Respiratory

• acute viral rhinopharyngitis


  - aka common cold

  - URI

  - spread by airborne droplet (e.g. talking, sneezing, breathing, or coughing)

  - MAN: 2-3 days after infection; runny nose, watery eyes, nasal congestion, sore throat, fever, headache, fatigue

  - NM:directed towards relieving symptomsrest, fluids, antipyretics, analgesics, antihistamines, decongestants (no more than 5 days)

  - sore throat -- warm saltwater, ice chips, lozenges sprays

  - nasal congestion -- saline nasal spray

  - complications: acute bronchitis, sinusitis, otitis media, tonsilitis, pneumonia

  - Pt teachings: recognize manifestations of worsening condition, green purulent nasal drainage (not normal), avoid crowed areas, frequent hand-washing

  PHARMACOLOGY

  - anticholinergic nasal spray -- reduce nasal secretions

  - antihistamines -- relieve acute symptoms of allergic reaction

  - second gen nasal spray -- block histamine release and reduce nasal congestion

  - corticosteroid nasal spray -- inhibits inflammatory response

  - decongestants -- promote vasoconstriction and reduce nasal congestion
• what is acute viral rhinopharyngitis

  - URI

  - aka common cold
• how is acute viral rhinopharyngitis spread?

  spread by airborne droplet (e.g. talking, sneezing, breathing, or coughing)
• clinical manifestations of acute viral rhinopharyngitis

  2-3 days after infection; runny nose, watery eyes, nasal congestion, sore throat, fever, headache, fatigue
• nursing management of acute viral rhinopharyngitis

  directed towards relieving symptoms; rest, fluids, antipyretics, analgesics, antihistamines, decongestants (no more than 5 days)

  - sore throat -- warm saltwater, ice chips, lozenges sprays

  - nasal congestion -- saline nasal spray
• complications of acute viral rhinopharyngitis

  acute bronchitis, sinusitis, otitis media, tonsilitis, pneumonia
• pt teachings of acute viral rhinopharyngitis


  recognize manifestations of worsening condition, green purulent nasal drainage (not normal), avoid crowed areas, frequent hand-washing
• pharmacology of acute viral rhinopharyngitis

  - anticholinergic nasal spray -- reduce nasal secretions

  - antihistamines -- relieve acute symptoms of allergic reaction

  - second gen nasal spray -- block histamine release and reduce nasal congestion

  - corticosteroid nasal spray -- inhibits inflammatory response

  - decongestants -- promote vasoconstriction and reduce nasal congestion
• influenza


  - most common and most virulent flu virus

  - MAN: onset is abrupt; chills, fever, myalgia, headache, cough, sore throat, fatigue

  - complications: pneumonia, ear infections, ARDS, pulmonary complications (dyspnea, diffused crackles)

  - Dx: culture collection (nasopharyngeal area), RIDTs (results w/in 15 min -- false negatives/more sensitive to A/B)

  - NM: flu vaccination, hand-washing, antiviral drugs (-ivir), rest/hydration
• what is influenza


  - most common and most virulent flu virus

  - A -- (humans/animals) most common

  - B -- (humans) regional epidemics

  - C -- (humans) mild illness

  - D -- (animals)
• clinical manifestations of influenza

  onset is abrupt; chills, fever, myalgia, headache, cough, sore throat, fatigue
• nursing mangement for influenza

  flu vaccination, hand-washing, antiviral drugs (-ivir), rest/hydration
• complications of influenza

  pneumonia, ear infections, ARDS, pulmonary complications (dyspnea, diffused crackles)
• dx for influenza

  culture collection (nasopharyngeal area), RIDTs (results w/in 15 min -- false negatives/more sensitive to A/B)
• Sinusitis


  - inflammation/swelling of mucosa block opening in sinuses

  - causes: nasal polyps, foreign body, deviated septa, tumors, bacterial secretion buildup

  - MAN: affected pain over sinus, purulent nasal drainage, nasal obstruction, congestion, fever, malaise

  - Dx: x-ray, CT

  - NM:focus on relieving symptoms; allergies before cause -- reduce sinus inflammation, decongestants -- topical -- promote drainage (no more than 5 days), corticosteroids -- initial -- decrease inflammation, sinus irrigation -- promote drainage
• what is sinusitis


  - inflammation/swelling of mucosa block opening in sinuses
• causes of sinusitis


  nasal polyps, foreign body, deviated septa, tumors, bacterial secretion buildup
• clinical manifestations of sinusitis


  affected pain over sinus, purulent nasal drainage, nasal obstruction, congestion, fever, malaise
• dx of sinusitis

  x-ray, CT
• nursing mangement is sinusitis

  focus on relieving symptoms; allergies before cause -- reduce sinus inflammation, decongestants -- topical -- promote drainage (no more than 5 days), corticosteroids -- initial -- decrease inflammation, sinus irrigation -- promote drainage; surgeries towards correcting nasal deviation; relieve blockages due to hypertrophy/nasal deviation
• pneumonia

  - acute inflammation of lungs -- alveoli fill up with mucus -- impaired gas exchange -- CO2 cant get out -- O2 cant get in

  - primary causes: lobar pneumonia (infection spreads between alveoli until its contained by segments of lung) broncho-pneumonia (infection is not confined by any barriers and extends to nearby areas of the lungs)

  - secondary causes: aspiration, decreased surfactant, gastric juices

  - manifestations: altered mental status (restlessness, confusion, agitation), fever, productive cough (yellow sputum), fine/coarse crackles, dyspnea, SOB, pleuritic chest pain (pleural friction rub) "sharp chest pain upon inspiration or cough"

  - complications: pleural effusion (key signs x4 D: during inhalation -- chest pain, dyspnea, diminished breath sounds, dull resonsance on percussion; primary to report: asymmetrical chest expansion, decreased breath sounds, ARDS, septic shock)

  - risk factors: advance age, VAP, prolonged immobility, anesthesia, smoking, immunosuppression, URI, COPD, feeding tubes

  - dx: sputum culture (1st for antibiotics), WBC -- to show effectiveness of treatment

  - treatment: Antibiotics, F/E, mobility, coughing/deep breathing, positioning, isolation, O2 PRN, nutrition, analgesics, symptom management

  - NM: prevent VAP -- reposition/ mouth care Q2h -- chlorhexidine

  - pt teachings: high fowler's position, avoid cough suppresants, cool mist humidifer, incentive spriometer, finish oral antibiotics, vaccination, hand-washing, report worsening S/S, mouthcare
• what is pneumonia


  acute inflammation of lungs -- alveoli fill up with mucus -- impaired gas exchange -- CO2 cant get out -- O2 cant get in
• what are the primary and secondary causes of pneumonia

  - primary causes: lobar pneumonia (infection spreads between alveoli until its contained by segments of lung) broncho-pneumonia (infection is not confined by any barriers and extends to nearby areas of the lungs)

  - secondary causes: aspiration, decreased surfactant, gastric juices
• clinical manifestations of pneumonia

  altered mental status (restlessness, confusion, agitation), fever, productive cough (yellow sputum), fine/coarse crackles, dyspnea, SOB, pleuritic chest pain (pleural friction rub) "sharp chest pain upon inspiration or cough"
• complications of pneumonia


  pleural effusion (key signs x4 D: during inhalation -- chest pain, dyspnea, diminished breath sounds, dull resonsance on percussion; primary to report: asymmetrical chest expansion, decreased breath sounds, ARDS, septic shock)
• risk factors of pneumonia

  advance age, VAP, prolonged immobility, anesthesia, smoking, immunosuppression, URI, COPD, feeding tubes
• dx of pneumonia


  sputum culture (1st for antibiotics), WBC -- to show effectiveness of treatment
• treatment of pneumonia

  Antibiotics, F/E, mobility, coughing/deep breathing, positioning, isolation, O2 PRN, nutrition, analgesics, symptom management
• nursing management of pneumonia

  prevent VAP -- reposition/ mouth care Q2h -- chlorhexidine
• pt teachings for pneumonia

  high fowler's position, avoid cough suppresants, cool mist humidifer, incentive spriometer, finish oral antibiotics, vaccination, hand-washing, report worsening S/S, mouthcare
• tuberculosis (TB)


  - bacterial infection of the lungs

  - spread via airborne route -- enters lungs, spreads to lymph and blood vessels

  - MAN: night sweats, anorexia (weight loss), cough + hemoptysis (blood tinged sputum), dsypnea/SOB, fever and chills

  - dx: mantoux test, CXR, sputum culutres, qauntiferon (*gold standard* x3 days)

  - NM: airborne isolation, PPE (N95), hand-washing, surgical mask outside of room, negative pressure, O2 therapy, emotional support

  PHARMACOLOGY

  - riphampin

  - isoniazid

  - pyrazinamide

  - ethambutol
• what is tuberculosis and how is it spread

  - bacterial infection of the lungs

  - spread via airborne route -- enters lungs, spreads to lymph and blood vessels
• clinical manifestations of TB

  night sweats, anorexia (weight loss), cough + hemoptysis (blood tinged sputum), dsypnea/SOB, fever and chills
• dx of TB


  mantoux test, CXR, sputum culutres, qauntiferon (*gold standard* x3 days)
• nursing management for TB

  airborne isolation, PPE (N95), hand-washing, surgical mask outside of room, negative pressure, O2 therapy, emotional support
• Riphampin


  (red-fampin)

  - normal: red/orange tears, urine, sweat

  - teachings: wear glasses instead of contacts, oral contraceptives ineffective, monitor for jaudice -- hepatotoxic
• isoniazid


  - #1 test drug for TB

  INH

  I - interferes with absorptions of B6 (leads to peripheral neuropathy)

  N - neuropathy (report: new numbness, tingling extremities, ataxia)

  H - hepatotoxic (REPORT IMMEDIATELY!! jaundice, dark urine, fatigue, elevated liver enzymes -- hold meds)

  teach: no alcohol
• Pyrazinamide


  - TB drug

  - hepatotoxic
• ethambutol


  - TB drug

  - EYES

  - report blurred vision, color changes

  - teach to have baseline eye exam and routine eye appointments

  - hepatotoxic
• COPD


  - chronic destruction of lungs resulting in decrased gas exchange -- chronic air trapping -- high CO2 in body

  - risk factors: airway obstruction, excessive mucus production, loss of elastic support to airways, smoking, bronchoconstriction, air pollution

  - MAN: emphysema ("pink puffer"); chronic bronchitis (blue bloaters)

  - key findings: O2 stats @ 88-93%

  - lab values: low PaO2 --hypoxemic; high PaCO2 -- hypercapnic

  - complications: respiratory failure -- hypercapnic -- BiPAP

  - NM: NO OPIODS/BENZOs -- increase exacerbations

  - pt teachings: diet (oral hygiene before meals, small frequent meals, high calories & protein, avoid carbs, avoid exercising before meals, avoid gassy foods), fluids (increase fluid intake and avoid drinking while eating), infection (report increase sputum, fever, worsening dyspnea), vaccines (pneumococcal/flu)

  - meds: albuterol (if SOB to vasodilate lungs and allow more airflow)