respiratory disorders

• albuterol: bronchodilator: kicks in bodys fight or flight
• isoniazid: TB medication; anti-infective
• rifampin: TB medication
• prednisone: steroid that suppress the immune system and decreases inflammation; COPD or other lung related medication
• influenza: high contagious viral illness that mutates yearly; reservoir in birds and mammals (hence why we cant get rid of it); spread via airborne
• influenza physical S&S: fever (101-102), tachycardia, hypoxia (rare), headache, sore throat, fatigue, NO GI symptoms
• influenza labwork S&S: viral culture (nose swab), ABGs (alkalotic then acidotic), WBC may be elevated
• influenza goal: complete recovery without complications such as pneumonia
• influenza interventions: teach hygiene, initiate isolation precautions, semi to high fowlers, provide adequate fluid intake, and provide nutritional intake
• collaborative influenza interventions: administer humidified oxygen to keep sats over 90%, administer analgesics or antivirals, and obtain cultures before meds
• pneumonia: inflammation of lung parenchyma (lung tissues)
• risks for pneumonia: recent antibiotic therapy, immunosuppression, chronic disease (CAP), treatment in healthcare facilities (HCA pneumonia)
• pneumonia physical S&S: altered mental status (d/t hypoxia), respiratory rate over 30, hypotension, heart rate over 125, fever, low PO2, crackles/rails/wheezing/bronchi
• pneumonia labwork S&S: ph below 7.35 (acidotic), sodium less then 130, hematocrit below 30%, pleural effusion on CT scan
• early signs of hypoxia: agitation, irritation, confusion, increased breathing, do NOT sedate
• pneumonia goal: patient to have resolution of the infection as evidenced by afebrile (no fever), clear lung sounds, RR 12-20 /min and oxygen saturation on room air 93% or greater
• clear sputum: normal

  cloudy white: chronic irritation

  yellow: infection is starting

  green: infection worsening

  brown/rust: old blood

  red: fresh blood

  black: fungal infection, smoker, pollution inhalation

  frothy (bubbly): pulmonary edema
• tuberculosis: a bacterial infection that causes inflammation of the lungs
• TB S&S: pale, bloody sputum, cough, night sweats, photosensitivity; "vampire like"
• TB at risk: immunosuppressed, malnourished, third world countries, prisoners and those living in poverty and crowded conditions, healthcare workers
• TB stages:

  latent (lie and wait)

  primary (infectious)

  symptomatic (full-blown)
• physical S&S TB: fatigue, weight loss, night sweats, cough, rust-colored or blood-streaked sputum, dyspnea, orthopnea (cant breathe lying down), rales (crackles), afternoon or nighttime fevers
• labwork S&S of TB: lab testing (sputum or interferon gamma release assay), skin test (mantoux), blood draw (QuanFERON Gold), or chest x-ray
• TB goal: control the spread of disease, maintain body weight, and reduction of symptoms
• obstructive sleep apnea (OSA): collapse of the soft tissues in the back of the pharynx during sleep causing periods of apnea and hypoxia
• risk factors of OSA: male gender, menopause, alcohol use, obesity
• OSA essentially is being suffocated while sleeping hence fight or flight being activated (increase HR, increase catecholates, increased BP, decreased O2)
• dangers of untreated OSA: cardiovascular disease, cardiac ischemia, MI, erectile dysfunction, stroke, atrial fibrillation, heart failure
• OSA patho: muscle tone of the nasopharynx decreases when you fall asleep which contracts the airway and desaturation occurs (drop in o2 and increase in co2)
• physical S&S of OSA: loud snoring, snorting, witnessed apnea, daytime sleepiness and falling asleep
• goal for OSA: pt to get uninterrupted periods of sleep with oxygen saturations of 93% or better
• OSA interventions: position in semi fowlers to fowlers position, monitor oxygen saturation, provide humidified oxygen, educate on disease process and risks if left untreated, instruction on CPAP use
• pulmonary embolism (PE): a blood clot that forms or travels to the pulmonary arteries occluding blood to the lungs
• PE risk factors: DVT, immobility, history of DVT, obesity, smoking, oral contraceptives, heart failure, pregnancy, central venous catheters
• physical S&S of PE: sudden dyspnea, sudden pain with deep breaths, tachypnea, sudden cough, chest pain, sudden death
• labwork for PE: D-dimer (elevated with any clot degradation), spiral CT scan (gold standard), ABGs (alkalosis then acidosis d/t over breathing initally then blood isnt flowing and exchanging so acidotic)
• goal for PE: resolution of chest pain, dyspnea, and RR of 12-20 unlabored without bleeding or cardiac complications
• PE interventions: oxygenation, position in high fowlers, monitor urine output, monitor ABGs and lactic acid, coagulation studies (PTT and PT/INR)
• if taking heparin test PTT
• if taking warfarin test PT/INR