Coordinating Care for Patients with Infectious Respiratory Disorders (Chapter 24)

What is pneumonia?

An infection of the lung parenchyma that leads to inflammation and consolidation of lung tissue with fluid/exudate.

What triggers the inflammatory response in pneumonia?

Organisms such as bacteria, viruses, or fungi invade alveoli.

What is Community-Acquired Pneumonia (CAP)?

Pneumonia contracted outside healthcare settings or within 48 hours of hospital admission.

What is Hospital-Acquired Pneumonia (HAP)?

Pneumonia that develops 48 hours after hospital admission, often caused by antibiotic-resistant bacteria.

Define Ventilator-Associated Pneumonia (VAP).

A subtype of HAP occurring 48 hours after endotracheal intubation.

What causes aspiration pneumonia?

Inhalation of oropharyngeal or gastric contents into the lungs.

What is the main symptom of tuberculosis (TB)?

Chronic cough often accompanied by hemoptysis (coughing up blood).

How is tuberculosis primarily spread?

Via airborne transmission, meaning tiny droplets can be inhaled by others.

What are hallmark symptoms of active TB?

Persistent cough, chest pain, hemoptysis, weakness, weight loss, fever, and night sweats.

What is the key diagnostic tool for tuberculosis?

Sputum culture for acid-fast bacillus (AFB) smear.

What are common symptoms of influenza?

High fever, chills, muscle aches, headache, fatigue, and dry cough.

What complications can arise from influenza?

Severe cases can progress to viral pneumonia or predispose to secondary bacterial pneumonia.

What is the main respiratory complication of COVID-19?

Viral pneumonia with diffuse alveolar damage.

What is the role of ACE2 receptors in COVID-19?

The virus SARS-CoV-2 binds to these receptors on alveolar cells to infect the lungs.

What is the primary treatment for pneumonia caused by streptococcus pneumoniae?

Antibiotics such as macrolides or respiratory fluoroquinolones.

What is the duration for first-line TB regimen (RIPE therapy)?

Usually 6–12 months, with the initial phase lasting 2 months.

What does RIPE stand for?

Rifampin, Isoniazid, Pyrazinamide, Ethambutol.

What are two key side effects of Isoniazid treatment?

Peripheral neuropathy and hepatotoxicity.

What precaution should be taken when giving Rifampin?

Monitor for orange discoloration of urine and liver function.

What is the purpose of using bronchodilators?

To improve airflow in patients with reactive airway components.

What adjunct medication is used to manage severe inflammation in COVID-19?

Dexamethasone.

What is a critical nursing intervention for patients with pneumonia?

Encouraging frequent positioning to improve lung expansion and secretion clearance.

What are signs of hypoxia to monitor for in respiratory patients?

Restlessness, anxiety, tachycardia, and cyanosis.

What does the acronym ‘RAT BED’ stand for regarding hypoxia signs?

Restlessness, Anxiety, Tachycardia; Bradycardia, Extreme Restlessness, Dyspnea.

Why is patient education crucial in antibacterial therapy?

Patients must complete the full antibiotic course to prevent resistance.

What education should be provided to patients regarding cough management?

Cough suppressants should be avoided if the patient needs to clear secretions.

What is the recommended fluid intake for patients with thick respiratory secretions?

Encourage 2-3 liters of fluid intake per day, as tolerated.

What dietary guidance is typically suggested for patients recovering from respiratory illness?

Encourage a balanced diet with small frequent meals to support recovery.

What is the recommended intervention for a patient with suspected TB?

Place the patient in an airborne isolation room with negative pressure.

What preventative measure is essential for patients with a history of respiratory infections?

Vaccination against influenza and pneumococcal pneumonia.

What lifestyle change is crucial for reducing the risk of respiratory infections?

Smoking cessation to repair lung defenses.

How should infection control precautions be communicated to patients?

Explain and educate on proper hand hygiene and isolation practices.

When should a patient seek medical attention after a respiratory infection?

If experiencing worsening shortness of breath, chest pain, or high fever persisting despite treatment.

Scenario: A 70-year-old patient with pneumonia is being treated with antibiotics. What vital sign change would be most concerning during their hospital stay?

A sudden increase in respiratory rate or the onset of hypoxia would be concerning, as it may indicate worsening of the pneumonia.

Scenario: A patient with active tuberculosis is following the RIPE regimen. What side effect would you need to monitor closely for related to Isoniazid?

Monitor for signs of peripheral neuropathy such as tingling or numbness in the extremities.

Scenario: A patient has been admitted for community-acquired pneumonia and is receiving macrolide antibiotics. They begin to exhibit signs of tachycardia and dyspnea. What would be your first nursing action?

Assess the patient's oxygen saturation level and provide supplemental oxygen if indicated.

Scenario: A patient recovering from influenza is experiencing persistent cough and difficulty breathing. Which assessment finding would be a priority to report to the physician?

Presence of wheezing or crackles upon auscultation, as it may indicate development of pneumonia.

Scenario: A patient with a history of smoking presents with cough, hemoptysis, and weight loss. What initial diagnostic test should be anticipated?

A chest X-ray to evaluate for any lung lesions or masses.

Scenario: A patient diagnosed with COVID-19 presents with severe hypoxia. What adjunct therapy should you expect to be ordered by the healthcare provider?

Dexamethasone to manage inflammation and improve oxygenation.

Scenario: During patient education for an elderly patient with recurrent pneumonia, what key advice should be emphasized regarding prevention?

Encourage annual influenza vaccinations and pneumococcal vaccinations to reduce risk.

Scenario: A patient with ventilator-associated pneumonia is being weaned off mechanical support. What key function should you assess before extubation?

Ensure the patient can maintain adequate oxygenation and has a strong cough reflex.

Scenario: An isolated patient with tuberculosis is being discharged. What critical instruction must be reinforced to prevent transmission?

The patient should adhere to the full course of prescribed medications and follow respiratory hygiene practices.

Scenario: A patient with pneumonia has become increasingly drowsy and confused, with a high fever. What assessment should be prioritized?

Perform a thorough neurologic assessment to evaluate for potential hypoxia or sepsis.

Scenario: A 65-year-old patient with COPD is admitted with increased shortness of breath. What is the priority nursing action?

Assess the patient's respiratory status, including oxygen saturation and work of breathing.

Scenario: A patient with pneumonia is experiencing confusion and increased lethargy. What vital sign changes would you expect?

Monitor for changes such as increased respiratory rate, heart rate, and possible hypotension, indicating potential sepsis.

Scenario: A patient with a history of heart failure is showing signs of edema and crackles in the lungs. What intervention should be performed first?

Administer diuretics as ordered to manage fluid overload and improve respiratory function.

Scenario: A patient recovering from surgery reports sudden onset chest pain and difficulty breathing. What should you do first?

Perform a rapid assessment, including vital signs, and call for immediate medical assistance.

Scenario: A diabetic patient presents with fruity-smelling breath and altered mental status. What should the nurse suspect?

Diabetic ketoacidosis and initiate a rapid assessment for further intervention.

Scenario: A patient newly diagnosed with TB is being discharged. What essential education should be provided?

Instruct the patient on the importance of adhering to the complete medication regimen and respiratory hygiene practices.

Scenario: A patient on anticoagulation therapy has a new onset of hematuria. What is your priority nursing action?

Notify the healthcare provider immediately and monitor the patient closely for signs of bleeding.

Scenario: A patient receiving IV antibiotics for pneumonia develops a rash and itching. What should be your action?

Stop the IV infusion and assess the patient's vital signs and symptoms for a potential allergic reaction.

Scenario: A chronic smoker presents with persistent cough and hemoptysis. What initial diagnostic test should be anticipated?

Request a chest X-ray to evaluate for any lung pathology.

Scenario: A patient with COVID-19 is exhibiting signs of severe respiratory distress. What should you prepare for?

Anticipate the need for oxygen therapy and potential intubation based on the patient's condition.