RESPIRATORY NOTES IV

Pulmonary Tuberculosis

-reportable communicable, infectious, inflammatory disease that can occur in any part of the body

-a chronc disorder characterized by formation of granuloma/tubercles in the lung

-spreads via AIRBORNE DROPLET

**Mycobacterium tuberculosis

-aerobic

-acid fast bacilli

-transmitted by droplet nuclei

-non-motile

-killed by heat & ultraviolet light

S/SX:

Constitutional

-weight loss -afternoon fever -night sweats

-anorexia -body malaise

Local

-cough -dyspnea -hemoptysis

-rales/crackles

Diagnosis:

-CXR

-Skin test (PPD):>10 mm after 48hr

-sputum examination: one needs 3 samples to make a positive diagnosis

-Culture:GOLD STANDARD

-WBC & ESR: elevated

WHO CLASSIFICATION:

PTB exposure PPD TOD SSx

I + - - -

II + + - -

III + + + +

IV + + + -

V + + +/- +/-

TB TREATMENT

Preventive Measures

-give Isoniazid, 300mg for 9-12 months

-WHO:

-newly infected (+PPD)

-close household contact

-susceptible healthcare workers

-(+) PPD + AIDS, steroid therapy, CRF

-inactive TB (+ PPD,CXR)

Therapeutic

2 Phases

a.Intensive Phase

-uses 2-3 drugs

-"bactericidal" phase

b.Maintenance Phase

-uses 2 drugs

-"sterilizing" phase

**done in 6,9,12,24 months

MEDICATIONS:

Primary Anti-tubercular Agents

Rifampicin

-Rifadin;impairs RNA synthesis

-negates effects of OCPs

-s/e: hepatitis or yellowish

discoloration of urine & sweat, nausea, vomiting ,thrombocytopenia,

drowsiness

*monitor liver function test

*teach about color changes of urine, feces (red-orange)

*avoid activities that require alertness

Isoniazid

-INH; interfers with DNA synthesis

-used as prophylactic tx

-s/e: peripheral neuritis & hepatotoxicity

-->Pyridoxine (B6) used to counteract effects of INH

Pyrazinamide

-s/e: hyperuricemia

Ethambutol

-Myambutol; impairs RNA synthesis

-s/e:optic neuritis, skin rash

Streptomycin

-s/e: ototoxicity (8CN damage)

-use in caution in renal patients

Nursing Care

a. respiratory precautions:2-4 weeks

b. needs well ventilated private room

c. mask to all visitors & staff, discard mask after use

d. strict handwashing after each contact with patient

e. small frquent meals with suppements

f. activity as tolerated

g. take medications as prescribed

Laryngeal Cancer

-accounts only 2-3% of all malignancy but care presents a unique challenge to nurse because of functional & cosmetic deformities commonly seen when disorder is treated

-untreated patient will die in 3 yrs

Risk Factors

-smoking -excessive alcohol consumption

-chronic laryngitis -vocal abuse

-family predisposition

Types

a.Supraglottic

-"extrinsic" laryngeal CA

-involves epiglottis & false cords

-usually assymptomatic until advance stage

b.Glottic

-"intrinsic" laryngeal CA

-involves true vocal cords

-produces early symptoms as :progressive hoarseness & dyspnea

Management

-Radiation

-Chemotherapy

-Surgery

a. partial laryngectomy

-patient can talk but can have difficulty swallowing

*Supraglottic Laryngectomy

-problem: ASPIRATION due to removal of epiglottis which closes over the larynx

b.Total Laryngectomy

-pharyngeal opening to trachea is closed & remaining trachea ,out to neck to form permanent tracheostomy

Problem -loss of normal speech

-loss of olfaction

-loss of normal breathing pattern

Nursing Care

Pre-operative

-explain procedure with emphasis to changes that will happen after surgery

-introduce client to changes in modes of communication

-etablish method os communication to be used immediately post-op

Post-operative

-promote optimum ventilatory status

-suction secretions regularly

-routine care for tracheostomy

-pain relief

-lean forward when expectorating

-wear ID bracelet at all times reminding everybody that patient is neck breather

-teach about proper exercises to increase ROM & muscle strength

*COMMUNICATION

>1-3 days post op :writing

>3-5 days post op :artificial larynx & esophageal speech

PLEURAL EFFUSION

-collection of fluid in the pleural space

-a symptom, NOT a disease which is caused by a lot of conditions

Classification:

a.Transudative

-systemic causes

-due to accumulation of protein poor & cell poor fluid such as :CHF, nephrosis, cirrhosis

-often called "hydrothorax"

b.Suppurative

-"empyema"-->pus

-accumulation of cells with high specific gravity & lactate dehydrogenase such as:

-malignancies

-infections

-inflammatory reactions

S/SX:

-dyspnea

-dullness on affected area

-absent or decreased BS on

affected area

-pallor

-fatigue

-fever

Diagnosis: -CXR -biopsy:

Management:

a. identify & treat the cause

b. thoracentesis

c. drug therapy

d. closed chest drainage