NURS 331 - EXAM 3 STUDY GUIDE
Nursing management – assessments, planning, interventions (independent
and collaborative/interprofessional), teaching, and evaluation
Module 7: respiratory
Lewis 10th ed. Ch. 25 review tables for respiratory topics listed: Tables 25-1, 25-2, 25-3, 25-10, 25-11
Pneumonia
Table 27-1, 27-4
Risk factors for pneumonia
o Abdominal or thoracic surgery
o > 65 yr.
o Air pollution
o Altered consciousness: alcoholism, head injury, seizures, anesthesia, drug
overdose, stroke
o Bed rest and prolonged immobility
o Chronic diseases: chronic lung and liver disease, diabetes mellitus, heart
disease, cancer, chronic kidney disease
o Debilitating illness
o Exposure to bats, birds, rabbits, farm animals
o Immunosuppressive disease and/or therapy (corticosteroids, cancer
chemotherapy, HIV, immunosuppressive therapy after organ transplant)
o Inhalation or aspiration of noxious substances
o Intestinal and gastric feedings via nasogastric or nasointestinal tubes
o IV drug use
o Malnutrition
o Recent antibiotic therapy
o Resident of a long-term care facility
o Smoking
o Tracheal intubation
o Upper respiratory tract
infection Interprofessional care
o Diagnostic assessment
History and physical
examination Chest x-ray
Gram stain of sputum
Sputum culture and sensitivity test
Pulse oximetry or ABGs (if indicated)
Blood cultures (if indicated)
o Management
Increased fluid intake (at least 3 L/day)
Balance between activity and rest
O2 therapy (if indicated)
o Drug therapy
, Appropriate antibiotic
therapy Antipyretics
Analgesics
Types
o Viral – most common
May be mild or life-threatening
o Bacterial – may require hospitalization
o Mycoplasma – atypical
o Aspiration – abnormal entry of oral or gastric material into lower
airway Major risk factors:
Decreased level of consciousness – depressed cough or
gag reflex Difficulty swallowing
Insertion of nasogastric tubes with or without tube
feeding Aspirated material triggers inflammatory response
Primary bacterial infection – most common
Empiric therapy based on probable causative organism, severity of
illness, and patient factors
Aspiration of acid gastric contents initially causes chemical (noninfectious)
pneumonitis results in possible bacterial infection in 24-72 hours
o Necrotizing
Rare complication of bacterial lung infection – often results
from CAP S/Sx:
Immediate respiratory
insufficiency/failure Leukopenia
Bleeding into airways
Tx – long-term antibiotics; possible surgery
o Opportunistic
Immunocompromised patients
Severe protein-calorie
malnutrition Immunodeficiencies
Chemotherapy/radiation recipients
Immunosuppression therapy – long-term corticosteroid therapy
Caused by bacteria, virus, or microorganisms that do not normally cause disease
o Pneumocystis jiroveci pneumonia (PJP) – fungal infection; most common
with HIV Slow onset and subtle symptoms
Fever, tachycardia, tachypnea, dyspnea, nonproductive
cough, and hypoxemia
Chest x-ray: diffuse bilateral infiltrates to massive
consolidation Can be life-threatening: respiratory failure
Spread to other organs
Tx – trimethoprim/sulfamethoxazole
Does not respond to antifungals
o Cytomegalovirus (CMV)
pneumonia Herpes virus
Asymptomatic and mild to severe disease (impaired immunity)
Most important life-threatening complications after hematopoietic
stem cell transplantation
, Tx – antiviral medication and high-dose
immunoglobulin o Community-acquired pneumonia (CAP)
Acute infection in patients who have not been hospitalized or resided in
a long-term care facility within 14 days of the onset of symptoms
Can be treated at home or hospitalized dependent on patient’s age, VS,
mental status, comorbidities, and condition
o Hospital-acquired pneumonia (HAP) or nosocomial pneumonia
HAP – Occurs 48 hours or longer after hospitalization and not present at
time of admission
Ventilator-associated pneumonia (VAP) – occurs more than 48
hours after endotracheal intubation
Diagnostics
o H and P
o Chest X-ray
o Sputum analysis – sputum gram stain, culture, and sensitivity
o CBC with diff
o O2 sat
o ABG – arterial blood gases
o Blood cultures – before antibiotics
o Bronchoscopy
o Symptoms
Cough, fever, chills, dyspnea, tachypnea, pleuntic chest pain, green/yellow/rust
sputum, older/debilitated patients (confusion or stupor), hypothermia
o Objective data:
General – fever, restlessness or lethargy, splinting affected area
Respiratory – tachypnea, asymmetric chest movements, use of accessory
muscles, nasal flaring, decreased excursion, crackles, friction rub, dullness
on percussion, increased tactile fremitus, sputum amount and color
o Physical examination:
Fine or coarse crackles
With consolidation – bronchial breath sounds, increased fremitus, with
pleural effusion, dullness to percussion
Prevention
o Positionings, acute care, breathing exercises, early ambulation, therapeutic
positioning, pain management
o Prevent aspiration pneumonia
Elevate head-of-bead 30 degrees and have sit up for all
meals Assist with eating, drinking, taking meds as needed
Assess for gag reflex
Monitor reflux and gastric residuals (NG
tube) Early mobilization
Cough and deep breathe, incentive
spirometry Twice-daily oral hygiene
o Medical asepsis and infection
control Hand hygiene
Sterile technique with tracheal suction
Careful handling of respiratory equipment
Nursing management – assessments, planning, interventions (independent
and collaborative/interprofessional), teaching, and evaluation
Module 7: respiratory
Lewis 10th ed. Ch. 25 review tables for respiratory topics listed: Tables 25-1, 25-2, 25-3, 25-10, 25-11
Pneumonia
Table 27-1, 27-4
Risk factors for pneumonia
o Abdominal or thoracic surgery
o > 65 yr.
o Air pollution
o Altered consciousness: alcoholism, head injury, seizures, anesthesia, drug
overdose, stroke
o Bed rest and prolonged immobility
o Chronic diseases: chronic lung and liver disease, diabetes mellitus, heart
disease, cancer, chronic kidney disease
o Debilitating illness
o Exposure to bats, birds, rabbits, farm animals
o Immunosuppressive disease and/or therapy (corticosteroids, cancer
chemotherapy, HIV, immunosuppressive therapy after organ transplant)
o Inhalation or aspiration of noxious substances
o Intestinal and gastric feedings via nasogastric or nasointestinal tubes
o IV drug use
o Malnutrition
o Recent antibiotic therapy
o Resident of a long-term care facility
o Smoking
o Tracheal intubation
o Upper respiratory tract
infection Interprofessional care
o Diagnostic assessment
History and physical
examination Chest x-ray
Gram stain of sputum
Sputum culture and sensitivity test
Pulse oximetry or ABGs (if indicated)
Blood cultures (if indicated)
o Management
Increased fluid intake (at least 3 L/day)
Balance between activity and rest
O2 therapy (if indicated)
o Drug therapy
, Appropriate antibiotic
therapy Antipyretics
Analgesics
Types
o Viral – most common
May be mild or life-threatening
o Bacterial – may require hospitalization
o Mycoplasma – atypical
o Aspiration – abnormal entry of oral or gastric material into lower
airway Major risk factors:
Decreased level of consciousness – depressed cough or
gag reflex Difficulty swallowing
Insertion of nasogastric tubes with or without tube
feeding Aspirated material triggers inflammatory response
Primary bacterial infection – most common
Empiric therapy based on probable causative organism, severity of
illness, and patient factors
Aspiration of acid gastric contents initially causes chemical (noninfectious)
pneumonitis results in possible bacterial infection in 24-72 hours
o Necrotizing
Rare complication of bacterial lung infection – often results
from CAP S/Sx:
Immediate respiratory
insufficiency/failure Leukopenia
Bleeding into airways
Tx – long-term antibiotics; possible surgery
o Opportunistic
Immunocompromised patients
Severe protein-calorie
malnutrition Immunodeficiencies
Chemotherapy/radiation recipients
Immunosuppression therapy – long-term corticosteroid therapy
Caused by bacteria, virus, or microorganisms that do not normally cause disease
o Pneumocystis jiroveci pneumonia (PJP) – fungal infection; most common
with HIV Slow onset and subtle symptoms
Fever, tachycardia, tachypnea, dyspnea, nonproductive
cough, and hypoxemia
Chest x-ray: diffuse bilateral infiltrates to massive
consolidation Can be life-threatening: respiratory failure
Spread to other organs
Tx – trimethoprim/sulfamethoxazole
Does not respond to antifungals
o Cytomegalovirus (CMV)
pneumonia Herpes virus
Asymptomatic and mild to severe disease (impaired immunity)
Most important life-threatening complications after hematopoietic
stem cell transplantation
, Tx – antiviral medication and high-dose
immunoglobulin o Community-acquired pneumonia (CAP)
Acute infection in patients who have not been hospitalized or resided in
a long-term care facility within 14 days of the onset of symptoms
Can be treated at home or hospitalized dependent on patient’s age, VS,
mental status, comorbidities, and condition
o Hospital-acquired pneumonia (HAP) or nosocomial pneumonia
HAP – Occurs 48 hours or longer after hospitalization and not present at
time of admission
Ventilator-associated pneumonia (VAP) – occurs more than 48
hours after endotracheal intubation
Diagnostics
o H and P
o Chest X-ray
o Sputum analysis – sputum gram stain, culture, and sensitivity
o CBC with diff
o O2 sat
o ABG – arterial blood gases
o Blood cultures – before antibiotics
o Bronchoscopy
o Symptoms
Cough, fever, chills, dyspnea, tachypnea, pleuntic chest pain, green/yellow/rust
sputum, older/debilitated patients (confusion or stupor), hypothermia
o Objective data:
General – fever, restlessness or lethargy, splinting affected area
Respiratory – tachypnea, asymmetric chest movements, use of accessory
muscles, nasal flaring, decreased excursion, crackles, friction rub, dullness
on percussion, increased tactile fremitus, sputum amount and color
o Physical examination:
Fine or coarse crackles
With consolidation – bronchial breath sounds, increased fremitus, with
pleural effusion, dullness to percussion
Prevention
o Positionings, acute care, breathing exercises, early ambulation, therapeutic
positioning, pain management
o Prevent aspiration pneumonia
Elevate head-of-bead 30 degrees and have sit up for all
meals Assist with eating, drinking, taking meds as needed
Assess for gag reflex
Monitor reflux and gastric residuals (NG
tube) Early mobilization
Cough and deep breathe, incentive
spirometry Twice-daily oral hygiene
o Medical asepsis and infection
control Hand hygiene
Sterile technique with tracheal suction
Careful handling of respiratory equipment
