Nursing Care of the Client with Alterations in Gas

Exchange

What is Influenza (Flu)?What is Influenza (Flu)?

The flu is a contagious respiratory illness The flu is a contagious respiratory illness caused by influenza viruses.caused by influenza viruses.

Every year in the United States on Every year in the United States on average:average:

►5%-20% of the population gets the flu;5%-20% of the population gets the flu;►More than 200,000 people are More than 200,000 people are

hospitalized for flu complications, and;hospitalized for flu complications, and;►About 36,000 people die from the flu.About 36,000 people die from the flu.Source – www.cdc.gov/fluSource – www.cdc.gov/flu

Influenza Reports for Week of January 14, Influenza Reports for Week of January 14, 2007 in United States2007 in United States

►

Influenza Activity as Assessed by State and Territorial Influenza Activity as Assessed by State and Territorial Epidemiologists*:Epidemiologists*:

► During week 3, the following influenza activity†† was reported:During week 3, the following influenza activity†† was reported:► • • Widespread activity was reported by three states (Indiana, Iowa, Widespread activity was reported by three states (Indiana, Iowa,

and South Carolina). and South Carolina). • Regional activity was reported by 15 states (Arkansas, California, • Regional activity was reported by 15 states (Arkansas, California, Connecticut, Idaho, Georgia, Kentucky, Maryland, Massachusetts, Connecticut, Idaho, Georgia, Kentucky, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, Oklahoma, Tennessee, Texas, and Minnesota, Nebraska, Nevada, Oklahoma, Tennessee, Texas, and Virginia). Virginia). • Local activity was reported by 14 states (Alabama, Arizona, • Local activity was reported by 14 states (Alabama, Arizona, Florida, Hawaii, Illinois, Kansas, Louisiana, Maine, Missouri, New Florida, Hawaii, Illinois, Kansas, Louisiana, Maine, Missouri, New Jersey, North Carolina, Pennsylvania, South Dakota, and Wisconsin). Jersey, North Carolina, Pennsylvania, South Dakota, and Wisconsin). • Sporadic activity was reported by the District of Columbia, New • Sporadic activity was reported by the District of Columbia, New York City and 17 states (Alaska, Colorado, Delaware, Michigan, York City and 17 states (Alaska, Colorado, Delaware, Michigan, Mississippi, Montana, New Hampshire, New Mexico, New York, North Mississippi, Montana, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, Utah, Washington, West Dakota, Ohio, Oregon, Rhode Island, Utah, Washington, West Virginia, and Wyoming). Virginia, and Wyoming). • No influenza activity was reported by one state (Vermont). • No influenza activity was reported by one state (Vermont).

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How do we get the flu?How do we get the flu?

Andy is a 30 year old first grade Andy is a 30 year old first grade teacher. Each day he teacher. Each day he interacts with the 20 children interacts with the 20 children in his class. On any given in his class. On any given day, at least 3 of them have day, at least 3 of them have a cough or runny nose. Andy a cough or runny nose. Andy rides public transportation to rides public transportation to work each day. He shares work each day. He shares an apartment with a college an apartment with a college buddy who works as a buddy who works as a cashier at a large grocery cashier at a large grocery store. Andy eats a well store. Andy eats a well balanced diet and exercises balanced diet and exercises regularly. Neither Andy nor regularly. Neither Andy nor his room mate were eligible his room mate were eligible for free flu shots so they did for free flu shots so they did not get one.not get one.

What are Andy’s risk factors for What are Andy’s risk factors for acquiring the flu? acquiring the flu?

► Consider the following:Consider the following:1.1. How is the flu virus spread?How is the flu virus spread?2.2. What is the difference between a What is the difference between a

viral and a bacterial infection?viral and a bacterial infection?3.3. How effective is the flu vaccine?How effective is the flu vaccine?4.4. Who should get the vaccine?Who should get the vaccine?5.5. How effective are antiviral How effective are antiviral

medications?medications?6.6. What does the flu look like?What does the flu look like?

What is Avian (Bird) Flu?What is Avian (Bird) Flu?Avian influenza is an infection caused by avian influenza Avian influenza is an infection caused by avian influenza

viruses.viruses.

These viruses occur naturally among birds – carried in their These viruses occur naturally among birds – carried in their intestines. Wild birds do not usually get sick from it.intestines. Wild birds do not usually get sick from it.

Very contagious among birds and can make domesticated Very contagious among birds and can make domesticated birds like chickens, ducks and turkeys very sick and can birds like chickens, ducks and turkeys very sick and can kill them.kill them.

Domesticated birds become infected through contact with Domesticated birds become infected through contact with saliva, nasal secretions, and feces of infected birds. This saliva, nasal secretions, and feces of infected birds. This can occur through direct contact, dirty cages, can occur through direct contact, dirty cages, contaminated water or feed.contaminated water or feed.

Humans can contract the disease through contact with Humans can contract the disease through contact with infected birds. Spread from one person to another is infected birds. Spread from one person to another is rare.rare.

Source –cdc.govSource –cdc.gov

Route of New Strains of Influenza

                                                                                                                                                                                                                                                                                                                                                                                                                        

             

New Strains of InfluenzaNew Strains of Influenza

Care of the Client with Care of the Client with PneumoniaPneumonia

► Sam is a very health, active 71 year old who called his physician’s office complaining of chills and a productive cough. He is instructed to go to the hospital emergency room with a diagnosis of r/o pneumonia. The nurse begins her assessment. Sam is not taking any medications and denies food and drug allergies.

What is pneumonia?What is pneumonia?

►Consider the following:Consider the following:

What is the difference between bacterial What is the difference between bacterial and viral pneumonia?and viral pneumonia?

How do people get pneumonia?How do people get pneumonia?

What is the onset of pneumonia like?What is the onset of pneumonia like?

How can Sam say he feels “healthy as a How can Sam say he feels “healthy as a horse”?horse”?

What assessments of Sam should the nurse perform first ?

Assessment Findings

► VS – 154/82, 105, 32, 103FVS – 154/82, 105, 32, 103F► Crackles in the LLL anterior and posteriorCrackles in the LLL anterior and posterior► Nailbeds dusky on fingers and toesNailbeds dusky on fingers and toes► Productive cough – rust colored sputumProductive cough – rust colored sputum► Pain in left chest with coughingPain in left chest with coughing► Well nourished and hydratedWell nourished and hydrated► States –”I am healthy as a horse”States –”I am healthy as a horse”► Got hives from an antibiotic a few years agoGot hives from an antibiotic a few years ago► Smoked for 20 years but stopped about 15 years Smoked for 20 years but stopped about 15 years

agoago

Which of these assessment findings Which of these assessment findings should concern the nurse?should concern the nurse?

What additional assessments should the What additional assessments should the nurse expect to make?nurse expect to make?

More about SamMore about SamThe physician writes the following orders:The physician writes the following orders:► Regular dietRegular diet► VS with temperature every 2 hoursVS with temperature every 2 hours► IV of D51/2NSS at 125/hrIV of D51/2NSS at 125/hr► Azithromycin 500mg IV once a day x 2 doses then Azithromycin 500mg IV once a day x 2 doses then

250mg once a day by mouth for 7 days250mg once a day by mouth for 7 days► Oxygen via nasal cannula – maintain pulse oximetry Oxygen via nasal cannula – maintain pulse oximetry

of greater than 90%of greater than 90%► Sputum for culture and sensitivity x3Sputum for culture and sensitivity x3► Blood cultures x2 for temperature above 102Blood cultures x2 for temperature above 102► Complete blood count and metabolic panelComplete blood count and metabolic panel► Urinalysis and culture and senstivityUrinalysis and culture and senstivity► Chest X-Ray now and in morningChest X-Ray now and in morning

What should the nurse do first?

Considering the Considering the orders written by orders written by the physician, which the physician, which ones should the ones should the nurse implement nurse implement first? Why?first? Why?

Consider the rationale for the following orders:

► Why was azithromycin ordered for this Why was azithromycin ordered for this client?client?

► What is the rationale for the intravenous line What is the rationale for the intravenous line when the nurse assessed a well nourished when the nurse assessed a well nourished and hydrated client?and hydrated client?

► Why is it important to maintain the pulse Why is it important to maintain the pulse oximetry at 90%?oximetry at 90%?

► Why all the cultures?Why all the cultures?► What additional diagnostics tests might be What additional diagnostics tests might be

ordered for this client?ordered for this client?

Health Promotion/Disease Health Promotion/Disease PreventionPrevention

Sam is preparing for discharge. The nurse Sam is preparing for discharge. The nurse learns that he has recently lost his wife and learns that he has recently lost his wife and now lives alone with no family near by. now lives alone with no family near by. What measures should the nurse include in What measures should the nurse include in discharge teaching to help Sam decrease his discharge teaching to help Sam decrease his risk for contracting community-acquired risk for contracting community-acquired pulmonary infections?pulmonary infections?

Care of the Client with TuberculosisCare of the Client with Tuberculosis

Some Facts about TuberculosisSome Facts about Tuberculosis► Leading killer of young adults worldwide.Leading killer of young adults worldwide.► 1/3 of the world’s population are thought to 1/3 of the world’s population are thought to

be infected.be infected.► According to WHO – 8 million people According to WHO – 8 million people

worldwide develop active Tuberculosis each worldwide develop active Tuberculosis each year – nearly 2 million die.year – nearly 2 million die.

► In the United States – 3.8% of population In the United States – 3.8% of population have active TB. 10-15 million have latent have active TB. 10-15 million have latent disease (2005)disease (2005)

► In 2004 – high percentages of Asians and In 2004 – high percentages of Asians and Hispanics born outside of US were reported Hispanics born outside of US were reported to have TB.to have TB.

Meet JaneMeet Jane

You are the nurse in a community clinic. You are the nurse in a community clinic. Jane, a 60 year old woman, needs a Jane, a 60 year old woman, needs a Mantoux (PPD) test in order to obtain a Mantoux (PPD) test in order to obtain a food handler’s license. She is required food handler’s license. She is required to show proof of a negative test. Jane to show proof of a negative test. Jane denies any history of tuberculosis or denies any history of tuberculosis or other pulmonary problems. The nurse other pulmonary problems. The nurse administers the test and gives Jane an administers the test and gives Jane an appointment to return to the clinic in 2 appointment to return to the clinic in 2 days.days.

AssessmentsAssessments

Jane returns in 2 days Jane returns in 2 days to have her PPD to have her PPD read by the nurse. read by the nurse. Is Jane’s PPD Is Jane’s PPD positive or positive or negative?negative?

Does a positive PPD Does a positive PPD mean that Jane has mean that Jane has active TB?active TB?

More about JaneMore about Jane

After assessing the PPD test site, the nurse asks Jane After assessing the PPD test site, the nurse asks Jane about her history. Jane is reluctant to answer but about her history. Jane is reluctant to answer but finally admits that her mother had tuberculosis as a finally admits that her mother had tuberculosis as a child. She admits to drinking 3-4 ounces of ETOH a child. She admits to drinking 3-4 ounces of ETOH a day and has smoked 1 ½ packs a cigarettes a day for day and has smoked 1 ½ packs a cigarettes a day for the past 40 years. Jane lives with her daughter and the past 40 years. Jane lives with her daughter and three grandchildren in a 2 bedroom apartment. She three grandchildren in a 2 bedroom apartment. She becomes annoyed at the suggestion that she may becomes annoyed at the suggestion that she may have tuberculosis. Jane states that she feels fine.have tuberculosis. Jane states that she feels fine.

What risk factors related to tuberculosis can be identified What risk factors related to tuberculosis can be identified from Jane’s history?from Jane’s history?

What additional assessments/diagnostic tests would the What additional assessments/diagnostic tests would the nurse expect to implement?nurse expect to implement?

What happens when someone has What happens when someone has tuberculosis?tuberculosis?

►What does the nurse teaching need to What does the nurse teaching need to include with Jane and her daughter?include with Jane and her daughter?

►What are the behaviors that Jane What are the behaviors that Jane should be aware of that could alert her should be aware of that could alert her to active disease?to active disease?

►Does Jane require treatment?Does Jane require treatment?