management of respiratory tract disorders

what are indicators of respiratory distress?

increased RR, position, labored talk not full sentences, accessory muscles, retractions, stridor (high pitched breathing), silent chest pneumonia

what can cause acute dyspnea?

asthma, COPD, airway inflammation, pneumonia, pleural effusion, spontaneous pneumothorax, heart failure

what is influenza?

high contagious viral respiratory infection

strains a, b, and c

older adults more susceptible to illness and death from the flu

vaccine is updated yearly based on strains that are expected to occur

how is influenza transmitted and diagnosed?

airborne droplet and direct contact

diagnosis: patient history, clinical symptoms, rapid influenza diagnostic tests

list the symptoms of influenza

fever, chills, body aches, cough, flushing, sweating, anorexia, chest pressure or pain, runny nose, sneezing, he ache, sore throat, swollen lymph nodes, fatigue

who is at high risk for flu that should be vaccinated?

adults 50 or older, children 6-59 months, people w/ chronic conditions, pregnant women, immunocompromised, indigenous peoples

what is the treatment for influenza?

fluids, antipyretics (acetaminophen), droplet isolation in hospital, antiviral medications (tamiflu, rapivab, relenza, xoluza)

what are the contraindications and precaution for the flu vaccine?

contra: have had GB syndrome

precautions: severe egg allergies

what are side effects of theft vaccine?

injection: soreness at sight

nasal spray: some flu like symptoms

what is pneumonia?

infection in the air sacs of the lungs

can be 1 or both lungs

filled w/ fluid or some other material

what causes pneumonia?

organisms that overpower the lungs defenses

taken in through inhalation, aspiration, or hematogenous

type of organism: bacterial, viral, fungal, chemical

what are the acquired types of pneumonia?

community acquired (CAP): community setting or <48 hrs admission, strep pneumonia/m. pneumoniae

health-care associated pneumonia (HCAP): not hospitalized but a healthcare context like a nursing home, dialysis center, IV home care

hospital acquired/ nosocomial (HAP): >48 hrs after admission, no evidence on admission

what are risk factors for pneumonia?

age

immune system dysfunction: disease, medications (steroids, chemotherapy, transplant)

medications that increase GI pH: PPIs

aspiration risk: fluids, airway secretions (swallowing dysfunction)

what is ventilator associated pneumonia (VAP)?

a type of HAP that develops >/= 48 hrs after endotracheal intubation

what is videofluoroscopic swallowing study?

also known as modified barium swallow or cookie swallow

test to determine swallowing dysfunction

determines ways to prevent aspiration

list the signs and symptoms of pneumonia

increase temp and chills, mucous or fluid cough, SOB, chest pain when coughing or inhaling, headache, clammy, confusion/change LOC, bacteria will cause temp of 105 and viral tends to be milder

how is pneumonia diagnosed?

chest x-ray: infiltrates

blood test: increase WBC

pulse ox decrease

sputum sample

CT scan if not clearing

what is some outpatient management of pneumonia?

fluids, Tylenol, cough syrup, rest, tea

what is some nursing management for pneumonia?

spo2 92-95%

control infection: culture and sensitivity to treat properly, start with empiric antibiotics and then move to targeted with results

promote secretion clearance: cough, ambulation, chest PT, incentive spirometer, PEP, flutter valve

adequate hydration: IV or oral

rest and comfort: elevated head of bed which improves gas exchange and prevents aspiration

decrease risk factors

who might need to be hospitalized for pneumonia?

over 65, comorbidities, change LOC, alt kidney function, already on supplemental O2

what are some gerontological consideration for pneumonia?

elderly are at greater risk: likely to have comorbidities, changes due to aging, more difficult to detect early

what causes pleurisy?

inflammation of layers of the pleura (visceral/parietal)

rub together: pleural friction rub

what is pleural effusion?

collection of fluid in pleural space due to another disease

normal fluid is 5-15 ml

can increase to several liters

what are characteristics of pleural effusion?

clear, bloody, purulent

transudate

exudate: inflammation, cancer

layered or loculated

what will a respiratory assessment for pleural effusion be like?

decreased or absent breath sounds

dull, flat to precision over fluid

dyspnea, cough, fever, chills

pleuritic chest pain

large effusions: acute respiratory distress

what are common causes of pleural effusion?

CHF, pneumonia, cancer

what are the types of pneumothorax?

hemothorax: blood enters pleural cavity

pneumothorax: air enters pleural cavity

simple (small): may resolve without treatment

if large, will need chest tube to drain

what is a thoracentesis?

a sample of the fluid in the lungs

what is management for a pneumothorax?

depends on accumulation

repeat thoracentesis

in-dwelling pleural catheter

pleurodesis (irritant instilled)

what are the causes of a pneumothorax?

trauma, preexisting lung disease, spontaneously, no apparent cause, iatrogenic

what is a tension pneumothorax?

air enters, trapped, causing intrathoracic pressure to increase. prevents inflow of blood, needs emergent CT placement