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NURS 303 Study Guide - Final Guide: Pericarditis, Esophagus, Azithromycin

5 pages77 viewsFall 2016

Department
Nursing
Course Code
NURS 303
Professor
Jennifer Lyn Baumbusch
Study Guide
Final

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Acute bronchitis
-inflammation of the bronchi in lower respiratory tract (RT) usually caused by infection.
-One of the most common conditions seen in primary care
-usually follows an upper respiratory tract infection (URI)
-A type of acute bronchitis is acute exacerbation of chronic bronchitis (AECB)
-Infection superimposed on chronic bronchitis
-May lead to respiratory failure
-Most cases of AECB are d/t viral (rhinovirus, influenza) infection. Bacterial causes are also
common in both smokers (strep puneumoniae, haemophilius influenzae) and nonsmokers
(mycoplasma pneumoniae, chlamydia pneumoniae).
-Persistent cough is most common symptom
-Production of clear, mucoid sputum, although some patients produce purulent sputum
-fever, headache, malaise, SOBOE
-mildly elevated temp, pulse, and RR with either normal breath sounds or expiratory
wheezing
-Radiography can differentiate between acute bronchitis and pneumonia, as there is no
radiographic evidence of consolidation or infiltrates with bronchitis
Pneumonia
-Acute inflammation of lung parenchyma caused by microbial agent.
-Discovery of sulpha drugs and penicillin was pivotal in treatment of pneumonia
-Still common and associated with significant morbidity and mortality rates
-Pneumococcal Pneumonia = most common bacterial pneum.
Etiology
-Airway distal to larynx generally sterile d/t filtration, warming and humidifaction, epiglottis
closure over trachea, cough reflex, mucociliary escalator mechanism, secretion of
immunoglobulin A, alveolar macrophages
Predisposition
-most likely when defence mechanisms become incompetent or are overwhelmed
-Decreased consciousness leading to depressed cough and epiglottal reflexes, allowing
aspiration of oropharyngeal contents into lungs
-tracheal intubation interferes w normal cough and mucociliary escalation mechanism. Also
bypasses upper airways, thus bypassing filtration, humidification
-Leukemia, alcoholism, DM, associated with gram-negative bacilli in oropharynx.
Acquisition of Organisms
1. Aspiration from nasopharynx or oropharynx
2. Inhalation of microbes present in air
3. Hematogenous spread from primary infection elsewhere (e.g., Staph aureus)
Types of pneumonia
-Community acquired (CAP) - LRI of lung parenchyma with onset in community or during first
2 days post admission.
-Highest incidence in winter
-Smoking!, COPD, recent use of abx, risk of aspiration
-Commonly caused by s pneumoniae and atypical organisms (e.g., legionella, mycoplasma,
chlamydia, viral).
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-CURB-65 score (0-1 = can do outpatient, 2 = hospitalization, 4-5 = consider CCU)
-confusion
-Urea > 17 mmol/L
-RR ~30
-BP < 90/60
-age > 65
-Hospital acquired (HAP) - 48 hours or longer after admission
-Accounts for 25% of CCU infections
-Bacterial causes incl. pseudomonas, enterobacter, s. aureus, MRSA, s. pneumoniae
-usually secondary to aspiration from own pharynx.
-immunosuppressive therapy, general debility, and endotracheal intubation = risk!
-Fungal Pneumonia (not assigned, but know it exists!)
-Aspiration Pneumonia
-sequelae of abnormal entry of secretions into lower airway
-Mouth or stomach -> lungs
-food, water, vomitus, toxic fluids
-Tox (gastic fluids) -> chemical injury to lung with infection as secondary event 48-72
hours later
-Usually loss of consciousness Hx. —> loss of gag, cough reflexes, aspiration more likely
-Superior segments of lower lobes and posterior segments of upper lobes most common
-ABX therapy is based on assessment of severity of illness, CAP vs HAP, and type of
organism present
-Opportunistic Pneumonia
-immunosuppression is prime target
-severe protein-calorie malnutrition
-transplant receivers
-pts undergoing radiation, chemo, or corticosteroids over period of time
-altered B- and T-lymphocyte function
-dressed bone marrow function
-decreased levels or function of neutrophils or macrophages
-May also be caused by
-P. Jiroveci - lung pathogen that rarely causes pneumonia, however, affects 70% of HIV
pts, most common opportun. inf. in pts. with AIDS.
-Radiograph shows bilateral alveolar pattern of infiltration. Lungs can become
massively consolidated.
-Clinical manifestations are insidious and include fever, tacypnea, tachycardia,
dyspnea, nonproductive cough, hypoxemia.
-Treatment = trimethoprim-sulfamethoxazole (Bactrim) or dapsone-trimethroprim.
Prohylaxis with trimethroprim-sulfamethoxazole may be advocated if AIDS+.
-cytomegalovirus (CMV)
-CMV = herpesvirus, generally mild disease, but can be fulminant and produce
pulmonary insufficiency/death
-Treated with Ganciclovir (Cytovene)
-fungi
Patho
1. Congestion - outpouring of fluid into alveoli d/t pneumococcus organisms in alveoli. Multiply
in serous fluid. Spread infection. Damage host thru overwhelming growth and interference w
lung function
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