Summary
Summary NURB 3130 Exam 2 Study Guide
- Course
- NURB 3130
- Institution
- Northwestern State University Of Louisiana
This is a comprehensive and detailed study guide on Exam 2 for NURB 3130. *An Essential Study Resource!! Here for YOU!!
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Exam 2 SG3130
Pneumonia
Atelectasis: closure or collapse of alveoli
- Acute: insidious, cough, sputum production, tachycardia, tachypnea, pleural pain, central
cyanosis
- Chronic: similar to acute, but may have an infection
Assessment and diagnosis
- Characterized by increased work of breathing and hypoxemia
- Decreased breath sounds and crackles over the affected area
- Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear
- Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen
(less than 90%)
- Tachypnea, dyspnea, and mild to moderate hypoxemia are the hallmarks of the severity of
atelectasis.
Nursing Interventions:
- Prevention:
o Frequent Turning
o Early mobilization
o Strategies to expand lungs and manage secretions
o Deep breathing
o Respiratory treatments/ metered-dose inhaler
- Chart 23-1, page 585
- Secretion management – if cause is bronchial obstruction from secretions, they will have
to be removed by coughing or suctioning to allow air to reenter that portion of the lung
- Respiratory treatments – bronchodilator or sodium bicarb to help patients expectorate the
secretions/metered-dose inhaler
Management:
- Improve ventilation and remove secretions
- First line measures: frequent turning, early ambulation, lung volume expansion
maneuvers, coughing
- ICOUGH:
o Incentive spirometry, Coughing and deep breathing, Oral care, Understanding,
Getting out of bed at least 3 times daily , Head-of- bed elevation
- If not responding to first-line intervention: PEEP, CPAB, bronchoscopy
o Assess and see if necessary
Pneumonia:
- Classification:
o Community Acquired: occurs less than 48 hours after being admitted into hospital
o Healthcare associated (HCAP): hospitalization greater than 2 days and gets within
90 days of stay, pt nursing home, pt that has been on chemo, antibiotics,
hemodialysis, wound care, a family member with an infection
, o Hospital acquired (HAP): appears 2 days after admitting and symptoms weren’t
present at admission
o Ventilator associated (VAP): develops 48 hours after intubation
Pneumonia Risk Factors:
- Occurs in pts with certain underlying disorders and diseases
o Heart failure, diabetes, alcoholism, COPD, and AIDS
o Influenza
o Wash your hands
- Cystic fibrosis
Clinical manifestations:
- Varied depending on type and underlying disease
- Streptococcal: sudden onset of chills, fever, pleuritic chest pain, tachypnea, and
respiratory distress
- Viral, mycoplasma, or legionella: bradycardia
- Other: respiratory tract infection, headache, low-grade fever, pleuritic pain, myalgia, rash,
and pharyngitis
- Orthopnea, crackles, increased tactile fremitus, purulent sputum
Assessment and Diagnosis
- History
- Physical exam: History, physical examination, and chest x-ray often provide enough
clinical information to make decisions about early treatment.
- Chest x-ray: Chest x-ray often shows a typical pattern characteristic of the infecting
organism and is very important in the diagnosis of pneumonia. X-ray may also show
pleural effusions.
- Blood culture: Blood cultures are done for patients who are seriously ill.
o Blood cultures are used to detect the presence of bacteria or fungi in the blood, to
identify the type, and to guide treatment.
o Testing is used to identify a blood infection (septicemia) that can lead to sepsis, a
serious and life-threatening complication.
o Once a sample is collected, it is placed in a container with a substance (called
growth medium or culture medium) that helps bacteria, fungus, or viruses grow.
o Bacteria usually need about 1 to 2 days to grow.:
o Leukocytosis occurs in the majority of patients with bacterial pneumonia; the
(WBC) count is usually >15,000/μL with the presence of bands (immature
neutrophils).
- Arterial blood gases (ABGs) may be obtained to assess for hypoxemia (partial pressure of
oxygen in arterial blood [PaO2] less than 80 mm Hg), hypercapnia (partial pressure of
carbon dioxide in arterial blood [PaCO2] greater than 45 mm Hg), and acidosis (pH
<7.35).
- Sputum examination: Ideally, a sputum specimen for culture and Gram stain to identify
the organism is obtained before beginning antibiotic therapy. However, antibiotic
administration should not be delayed if a specimen cannot be readily obtained. Delays in
antibiotic therapy can increase the risk of morbidity and mortality.
o Rinse mouth with water, deep breaths, cough deeply, cough sputum into sterile
container
, - Bronchoscopy: A bronchoscopy with washings may be used to obtain fluid samples from
patients not responding to initial therapy. (ATI)
o Pre-Procedure
Pulmonologist or surgeon in monitored setting - bronchoscopy suite, OR,
ICU
Informed Consent
NPO (follow policy) at least 6 h before bronchoscopy, IV access, BP
monitoring, continuous pulse ox/cardiac monitoring, supplemental O2
Conscious sedation with short-acting benzodiazepines, opioids, or both
before the procedure to decrease anxiety, discomfort, and cough. In some
centers, general anesthesia (eg, deep sedation with propofol and airway
control via endotracheal intubation or use of a laryngeal mask airway) is
commonly used before bronchoscopy.
o Intra-Procedure
The pharynx and vocal cords are anesthetized with nebulized or
aerosolized lidocaine. The bronchoscope is lubricated and passed either
through the nostril, the mouth with use of an oral airway or bite block, or
an artificial airway such as an endotracheal tube. After inspecting the
nasopharynx and larynx, the clinician passes the bronchoscope through the
vocal cords during inspiration, into the trachea and then further distally
into the bronchi.
o Post-Procedure
Patients are typically given supplemental O2 and observed for 2 to 4 h
after the procedure.
Return of gag reflex and maintenance of oxygen saturation when not
receiving supplemental oxygen are the two primary indices of recovery.
Standard practice - posteroanterior chest x-ray after transbronchial lung
biopsy to exclude pneumothorax.
Blood tinged sputum is okay
Oral hygiene
Cough reflex present
- Thoracentesis:
o is the insertion of a large-bore needle through the chest wall into the pleural space
to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill
medication into the pleural space
The patient is positioned sitting upright with elbows on an over bed table
and feet supported. Positioning - positioned in a way that allows MD to
access the pleural space. An ultrasound may be done prior to, to ascertain
the correct area where the needle will go
The skin is cleansed, and a local anesthetic (Xylocaine) is instilled
subcutaneously.
A chest tube may be inserted to permit further drainage of fluid.
o MD Office or hospital…Informed Consent
o Awake, but you may be sedated - someone else to drive after the procedure if
sedated
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