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nurs 301 STUDENT RESPIRATORY II 2013

nurs 301 STUDENT RESPIRATORY II 2013 - Respiratory Unit II...

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Respiratory Unit II Mrs. Mary Lynn Clarke, RN MSN CCRN Mrs. Emilee B. Harker, RN MSN
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Lower Respiratory Tract Problems
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Acute Bronchitis u Inflammation involving the bronchi u Etiology Usually viral may be bacterial
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Bronchitis u Presentation Cough Substernal discomfort with coughing Wheezing and slight DOE  Low Grade Fever Malaise Headache Chest Xray: No consolidation or infiltrates
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Acute Bronchitis u Nursing Implications Rest Anti-inflammatory  drugs Encourage fluids  Vaporizer or moisture Cough suppressor at night If bacterial, antibiotics
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Pneumonia (PNA) u Acute inflammation in lungs that produces excess fluid  from microbial organism or aspirated irritant u Inflammatory process   edema and exudate in alveoli u Can be primary disease or complication of another  condition Aspiration of normal flora Inhalation of airborne microbes Hematogenous spread u Classified as Community Acquired PNA & Hospital- Acquired PNA u Review P. 547 Table 28-1 for risk factors for PNA
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Pneumonia
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Community Acquired Pneumonia (CAP) u Onset is in community or during first 2 days of  hospital stay
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Hospital Acquired Pneumonia (HAP) u Health care-associated pneumonia= HCAP u Ventilator associated pneumonia = VAP  u High mortality rate u Determine type of PNA first which dictates drug  therapy u Multidrug resistant organisms is a problem u Acquired 48  hrs or longer after hospital  admission
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Aspiration Pneumonia u When abnormal secretions or substances  enter lower airway u Mouth  or Stomach secretions enter lungs u High risk in patients with   LOC,  swallowing, and Tube Feedings
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Opportunistic Pneumonia u Occurs in pts who have suppressed   immune systems u Highly susceptible to respiratory infections u Causative Agents: gram negative bacteria Pneumocystis jiroveci (PCP) Cytomegalovirus (CMV) Other fungi
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Clinical Manifestations of Pneumonia u Typical Sudden  onset of fever, chills, SOB, productive cough, possibly  pleuritic pain, crackles  Older adult may only present with confusion or stupor - Ex: H.  influenzae  & S.  pneumoniae u Atypical Gradual  onset, dry cough, extra pulmonary manifestations  u headache, sore throat, nausea, vomiting, diarrhea, fatigue,  crackles Ex:  Legionella, Chlamydia pneumoniae u Viral Chills, fever, dry, nonproductive cough
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Complications of Pneumonia u Pleurisy u Pleural effusion u Atelectasis u Bacteremia u Lung abscess u Empyema (Puss  in the plueral  space) u Pericarditis u Meningitis u Endocarditis
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Diagnostic Studies Pneumonia q Chest x-ray q History q Physical Exam q Sputum for culture  gram stain q Pulse Oximetry & ABGs q Labs q Leukocytosis (WBC usually >15000 with bands)
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Nursing Interventions Prevent aspiration
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