Nursing 211

N211: Health Differences Across the Lifespan I Chemoprophylaxis Regimens: Nine months of therapy with INH; dosing daily or twice weekly. Two months of therapy with Rifampin and pyrazinamide; improves adherence and eliminates most strains. Four months of therapy with Rifampin; used if unable to take INH or Pyrazinamide or for organisms resistant to these drugs. Pleural Effusion is an accumulation of fluid in the pleural space that indicates underlying pulmonary disease or abnormality; pressure exerted by fluid compresses normal lung tissue. Transudative pleural effusion contains small amounts of protein and may be associated with increased hydrostatic pressure (heart failure) or decreased oncotic pressure from low albumin levels (chronic renal or liver disease). Exudative pleural effusion contains larger quantity of protein. This results from increased capillary permeability and fluid shift out of capillaries associated with inflammatory processes such as pulmonary tumors, infection or emboli. Empyema is pleural fluid containing pus associated with infections such as pneumonia, lung abscess and tuberculosis. Nursing Assessment Includes worsening dyspnea with diminished or absent breath sounds on affected side from lung compression, dullness to percussion on the affected side, chest, wall pain, fever persistent cough, night sweats and weight loss with empyema. Nursing Diagnosis • Impaired gas exchange related to fluid in lung and pleural space • Ineffective breathing pattern related to pressure on the diaphragm and lung by fluids • Anxiety related to feels of inability to breathe and pain Diagnostics Thoracentesis will differentiate the source of pleural fluid; if fluid is greater than 250ml will be visible on chest x-ray. Nursing Interventions Include treating the underlying cause, Thoracentesis to drain pleural cavity, monitor respiratory and oxygenation status, provide supplemental oxygen as indicated. Provide adequate nutrition with a focus on adequate protein intake. Medications include analgesics, antipyretics and antibiotics if indicated. 2.14 Atelectasis


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