M/S Ch. 28 Infectious Respiratory Problems

Mantoux test indicates?

*EXPOSURE*, not infection > 10mm: Possible infection >5mm: Possible infection in adults with reduced immunity

Pnuemonia s/sx

Flushed cheeks Anxious expression Chest pain/discomfort Myalgia HA Chills Tachycardia Dyspnea/Tachypnea Hemoptysis- blood tinged sputum Hypoxemia Sputum "Tripoding" Crackles Hypotensive

Tuberculosis risk

Frequent contact untx'd person Immunocompromised d/t HIV/AIDS Crowded living- dorms, jails, military, LTC facilities, homeless shelters, low socioeconomic status, ETOH/ Illicit drug users with malnutrition

Pandemic flu

From birds/animals- spreads to humans Social distance Stop nonessential public activities Have enough food/H2O for two weeks per person

Tuberculosis

Gets in lungs, multiplies in rhonchi + bronchiole sacs Slow-growing Happens with contact with untx'd person Airborne route-precautions

Seasonal flu s/sx

HA Body aches Fever Fatigue Weakness Sore throat, cough, watery discharge Infection can lead to N/V/D

Seasonal flu

Highly contagious Contagion starts 24 hrs before symptoms and lasts yp to 5 days after Can lead to cx in pneumonia or death, esp in aged, HF, chronic lung disease, and immunocompromised pts

HAP

Hospital acquired pneumonia -Within 48 hrs of admission

.A client is admitted with suspected pneumonia from the emergency department. The client went to the primary care provider a few days ago and shows the nurse the results of what the client calls an allergy test, as shown below: What action by the nurse takes priority?

Immediately place the client on Airborne Precautions

.A client seen in the emergency department reports fever, fatigue, and dry cough but no other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What action by the nurse is best?

Inform the client that antibiotics will be needed for 60 days

A client in the emergency department is taking rifampin (Rifadin) for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? (Select all that apply.)

International normalized ratio (INR): 6.3 Prothrombin time: 35 seconds

Tuberculosis Rx

Isonaizid Rifampin Pyrazinamide Ethambutol ADHERE TO MEDICATION PROTOCOL!!!

Pyranzamide

Makes gout worse 8 oz H2O when taking Increased photosensitivity- wear protection outside sun ETOH and liver failure

Pneumonia int

O2 therapy Incentive spirometer- sit up, inhale fully, mouth to mouthpiece, long/slow deep breathe, hold 2-4 secs, slowly exhale, 5-10 breaths/hour while awake Cough/ deep breathe q 2 hrs 2L fluid daily *Monitor ABGs*

.A client has the diagnosis of valley fever accompanied by myalgias and arthralgias. What treatment should the nurse educate the client on?

Oral fluconazole (Diflucan)

Rifampin

Orange-reddish urine/body fluids- don't wear white! Permanent stains Additional protection with PO contraceptives Avoid ETOH, report sx liver failure

Pneumonia labs

PaO2 < 70: notify HCP

HCAP

Pneumonia acquired after being in long-term care facility for at least 90 days- assisted living, rehab, any place outside hospital

.A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)?

Provide oral care every 4 hours.

Pneumonia

Rapidly progresses to sepsis, death Forms fluid in lungs-alveoli sacs, stems from inflammatory process CO2 exchange cannot occur

Isoniazid

Take with B vitamin Empty stomach Avoid ETOH Report dark urine, yellow sclera/skin

.A client is in the family practice clinic reporting a severe cold that started 4 days ago. On examination, the nurse notes the client also has a severe headache and muscle aches. What action by the nurse is best?

Teach the client to sneeze in the upper sleeve.

Tuberculosis assessment

Travel from foreign country? BCG vax?

Aspiration pneumonia

Tx with PPI- keeps gastric acid low Causes lung inflammation-leads to ARDS

Tuberculosis s/sx

Unintended wt loss Anorexia Night sweats Dyspnea Hemoptysis Persistent cough SOB Fever Chills Fatigue Lethargy Irregular menses

Pneumonia prevent

Vaxxy! Older adults Strict handwashing Avoid crowds during flu season See HCP for fever >24 hrs

VAP

Ventilator associated pneumonia -Remember to follow order sets for vent: PO care, chlorohexidine, suction PRN, elevate HOB

Seasonal flu tx

Viral- no abx *Tamiflu*- any "-vir": must be taken within 24-48 sx onset -Percamivir (IV), Baloxavir (PO) Thoroughly wash hands Stay home from work Cover mouth when cough/sneeze Social distancing Rest several days Increase fluid intake Saline gargles Antihistamines

.A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate?

Visiting Nurses for directly observed therapy

Empyema

When fluid moves out of alveoli and into pleural cavity

.A nurse is providing pneumonia vaccinations in a community setting. Due to limited finances, the event organizers must limit giving the vaccination to priority groups. What clients would be considered a priority when administering the pneumonia vaccination? (Select all that apply.)

. 22-year-old client with asthma . Client with well-controlled diabetes Healthy 72-year-old client Client who is taking medication for hypertension

.A nurse admits a client from the emergency department. Client data are listed below: History Physical Assessment Laboratory Values 70 years of age History of diabetes On insulin twice a day Reports new-onset dyspnea and productive cough Crackles and rhonchi heard throughout the lungs Dullness to percussion LLL Afebrile Oriented to person only WBC: 5,200/mm3 PaO2 on room air 65 mm Hg What action by the nurse is the priority?

. Administer oxygen at 4 liters per nasal cannula

.A hospital nurse is participating in a drill during which many clients with inhalation anthrax are being admitted. What drugs should the nurse anticipate administering? (Select all that apply.)

. Amoxicillin (Amoxil) Ciprofloxacin (Cipro) Doxycycline (Vibramycin)

.The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met?

. Antibiotics started before admission

A client has been hospitalized with tuberculosis (TB). The clients spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best?

. Ask the spouse to explain the fear of visiting in further detail

.A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give fluids, the client questions this action, saying I have been drinking tons of water. How am I dehydrated? What response by the nurse is best?

. Breathing so quickly can be dehydrating

.A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority?

. Educating the client on adherence to the treatment regimen

.A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks. The client is so exhausted after coughing that work has become impossible. What action by the nurse is most appropriate?

. Facilitate polymerase chain reaction testing.

.A nurse working in a geriatric clinic sees clients with cold symptoms and rhinitis. Which drug would be appropriate to teach these clients to take for their symptoms?

. Fexofenadine (Allegra)

.A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective?

. I will take this medication on an empty stomach.

An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The client is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best?

. Older people often have vague symptoms, so an x-ray is essential.

.Which teaching point is most important for the client with bacterial pharyngitis?

. Take all antibiotics as directed.

.A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most helpful?

. Try warm, moist heat packs on your face.

A client has been admitted for suspected inhalation anthrax infection. What question by the nurse is most important?

. What is your occupation?

A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately?

Alanine aminotransferase (ALT): 180 U/L

.A client is in the family medicine clinic reporting a dry, sore throat. The provider asks the nurse to assess for odynophagia. What assessment technique is most appropriate?

Assess the client for pain when swallowing

Pneumonia tx

Bronchodilators Abx Expectorants IS hourly! Breathing tx Coughing-sit up! Supplemental O2

Pneumnia dx

CT scan Gram stain Sputum cultures CXR- esp older adult- sx can be vague

Tuberculosis dx

CXR Sputum cultures-AFB Mantoux-induration test-DOES NOT MEAN INFECTION

.The charge nurse on a medical unit is preparing to admit several clients who have possible pandemic flu during a preparedness drill. What action by the nurse is best?

Cohort the clients in the same area of the unit

CAP

Community acquired pneumonia

Empyema tx

Drain chest cavity Chest tube- closed drainage Don't smoke/vape Pneumonia is a risk factor

Flu vaxxy

Each seasonal dose is 3-4 strains *expected* to be prevalent that year Adults over 50 who have: -Chronic illness -Immune compromised -Institutionalized -Lives with/cares for others who are high risk -Healthcare personnel