Escolar Documentos
Profissional Documentos
Cultura Documentos
Atelectasis
Pneumonia, SARS, Swine Flu
Pulmonary Tuberculosis
Pleural Effusion
Pulmonary Fibrosis
What do they have in common?
A 19 year old with rib fractures
Atelectasis
Risk Factors
Post op patients – immobility – low TV
Incorrect intubation
Red: ETT in
right
Atelectasis
main-stem
bronchus Overinflation
Compressive Atelectasis
A space-occupying lesion of the thorax
compresses the lung and forces air out of
the alveoli.
Consequences
Atelectasis can lead to:
Pneumonia
Respiratory Failure
Death
Bronchoscopy
Thoracentesis/paracentesis
Surgery or radiation
Pneumonia
Infection/inflamation of the lung
Immunocompromised: Cytomegaloviris
Herpes simplex
What do these people have in
common?
Client #1 takes 10 mg prednisone qd
Recommended for:
> 65 y/o/a
Chronic illnesses
Functional or anatomic asplenia
Immunocompromised
College students
E. Coli - Proteus -
H. Influenzae Serratia -
Pseudomonas - MRSA*
S. Pneumoniae
Narcotics/ALOC/coma
Malnutrition Hypotension
Maliase, fatigue
Fever, tachycardia*, tachypnea (25-45 bpm)
Cough & purulent sputum*
Leukocytosis
Sputum culture*
*rinse mouth with H2O
*deep breathe several times
*cough
*expectorate into sterile container
*send immediately to lab
Indications of consolidation:
Whispered pectoriloquy
+ Tactile fremitus (“99”)
Dullness to percussion
Egophony (“E” becomes “A”)
CDC Recommendations
1. Staff education
3. Prevention of transmission
Shock
Respiratory failure
Atelectasis
Pleural effusion
Superinfection
Goals
Improved airway patency
Ability to perform ADL’s
Adequate fluid volume
Adequate nutrition
Understanding of treatment protocol &
prevention measures
Absence of complications
AEB:
Treatment: Obtain cultures PTA
CAP FAP
Aminoglycosides
Viral Infections
Allergies?
C & S results?
ATB
Prevent antibiotic resistant organisms:
*Give on time*
Antitussives Bedrest
Pain medications
Interventions
ETOH & Smoking cessation*
Rescue position for high risk patients
Oral care
Clean respiratory equipment
Hand washing
TCDB & Chest PT
Suctioning prn
Early ambulation
IS
Interventions
Elevate the head of the bed
Pace activities
OR
Headache
Malaise
Diarrhea (10-20 %)
Containment of secretions
Containment of Secretions
Cover the nose/mouth
Use tissues
Healthcare workers should wear a surgical or procedure mask for close contact
Place together in the same room (cohort) patients who are infected the
same pathogen
Ensure that patients are >3 feet apart & curtain is drawn
Unlike most cases of swine flu, this one can spread from
person to person
OR
Coughing
*HIV
*Increased immigration
*Multidrug-resistant strains
*Increased homelessness
*Decreased detection
*Inadequate funding of the US public health
system
Transmission
Airborne droplet
CXR: lesions
AFB: mycobacteria
Positive skin test
Reaction of 0-4 is not significant
nor do
Approved in 2005
Malnutriton
Multi-drug resistance
Increased knowledge
Absence of complications…….AEB:
Orders
Admit all suspected/confirmed cases to AFB isolation
(Airborne Precautions < 5 microns)
Ultraviolet light
Disposable particulate respirators
Monitor HCP for s/s TB
Airborne Isolation
HCP wears:
Standard Precautions*
Particulate Mask
Client Transport:
Thrombocytopenia
Fever, arthralgias,
GI distress
These are caused by bleeding underneath the skin. Petechiae measure less than 0.5 cm,
purpura 0.5 – 1 cm, and ecchymoses are greater than 1 cm (Tongue)
Side Effects
Take on empty stomach or 1 hr before meals
Beta-blockers
Coumadin
Oral hypoglycemics
Digoxin
Oral contraceptives
Theophylline
Verapamil
High-calorie supplements
Handwashing
Neoplastic tumors
CM
S/S underlying disease (occurs with >500 mL):
Decreased/absent BS
Decreased fremitus
Dull, flat to percussion
Tracheal deviation
CXR
Upright A & P (>300mL’s to detect)
A = pleural effusion
B = width of the
hemithorax
Treatment
Gram stain
C&S
AFB
RBC, WBC
Gl, amylase LDH, protein
Cytology
pH
Treatment
Note & record pt’s tolerance, condition
afterwards, color /characteristics of fluid
Mechanical Chemical
Pleurodesis
Can be done with thoracentesis or CT
Clamp CT 60-90”
Chemotherapy meds:
Bleomycin
Mitomycin
BCNU
Busulfan.
CM
Progressive:
Respiratory failure
Pulmonary HTN
Cor Pulmonale
DVT & PE
Cor Pulmonale
Diagnosis
The origin and development of the disease is not
completely understood so misdiagnosis is common.
CXR
PFT’s
Steroids (Prednisone)
Supplemental O2
Lung transplant
Question
Which infection control technique is
unnecessary when caring for a client
with tuberculosis (TB)?