Pneumonia and Tuberculosis Nursing Care

• Hospital-acquired pneumonia occurs after intubation in the hospital for 48 hours or longer and was not present on admission.
• Community-acquired pneumonia occurs when not hospitalized and living in a facility for 14 days or longer.
• Nursing care involves monitoring respiratory status, administering antibiotics, elevating the head of the bed to 30 degrees, turning the patient every 2 hours, and assessing cough.

Drug Therapy for Active TB

• Ethambutol can cause headaches and blurred vision.
• Isoniazid can cause liver toxicity, increased ALT/AST, and vomiting.
• Pyrazinamide can cause liver toxicity and joint pain.
• Rifampin can cause liver toxicity and orange bodily fluids.
• Pleural effusion involves fluid collection in the pleural space and is a sign of another condition.
• Cardiac tamponade involves blood collection in the pericardial sac, muffled heart sounds, neck vein distention, and requires pericardiocentesis by a doctor.
• Flail chest involves a fracture of 2 or more ribs in 2 or more places, leading to chest wall instability and respiratory distress, with treatment including oxygen as needed and positive pressure mechanical ventilation.
• Hemothorax involves blood in the pleural space, shortness of breath, absent breath sounds, and requires chest tube insertion with chest drainage and possibly packed red blood cells.
• Pneumothorax involves air in the pleural space, shortness of breath, absent breath sounds on the affected side, and requires a chest tube for chest drainage.
• Tension pneumothorax involves air in the pleural space that does not escape, shifting organs, increasing intrathoracic pressure, causing cyanosis, air hunger, neck vein distention, and requires needle decompression and chest tube for drainage.
• Interprofessional care for pneumothorax depends on severity and underlying cause; minimal air may require no treatment, while severe cases such as collapsed lung require a chest tube to allow air to escape.
• Chest trauma interventions include monitoring ABCs, applying O2 to keep saturation over 90%, using 2 large bore IVs, covering the wound with a nonporous dressing taped on 3 sides, and not removing the object.

Chapter 31: Lung Conditions and Treatments

• Bronchiectasis involves dilated bronchioles, making it hard to clear secretions.
• Bronchiectasis also presents with abnormal dilation of medium-sized bronchi, inflammation, edema, impaired respiratory function, activity intolerance, and deficient knowledge.
• Asthma risk factors and triggers are related to person or environment, nose and sinus problems, allergens, cigarette smoke, air pollutants, genetics, and occupational exposure.
• Asthma symptoms include wheezing, cough, shortness of breath, and chest tightness.

Drug Therapy for Asthma and COPD

• Short-acting anticholinergics like Ipratropium are used for asthma and COPD, administered via nebulizer, cause bronchodilation within minutes, and can cause headache and dry mouth.
• Inhaled corticosteroids like Qvar (asthma, MDI) can cause headaches and hoarseness after 2 weeks of treatment.
• Budesonide (asthma, DPI) can cause headaches and cold symptoms after 2 weeks of treatment.
• Alvesco (asthma, MDI) can cause cold symptoms and nose bleeds.
• Fluticasone (asthma, MDI, DPI) requires rinsing mouth after use and can cause headache and cold symptoms after 2 weeks of treatment.
• Mometasone (asthma, DPI) can cause these symptoms after 2 weeks of treatment.
• Inhaled short-acting beta-adrenergic drugs like Albuterol are used for asthma and COPD, administered via nebulizer, MDI, or orally, work within 5 minutes, and can cause tremors, headaches, and tachycardia.
• Epinephrine (asthma, MDI) is available OTC, can cause tachycardia and increased blood pressure, and should be avoided with MAOIs.
• Levalbuterol (asthma, COPD, nebulizer, MDI) works within 15 minutes and can cause tremors, headaches, and rash.
• Symptoms of cor pulmonale include exertional shortness of breath, tachypnea, cough, fatigue, and chronic hypoxemia.
• Interprofessional care for COPD includes history and physical, chest x-ray, ABGs, 6-minute walk test, drug therapies, ABC techniques, hydration, immunizations, O2, surgical therapy, and lung transplant.
• Interprofessional care for cystic fibrosis includes CF foundation support, aerosols and nebulizer treatments, airway clearance techniques, antibiotics to prevent lung damage by infections, and CFTR genotyping.
• Dry powder inhaler teachings include loading medicine, not shaking, tilting head back, breathing out, inhaling deeply and quickly, holding for 10 seconds, and repeating if needed.
• Expiratory volume flow rate measures peak expiratory flow rate, volume of air forcefully expelled from lungs in one quick exhalation, and provides a baseline of health status.

Chapter 43: Abdominal Assessment

• Inspection involves assessing the abdomen for skin changes, symmetry, contour, and movement.
• Auscultation involves assessing the frequency and intensity of bowel sounds, with normal sounds being high pitched and gurgling.
• Percussion involves estimating the size of the liver and spleen, and determining the presence of fluid, distension, and masses.
• Palpation involves assessing abdominal organs and tenderness, distension, masses, or fluids, which may reveal a tumor, starting lightly to assess tenderness, and using deep palpation to delineate organs and masses.
• Absent bowel sounds can indicate obstruction or peritonitis.
• Ascites indicates fluid in the abdominal cavity and peritoneal inflammation.
• Borborygmi are waves of loud gurgling sounds, indicating hyperactive bowels from eating.
• A hernia is a bulge in the abdomen.
• Melena is black, tarry stool, which may indicate cancer or GI bleeding.
• Steatorrhea presents as fatty, frothy, foul-smelling stool, associated with chronic pancreatitis.
• Normal amylase levels are 60-120 u/l, and it is an enzyme produced by the pancreas used in diagnosing pancreatitis.
• Normal lipase levels are 0-160 u/l, produced by the pancreas and used in diagnosing pancreatitis.
• Fecal occult blood tests detect blood in stool, indicative of IBD, diverticulitis, or GI problems.
• Stool cultures check for normal intestinal flora and identify bacteria like C. diff.
• Gerontologic assessment differences include decreased taste, smell, esophagus motility, LES pressure, thinner and less taut abdomen, decreased blood flow, liver size, anal sphincter tone and motility, transit time, and sensation to defecate.
• Structures in the right upper quadrant (RUQ) include the liver, gallbladder, head of pancreas, and ½ kidney.
• Structures in the left upper quadrant (LUQ) include the left lobe of the liver, spleen, stomach, body of pancreas, and ½ kidney.
• Structures in the right lower quadrant (RLQ) include ½ kidney, cecum, appendix, bladder, uterus, ovary, and fallopian tube.
• Structures in the left lower quadrant (LLQ) include ½ kidney, bladder, ovary, fallopian tube, and uterus.

Chapter 46: Ulcers

• Gastric ulcers are superficial, smooth, round/oval/cone-shaped, located in the body and fundus of the stomach, with normal to decreased gastric secretion, increased cancer risk, burning or pressure in the epigastrium, and pain 1-2 hours after meals.
• Duodenal ulcers are penetrating, located in the first 1-2 cm of the duodenum, with decreased gastric secretion, no cancer risk, burning, cramping, pain across midepigastrium and upper abdomen, and pain 2-5 hours after meals.
• Normal AST levels are 8-33 u/l.
• Normal amylase levels are 60-120 u/l.
• Normal calcium levels are 8.5-10.2 mg/dl.
• Normal sodium levels are 136-145 mmol/l.
• Normal potassium levels are 3.5-5.0 mmol/l.
• Normal WBC count is 4,500-11,000 ul.
• Normal chloride levels are 96-106 meq/l.
• Upper GI bleeding manifests as hematemesis and melena.
• Hematemesis is blood in vomit that is either bright red or has a coffee ground appearance.
• Melena is black, tarry stool.
• Occult bleeding involves small amounts of blood in gastric secretions, vomit, or stools.

Teaching for GERD

• Low-fat diet
• Small, frequent meals
• Avoid alcohol and caffeine
• Stop smoking
• Don't lie down 2-3 hours after eating
• Elevate the head of the bed to 30 degrees
• Drug therapy for GERD and peptic ulcer disease includes proton pump inhibitors, histamine receptor blockers, and antacids.
• Complications of PUD include GI bleeding, perforation, and gastric outlet obstruction.
• Perforation involves the ulcer penetrating and spilling gastric or duodenal contents into the peritoneal cavity, causing severe upper abdominal pain that radiates to the back and shoulders, nausea, vomiting, and a weak pulse.
• To prevent food poisoning, cook all meat thoroughly, send back undercooked meat, keep raw meat away from ready-to-eat meat, wash fruits and veggies, and use pasteurized milk and juice.
• Risk factors for gastritis include drugs (aspirin, corticosteroids, NSAIDs), alcohol, spicy foods, microorganisms, radiation, smoking, burns, Crohn's disease, renal failure, sepsis, NG tubes, and stress.

Chapter 47: Bowel Disorders

• IBS involves chronic abdominal pain or altered bowel patterns, diarrhea, constipation, or both, abdominal distension, nausea, flatulence, bloating, and urgency.
• IBD includes Crohn's disease (GI tract from mouth to anus) and ulcerative colitis (colon), both causing inflammation of the GI tract.
• Bowel perforation is a tear in the wall of the GI tract caused by trauma, IBD, infection, or obstruction, and requires emergency surgery and pain relievers.

Types of Ostomies

• Ileostomy: liquid to semiliquid stool, increased fluid requirement, no bowel regulation, pouch and skin barriers.
• Ascending Colostomy: semiliquid stool, increased fluid requirement, no bowel regulation, pouch and skin barriers.
• Transverse Colostomy: semiliquid to semiformed stool, increased fluid requirement, no bowel regulation, pouch and skin barriers.
• Sigmoid Colostomy: formed stool, no change for fluids, bowel regulation possible, pouch and skin barriers dependent on regulation.

Effects of food on stoma output

• Odor-producing foods include alcohol, greens, eggs, fish, and garlic.
• Gas-forming foods include beans, beer, cheese, and onions.
• Diarrhea-causing foods include alcohol, coffee, fruits, and spicy foods.

Types of Hernias

• Umbilical hernias occur when the rectus muscle is weak, or the umbilical opening doesn't close after birth.
• Femoral hernias involve protrusion through the femoral ring into the femoral canal and can easily strangulate.
• Inguinal hernias are the most common, involving a point of weakness in the abdominal wall where the spermatic cord (men) or round ligament (woman) emerges.
• Ventral/incisional hernias happen at the site of a previous incision.

Chapter 48: Hepatitis

• Hepatitis A is fecal-oral, causing small outbreaks by fecal contamination of food or drinking water, or food contaminated by handler.
• Hepatitis B is transmitted through percutaneous or mucosal exposure to blood or blood products, sexual contact, contaminated needles, infected mothers, or sexual activity with an infected partner.
• Hepatitis C is transmitted through percutaneous or mucosal exposure to blood or blood products, or high-risk sexual contact, and can lead to cirrhosis or liver failure, potentially requiring a liver transplant.
• Hepatitis D is similar to HBV, causing more rapid progression of liver disease, and has no vaccine.
• Hepatitis E is transmitted via the fecal-oral route, contaminated water, and poor sanitation.
• Acute hepatitis manifests as clay-colored stools, dark urine, diarrhea, constipation, jaundice, fever, RUQ tenderness, and weight loss.
• Chronic hepatitis manifests as increased ALT, AST, bilirubin, bleeding problems, ascites, joint and muscle pain.

Hepatitis Labs

• Normal ALT levels are 0-40 u/l.
• Normal platelet count is 150,000-450,000 ul.
• Normal ammonia levels are 10-80 umol/l.

Nursing Management and Prevention of Viral Hepatitis

• Hepatitis A: HAV vaccine.
• Hepatitis B: Hand hygiene, not sharing razors, toothbrushes, personal items, 3 injections every 3 months.
• Hepatitis C: No vaccine available, screening blood, organ, and tissue donors to prevent.

Cirrhosis

• Cirrhosis complications include portal hypertension, esophageal and gastric varices, peripheral edema, and abdominal ascites.
• Cirrhosis causes include chronic HCV, alcohol-induced liver disease, extreme dieting, malabsorption, obesity, and environmental factors.
• Interprofessional care for cirrhosis includes labs (CBC, serum electrolytes, serum albumin, liver function tests), history and physical, CT scan, MRI, drug therapy, nutrition therapy, and avoiding alcohol and NSAIDs.

Pancreatitis

• Pancreatitis manifestations include abdominal pain, nausea, vomiting, fever, hypotension, and tachycardia.
• Causes of pancreatitis include:
  • Idiopathic factors
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps, malignancy
  • Autoimmune factors
  • Scorpion stings
  • Hypercalcemia, hypertriglyceridemia
  • ERCP
  • Drugs
• Total pancreatectomy is the total removal of the pancreas.