Study Guide Test 1 Medsurg

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STUDY GUIDE TEST 1Rhinitis Definition inflammation of nasal cavities Allergic rhinitis: pollens Acute viral rhinitis: coryza, spread by droplets. Home care: fluids, bedrest, humidification, Echinacea, Vit. C, Zinc, Handwashing. Etiology: Allergen- plant, food: hay fever, complication: otitis media, hearing loss, pneumonia. Virus, bacterial, excessive medication use Transmission: droplet or direct contact (Table 25-3, p. 447, PPE review: Table 25-2, p. 446) Assessment: rhinorrhea, congestion, sore throat (initial symptom if viral), HA, fever Implementation: Pharmocological: OTC medications : Antihistamines, decongestants, nasal steroids, Analgesics, antipyretics, antibiotics (bacterial), desensitization Complemenary/Alternative: Nursing: Deficient Knowledge-

Sinusitis: Definition- inflammation of mucous membranes of one or more sinus cavity Acute- Etiology- bacteria, virus Chronic- Etiology- repeated infections causing mucous membranes to thicken resulting in : h/a, dull aching pain, facial swelling, chronic cough, sleeplessness. Obstruction of drainage Assessment- HA, facial pain, nasal congestion, fever, purulent nasal drainage, tenderness, bad breath Complications: orbital celulitis, meningitis, abscess. Implementation: Medical: Pharmacologic-Broad spectrum antibiotics, analgesics, decongestants, expectorants Surgical: Maxillary Antral Irrigation- under local anesthesia, antral puncture+lavage, outpt. Procedure- irrigated w/saline. Caldwell Luc Procedure- incision under upper lip into maxillary sinus. Infection removed- may have difficulty eating b/c pain and swelling. Ice packs, oral hygiene (Gentle), change dressing prn, limit valsalva maneuver, no coughing or blowing nose, no lifting, situate in semi-fowlers, eat soft foods, use analgesics, increase fluid intake.

Nursing: Post-op (Iggy, Chart 33-1, p. 655) Education: Post-opConservative treatment- Use of meds, comfort measures, humidification, saline irrigations, hot wet packs over sinus, increase fluids

Influenza: Definition: Acute viral resp infection, seasonal Etiology: Virus A, B, C, H1N1 (3-7 day duration, malaise 14 days after) Assessment: Initial- severe HA, myalgia, fever, chills, fatigue 1-2 weeks later- sore throat, cough, rhinorrhea, fatigue Implementation: Acute- Antiviral agents, antihistamines BR, increase fluids Prevention- Immunizations Complications- pneumonia CDC. Seasonal Influenza: complications: bronchitis, pneumonia, worsen COPD. Symptoms begin 2-4 days after exposure and last 5-6 days.

MRSA - transmitted by infection (hands) or colonized carriers (nares). -eradicate with topical agent (bactroban) to nares & oral Ab (Bactrim). -tx. Of infectious patients Vancomycin or Rifampin IV. Alcohol foam can be used for MRSA but can NOT be used for C-diff. -contact/ airborne/ droplet isolation- wearing gloves & gown if direct contact, mask, private room-------dont use shared equipment or do not allow to touch bed or bedstand------clean room items daily with antiseptic. Pts are in negative pressure room. - they might need fit tested masks, that are different than a regular surgical mask. M95 mask

Pneumonia: 8th leading cause of death in US + 3rd leading cause of death in persons >85 y/o. Description- Acute infectious process of bronchioles, alveoli, interstitial spaces Decreasing compliance & causing hypoxemia Pathophysiology: organisms: streptococcus (pneumococcal pneumonia, hemophilous influenza, staphylococcus aureus, pneumocystitis carnii (AIDS).

ClassificationBacterial vs viral: Bacterial- acute onset, chills, fever, productive cough, pleuric chest pain, crackles, tachypnea, tachycardia. VIRALsudden, gradual, mild, and flu-like. Community acquired (CAP) vs hospital acquired (HAP) Location- bronchopneumonia, lobar Etiology- Infectious- bacteria, virus, mycoplasma, fungi, protozoa Non-infectious- toxic gases, chemicals, smoke, aspiration Risk factors: older, institutionalized, ventilator. Assessment- (Iggy, Table 33-3, p. 663) Subjective: Exposure? Risk factors? Objective: fever (high in bacterial), cough, pleuritic chest pain VS- tachypnea, tachycardia, BP____low_____ Adventitious lung soundsSputum- hemoptysis, rust, bloody-colored, creamy yellow, green, white, cleareen. Sputum: pneumococcal- rusty brown, blood tinged. Staphcreamy yellow. Pseudomonasgreen. Diagnostics- sputum C&S, CBC, ABGs, CXR (diffuse patches or consolidation), blood cultures, Pulse oximetry, electrolytes White count elevated, pulse ox lowered, check BUN and Na+ for dehydration. Droplet Precautions- (Table 25-3, p. 447) Implementation: Medical- oxygen, supportive, nasotracheal suction as needed Pharmacologic- antimicrobials, bronchodilators, antitussives, mucolytics, expectorants, Steroids (aspiration pneumonia), nicotine patches, Goldenseal, immunizations Nursing- Nursing Diagnosis (Iggy, Concept Map, p. 662; Chart 33-6, p. 664; Chart 33-4, p. 660) & Guidelines for Preventing Health Care Associated Pneumonia (CDC) Impaired Gas Exchange- Oxygen therapy, monitor respirations, positioning Ineffective Airway Clearance- Encourage effective coughing techniques, hydration, position pt sitting straight up, incentive spirometer, have suctioning available. Acute Pain- analgesics---relieve pleuritic pain Hyperthermia Deficient Fluid Volume- Manage fluids, monitor sodium, nutrition--- increase fluids 2500-3000 ml/day.

Deficient Knowledge- Use of meds, activity, infection control, S&S to report----explain about pneumonia vaccine. Health Promotion- Prevention (pneumococcal & influenza vaccine) Complications: hypoxemia, hypercapnia (Elevated CO2), atelectasis, pleural effusion, empyema, septicemia

Tuberculosis Description- Highly communicable acute/chronic, bacterial reportable disease; Insidious onset Can affect lungs or extra-pulmonary organs-----characterized by formation of tubercles. For curable infections, it is the number one cause of death. Highly contagious, can be acute or chronic. Is found in the lngs, joints, kidneys, or pericardium. When cases are known they must be reported to the health department. Is an indisious disease so people can have it for a while before knowing it, thus spreading it to others. Transmitted by infected inhaled droplets entering the lungs, and traveling to the small air sacs (Alveoli). ---suspended in the air or on dust particles for long periods. Spread by coughing, talking, singing, laughing. The inflamed area becomes surrounded by collagen, fibroblasts, and lymphocytes. If there is no tx, the site can become necrotic (caseation), and become a cavity.if still continues, can progress into effusion like pericardial effusion. 2-8 weeks after exposure the immune system walls off the infection with macrophages. Risk Factors- Repeated close contact, foreign born or travel to high risk countries, known HIV+, Immunosuppressed, high risk health care worker, IV drug users, malnutrition, inadequately treated Transmission/Pathogenesis Mycobacterium tuberculosis- acid fast rod, aerobic Exposure- Transmitted by airborne route (Table 25-3, p. 447): Concern with exposure to concentration of droplets and close proximity over prolonged period of time Infected without Active Disease- Usually immune system competent; usually resolution Infected with Active Disease- Tubercle lesion encapsulated; caseation; calcification ro liquifiecation; cavitation; may spread to pleura or other organs Latent TB Infection (LTBI) which may be reactivated later; No symptoms, not appear ill, not infectious, Usually has +PPD w/ normal chest x-ray, sputum culture negative, TST or blood test results usually positive. Inactive, confined tubercle bacilli in the body. TB disease in Lungs: Active, multiplying tubercle bacilli in the body, TST or blood test results usually positive, Chest X-ray usually abnormal, Sputum smears and cultures may be positive, Symptoms such as cough, fever, weight loss, Often infectious before tx., A case of TB. Assessment History: Recent exposure? Travel to other countries? Previous tests? Past tx? Recent BCG vaccine?

Other risk factors? Early S&S: persistent cough w/ sputum production, low grade fever (In afternoon), fatigue, night sweats, Anorexia, wt loss. Later S&S: Bloody sputum (hemoptysis), chest pain, SOB Diagnostics: Tuberculin Skin Test Purified Pretein Derivative (PPD)(Mantoux): 0.1ml = 5 U tuberculin, intradermal Read ______48-72______hrs (Evidence Based Practice) Measure ONLY induration & record in mm < 5-9 mm (+) HIV + Immunosuppressed Fibrotic changes consistent w/ old TB on chest x-rays >10-14 mm (+) Travelers/immigrants IV drug users Residents & workers in crowded living conditions >15 mm (+) No known risk

Ten mm under normal circumstances, and 5mm in immunocompromised pts. Other diagnostics: Chest x-ray= does not confirm diagnosis Sputum smear for AFB- early morning specimens on 3 consecutive days Sputum culture for M. tuberculosis = Confirms diagnosis Drug susceptibility testing- ensure appropriate treatment & ID drug resistance Goal- prevent transmission, control symptoms, & prevent progression of disease Treatment: active disease6-12 months tx. -Direct Observation Therapy- If pts not compliant, health care workers go to the residence and MAKE them take their pills. TXs are: Isoniazid, Rifampin, Pyrazinamide, Ethambutaol.

Implementation: Medical: PharmacologicInfected without Active Disease- Chemoprophylaxis with INH, PZA Infected with Active Disease- Combination therapy (Iggy, Chart 33-8, p. 671) Direct Observed Therapy (DOT) Length of tx Be aware of multi-drug resistance

BCG (Bacillus of Calmetter & Guerin) vaccination- not widely used in US; Effectiveness is variable Nursing: Impaired Gas Exchange Ineffective Airway Clearance Deficient Knowledge: Transmission/Prevention behaviors Transmission-Based Precautions (Infection Control)Airborne Precautions- Pt wears mask if must lea