CAP= community acquired pneumonia, lower resp. tract infx w/in 1st 2 days of hospitalization. HAP=hosptial/health care assoc. pneumonia occuring 48 hrs or longer after hospital admission & not incubating at time of hospitalization
massive dilation of caplillaries & alveoli filled with organisms in lung parenchyma d/t inflammatory mediator arrival
blood flow decreases & leukocytes and fibrin consolidate in affected part of lung.
complete resolution & healing occur if no complications. Exudate is lysed & processed by macrophages. Normal lung tissue is restored & person's gas exchange returns to normal
Patho of pneumonia
aspiration of s. pneumoniae→release of bacterial endotoxin→inflammatory response (neutrophils, mediators; accumulation of fibrinous exudate, RBCs & bacteria→red hepatization & consolidation of lung parenchyma→gray hepatization & fibrin deposits on pleural surfaces; phagocytosis in alveoli
take every dose of ABs (discuss drug-drug, drug/food interactions & need for rest); may be sev wks b4 usual vigor & well-being returns; teach about vaccines (can get flu shot @ same time in diff. arms); deep breathing exercise for 6-8wks post care
G + acid fast bacillus-droplets which can remain airborne from minutes to hours.
Types of places that ↑ RF spreading of myobacterium TB
LTC, crowded areas, poor areas
Macrophages phagocytose bacteria & release a lytic enzyme that damages lung tissue. A grey/white lesion contains the bacteria (Ghon Focus) which is latent. It can undergo necrosis (granuloma) & if taken up by lymph, it becomes Ghon Complex.
central portion, necrosis, liqueactive necrosis, liquid drains into connecting bronchi & produces a cavity
Classification of TB: 0
No TB exposure, no Hx of exposure; negative skin test
Classification of TB: 1
TB exposure, no infx.; negative skin test; hx of exposure
Classification of TB: 2
Latent TB infx.: no disease (significant rxn to skin test, neg. labs, neg. xray, no clinical evidence of TB)
Classification of TB: 3
TB clinically active (TB infx); positive labs, sig. rxn to skin test, positive xray of disease)
Classification of TB: 4
TB but not clinically active (no current Dx, hx of previous episode, stable xray, rxn to skin test)
Classification of TB: 5
TB suspect (dx pending); person should not be in this class for >3months
Clinical Manis: early stages
usually no sx; ppl w LTBI asymptomatic, but positive skin test
Clinical Manis: systemic symptoms
fatigue, malaise, wt. loss (unexplained), low grade fever & night sweats
Clinical Manis: acute symptoms
chornic cough with blood tinged sputum, high fever, chills, generate flu-like symptoms, pleuritic pain, productive cough
Clinical Manis: miliary TB
large amount of organisms that can invade bloodstream & spread to all body organs. Secondary to primary Dx or reactivation of latent infx. Always serious and if untreated is almost always fatal!!
Complications of Miliary TB
pleural effusion & empyema; TB pneumonia (sim. manis of bact. pneumonia); other organ involvement (meningitis or bone, joints, kidneys, adrenals)
Diagnostic Test: skin testing
TST uses purified protein derivative (PPD); Inject 0.1mL PPD intradermally on forearm. Inspected & read 48-72 hours later for presence or absence of induration. If + do NOT get test again. If - means person has developed antibody
Diagnostic Test: chest xray
important, but can't make a Dx solely on xray. Other Dx mimic TB. Sugggestive findings: upper lobe infiltrates, cavity infiltrates, lymph node involvement
Diagnostic Test: bacteriologic studies
microscopic exam of stained sputum smears for acid-fast bacilli (AFB). 3 consecutive sputum specimens on different days obtained & sent for smear & culture
Diagnostic Test: culture
takes up to 8 wks-can collect from GI washings, CSF or fluid from effusion or abscess
Diagnostic Test: Nucleic acid amplification (NAA)
new test results w/in a few hours. Does not replace cultures
Initial phase of drug therapy regimen, option 1
4-drug regimen consisting of INH, rifampin, pyrazinamide, ethambutol (daily for 56 doses & continuation phase includes INH/rifampin for 126 doses)
INH, rifampin, pyrazinamide, ethambutol daily for 14 doses, then 2x wk for 12 doses; continue INH/rifampin for 2x/wk for 36 doses
INH, rifampin, pyrazinamide & ethambutol 3x/wkly for 24 doses, then INH/rifampin 3x/wk for 54 doses
INH, rifampin, ethambutol daily for 56 doses, then INH/rifampin daily for 217 doses
What is DOT?
Direct Observational Therapy. Providing TB druggs directly to pts and watching as they swallow meds to ensure adherence.
Which TB drug is usually the only one used for LTBI?
Nursing Assessment includes:
assess for productive cough, night sweats, afternoon temp. elevation, wt. loss, pleuritic chest pain & crackles over apices of lungs, get sputum from cough in morning
Ineffective breathing pattern r/t ↓ lung capacity
3 main plans/goals
comply with therapeutic regimen; have no recurrence of disease; have normal pulmonary function
Definition, two types and what events leads you to suspect a pneumothorax?
complete or partial collapse of lung as a result of an accumulation of air in the pleural space. Suspected after blunt trauma to the chest wall. Can be closed or open.
no external wound; usually spontaneous (cased by rupture of small blebs on the visceral pleura); broken ribs can lacerate or puncture lung; excessive pressure used during manual or mechanical ventilation, alveoli or bronchioles can rupture.
result of airway inflammation, d/t smoking usually.
air enters pleural space via opening in chest wall. Ex: gun shot, stab, surgical thoracotomy.
ER tx for open pneumothorax
occlusive dressing, open on 1 side
How does the 3-sided occlusive dressing working to let air out, but not in?
Upon inspiration, negative pressure increases, the dressing pulls against wound & prevents air from coming in. during expiration, pressure rises in pleural space, dressing is pushed out, air escapes through wound & from under dressing.
rapid accumulation of air in pleural space can cause high intrapleural pressures. Puts pressure on heart & great vessels
hemothorax aka "hemopneumothorax"
accumulation of blood in intrapleural space; usu associated with open pneumothorax
Clinical Manis (if small pneumothorax)
mild tachycardia & dyspnea
large pneumothorax manis
shallow, rapid RR, dyspnea, and air hunger
chest pain, cought w/ or w/o hemoptysis; no breeath sounds over affected area & hyperresonance may be heard
Manis during a tension pneumothorax
severe resp. distress, tachycardia & hypoTN; mediastinal displacement occurs & trachea shifts to the unaffected side
CC if amt of air/fluid is minimal
no tx, usu resolves spontaneiously or pleural space can be aspirated with large-bore needle
CC open pneumothorax
cover with vented dressing; if object is in, leave it in and apply bulky dressing
CC most common tx:
chest tube and connect it to water-seal drainage;
if spontaneous pneumothoraces occur, may need partial pleuralectomy or stapling to promote adherence of pleurae to one another