patient with respiratory disease

8/3/2019 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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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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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)



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How can TB be diagnosed?


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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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patient with respiratory disease

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