NSG 326 Adult Health IBronchitisSlide 3Risk Factors for BronchitisSlide 5Signs & SymptomsSlide 7Diagnostic & Laboratory TestsSlide 9Nursing Management of BronchitisNursing Management (cont.)Drugs Used with BronchitisSlide 13PneumoniaSlide 15Slide 16Slide 17Pneumonia (cont.)Community Acquired Pneumonia (CAP)CAP SymptomsCAP ComplicationsCAP TreatmentHospital-Acquired Pneumonia (HAP)Slide 24HAP TreatmentRML PneumoniaHistory & Physical AssessmentDiagnosticsPleural EffusionPleural EffusionsPleural Effusion CausesSlide 32Collaborative Care & Nursing Management of HAPNDx for Patient with PneumoniaEvaluationPneumonia PreventionSlide 37Slide 38TuberculosisSlide 40Slide 41Tuberculosis (TB)Aerosol Transmission of TBSlide 44Clinical Manifestations of TuberculosisClinical Manifestations of Tuberculosis (cont.)TB ComplicationsMiliary TBTB DiagnosticsSlide 50Slide 51TB Diagnostics (cont.)Collaborative CareMycobacterium tuberculosis bacilli, which have been stained.Collaborative Care (cont.)TB ManagementSlide 57Slide 58Slide 59TB Management (cont.)Slide 61Slide 62Slide 63Slide 64Slide 65Slide 66Slide 67These buildings, which were once all part of a tuberculosis sanatorium, were constructed around 1910 by Dr. Nathan Boyd, medical doctor and international businessman. Legend says that Dr. Boyd had a beloved wife who was suffering from the terrible disease, and that he built the place, up in the rugged yet beautiful mountains, for her. There are other rumors about Boyd's Sanatorium, as well. Rumors of a more... unknown element. Some say that this canyon is filled with restless spirits, and that some of them happen to be the spirits of the patients who passed away up at the mountainside sanatorium. Note: located in Dripping Springs, NM near Las Cruces and the Organ Mountains.Prepared by Dr. K. A. EnnenNSG 326 Adult Health IWeek #10SPRING 2011Problems of OxygenationPart 12Bronchitis•Classified as acute or chronic•Acute bronchitis is a sequela to URI•Nonproductive cough that becomes productive•Chronic bronchitis is one component of COPD•Inflammation of bronchi & bronchioles•Continuous exposure to infectious or noninfectious irritants•Smoke•Chronic = Productive cough lasting at least three (3) months & occurring for two consecutive years •Complications•Pneumonia; Bronchiectasis4Risk Factors for Bronchitis•Tobacco use•Exposure to respiratory pollutants•Exposure to tobacco smoke•Viral or bacterial upper respiratory infection•Surgical procedures•Medications•Malnutrition•Gerontological Considerations•Increased risks related to colds, influenza [viral infections]•Changes in immune response•Decreased number of cilia & weakened cough responses•Prone to dehydration increasing risk of thickened mucous6Signs & Symptoms•Acute•Productive cough•Diffuse rhonchi & wheezes•Dyspnea•Chest pain from coughing•Low-grade temperature•Chronic•Productive cough, most pronounced in mornings•Increased dyspnea & use of accessory muscles•Later stages of disease, cyanosis often accompanied by right ventricular failure (Cor Pulmonale)•Reddish-blue skin color also associated with right ventricular failure8Diagnostic & Laboratory Tests•History & physical examination•Chest x-ray•Sputum culture•Bronchoscopy10Nursing Management of Bronchitis•Assess & Monitor•Respiratory status; vital signs; auscultation of lung sounds; presence of wheezing or basilar crackles•For respiratory compromise: changes in sputum --- color, appearance, thickness•Body temperature; signs/symptoms of infection11Nursing Management (cont.)•Nursing Interventions•Prevent secondary infections•Provide rest for recovery•Humidified air •Increased fluid intake (avoiding milk – thickens secretions)•Facilitate removal of secretions•Encourage smoking cessation•Prophylactic vaccination against pneumonia, influenza•Administer antibiotics for current infections as prescribed •Minimize exposure to environmental irritants•Instruct/assess understanding of signs/symptoms that may indicate worsening infection•Teach importance of following prescribed medical regimen12Drugs Used with Bronchitis•Mucolytics & expectorants•Bronchodilators (albuterol inhaler)•Antibiotics (macrolides, cephalosporins, levofloxacin)•Antipyretics (acetaminophen, ibuprofen)•Corticosteroids (prednisone, methylprednisolone)14Pneumonia•Acute inflammation of lung caused by microbial organism •Leading cause of death in the United States from infectious disease•Discovery of sulfa drugs and penicillin decreased morbidity and mortality rates •Likely to result when defense mechanisms become incompetent or overwhelmed•↓ Cough and epiglottal reflexes may allow aspiration18Pneumonia (cont.)•Mucociliary mechanism impaired •Pollution•Cigarette smoking•Upper respiratory infections•Tracheal intubation •Aging •Alteration of leukocytes from malnutrition•Increased frequency of gram-negative bacilli from leukemia, alcoholism, and diabetes mellitus19Community Acquired Pneumonia (CAP)•Community-acquired pneumonia •Lower respiratory infection of lung •Onset in community or during first 2 days of hospitalization•4 million U.S. adults diagnosed yearly•Highest incidence in midwinter•Smoking important risk factor•Organisms implicated•Streptococcus pneumoniae•Haemophilus influenzae•Legionella•Mycoplasma•Chlamydia20 CAP Symptoms•Sudden onset of fever•Chills•Cough productive of purulent sputum •Pleuritic chest pain•Physical examination findings•Dullness to percussion•↑ Fremitus•Bronchial breath sounds•Crackles•Confusion or stupor may manifest in older or debilitated patient •Patients with infection from Staphylococcus aureus may present only with dyspnea and fever while lung tissue is necrotized21CAP Complications•Pleurisy•Pleural effusion •Usually is sterile and reabsorbed in 1 to 2 weeks or requires thoracentesis•Atelectasis •Usually clears with cough and deep breathing •Bacteremia•Bacterial infection in the blood•Lung abscess•Seen when caused by S. aureus and gram-negative pneumonias• Empyema•Requires antibiotics and drainage of exudate•Pericarditis•Spread of microorganism to heart•Meningitis•Patient who is disoriented, confused, or somnolent should have lumbar puncture•Endocarditis•Microorganisms attack endocardium and heart valves•Manifestations similar to bacterial endocarditis22CAP Treatment•Three-step