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Group 3 and 4

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Clinical Manifestations:
·         Signs & Symptoms:

o   Flu-like cough, green mucus, high fever

o   Chest pain, SOB

o   Chills

o   Headache

o   Rusty mucus

o   Aching chest muscles

o   Rales to no breathing sounds

o   Tachypnea for children<5 yrs.

o   less likely to have fever in older adults

Diagnostic Tests:

·         Chest X-rays @ 3-4 sites

·         Sputum test

·         Spirometry

·         Oximetry

·         Blood tests for WBCs

·         Urine sample

·         Bronchoscopy

Drugs of Choice and Nursing Interventions:

·         Drugz :) :

·         Antibioti1/cs (start off w/ broad spectrum)

·         Aerosols/Inhaler (salbutamol)

·         Antitussives

·         Expectorants

·         Nursing Interventions:

·         Tripod position

·         Humidifier

·         More fluids

·         Breathing and coughing exercises

·         Good ventilation

·         Nutrition

·         Analgesics/ NSAIDs

·         Thoracentesis

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Signs & Symptoms:
- Cough
- Tachypnea
- Shortness of breath
- Secretions-- thick and purulent
- Cough and rhonchi seen in the morning--d/t pooling of secretion during the night
- Hypoxia
- Hypercapnia
- Secondary polycythemia
- Severe weight loss
- Cor pulmonale (systemic edema) d/t vascular damage and pulmonary hypertension progresses

Diagnostic Tests:
- How long have you had your cough?
- Are you coughing up mucus?
- Is there blood in your sputum?
- Did you ever have a fever or other symptoms, such as chest tightness?
- Did you have a cold before the cough?
- Are you wheezing?
- Do you have trouble catching your breath?
- Have you been around other people who have the same kinds of symptoms?

Medications/Treatments:
- Bronchodilators
- Humidifiers
- Oxygen Therapy
- Chest Therapy
- Nutrition Supplements
- Lifestyle Changes

Nursing Interventions:
- Report changes immediately.
- Monitor patient's weight by weighing him three times weekly.
- Assess for edema
- Watch the patient for signs and symptoms of respiratory infection, such as fever, increased cough and sputum production, and purulent sputum.

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Manifestations:
S&S systemic "initial":
- fatigue
- malaise
- anorexia/ weight loss
- low grade fever
- night sweats
S&S pulmonary:
- cough
- purulent sputum with blood.
- chest pain "dull tightness"

Two different stages:
Primary infection:
- microorganism enters into lungs.
- microorganisms are engulfed by macrophages causing local inflammatory rxn.
- Migrates to lymph nodes causing hypersensitivity rxn.
- Granuloma is formed from lymphocytes and macrophages at the site of inflammation- this contains bacilli forming a tubercle.
Secondary infection:
- stage of active infection
- years after primary infection:

Diagnostic tests:

Positive tuberculin skin test (anything equal to 5 to 9 mm)
Acid-fast sputum test
chest radiograph
sputum culture and sensitivity

Medications:
Prototype: Isoniazid (administered orally)

Nursing intervention:
PPE

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Signs and symptoms:
-Anorexia and fatigue contribute to weight loss
-Clubbed fingers can be developed as compensation
-Hyperventilation with a prolonged expiration phase uses accessory muscles which leads to the development of a "barrel chest"

Diagnostic Test
-Chest Xrays
-Pulmonary function tests: indicates increased residual volume and total lunch capacity, also decreased forced expiratory volume and vital capacity

Treatment
- Avoidance of respiratory irritants
-Cessation of smoking
-immuziation against influenza and pnuemonia
- pulmonary rehabilitation

Medications/Drugs
1. Ipratropium bromide (Atrovent)
2. Combivent (Ventolin) - combines ipratropium and albuterol)
MOA: has an effect on beta 2 receptors
3. bronchodilators
decrease muscle tone
MOA
produce direct bronchodilation and has some anti inflammatory actions in the airways.

Nursing Interventions:
1. Auscultation
2. Suctioning
3. Monitor oxygen saturation

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Signs and Symptoms

- Cough

- Dyspnea

- Tight feeling in the chest

- Agitation develop as airway obstruction increases

- Patient is unable to talk

- Wheezing

- Breathing is rapid

- Thick and tenacious or sticky mucus is coughed up

- Tachycardia

- Hypoxia

- Respiratory alkalosis develops initially because of hyperventilation

- Respiratory acidosis develops in time, due to air trapping

- Severe respiratory distress is evident

- Respiratory failure is indicated by decrease in responsiveness and cynosis

Diagnostics:

-       Skin tests for allergic reactions are helpful in determining specific stimuli to be avoided

-       Spirometry – volume and duration of inhaled and exhaled air.

-       Bronchial challenge test – Pt breaths in metacholine or histamine. It causes constriction and narrowing of airways . Degree of narrowing can be quantified. Lower doses may aggravate the symptoms in people of preexisting asthma.

Medications:

- Self-administer a bronchodilator, usually a beta2 - adrenergic agent such as salbutamol (Ventolin).
- These more specific drugs, which have largely replaced isoproterenol and epinephrine, act on receptors to relax bronchial smooth muscle but have minimal effects on the heart

- Glucocorticoids such as beclomethasone (Beclovent) may be administered by inhalation also, but are more effective in reducing the second stage of inflammation in the airways. This type of drug may be useful when chronic inflammation develops.

- Leukotriene receptor antagonists such as zafirlukast (Accolate) and montelukast (Singulair) block inflammatory responses in the presence of stimuli.

-  Cromolyn sodium is a prophylactic medication that is administered by inhalation on a regular daily basis.

Nursing interventions

- Assess respiratory status (lung sounds, respiratory, depth, presence/severity of wheezing, breathing pattern, use of neck or abdominal muscles) q1h after acute attack
- Assess sounds of cough (hacking, wet cough, dry cough etc)
- Plan periods of rest between activities to reduce fatigue
- Keep client in High Fowler's position to open lung bases and airways
- Tell client to purse lips while exhaling
- Provide supplemental oxygen PRN
- Monitor arterial blood gases and pulse oximetry
- Check o2 saturation
- Encourage fluid intake (2000-3000 ml/day) as tolerated to thin out sputum secretions
- Teach patient strategies for reducing anxiety
- Educate patient about triggers and make sure room does not contain triggers ( dust, pollen, animal fur)
- Obtain PQRSTAU of attacks
- Determine whether client smokes or not. If they do, discuss a smoking cessation plan with them
- Auscultate lung sounds - make sure they are not wheezing (closing airways) or any crackles (may have pneumonia)
- If patient is having an asthma attack, stay with them and help with breathing and try to calm them down. Provide a relaxing environment after the asthma attack is over