Respiratory Part 2

1. Respiratory Part 2 Medical Surgical Nursing

2. Influenza • AKA • Flu • Highly contagious • Pathogen • Viral • Epidemic • Rapid and extensive spreading infection and affecting many individuals in an area or a population at the same time

3. FYI • Influenza & its complications (primarily bacterial pneumonia) are the 8th leading cause of death in the US. • @60,000 year

4. H1N1 • Newly identified stain •  Pandemic • (World-wide epidemic)

5. Mode of transmission • Airborne droplet • Direct contact

6. Influenza Statistics • Incubation period • Short • Onset • Rapid • Duration • Up to a week

7. Influenza: S&S (local) • Runny nose • Sore throat • Cough • Dry • Non-productive  productive • Substernal burning

8. Influenza: S&S (systemic) • Chills & fever • H/A • Malaise • Muscle aches • Fatigue & weakness

9. Older adults • Higher risk of • Complications • Pneumonia • Death

10. Why are older adult more susceptible to complications of influenza? • Cilia • i • Chest muscle strength • i • Chest wall • Stiffer • Cough • Less effective

11. Assessment • S&S • Vital Signs

12. IDT • “Most URI’s are self-limiting”

13. IDT • Self-care • Symptomatic relief • Prevent complications • Prevent spread

14. Dx test • Throat swab • R/O streptococci • CBC • WBC normal • Vial • WBC increased • Bacterial • Chest x-ray • R/O pneumonia

15. Flu Vaccine: Is it effective? • Polyvalent influenza virus vaccine • 85% effective

16. Flu Vaccine: Who should get it? • Age >50 years • Nursing home residents • Pg women • Chronically ill • Immunosuppressed • Resp. conditions • Healthcare workers • Fam. members of those at risk

17. Flu Vaccine: Who should not get it? • Allergic to eggs

18. Small Group Questions • What pathogen is assoc. with flu? • Identify 5 S&S of the flu • What type of isolation would you use for a client with the flu • Mary asks you if she should get the flu vaccine, how do you respond? • What priority nursing diagnosis would you give for a person with the flu?

19. Which of the following nursing interventions is appropriate after a client has had a bronchoscopy? • Report abnormal lab values • Lay flat for 8 hours with a sand bag to the puncture site • NPO until gag reflex returns • Push fluids

20. Tuberculosis • AKA • TB

21. Tuberculosis - FYI • Causes more death than any other disease. 2 billion world wide, 15 million in the US

22. Tuberculosis - FYI • When treated, about 90% of those with active TB survive!

23. Tuberculosis • Pathophysiology • Mycrobacterium tuberculosis • Tubercle bacillus

24. Tuberculosis Pathophysiology • Mode of transmission • Air-borne •  alveoli • Multiplies in alveoli

25. Tuberculosis • Immune response phase • Macrophages attack TB • TB has waxy cell wall that protects it from macrophages • Immune system surrounds the infected macrophages • Forms a Lesion • Called a Tubercle

26. Tuberculosis • Dormant phase • Contagious? • No • Symptomatic? • No • PPD? • positive • chest x-ray? • Negative

27. Tuberculosis • Active phase • If an infected person has a weakened immune system,  • the TB escapes and infects the body

28. Tuberculosis • 5-10% become active • Only contagious when active • Primarily affect lungs but… • Kidneys • Liver • Brain • Bone

29. Tuberculosis Etiology • Assoc. w/ • Poverty • Malnutrition • Overcrowding • Substandard housing • Inadequate health care • Elderly • HIV • Prison

30. Tuberculosis: S&S (active phase) • NOC sweats • Low grade fever • Wt loss • Chronic productive cough • Rust colored & thick • Hemoptysis • SOB

31. Tuberculosis: Dx test • PPD • Mantoux skin test • > 10mm in diameter • induration • Indicates: • Latent TB • Read • 48-72 after • Intradermal: • 15-degrees

32. Tuberculosis • Diagnostic tests • X-ray • Symptoms • Acid Fast Bacillus

33. Tuberculosis: Tx / Rx • INH • isonicotinyl hydrazine • Isoniazid • Toxic to the liver • Rifampin • Turns urine red

34. Tuberculosis: Prevention • Clean well ventilated living areas • Resp. isolation • Negative pressure room • If exposed take • INH

35. Tuberculosis: complication • Malnutrition • S/E of Rx treatment • Multi-drug resistance • Spread of TB infection

36. Small Group Questions • What type of pathogen is TB? • What is the mode of transmission? • What are the classic S&S of TB ? • How to administer and read a PPD? • If a pt is PPD +, what does that mean?

37. Small Group Questions • What is the standard screening method of TB? • That medications are used to treat TB, what are their side effects? • Where in the US is TB most prevalent? Why?

38. COPD - overview COPD? • Chronic Obstructive Pulmonary Disease • Broad classifications of diseases

39. COPDCharacteristics • Airflow limitation • Irreversible • Dyspnea on exertion • Progressive • Abn. inflammatory response of the lungs to noxious particles or gases

40. Pathophysiology • Noxious particles of gas • Inflammatory response  • Narrowing of airway

41. Pathophysiology • Inflammation  • Thickening of the wall of the pulmonary capillaries

42. COPD • Includes • Emphysema • Chronic bronchitis • Does not include • Asthma

43. COPD - FYI • COPD 4th leading cause of death in the US • 12th leading cause of disability • Death from COPD is on the rise while death from heart disease is going down

44. COPD: Risk Factors • Smoking • Passive smoking • Occupational exposure • Air pollution

45. COPD risk factors • #1 • Smoking • Why is smoking so bad?? • ↓ phagocytes • ↓ cilia function • ↑ mucus production

46. Chronic Bronchitis • Disease of the airway • Definition: • cough + sputum production • > 3 months

47. Chronic Bronchitis Pathophysiology • Pollutant irritates airway  • Inflammation • h secretion of mucus  • Bronchial walls thicken  • Lumen narrows • plugs

48. Chronic Bronchitis • Alveoli/bronchioles become damaged • ↑ susceptibility to LRI

49. Emphysema: Pathophysiology • Affects alveolar membrane • Destruction of alveolar wall • Loss of elastic recoil • Over distended alveoli

50. Emphysema Pathophysiology • Over distended alveoli • Damage to adjacent pulmonary capillaries • Impaired passive expiration