Jotham C. Marfil, RN

CHEST X-RAYy Remove all jewelry and other metal objects from the

chest areay Assess the client's ability to inhale and hold his or her

breathy Question women regarding pregnancy y Help the client get dressed after the procedure

SPUTUM SPECIMENy Specimen obtained by expectoration or tracheal

suctioning to assist in the identification of organisms or abnormal cellsy Obtain an early morning sterile specimen from

suctioning or expectorationy Instruct the client to rinse the mouth with water

before collection

y Obtain at least 15 mL of sputum y Instruct client to take several deep breaths and then

cough deeply to obtain sputum

y Always collect the specimen before the client begins

antibiotic therapy

y If a culture of sputum is prescribed, transport the

specimen to the laboratory immediately

y Assist the client with mouth care

PULMONARY ANGIOGRAPHYy An invasive fluoroscopic procedure in which a catheter

is inserted through the antecubital or femoral vein into the pulmonary artery or one of its branchesy Involves an injection of iodine or radiopaque contrast

materialy Obtain informed consent

y Assess for allergies to iodine, seafood, or other

radiopaque dyesy Maintain NPO status of the client for 8 hours before

the procedurey Monitor vital signs y Assess results of coagulation studies y Instruct the client to lie still during the procedure

y Instruct the client that he or she may feel an urge to

cough, flushing, nausea, or a salty taste following injection of the dye

y Have emergency resuscitation equipment available y Avoid taking BP for 24 hours in the extremity used for

the injection

y Assess insertion site for bleeding y Monitor for delayed reaction to the dye

BRONCHOSCOPYy Direct visual examination of the larynx, trachea, and

bronchi with a fiberoptic bronchoscopey Obtain informed consent y Maintain NPO status for the client form midnight

before the procedurey Obtain vital signs

y Remove dentures or eyeglasses y Prepare suction equipment y Establish an IV access as necessary and administer

medication for sedation as prescribedy Have emergency resuscitation equipment available y Maintain the client in semi-Fowler s position after the

procedure

y Assess for the return of gag reflex y Have an emesis basin readily available for the client to

expectorate sputumy Monitor for bloody sputum y Notify the physician if fever, difficulty in breathing, or

other signs of complications occur following the procedure

THORACENTESISy Removal of fluid or air from the pleural space via a

transthoracic aspirationy Obtain informed consent y Obtain vital signs y Prepare the client for ultrasound or chest radiograph,

if prescribed, before the procedure

y Note that the client is positioned sitting upright, with

the arms and shoulders supported by a table at the bedside during the procedure

y If the client cannot sit up, the client is placed lying in

bed toward the unaffected side, with the head of the bed elevated

y Instruct the client not to cough, breath deeply, or move

during the procedure

y Apply a pressure dressing, and assess the puncture site

for bleeding

PULMONARY FUNCTION TESTSy Tests used to evaluate lung mechanics, gas exchange,

and acid-base disturbance through spirometric measurements, lung volumes, and arterial blood gas levelsy Consult

with the physician bronchodilators before testing

regarding

holding

y Instruct the client to void before the procedure and to

wear loose clothing

y Remove dentures y Instruct the client to refrain from smoking or eating a

heavy meal for 4 to 6 hours before the testy After the procedure, client may resume normal diet

and any bronchodilators and respiratory treatments that were held before the procedure

VENTILATION-PERFUSION LUNG SCANy The perfusion scan evaluates blood flow to the lungs y The ventilation scan determines the patency of the

pulmonary airways and detects abnormalities in ventilationy A radionuclide may be injected for the procedure

y Obtain informed consent y Assess the client for allergies to dye, iodine or seafood y Remove jewelry around the chest area y Review breathing methods that may be required

during testing

y Monitor client for reaction to the radionuclide y Instruct client that the radionuclide clears from the

body in about 8 hours

ARTERIAL BLOOD GASESy Measurement of the dissolved oxygen and carbon

dioxide in the arterial blood that helps indicate the acid-base state and how ell oxygen is being carried to the body

y Perform Allen's test before drawing radial artery

specimens

y Have the client rest for 30 minutes before specimen

collection to ensure accurate measurement of body oxygenation

y Avoid suctioning before drawing the ABG sample y Do not turn off oxygen unless the ABG sample is

ordered to be drawn with the client breathing room airy Place specimen on ice y Note the client temperature on the lab form y Note the oxygen and type of ventilation the client is

receiving on the lab form

y Apply pressure to the puncture site for 5 to 10 minutes

or longer if the client is taking anticoagulant therapy or has a bleeding disordery Transport the specimen to the laboratory within 15

minutes

y Apply direct pressure over the client s ulnar and radial

arteries simultaneously

y While applying pressure, ask the client to open and

close the hand repeatedly; the hand should blanch

y release

pressure from the ulnar artery while compressing the radial artery and assess the color of the extremity distal to the pressure point

y If pinkness fails to return within 6 seconds, the ulnar

artery is insufficient, indicating that the radial artery should not be used for obtaining a blood specimen

y pH

7.35 7.45 35 45 mmHg 22 27 mEq/L

y PCO2 y HCO3

PULSE OXIMETRYy Is a noninvasive test that registers the oxygen

saturation of the client s hemoglobin

y The capillary oxygen saturation is recorded as a

percentage

y The normal value is 96% to 100% y A pulse oximeter reading can alert the nurse to

hypoxemia before clinical signs occur

y A sensor is placed on the client s finger, toe, nose, ear

lobe or forehead to measure oxygen saturation, which then is displayed on a monitor

y Do not select an extremity with an impediment to

blood flow

y Results

lower than 91% treatment

necessitate immediate

y If

the oxygen saturation is lower than 85%, oxygenation to body tissues is compromised; if less than 70% it is life threatening

LUNG BIOPSYy A percutaneous lung biopsy is performed to obtain

tissue for analysis examination

by

culture

or

cytological

y A needle biopsy is done to identify pulmonary lesions,

changes in lung tissue, and the cause of pleural effusion

y Obtain informed consent y Maintain NPO status of the client before the

procedurey Inform client that a local anesthetic will be used but a

sensation of pressure during needle insertion and aspiration may be felty Apply a dressing to the biopsy site and monitor for

drainage or bleeding

y Monitor for signs of respiratory distress, and notify the

physician if they occury Prepare client for chest radiography if prescribed

y Is more commonly known as nosebleed y Bleeding can either be in the anterior or posterior

regiony Anterior bleeds are more common and originates from

the group of vessels called Kiesselbach Plexus

Etiologyy Most common cause of epistaxis is dry, cracked

mucous membranesy Other causes include trauma, forceful nose blowing,

nose picking, and hypertensiony Anything that reduces the blood clotting ability can

also trigger epistaxis (hemophilia, anticoagulants, cocaine use)

Interventionsy Let client sit in a chair and lean forward y Be sure to wear gloves and standard precautions y Place pressure on the nares for 5 to 10 minutes to stop

bleeding (not done for clients with nose fracture)y Apply ice packs or cold compress on the nose area

y Nasal pack with neosenephrine for 3 to 5 days y Liquid diet progressing to soft diet y Avoid oral temperature taking y Instruct client not to blow and pick nose for 2 days

after removal of the nasal pack

y Instruct client not to bend over y Notify physician if bleeding is recurrent

y Are grapelike clusters of mucosa in the nasal passages y Usually benign, but can obstruct the nasal passages y Exact cause is unknown but are related to chronic

inflammationy Some people with allergies are prone to develop polyps

Interventionsy Control allergy symptoms with oral antihistamines or

nasal corticosteroid spraysy Removal of polyps when it is obstructs breathing y Instruct client to avoid using aspirin after surgery

y The septum dividing the nasal passages is slightly

deviatedy May result form nasal trauma but often has no cause y Clients may complain of chronically stuffy nose y Other client may have headaches and nosebleeds

Interventionsy Submucous resection (SMR) or nasoseptoplasty

can be doney Nasal packing is placed postoperatively to reduce

bleeding

y Inflammation of the mucosa of one or more sinuses y Can either be acute or chronic y Chronic is present for more than 2 months and are

unresponsive to treatmenty Maxillary and ethmoid sinuses are the most commonly

affected

y Inflammation is often the result of a bacterial

infection

y Because the mucous lining of the nose and sinuses is

continuous, nasal organisms easily travel to the sinuses

y Drainage is blocked when sinuses swell due to

infection

y S. pneuomoniae and H. influenzae y Other causes are allergies, fungal infection and NGT

Signs and Symptomsy Pain over the affected sinuses y Purulent nasal drainage y Fever in acute infection y Fatigue y Foul breath

y Maxillary sinus pain over the cheek and upper teeth y Ethmoid sinus y Frnotal sinus

pain between and behind the eyes pain in the forehead

Diagnostic Testsy Uncomplicated sinusitis may be diagnosed based on

symptoms aloney X-ray, CT scan, or MRI may be done to confirm the

diagnosis and determine the causey Culture and sensitivity of the nasal discharge

Interventionsy Aimed at relieving pain and promoting sinus drainage y Place client in semi-Fowler s position y Hot moist packs for 1 to 2 hours twice a day y Acetaminophen or ibuprofen may be prescribed by the

physician for pain and fever

y Encourage client to increase oral fluid intake unless

contraindicated

y Antihistamines are generally avoided because it dries

and thickens secretionsy Adrenergic nasal sprays such as oxymetazoline for up

to 3 daysy Caldwell-Luc procedure to drain sinus if conservative

treatments cannot relieve symptoms

y Also called as CORYZA y Inflammation of the nasal mucous membranes y Occurs as a reaction to allergens or may be caused by

viral or bacterial infection

Signs and Symptomsy Nasal congestion y Localized itching y Sneezing y Nasal discharge y Fever and malaise may accompany viral or bacterial

rhinitis

Interventionsy Rest and fluids are the most effective treatment y Never give antibiotics for a viral infection y Acetaminophen may be prescribed for generalized

discomforty Antihistamines may also be prescribed to control

symptoms

y Inflammation of the pharynx y Usually related to bacterial or viral infection as well as

traumay Beta-hemolytic streptococci y If strep throat is untreated it can lead to rheumatic

fever or glomerulonephritis

Signs and symptomsy Most common is sore throat y Dysphagia y Throat appears red and swollen, and exudate may be

presenty Fever, chills, headache, and general malaise

Diagnostic testy Culture and sensitivity

to identify the causative organism and determine which antibiotic will be effective

Interventionsy Encourage rest y Increase fluid intake if not contraindicated y Saltwater gargles help reduce swelling y If bacterial, antibiotics may be prescribed y Acetaminophen

may

be

prescribed

to

relieve

discomforts

y Inflammation of the mucous membrane lining the

larynx (voice box)y Caused by irritation from smoking, alcohol, chemical

exposure or infectiony Often follows an upper respiratory infection

Signs and symptomsy Common symptom is hoarseness y Cough y Dysphagia y Fever

Diagnostic testy Laryngoscopy may be done if hoarseness persists for

more than 2 weeks to rule out cancer of the larynx

Interventionsy Provide rest y Encourage fluids unless contraindicated y Provide humidified oxygen y Encourage client to avoid talking y Obtain paper and pen to help client communicate

y Antibiotics may be prescribed for bacterial infection y Throat lozenges may help increase comfort y Help client to identify causative factors that need to be

avoided

y Tonsils are masses of lymphoid tissue that lie on each

side of the oropharynxy Tonsils filter microorganisms to protect the lungs from

infectiony Tonsillitis occurs when the filtering function becomes

overwhelmed with virus or bacteria and infection results

y Adenoids is a mass of lymphoid tissue at the back of

the nasopharynxy Tonsillitis is more common in children y Streptococcus species, S. aureus, H. influenzae, and

pneumococcus species

Signs and symptomsy Begins suddenly with a sore throat y May be accompanied by fever, chills, and pain on

swallowingy Headache, malaise and myalgia y Tonsils appear red and swollen and may have yellow or

white exudates

y If adenoids are involved client may have complaints of

snoring, nasal obstruction, and a nasal tone to the voice

Diagnostic testsy Throat culture and sensitivity y WBC count y Chest x-ray

Interventionsy Promote rest y Increase fluid intake if not contraindicated y Warm saline gargle y Analgesics as ordered y Antibiotics as ordered (penicillin) y Surgery: TONSILLECTOMY/ADENOIDECTOMY

TONSILLECTOMY/ ADENOIDECTOMYy Indicated if tonsillitis recurs 5 to 6 times a year or unresponsive to antibiotic therapy y If breathing or swallowing is affected y If it causes obstruction and obstructive sleep apnea y If client will have repeated attacks of purulent otitis media

Preoperative carey Assess for URTI. Coughing and sneezing may cause

bleeding in the postoperative periody Check prothrombin time

Postoperative carey Position client prone with head turned to side or

lateral positiony Semi-Fowler s if client is already awake y Provide oral airway until swallowing reflex returns y Monitor for hemorrhage (frequent swallowing/bright

red vomitus)

y Apply ice collar y Avoid administration of ASA y Offer ice cold fluids if client is able to eat y Bland diet y Instruct client to avoid clearing of throat

y Inform client to avoid coughing, sneezing, blowing

nose for 1 to 2 weeksy Encourage client to take 2 to 3 liters of fluid a day until

mouth odor disappearsy Educate client to avoid hard/scratchy foods until

throat is healedy Inform client that throat discomfort between the 4th

and 8th postoperative day is expected

y Inform client that his/her stools will be black/dark for

few daysy Encourage client to take rest for 2 weeks y Instruct client to avoid colds and overcrowded places

y Commonly refereed to as the flu y A viral infection of the respiratory tract y New strains appear each year y Easily transmitted via droplets from coughs and sneezes of infected individuals y May also be transmitted by physical contact with an infected person or object y Incubation period is 1 to 3 days

Signs and symptomsy Abrupt onset of fever y Chills y Myalgia y Sore throat and cough y General malaise with headache

Diagnostic testy Viral culture

Interventionsy Treatment is primarily symptomatic y Encourage rest and fluids y Acetaminophen may be prescribed for fever, headache,

and myalgiay Oseltamivir (Tamiflu) may be prescribed to reduce

severity and duration of symptoms

y Visceral and parietal pleurae becomes inflamed and

does not slide easilyy Usually related to another underlying respiratory

disordery The irritation causes an increase in the formation of

pleural fluid, which in turn reduces friction and decreases pain

Signs and symptomsy Sharp pain in the chest on inspiration y Pain during coughing or sneezing y Shallow and rapid breathing y Fever, chills and elevated WBC y Pleural friction rub upon auscultation

Diagnostic testsy Auscultation y Chest x-ray examination

y Excess fluid collects in the pleural space y With increase in fluid production and inadequate

reabsorptiony Normal amount of pleural fluid for each lung is 1 to

15mLy Effusion can be transudative or exudative y Generally caused by another lung disorder

Signs and symptomsy May or may not experience pleuritic pain y Shortness of breath y Cough and tachypnea y Dull sound upon percussion of the affected area y Lung sounds can be decreased or absent over the

effusion

Diagnostic testsy Chest x-ray y Thoracentesis

Interventionsy Encourage bedrest y Therapeutic thoracentesis y Treatment of underlying cause

y Collapse of the alveoli y Commonly occurs in postsurgical clients who do not

cough and deep breathe effectivelyy Areas of the lungs that are not well aerated become

plugged with mucus, which prevents inflation of alveoli

y Instruct client to perform coughing and deep

breathing exercisesy Encourage frequent position changes and ambulation

y Occurs when a thrombus forms (deep vein) detaches,

travels to the right side of the heart, and then lodges in a branch of the pulmonary arteryy At risk are those with deep vein thrombosis including

those with prolonged immobilization, surgery, obesity, pregnancy, congestive heart failure, advanced age, or a history of thromboembolismy Fate emboli can occur as a complication following

fracture of a long bone

Signs and symptomsy Blood-tinged sputum y Chest pain y Cough y Cyanosis y Distended neck veins

y Dyspnea accompanied by anginal and pleuritic pain,

exacerbated by inspirationy Hypotension y Shallow respirations y Tachypnea and tachycardia y Wheezes on auscultation

Diagnostic testsy CT scan can diagnose PE quickly y Ventilation-perfusion scan y Pulmonary angiogram y Chest x-ray, ECG, ABG analysis, MRI y D-dimer a blood test to help rule out PE

Interventionsy Administer oxygen as prescribed y Place client in high fowler s position y Monitor lung sounds y Maintain bed rest and active and passive ROM

exercises

y Encourage use of incentive spirometry

y Monitor pulse oximetry y Prepare for intubation and mechanical ventilation for

severe hypoxemiay Administer anticoagulation therapy intravenously or

orally as prescribedy Monitor coagulation studies closely y Prepare the client for embolectomy or vein ligation

y Is a chronic multisystem disorder characterized by

exocrine gland dysfunctiony Autosomal recessive trait disorder y The mucus produced by the exocrine glands is

abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, GI, and reproductive systems

y The most common symptoms are pancreatic enzyme

deficiency caused by duct blockage, progressive chronic lung disease associated with infection, and sweat gland dysfunction resulting in increased sodium and chloride sweat concentrationsy Is a fatal genetic disorder and respiratory failure is the

most common cause of death

Signs and symptomsy Thick tenacious or purulent sputum y Cough y Chronic sinusitis y Finger clubbing y Hemoptysis

y Frequent bouts of infection y Foul-smelling stools y Poor appetite y Malnutrition y Bowel obstruction y Delayed sexual maturation and infertility

Diagnostic testy Sweat chloride test most reliable Production of sweat is stimulated with pilocarpine iontophoresis Sweat is collected and the sweat electrolytes are

measured (minimum of 50mg of sweat) Normal sweat chloride concentration is 40mEq/L Between 40-60 requires repeat testing; above 60 is

positive

Interventionsy Chest

physiotherapy (percussion and drainage) on awakening and the evening

postural

y Administer bronchodilators as prescribed y Instruct

significant others not to give suppressants such as guaifenesin (Robitussin)

cough

y Teach client on forced expiratory technique to

mobilize secretions

y Administer antibiotics as prescribed y Administer oxygen as prescribed y Monitor for hemoptysis; more than 300mL in 24 hours

for older children needs to be treated immediatelyy Promote bed rest in case of hemoptysis y Pancreatic insufficiency should be replaced with

pancreatic enzymes

y Administer pancreatic enzymes (Pancrease, Viokase)

with all meals and snacksy Enteric-coated pancreatic enzymes should not be

crushed or chewedy Pancreatic enzymes should not be given if the child is

NPOy Encourage a well-balanced, high-protein, high-calorie

diet

y Assess for weight and monitor for failure to thrive y Monitor for constipation and intestinal obstruction y Ensure adequate fluid and salt intake y Promote adequate hydration y Encourage regular exercise y Recommend use of hot shower occasionally y Inform client to use breathing and coughing exercises

y Unexpected death of an apparently healthy infant

younger than 1 year for whom a thorough autopsy fails to demonstrate and adequate cause of death

y Unknown cause that may be related to a brain stem

abnormality in the neurological cardiorespiratory control

regulation

of

y Most frequently occurs during winter months y Death usually occurs during sleep periods, but not

necessarily at night

y Most frequently affects infants from 2 months to 4

months of agey Incidence is higher in males y Incidence is higher in Native Americans, African

Americans, Hispanics

Signs and symptomsy Child is apneic, blue, and lifeless y Frothy blood-tinged fluid in the nose and mouth y Typically found in disheveled bed, with blankets over

the head, and huddled in a corner

y Child may appear to have been clutching bedding y Diaper may be wet and full of stool

Preventiony Place infant in supine position when sleeping y Soft moldable mattresses and bedding, such as pillows,

should not be used for beddingy Stuffed animals should be removed from the crib while

the infant is sleepingy Discourage bed sharing y Avoid overheating during sleep

y Chronic inflammatory disorder of the airways that

causes varying degrees of obstruction in the airwaysy Marked

by airway inflammation and hyperresponsiveness to a variety of stimuli or triggers recurrent episodes of wheezing, breathlessness, chest tightness, and coughing associated with airflow obstruction that may resolve spontaneously; it is often reversible with treatment

y Causes

Classificationy Severe Persistent Symptoms are continuous Physical activity requires limitation Frequent exacerbations occur Nocturnal symptoms occur frequently

y Moderate Persistent Daily symptoms occur Daily use of inhaled short acting beta agonist is needed Exacerbations affect activity Exacerbations occur at least twice a week and may last

for days Nocturnal symptoms occur more frequently than once

weekly

y Mild Persistent Symptoms occur more frequently than twice weekly but less often than once daily Exacerbations may affect activity Nocturnal symptoms occur more frequently than twice a

month

y Mild Intermittent Symptoms occur twice weekly or less Client is asymptomatic between exacerbations Exacerbations are brief (hours to days) Intensity of exacerbations vary Nocturnal symptoms occur twice a month or less

Signs and symptomsy Restlessness y Wheezing or crackles upon auscultation y Absent or diminished lung sounds y Hyperresonance y Use of accessory muscles for brething

y Tachypnea y Prolonged exhalation y Tachycardia y Pulsus paradoxus y Diaphoresis y Cyanosis y Decreased oxygen saturation

Interventionsy Position client in a high Fowler s position or sitting to

aid in breathingy Administer oxygen as prescribed y Stay with the client to decrease anxiety y Administer bronchodilators as prescribed

y Record the color, amount and consistency of sputum, if any y Administer corticosteroids as prescribed y Auscultate lung treatments y Monitor vital signs y Monitor pulse oximetry y Instruct client to avoid triggers

sounds

before,

during,

and

after

y Also known as chronic obstructive lunge disease and

chronic airflow limitation

y Is a disease state characterized by airflow obstruction

caused by emphysema or chronic bronchitis

y Progressive airflow limitation occurs, associated with

an abnormal inflammatory response of the lungs that is not completely reversible

y Can lead to pulmonary insufficiency or pulmonary

hypertension

Diagnostic testsy Chest x-ray y Ultrasound y ABG y CBC y Sputum analysis

Signs and Symptomsy Cough y Exertional dyspnea y Wheezing and crackles y Sputum production y Weight loss

y Barrel chest (emphysema) y Use of accessory muscles for breathing y Prolonged expiration y Orthopnea y Congestion and hyperinflation seen on chest x-ray y Respiratory acidosis

Interventionsy Monitor vital signs y Administer low concentration of oxygen as prescribed y Monitor pulse oximetry y Provide chest physiotherapy y Instruct client to do breathing techniques

y Record the color, amount, and consistency of sputum y Monitor weight y Encourage small frequent meals to maintain nutrition

and prevent dyspneay Provide a high caloric, high protein diet with

supplementsy Encourage fluid intake up to 3L per day

y Place client in high Fowler s position y Allow activity as tolerated y Administer bronchodilators as prescribed y Administer corticosteroids as prescribed y Administer mucolytics as prescribed y Administer antibiotics for infection if prescribed

Client educationy Adhere to activity limitations, alternating rest periods

with activityy Avoid eating gas producing foods, spicy foods, and

extremely hot or cold beveragesy Avoid crowds y Avoid extremes in temperature

y Avoid fireplaces, pets, feather pillows and other

environmental allergensy Avoid powerful odors y Receive immunization as recommended y Stop smoking y Recognize signs of infection

y Use medications and inhalers as prescribed y Use oxygen therapy as prescribed y Use breathing techniques y When dusting, use a wet cloth

y Infection of the pulmonary tissue, including the

interstitial spaces, the alveoli, and the bronchiolesy The edema associated with inflammation stiffens the

lung, decreases lung compliance and vital capacity, and causes hypoxemiay Can be community-acquired or hospital acquired y Chest x-ray shows lobar or segmental consolidation,

pulmonary infiltrates, or pleural effusions

y A sputum culture identifies the organism y The white blood cell count and the erythrocyte

sedimentation rate are elevated

Signs and symptomsy Chills y Elevated temperature y Pleuritic pain y Tachypnea y Rhonchi and wheezes

y Use of accessory muscles for breathing y Mental status changes y Sputum production

Interventionsy Administer oxygen as prescribed y Monitor respiratory status y Monitor for labored respirations, cyanosis, and cold

and clammy skiny Encourage coughing and deep breathing and use of

the incentive spirometer

y Place the client in a semi-Fowler s position to facilitate

breathing and lung expansiony Change the client s position frequently and ambulate

as tolerated to mobilize secretionsy Provide CPT y Perform nasotracheal suctioning if the client is unable

to clear secretions

y Monitor pulse oximetry y Monitor and record color, consistency, and amount of sputum y Provide a high-calorie, high-protein diet with small frequent meals y Encourage fluids, up to 3 liters/day, to thin secretions unless contraindicated y Provide a balance of rest and activity, increasing activity gradually

y Administer antibiotics as prescribed y Administer

antipyretics, bronchodilators, cough suppressants, mucolytic agents, and expectorants as prescribed

y Prevent the spread of infection by hand washing and

the proper disposal of secretions

y Highly

communicable disease Mycobacterium tuberculosis

caused

by

y An aerobic bacterium that primarily affects the

pulmonary system, especially the higher lobes, where the oxygen content is highest

y TB has an insidious onset, and many client are not

aware of symptoms until the disease is well-advanced

y Improper or noncompliant use of treatment programs

may cause the development of multidrug-resistant strain of TB

y Transmission is via the airborne route by droplet

infectiony Droplets enter the lungs, and the bacteria form a

tubercle lesion

Risk Factorsy Child younger than 5 years of age y Drinking unpasteurized milk y Homeless

individuals socioeconomic status

or

those

from

low

y Individuals in constant, frequent contact with an

untreated or undiagnosed individual

y Individuals living in crowded areas y Older client y Individuals with malnutrition, infection, immune

dysfunction or HIV infection, or immunosuppressed

Signs and Symptomsy Fatigue y Lethargy y Anorexia y Weight loss y Low-grade fever

y Chills y Night sweats y Persistent cough and the production of mucoid and

mucopurulent sputum, which is occasionally streaked with bloody Chest tightness and a dull, aching chest pain may

accompany the cough

y Chest x-ray reveals multinodular infiltrates with

calcification in the upper lobesy Sputum cultures reveal presence of causative agent y Mantoux test

Interventionsy Place client in respiratory isolation precautions in a

negative-pressure roomy Provide the client and family with information about

TBy Instruct client to follow the medication regimen

exactly as prescribed

y Inform client to resume activities gradualy y Instruct client to increase intake of foods rich in iron, protein, and vitamin C y Instruct client to cover nose and mouth when coughing or sneezing y Encourage handwashing y Inform client that when the results of three sputum cultures are negative he/she is no longer considered infectious

y Advise client to avoid excessive exposure to silicone or

dusty Instruct client regarding the importance of compliance

with treatment, follow-up care, and sputum cultures, as prescribed

Bronchodilatorsy Sympathomimetic bronchodilators dilate the airways

of the respiratory tree and relax the smooth muscle of the bronchi (Albuterol)y Methylxanthine bronchodilators stimulate the CNS

and respiration, dilate coronary and pulmonary vessels, cause diuresis, and relax smooth muscle (theophylline)

Side effectsy Palpitations and tachycardia y Dysrhythmias y Hyperglycemia y Restlessness, nervousness, tremors y Anorexia, nausea, and vomiting y Headaches and dizziness y Mouth dryness and throat irritation

Interventionsy Assess vital signs y Monitor for cardiac dysrhythmias y Assess for cough, wheezing, decreased breath sounds, and sputum production y Monitor for restlessness and confusion y Provide adequate hydration administer oral medications with or after meals

y Instruct the client to stop smoking y Monitor for a therapeutic serum theophylline level of

10 to 20mcg/mL

Antihistaminesy Are called histamine antagonists or H1 blockers; these

medications compeet with histamine for receptor sitesy Decrease

nasopharyngeal, GI, and secretions by blocking the H1 receptor

bronchial

y Diphenhydramine (Benadryl), Loratadine (Claritin),

Cetirizine hydrochloride (Zyrtec)

Side effectsy Drowsiness and fatigue y Dizziness y Urinary retention y Blurred vision y Wheezing

y Constipation y Dry mouth y GI irritation y Hypotension y Confusion

Interventionsy Monitor vital signs y Administer with food or milk y Instruct client to avoid hazardous activities, alcohol,

and other CNS depressantsy Instruct the client to suck on hard candy or ice chips

for dry mouth

Expectorants and Mucolytic Agentsy Expectorants loosen bronchial secretions so that they

can be eliminated with coughing; they are used for dry, unproductive cough and to stimulate bronchial secretionsy Mucolytic agents thin mucous secretions to help make

the cough more productivey Acetylcysteine

(Mucomyst),

Dornase

alfa

(Pulmozyme)

Side effectsy GI irritation y Skin rash y Oropharyngeal irritation

Interventionsy Take medication with full glass of water to loosen

mucusy Maintain adequate fluid intake y Encourage client to cough and deep breathe y Monitor for side effects

Isoniazidy Inhibits the synthesis of mycolic acids and acts to kill

actively growing organisms in the extracellular environmenty Active only during cell division and is used in

combination with other anti TB drugs

Side effectsy Hypersensitivity reactions y Peripheral neuritis y Hepatotoxicity y Pyridoxine (vitamin B6) deficiency y Nausea and vomiting y Dry mouth

Interventionsy Assess for hypersensitivity y Assess for hepatic dysfunction y Monitor for tingling, numbness, or burning of the

extremities

y Administer 1 hour before or 2 hours after meals y Administer pyridoxine as prescribed

y Instruct client to avoid alcohol y Instruct the client not to skip doses

Rifampin (Rifadin)y Inhibits bacterial RNA synthesis y Binds to DNA-dependent RNA polymerase and blocks

RNA transcription

Side effectsy Hypersensitivity reaction y Heartburn y Nausea and vomiting y Red-orange-colored body secretions y Hepatotoxicity

Interventionsy Asses for hypersensitivity y Evaluate CBC, uric acid, and liver function test results y Monitor mental status y Instruct client not to skip doses y Instruct client to avoid alcohol

Ethambutoly Interferes with cell metabolism and multiplication by

inhibiting one or more metabolites in susceptible organismsy Inhibits bacterial RNA synthesis

Side effectsy Hypersensitivity reactions y Nausea and vomiting y Dizziness y Malaise y Mental confusion y Optic neuritis y Increased uric acid levels

Interventionsy Assess the client for hypersensitivity y Evaluate the results of CBC, uric acid, and renal and

liver function testsy Obtain baseline visual acuity and color discrimination,

especially to greeny Monitor for visual changes

y Monitor intake and output y Asses mental status y Instruct client not to skip doses

Pyrazinamidey Exact mechanism of action is unknown

Side effectsy Increases liver function tests and uric acid levels y Myalgia y Photosensitivity y Hepatotoxicity y Thrombocytopenia

Interventionsy Assess for hypersensitivity y Evaluate CBC, liver function test results, and uric acid levels y Assess for painful or swollen joints y Take with food y Avoid sunlight or UV light y Instruct client not to skip doses

Streptomyciny An aminoglycoside antibiotic used with at least one

other antitubercular medicationy Interferes with protein synthesis

Side effectsy Hypersensitivity y Visual changes y Increased liver and renal function studies y Peripheral neuritis

Interventionsy Assess for hypersensitivity y Monitor liver and renal function test results y Perform baseline audiometric testing and repeat every

1 to 2 months because the medication impairs the eighth cranial nervey Monitor for visual changes

y Monitor intake and output y Instruct the client not to skip doses