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Respiratory Part 2

Respiratory Part 2. M edical Surgical Nursing. 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. FYI.

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Respiratory Part 2

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  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

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