Respiratory 2

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Respiratory 2
2012-08-22 20:07:59
Nursing 210 Respiratory

Respiratory 210
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  1. Sympathetic Nervous System what happens to systems
    Pupils Dilate, Nose Vasoconstriction reduced mucous secretion, Mouth decreased saliva dry mouth, GI constipation intestines relax, decreased peristalsis , Lungs bronchi dilated, Brain more alert, Heart Increases, stronger, increase BP, contractility, cardiac output, decrease blood flow to digits, bladder retention, Large Muscles increase blood flow, tensing of muscles goosebumps, relaxation of smooth muscle
  2. Alopecia
    hair loss partial or complete
  3. Aspiration
    Breathing in fluids, foods into trachea and lungs. Drawing in or out by suction
  4. Dysphagia
    Difficulty Swallowing
  5. Hemoptysis
    Bloody sputum
  6. Infiltrate
    Unintentional administration of solution meds in surrounding tissues
  7. Orthopnea
    Trouble breathing except in upright position
  8. Neutropenia
    Decrease number of neutrophils (Mature WBC's)
  9. Nosocomial
    Originating from hospital during hospitalization (Not present on admission)
  10. Tracheobronchitis Assessment
    Dry, hacky, irritating cough, sternal soreness from coughing, possible fever, general malaise, noisy inspiration, inspirational strider, expiratory wheezes, purulent sputum
  11. Breath sounds heard with Tracheobronchitis
    Will hear course breath sound Rhonci best over Trachea and Bronchioles
  12. Causative agent of Tracheobronchitis
    • Follows a viral upper respiratory infection
    • Commonly Strep (Streptoccus)
    • Also Haemophius (Rusty Brown Sputum)
  13. Intervention os Tracheobronchitis
    • Treat Symptoms
    • NSAIDs, Fluids (loosen secretions so cilia can remove, rehydrate due to fever increase RR, help kidneys eliminate waste), Rest, Antipyretics (Tylenol, Ibuprofen, ASA), Analgesics, Expectorants
  14. Pneumonia is
    • Consolidation of exudate in lungs (Alveoli)
    • It effects ventilation/perfussion
  15. Assessment findings of Pneumonia
    Crackles, wheezing, diminished breath sounds in alveoli, cough, fever (infection), purulent sputum, infiltrate on x-ray, increase resp rate, tachycardia, change in mental status (increase irritability, restlessness, confustion, lethargy)
  16. Crackles
    Alveoli popping open
  17. Sputum Culture for Pneumonia
    Should come from lower resp tract (lungs, bronchi, trachea), first thing in morning, rinse mouth first)
  18. Classifications of Pneumonia
    • CAP Community acquired (Droplet Isolation)
    • HAP Nosocomial hospital acquired
    • Aspiration
  19. At Risk Population of Pneumonia
    • Immuniocompromised, Cancer, COPD, Diabetes
    • Aids, Alcoholism, Smokers(Cilias impared more mucous),
    • Obesity(limits movement of diaphragm)
    • Steroid Users, Malnutrition
    • Immunosuppressant agents
    • Age
  20. Those at risk for aspiration
    • Can't swallow normally
    • altered level of consciousness
    • mechanically ventilated
    • presence of a NG
    • those fed by someone else
    • Dementia, Medications that increase gastric pH
  21. Post Op Patients
    • Closer to the diaphram the higher the respiratory risk
    • Abdominal surgeries
    • General anesthesia
    • Extended immobilization
    • Pain
  22. Pneumonia is defined by location & cause
    pneumonia is found in the alveolia & bronchioles
  23. Lobar pneumonia
    • Lobe of lung
    • Lobe consolidated
    • Exudate chiefly intra-alveolar
    • Common cause-klebsiella
  24. Bronchiole pneumonia
    • Patchy consolidation
    • Exudate chiefly in bronchioles
    • Common cause: staph & strep
  25. Community Acquired Pneumonias
    • Streptococcus pneumoniae (pneumococci)
    • Most common community acquired pneumonia (winter months)
    • Onset is typically sudden, chills, fever, pleuritic pain, cough, hypoxia
    • Those of african descent, elderly, after influenza, or comormidities
  26. Hamophilus
    • Higher Mortality
    • Long term care residents, alcoholics, COPD, DM
    • Sputum may beĀ rust colored
  27. Legionella
    • Middle aged men
    • Episodic/Sporadic
    • Outbreak at American Legion convention in 1970's
    • Thrives in aquatic envinronments (stagnant lakes, hot tubs, humidiferes, air-conditioning units, evacuation sites)
  28. Viral pneumonia
    • Commonly adenoviruses or influenza
    • No shift to right in CBC with viral infection
    • May set the stage for bacterial infection
    • Treatment support immuine system (water, rest, O2, nutrition)
    • No antibiotic
  29. Pneumocystis (PCP)
    • Jiroveci--Indicates pt shifted from HIV to full blown AIDS
    • Major terminal infection in those with AIDS
  30. Hospital Acquired Bacterial Infection (usually secondary infection)
    Staphylococcus Aureus (staph aureus)
    • Common secondary infection esp viral resp tract infection
    • Thick Yellow Sputum
    • May require intubation and mechanical ventilation for sputum removal
    • MRSA
  31. Pseudomonas
    • Sweet smell
    • Hospitalized pts wtih marked supression of immunological functions
    • treat with aminoglycosides (SE kidney damage, hearing loss)
    • Those who are terminally ill
    • Green to Gray sputum
  32. Klebsiella
    • Those ho have some other chronic disease (alcoholism)
    • Long term care facilities
    • Red Currant Jelly Sputum
  33. Nephrotoxicity and Ototoxicity check
    Creatinine 1 hr before and 1 hr after
  34. Nursing Diagnosis for Pneumonia
    • Ineffective breathing pattern
    • Ineffective airway clearance
    • Anxiety
    • Imparied gas exchange
    • Acute Pain
    • Activity Intolerance
    • RF Fluid Volume deficit
    • RF aspiration, Knowledge deficit
  35. Pneumococcal vaccine who should get
    <5 over 60,
  36. Prevention of Pneumonia
    Proper positioning, Early ambulation, Deep breathing, effecctive coughing, adequate pain control, wash hands, asess
  37. Supportive Measures of Pneumonia
    Supplemental oxygen, Hydration, Assist with deep breathing and coughing, Frequent position changes, early ambulation, Improve airway patency, rest and conserve energy, promote fluid intake, maintain nutrition, smoking cessation
  38. Medical Management of Pneumonia
    • Antibiotics
    • Monitor for anaphylaxis
    • Monitor for pseudomenbranous colitis (diarrhea, slough of tissue)
    • may appear up to 3 weeks after cessation of PO antibiotic
    • Renal excretion (Ototoxicity, nephrotoxicity) creatine
  39. Meds for Pneumonia
    PCN, Cephlasporin, Macrolides (DC first sign of rash, risk for Stevens Johnson Syndrome), Florquinolone, Carbapenems, Aminglycosides (IV, IM Only, OTO-Renal toxicity), Zanamivir (antiviral)
  40. Highest arterial oxygen levels in what positions
    Alternate between semi-fowlers position and lying with good lung down
  41. Tuberculosis is
    an infectious disease that most commonly effects the parenchyma of the lungs
  42. TB can also affect other organs...
    Kidneys, GI System, Meninges of the brain
  43. How is TB transmitted
    Airborne transmission, very small droplets containing mycobacterium bacilli, talking, sneezing, laughing or singing, coughing
  44. Latent period of TB
    Person can not transmit the disease but remains infected 2-10 weeks out