TB, Sleep Apnea, atelectasis, pneumonia

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TB

an infectious disease caused by Mycobacterium tuberculosis. usually affects the lungs but can effect other parts of the body.

atelectasis

Collapsed lung; incomplete expansion of alveoli

dyspnea

Difficult or labored breathing

sleep apnea

A sleep disorder characterized by temporary cessations of breathing during sleep and repeated momentary awakenings.

pneumonia

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respiratory disorders

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How to interpret a TB skin test.

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How to interpret a TB skin test for an HIV client.

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Community Health Measures to control TB - Primary prevention

1. Primary prevention-- before disease
a. Public education re: health promotion, nutrition, how it's spread.
b. Identify & refer those in need of prophylactic drugs & BCG immunization (travelers to countries with high prevalence, e.g.).

Community Health Measures to control TB - Secondary prevention

identifying disease & following thru with treatment
a. Screening & counseling services.
b. Case finding & referral for treatment with medication.
c. Monitor & treat medication side effects.
d. Identify need for & initiate isolation procedures when necessary.

Community Health Measures to control TB - Tertiary prevention

prevent spread & re-occurrence
a. Follow-up after cultures are negative--still taking meds?
b. Monitor effects of treatment.
c. Re-check for prevention of re-infection.

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Describe pathophysiology, assessment, treatment & prevention of these disorders. Know drugs used to treat TB & potential side effects. Choose appropriate nursing diagnoses for the patient with respiratory problems.

Community-Acquired Pneumonia

is a lower respiratory tract infection with onset in the community or during the first 2 days of hospitalization

INH isoniazid side effects

hepatitis, monitor liver function test monthly

Discuss the pathophysiology of pneumonia.

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Discuss assessment data in clients with pneumonia,

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11. Determine correctly written expected outcomes for clients with pneumonia.

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Discuss medical and nursing interventions for the client with pneumonia.

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Review manifestations of pneumonia in the elderly.

Typical signs & symptoms of pneumonia in the elderly:
weakness
fatigue,
lethargy,
confusion,
poor appetite;
may not have fever,
low grade fever
hypoxemia.

UPPER AIRWAY PROPLEMS: Apnea

cessation of air flow through the nose & mouth for a period of 10 seconds or longer.

UPPER AIRWAY PROBLEMS: Sleep Apnea

occurrence of 30 or more apneic episodes during 7 hours of sleep, or 5 or more apneas per hour.

UPPER AIRWAY PROBLEMS: Obstructive Sleep Apnea

partial or complete airway obstruction during sleep.
Affects men, women, and people of any age, including children & elderly; all races.

Central Apnea (upper airway problem)

Brain & CNS-related. Brain does not send message to breath. Seen with neuro-related disorders (CVA involving brainstem, meningitis, encephalitis, prematurity of the newborn).

Hospital acquired or Health-Care Acquired Pneumonia (HAP or HCAP)

Onset in hospital, long term care facility, hospital or hemodialysis clinic. Nosocomial

VAP

Ventilator Acquired PNA

First step of pathophysiology of pneumonia

Pathogen successfully penetrates airway mucosa & pulmonary tissue, releasing toxins & causing congestion
Decrease mobility of cilia can get congesting

Contributing causes for pneumonia, list 8.

1. Condition of host-- run-down, immunosuppressed, post-op.
2. Chronic disease (Lupus, aids, COPD etc.)
3. Age -- elderly esp.
4. Immobility, bedrest
5. Poor nutrition
6. Smoking -- decreased cillia
7. Caustic -- chemical or environmental agents (air pollution)
8. Nosocomial causes (hosp. acquired)

Review manifestations of pneumonia in the younger adult.

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Complications from Pneumonia (list six)

1. Pleurisy
2. Pleural effusion
3. Lung abscess
4. Empyema --
5. Bacteremia -- SEPSIS
6. Atelectasis - collapse of the lungs

pleurisy

INFLAMMATION of the pleura, often leading to adhesion between the parietal and visceral layers, fairly common; painful when breathing

pleural effusion

Abnormal accumulation of fluid in the pleural space

bacteremia

Bacteria in the blood

empyema

Accumulation of pus/purulent fluid in the pleural cavity

Lab diagnostics for pneumonia (Hematology)

1) WBC with differential - often  15000 - 25000;
neutrophilia (with a shift to the left)

2) Blood cultures --will show organisms if they have invaded bloodstream. (bacteremia)

Lab diagnostic for pneumonia (urinalysis)

hematuria, pyuria, protein with sepsis. (Pts with pneumonia can become septic easily--especially elderly.)

What labs for pneumonia are used to rule out dehydration & sepsis?

serum creatinine, BUN, glucose, electrolytes, & liver function tests

With pneumonia what tests are used for oxygenation?

1) Pulse oximetry --

2) Blood gasses (ABG's) -- Assess for:
a) Hypoxemia R/T decreased surface area for gas exchange.
b) Respiratory acidosis - seen with underlying lung disease &
R/T hypoventilation & fatigue.

What do Blood gasses (ABG's)--assess for?

used to assess for Hypoxemia and Respiratory acidosis - seen with underlying lung disease &
R/T hypoventilation & fatigue.

respiratory acidosis

decrease in the pH of body fluids as a result of a buildup of carbon dioxide

hypoxemia

Arterial blood oxygen level less than 60 mm Hg; low oxygen level in the blood.

lung parenchyma

where does pneumonia affect?

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