acute resp disorders

what is influenza

an upper respiratory infection caused by one of 4 diseases

who is at risk for influenza

older adults

residents in long-term care facilities

those with comorbidities

what causes the mortality with influenza

the respiratory distress

when should antivirals be started in the immunocompromised (influenza)

ASAP

when should antivirals be started in the healthy (influenza)

within 48 hours of onset

which influenza doesn't need to be vaccinated against

influenza C

antiviral tx drugs for the flu

oseltamivir (PO) and peramivir (IV)

what kind of precautions are used with influenza patients

droplet precautions

what does COVID-19 bind to?

angiotensin-converting enzyme cellular surface receptors

risk factors for COVID-19

any age ( especially younger than 6 months or older than 50 years)

hx of chronic disease

the immunocompromised and unvaccinated

AA and Hispanics

what is the incubation period of COVID-19

14 days

what is time from exposure to onset of s/s

4- 5 days

COVID-19 s/s

fever

non-productive cough

sore throat

fatigue

myalgias

nasal congestion

N/V/D

ansomia/aguesia

may be asymptomatic

can cause severe resp illness, pneumonia, and death

COVID-19 can mimic other disease

true

how is COVID-19 diagnosed

PT-PCR (from nasopharyngeal swab)

COVID-19 tx

supportive care

- oxygen therapy

- antipyretics

- antibiotics

- corticosteroids

- antivirals

- anticoagulants

- analgesics

- antitussives

- intubation and mechanical ventilation

what are the new antiviral meds used for COVID-19

paxlovid and lagevrio

what is Nirmatrelvir -Rionavir (paxlovid)

PO viral protease that cleaves viral polyproteins

paxlovid SE

dysguesia

diarrhea

increased BP

myalgias

what is tocilizumab (actemra)

monoclonal antibody, interleukin-6 receptor antagonist

actemra SE

transamintis

infusion related reactions

peripheral edema

what is acetmra used for?

to prevent cytokine storm

what does remdesivir do

inhibits RNA polymerase to prevent viral replication

nursing considerations for remdesivir

it is given IVPB given for 5 to 10 days

check LFTs

acetmra nursing considerations

check the LFTs

who is paxlovid for?

12 years and older

paxlovid dosing

twice a day for 5 days

COVID 19 precautions

droplet and contact

how to prevent the spread for COVID 19

stay home until fever-free for 24 hours without meds

no AGPs ( if necessary do it in airborne isolation)

what to watch out for with COVID-19

VTE, VS, SpO2

complications of COVID-19

pneumonia

respiratory failure

sepsis

cardiomyopathy (bc large amounts of catecholamines stun the heart)

myocarditis

arrhythmias

kidney failure

hypercoagulability ( watch for VTE)

cytokine storm

what is Long COVID

Post-COVID Conditions

Long COVID s/s

brain fog

fatigue

dizziness

cognitive impairment

heart failure

atrial fibrillation

myocardial infarction

postural orthostatic tachycardia syndrome (POTS)

anxiety

depression

suicidial ideation

tx for POTS

compression stockings and IV drips

what is pulmonary TB

infection of the lung parenchyma and spreads to meninges, kidneys, bone and lymph nodes

pulmonary TB risk factors

close contact with infected person

immunocompromised

substance abuse

homelessness, poverty, institutionalization

preexisting conditions

travel conditions with high prevalence

health care workers

Children younger than 15 years and young adults between ages 15 and 44

TB s/s

vary based on active and latent

low grade fever

cough ( can be non-productive, mucopurulent, hemopytosis)

night sweats

fatigue

weight loss

dx for TB

Mantoux skin test

blood test (TB Quantiferon)

sputum culture

chest xray

TB in older adults

can be insidious

unusual behavior

altered mental status

fever

anorexia

weight loss

which dx is preferred if the individual has the BCG vaccine

blood test

what can sputum culture show?

can INDICATE disease

when must active TB be reported

within 1 working day

when must latent TB be reported

within 1 week

what should you ask before giving the skin test

Have you gotten the BCG vaccine

sputum culture procedures

3 consecutive postives 18 to 24 hours a part

how much tuberculin purified protein deriative is injected

0.1 mL

where is the PPD injected

intradermally (10 degree angle)

what size wheal should be after injection

6 to 10 mm in diameter

induration of 15 mm or more

positive

induration of 10 mm or more

positive if under 5, from a country or workplace where TB is high

induration of 5 or more

positive if immunocompromised

how long must anti-TB agents be taken

4 to 9 months

what countries are high risk for TB

southeastern Asia, Africa, Latin America, Caribbean

what the TB meds

isonizaid

rifampin

pyrazinamide

ethambutol

how long is the intial treatment phase

8 weeks

how long is the continuation phase

4 or 7 months

what guides TB treatment =

sputum cultures

what is multidrug resistance

resistance to isoniazid and rifampin

what to monitor for with TB meds monthly

liver enzymes

BUN

creatinine levels

isoniazid SE

Peripheral neuritis, hepatic enzyme elevation, hepatitis, hypersensitivity

rifampin SE

Hepatitis, febrile reaction, purpura (rare), nausea, vomiting

pyrazinamide SE

Hyperuricemia, hepatotoxicity, skin rash, arthralgias, GI distress

ethambutol SE

Optic neuritis (may lead to blindness; very rare at 15 mg/kg), skin rash

nursing interventions to promote airway clearance and oxygenation

hydration

positioning

postural drainage

TB precautions

airborne and negative pressure room

what can help gravity move secretions

wedge pillows or leaning over a chair

diet for active TB

higher calories

more protein

healthy fats

what are the types of pneumonia

CAP, HAP, HCAP, VAP, and aspiration

what is healthcare associated pneumonia

non-hospitalized but have extensive healthcare contact

hospitalization for more than 2 days in an acute care facility within 90 days of an infection

what is community acquired pneumonia

less than 48 hours of hospitalization or in the community

pneumonia risk factors

underlying disorders and diseases

advanced age

smoking

immunosuppression

abnormal swallowing/cough

presence of NG/OG/ET tube

prolonged immobilty

transmission of organisms from providers or equipment

pneumonia s/s

sudden onset of chills, fever, pleuritic chest pain, tachypnea, and respiratory distress

headache, low-grade fever, myalgia, rash, pharyngitis, orthopnea, crackles purulent sputum

pneumonia assessment findings

increased tactile fremitus

dullness upon percussion

bronchial, egophony, and whispered pectoriloquy breath sounds

pneumonia in older adults

changes in mental status

fatigue

edema

dehydration

concomitant HF

dx for penumonia

chest xray

blood cultures

sputum examination

bronchoscopy

what are blood cultures for (pneumonia)

to rule out septicemia

what is the gold standard for penumonia

chest xray

when are bronchoscopies done for pneumonia

with refractory cases of pneumonia

who should get the pneumonia vaccine

those 65 and older and those 19+ and immunosuppressed

medical management for pneumonia

IV antibiotics/antiviral/antifungal

antipyretics

antitussives

decongestants

antihistamines

IV fluids

oxygen

collaborative problems with pneumonia

sepsis

septic shock

respiratory failure

ateletasis

pleural effusion

delirium

empyema

why can delirium be caused from pneunmonia

increased inflammation in the brain from infection

when to start humidifcation

after 24 hours of oxygen therapy

s/s of aspiration pneumonia

tachycardia

tachypnea

central cyanosis

HTN

hypotension

potential death

how often should should feeding tubes be checked

every 4 hours

diet for swallowing problems

thickened fluids

risk factors for aspiration

seizure activity

brain injury

decreased LOC

flat body positioning

stroke

swallowing disorders

cardiac arrest

bedside swallow evaluation

30 mL of water and pt takes it in one sip

if choking and wet sounds heard

what to do if choking and wet sounds heard

NPO and get speech therapist consult

types of lung cancer

SCLC and NSCLC

lung cancer s/s

asymptomatic until late in course

chronic cough, dyspnea, hemopytosis, chest/shoulder pain, recurrent fever

lung cancer cough changes

first is dry and then becomes productive

dx for lung cancer

chest xray

CT

fiberoptic bronchoscopy

fine needle aspiration

dx for lung cancer mets

PET scans, abdominal scans, bone scans, liver ultrasound, MRI brain

what is the screening for those with a 20 year pack history

low dose CT scan

which diagnostic has to be done for lung cancer

biopsy

complications of lobectomy

respiratory distress

arrhythmias

hemorrhage

shock

infection

pneumothorx

hemothorax

how should a patient recovering from a lobectomy be positioned

on their affected side