Download - Patient With Respiratory Disease
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Patient with Respiratory Disease
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PNEUMONIA
is an infection of the small air sacs
of the lungs (alveoli) and the
tissues around them.
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Causes
Viruses, bacteria, or (in rare cases) parasites or
other organismsIf bacteria, it is usually the bacteria Streptococcus
pneumoniae.
Other bacteria include Haemophilus influenzae,
Mycoplasma pneumoniae, Chlamydophilapneumoniae, Legionella pneumophila
Staphylococcus aureus, Moraxella catarrhalis,
Streptococcus pyogenes, Neisseria meningitidis, or
Klebsiella pneumoniae.
Viruses, such as influenza A (the flu virus)
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Symptoms
often start during or after an upper
respiratory infection such as influenza or a cold,
and may include:
Cough, often producing mucus (sputum) from
the lungs. Mucus may be rusty or green or
tinged with blood.
Fever
Shaking, "teeth-chattering" chills
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Fast, often shallow, breathing and the
feeling of being short of breath.
Chest wall pain that is often made worse
by coughing or breathing in.
Fast heartbeat.Feeling very tired (fatigue) or feeling very
weak (malaise).
Nausea and vomiting.
Diarrhea.
Symptoms
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Classifications of Pneumonia
Community acquired
Typical Strep. Pneumoniae, H. Influenzae type B
Atypical Pneumonia S. Aureus, M. Pneumoniae, L.Pneumophila, P. Cariini
Nosocomial Pseudomonas, S. Aureus
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Exams and Tests
medical history
physical exam
chest X-ray
sputum culture and sensitivity
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Treatment:
Antibiotics:
Macrolides, such as azithromycin,
clarithromycin, and erythromycin.Tetracyclines, such as doxycycline.
Fluoroquinolones, such as gemifloxacin,
levofloxacin, and moxifloxacin.
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Treatment:
Fluids given through a vein
(IV).
Respiratory therapy
deep breathing exercises
postural drainage
spirometrychest physiotherapy
Oxygen therapy
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CHILDHOOD PNEUMONIA
IMCI Guidelines1. Nopneumonia
- infant, 60/min and no chest indrawing
2. Pneumonia
- young infant >60/min, fast breathing without chest indrawing
3. Severe pneumonia- fast breathing, severe chest indrawing, with one of danger signs
4. Very severe pneumonia
- below 2 mos old, fast breathing, chest indrawing, with danger
signs
4 Danger Signs
Vomits
Convulsion
Drowsiness/lethargy
Difficulty of swallowing or feeding
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DIPHTHERIA
Diphtheria is an infectious disease caused by the bacterium
Corynebacterium diphtheriae.
This disease primarily affects the mucous membranes of the
respiratory tract (respiratory diphtheria)
It may also affect the skin (cutaneous diphtheria) and lining
tissues in the ear, eye, and the genital areas.
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Transmitted by droplets or
fomites
Begins with severe sore throat,lowgrade fever and swollen
lymph
gray membrane
(pseudomembrane) forming over
the lining tissues of the tonsils
and/or nasopharynx
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malaisehoarsenessdifficulty swallowing
difficulty breathing
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Corynebacterium diphtheriae Aerobic Gram + bacillus
Toxin it produce inhibits protein
synthesis of cells to which it binds
Destroyed cells and WBC
form"pseudomembrane" which
blocks airways
There are four biotypes of the bacterium
(gravis, mitis, intermedius, and belfanti),and
each differs in the severity of disease it
produces
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Diphtheria antitoxin is the mainstay of
therapy.
Antibiotics - Penicillin and erythromycin
Supportive measures, such as inserting a
breathing tube (intubation), if there is
the potential for airway obstruction.
Potential cardiac and neurologic
complications also need to be closely
followed and addressed
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Prevention:
immunization with diphtheria
toxoid-containing vaccines.
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Whooping cough (pertussis) is an acute, highly
contagious respiratory infection that is caused by a
bacterium.
The bacterium responsible for the infection,
Bordetella pertussis, was not isolated until 1906.
Whooping cough commonly affects infants and
young children but can be prevented by
immunization with pertussis vaccine.
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Bordetella pertussis
Gram negative
cocco-bacillus Capsule
Adherence to
ciliated cells
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SYMPTOMS: Stages
The first stage - the catarrhal stage typically lasts from one to two weeks
runny nose
sneezing,
low-grade fever
mild, occasional cough, similar to the
common cold
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The second stage (the paroxysmal stage)
Bursts or paroxysms of coughing, or numerous rapid coughs, are
apparently due to difficulty expelling thick mucus from the airways in the
lungs.
At the end of the bursts of rapid coughs, a long inspiratory effort
(breathing in) is usually accompanied by a characteristic high-pitched
"whoop."
During an attack, the individual may become cyanotic from lack of
oxygen.
Vomiting and exhaustion commonly follow the episodes of coughing.
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The person usually appears normal between episodes.
Paroxysmal attacks occur more frequently at night, with anaverage of 15-24 attacks per 24 hours.
The paroxysmal stage usually lasts from one to six weeks but
may persist for up to 10 weeks.
Infants under 6 months of age may not have the strength to
have a whoop, but they do have paroxysms of coughing.
The second stage (the paroxysmal stage)
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The third stage of whooping cough is the recovery or
convalescent stage.
The cough becomes less paroxysmal and usually disappears overtwo to three weeks; however, paroxysms often recur with
subsequent respiratory infections for many months.
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.
Treatment with antibiotics is recommended for anyone
who has had the disease for less than 21 days.
Azithromycin Zithromax), clarithromycin (Biaxin),
erythromycin, and trimethoprim/sulfamethoxazole are
antibiotics which have been shown to be effective in
treating whooping cough.
Treatment:
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Mycobacterium tuberculosis
Tuberculosis (TB) describes an infectious disease that hasplagued humans since the Neolithic times.
Two organisms cause tuberculosis -- Mycobacterium
tuberculosis and Mycobacterium bovis.
Physicians in ancient Greece called this illness "phthisis" or"consumption." to reflect its wasting character.
Robert Koch isolated the tubercle bacillus in 1882 andestablished TB as an infectious disease.
Streptomycin, t, and isoniazidhe first antibiotic to fight TB, wasintroduced in 1946 (Laniazid, Nydrazid) became available in 1952
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More than 90% of TB cases occur in developing nations
that have poor resources and high numbers of people
infected with HIV
In 1995, 3 million people died from TB.
In 2008, theWorld Health Organization (WHO)
estimated that one-third of the global population
was infected with TB bacteria.
A new infection occurs every second.
The emergence of drug-resistant organisms
threatens to make this disease once again
incurable
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M. tuberculosis is a rod-shaped, slow-growing
bacterium.
M. tuberculosis' cell wall has high acid content, whichmakes it hydrophobic, resistant to oral fluids.
The cell wall absorbs a certain dye used in the
preparation of slides for examination under the
microscope and maintains this red color despite
attempts at decolorization, hence the name acid-fastbacilli
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Mycobacterium tuberculosis
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Types of TB patients
Extrapulmonary TB can either be "severe," which includes
meningitis, pericarditis, peritonitis, bilateral or extensive
pleural effusion, spinal, intestinal, genitourinary, and
miliaryTB, or "less severe" which includes the lymphnode, bone other than the spine, peripheral joint, skin, or
unilateral pleural effusion
Pulmonary TB - refers to a patient with TB disease
involving the lung parenchyma
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How is the disease transmitted?
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Mycobacterium tuberculosis
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Tuberculosis stages
Primary
Lung tubercles, caseous, tuberculin skin
reaction Secondary (reactivation)
Consumption: Coughing and chronic
weight loss
Dissemination Extrapulmonary TB (lymph nodes,
kidneys, bones, genital tract, brain,
meninges)
Mycobacterium tuberculosis
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Mycobacterium tuberculosis
How can TB be diagnosed?
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Mycobacterium tuberculosis
Mantoux TuberculinSkin Test
Test Administration: Give 0.1 ml of 5
Tuberculin Units PPD intradermally
All tests should be read between 48 and
72 hours
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TuberculinSkin Test
Caliper Rulers
Measure and report results in
millimeters of induration.
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Positive Reactions
15 or more millimeters induration is always
consideredpositive.
Mantoux Tuberculin Skin Test
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TREATMENT
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Categories & Treatment: WHO
Guidelines
Category I are new cases of smear-positive PTB, orsmear-negative PTB with extensive x-ray lesion, or severe
extrapulmonary TB.
Treatment:
Intensive phase: 2 months of isoniazid (H), rifampicin (R),
pyrazinamide (Z), ethambutol (E)Continuation phase : 4 months of HR daily or thrice a
week (TIW)
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Category II are retreatment cases due to relapse,
treatment failure, treatment after loss & others
Treatment:
Intensive phase: 2 months of HRZE + streptomycin (S) then
1 month of HRZE
Continuation phase : 5 months of HRE daily or TIW
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Categories & Treatment: WHO
Guidelines
Category III are new cases of smear-negative PTB with
mild x-ray lesion, or less severe extrapulmonary lesion
Treatment:
Intensive phase: 2 months of HRZ
Continuation phase : 4 months of HR daily or TIW
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If the treatment is takenirregularly, there may beserious consequences:
- the TB germs become
resistant to the drugs - the disease cannot becured - the disease can bespread to others- death
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Preventivemeasures for tuberculosis
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Publicity for TB
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