Antibiotic Choice

The process of selecting the most appropriate antibiotic for a given infection.

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Pulmonary Tuberculosis

A contagious infection caused by Mycobacterium tuberculosis that affects the lungs and can spread to other organs.

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TB Transmission

The spread of TB occurs through airborne droplets released when an infected person coughs, sneezes, talks, or sings.

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TB Risk Factors

Individuals with weakened immune systems, such as those living with HIV, are more susceptible to TB infection.

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Mantoux PPD Test

A skin test used to identify past exposure to TB. It involves injecting a small amount of tuberculin under the skin.

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Mantoux PPD Reaction

A reaction to the Mantoux PPD test indicates exposure to TB, but not necessarily active disease.

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QuantiFERON-TB Gold Test

A blood test that detects the presence of TB antibodies, indicating exposure to the bacteria.

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CXR for TB

A type of chest X-ray used to diagnose TB and monitor its progress.

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TB Clinical Manifestations

The typical symptoms of TB include a persistent cough, fever, night sweats, fatigue, and weight loss.

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Sputum-AFB culture for TB

Early morning sputum samples are collected over 3 days to detect Mycobacterium tuberculosis, the bacteria causing tuberculosis.

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Tuberculosis Classification (Classes 0-5)

This classification system categorizes tuberculosis based on exposure, infection, and disease activity.

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Tuberculosis Treatment Phases

The first phase of treatment involves multiple medications taken daily for 8 weeks. The second phase continues with fewer medications for another 4-7 months.

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Monitoring TB Medication Side Effects

The medications used to treat tuberculosis can cause harmful side effects. Monitoring liver enzymes, blood urea nitrogen (BUN), creatinine levels, and sputum cultures is essential.

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Tuberculosis Isolation Precautions

Airborne Isolation Precautions are taken for individuals with active tuberculosis. They include a private room with negative pressure, a respirator mask, and continued precautions until the AFB is negative, usually for 2-3 weeks.

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Vitamin B & INH

Vitamin B is commonly given along with INH to prevent the development of peripheral neuropathy, a common side effect of INH.

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INH Prophylactic Use

INH is also used as a preventive measure for people at risk of developing latent tuberculosis, typically for 6-12 months.

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Tuberculosis Nursing Management

Nursing care for patients with tuberculosis focuses on airway clearance, ensuring medication adherence, promoting activity and good nutrition, and providing education about preventing the spread of the disease.

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Study Notes

Assessment of the Respiratory System

  • Health History: Includes major signs and symptoms related to respiratory status, how these signs/symptoms affect daily activities, work, and family life; risk factors; and medical history.

Respiratory System Anatomy

  • Upper Respiratory Tract: Includes nasal cavity, pharynx, and larynx.
  • Lower Respiratory Tract: Includes trachea, primary bronchi, and lungs.

Assessment of the Respiratory System - Physical Assessment

  • General Appearance: Focuses on mental status.
  • Upper Respiratory System: Assessment of this system.
  • Lower Respiratory System (Thorax): Includes chest patterns (e.g., prolonged expiratory phase), respiratory rates, and breath sounds. (Table 20-6, p.481)

Diagnostic Evaluation of the Respiratory System

  • Lab & Diagnostic Testing: Includes arterial blood gases (ABGs), pulse oximetry, pulmonary function tests (PFTs), throat cultures, sputum analysis, complete blood count (CBC), and various imaging studies (e.g., chest X-ray (CXR), computed tomography (CT) scan, magnetic resonance imaging (MRI), and lung scans).
  • Endoscopic Studies: Includes bronchoscopy, thoracoscopy, and thoracentesis.
  • Biopsy: A procedure to remove tissue samples for analysis.

Nursing Interventions

  • Airway Management: Includes oxygen therapy (different methods), artificial airways, and tracheal care.
    • Various oxygen delivery methods are mentioned (simple face mask, partial rebreather mask, non-rebreather mask, venturi mask, nasal cannulae).
  • Goals of oxygen therapy. Correct hypoxemia by raising alveolar and blood oxygen levels; ease of measurement; decrease symptoms of hypoxemia (e.g., dyspnea/work of breathing, improve mental function).

Disorders of the Respiratory System - Atelectasis

  • Definition: Collapse or closure of alveoli due to reduced alveolar ventilation.
  • Causes: Excess secretions, abnormal breathing patterns, pain, airway issues, prolonged supine position, and musculoskeletal/neurological disorders.
  • Risk Factors: Post-operative patients, immobilized individuals, those with impaired coughing.
  • Common Causes: Hypoventilation, compression, airway obstruction, and adhesions.

Disorders of the Respiratory System - Signs & Symptoms & Diagnostic Testing

  • Signs and Symptoms: Includes insidious onset, dyspnea, cough, sputum production, tachycardia, tachypnea, and pleural pain. Signs can also include anxiety (decreased or absence of) or absent breath sounds.
  • Diagnostic Testing: Mentioned in the context of prevention (Chart 23-1)
  • Nursing Management: Improve ventilation, remove secretions.

Disorders of the Respiratory System - Treatment for Atelectasis

  • Treatment: Includes coughing and deep breathing exercises, analgesia (pain relief), early ambulation, incentive spirometry, intermittent positive pressure breathing, oxygen therapy, chest percussion, postural drainage, bronchodilators (e.g., Proventil), antibiotics, and mucolytic agents (e.g., Mucomyst). Chest tubes may also be used.

Disorders of the Respiratory System - Acute Tracheobronchitis

  • Definition: Inflammation of the tracheal and bronchial tree mucous membranes (secondary to upper respiratory infection).
  • Symptoms: Cough, fever, chills, night sweats, headache, weakness, and shortness of breath (SOB), noisy respirations.

Disorders of the Respiratory System - Medical Management

  • Medications:
  • Nursing Management: Encourage fluid intake, avoid overexertion, encourage coughing.

Disorders of the Respiratory System - Acute Bronchitis

  • Cause: Bacterial or fungal infection; chemical irritation.
  • Diagnostics: Sputum cultures, Chest films.
  • Signs/Symptoms: Initial non-productive cough, fever, malaise; later blood-streaked sputum, coughing attacks, and inspiratory crackles.
  • Treatment: Antipyretics, expectorants, antitussives, humidifiers, and broad-spectrum antibiotics.

Disorders of the Respiratory System - Acute Tracheobronchitis - Nursing Care

  • Management: Antibiotic treatment, expectorants, deep suctioning, and ventilation support.
  • Nursing Care: Increasing fluid intake, breathing and coughing exercises, encourage rest, education related to medications.

Disorders of the Respiratory System - Pneumonia

  • Definition: Inflammation of the lungs commonly secondary to infection or inhaled toxins (e.g., aspiration).
  • Cause: Inflammatory reaction in alveoli interfering with gas exchange, potentially occluding bronchi or alveoli.
  • Pneumonia Types: Different Types (Community-acquired; Hospital-acquired) described.

Disorders of the Respiratory System - Pneumonia - Types

  • Community-acquired: Pneumococcal (high fever, sputum); Mycoplasma (older children/adults, spread by droplets).
  • Community-acquired (contd.): H. Influenza (elderly, comorbidities; cough, low-grade temp); Viral Pneumonia (infants/children, immunocompromised adults).
  • Hospital-acquired: Onset of symptoms typically more than 48 hours after admission; often associated with endotracheal intubation and mechanical ventilation. Common organisms: Klebsiella, Pseudomonas aeruginosa, MRSA
  • Hospital-acquired (contd): Pseudomonas pneumonia, Staphylococcal pneumonia, characterized by destruction of lung structures and alveolar walls (consolidation).
  • Pneumonia in immunocompromised host - -PCP (Pneumocystis jirovecii pneumonia), caused by use of steroids, chemotherapy, nutritional depletion, etc. (similar organisms as CAP and HAP). Aspiration Pneumonia (aspiration of bacteria in the upper airway or other substances in the lungs leading to bacterial growth).
  • Pathophysiology (Aspiration Pneumonia): Occurs due to normal flora (or introduced substances) in the upper airway and lungs. Affects ventilation and diffusion.

Disorders of the Respiratory System - Risk Factors

  • Risk Factors: Residence in long-term care facilities, compromised immune defenses, and underlying diseases.

Disorders of the Respiratory System - Clinical Manifestations

  • Clinical Manifestations: Symptoms vary depending on type, organism, and presence of underlying diseases. Assessment; includes dyspnea, tachypnea, fever, sputum, chest pain, WBC, mental status changes, abnormalities in breath sounds (e.g., crackles, rhonchi, rales). Certain types of pneumonia may present with a variety of symptoms.

Disorders of the Respiratory System - Tuberculosis (TB)

  • Cause: Communicable infection caused by Mycobacterium tuberculosis.
  • WHO Estimates: TB is the cause of death for 11% of all AIDS patients.
  • TB Classification: The infection exists in stages (latent and disease), and is classified differently (class 0-5).
  • Medical management (TB): Anti-tuberculosis agents for 6-12 months with prolonged treatment to prevent relapse. Treatment is in stages.
  • Nursing Management (TB): Airway clearance, adherence to the treatment regimen, activity and nutrition, hygiene, and handwashing education.

Disorders of the Respiratory System - Diagnostic Testing (Pulmonary Tuberculosis)

  • Diagnostic Testing for TB includes Mantoux PPD test (exposure indicator), BCG vaccine response, and CXR. The QuantiFERON-TB Gold Test helps determine TB infection but not the stage of disease.
  • Sputum-AFB & culture: Used to diagnose TB; takes 3+ weeks to get results from the lab. Helps classify the stage of TB (classes 0-5).

Disorders of the Respiratory System - Nursing Management

  • Interventions: Airway clearance, adherence to treatment, activity, nutrition, and education on hygiene and living conditions.

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