respiratory diseases wk 5

8/6/2019 Respiratory Diseases Wk 5

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y is the inflammation of the lung parenchyma(terminal bronchioles, respiratorybronchioles, alveolar ducts, alveolar sac,and alveoli)

y it is classified according to its causativeagent;

y the incubation period depends on whattype of microorganism caused the disease;


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pneumonia usually arises from endogenousmicroflora of the person whose resistance

have been altered or from aspiration oforopharyngeal secretions;

patients with pneumonia may have anunderlying infection that impairs hostdefense;


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V iral Pneumoniax Influenza virusesx Parainfluenzax A denoviruses


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Fungal Pneumoniax A spergillus fumigatusx Pneumocystis carinii AIDS patients


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M ode of Transmission: Inhalation of respiratory secretions from

an infected individual;

A spiration of oropharyngeal secretions; Thru the bloodstream; From direct spread as a result of surgery

or trauma;


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y C linical M anifestations:Sudden onset of fever, high-grade with chills;Cough, productive;D yspnea;

Pleuritic chest pain aggravated by coughingor breathing;Tachypnea accompanied by grunting, nasalflaring, use of accessory muscles and fatigue;

Rapid, bounding pulse;


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yD iagnostic Evaluation:CBC

Chest X-ray to show presence of pneumonicinfiltrates and the extent of pneumonia.S

putumG

rams stain - may indicate offendingmicroorganism;Sputum culture and sensitivity may alsoconfirm offending microorganism;Blood culture to confirm the presence ofbacterial pneumonia;Immunologic test detecting microbial antigensin serum, sputum, and urine.


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M edical M anagement:

A ntimicrobial therapyx D epends on laboratory identification of

causative agents and its sensitivity;x For Bacterial pneumonia:

xPenicillinx Cefuroxime

x Ceftriaxonex Cotrimoxazolex A zithromycin


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x For V iral Pneumoniax M ost of the time it is self-limiting.x Symptomatic and supportive

management.


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O xygen therapy M ucolytic and other cough medicines Bronchodilators Steroid therapy


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N ursing D iagnosis: Impaired gas exchange Ineffective airway clearance


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y N ursing Interventions:A ssess px for cyanosis, dyspnea, hypoxia, and

confusion;A dminister oxygen as indicated at 1-2 L/min.Isolate the client.Put client is semi-Fowlers position.

Encourage the px to cough out secretions.Encourage increase fluid intake.Employ chest wall percussion and posturaldrainage.

A uscultate chest for crackles and rhonchi.M obilize client even on bed to improvesecretion clearance.


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C omplications: Pleural effusion parapneumonic effusion Cardiovascular collapse especially from

gram (-) bacteria/sepsis; Superinfection D elirium due to cerebral hypoxia; A telectasis


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y is a chronic bacterial infectioncharacterized by granuloma formation,necrosis, and calcification of involvedtissues;

y one of the leading cause of morbidity andmortality in the Philippines and other developing countries.

y fairly common among low-income,congested families;


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y approximately 10% (5 - 14%) of cases areASYM PTOMA TIC;

can be:

Minimal slight lesions withoutdemonstrable excavation and confined to

the apex;Moderately Advanced cavities less than 4cm involving one or both lungs;

Far Advanced lesions more extensive thanmoderately advanced TB;


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C ausative A gent: Mycobacteriumtuberculosis

x acid-fast bacilli, aerobic ;

y

IP:3

8 weeks;

y M ode of Transmission ;N asopharyngeal secretionsD rinking of infected cows milk D roplet nuclei infection


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TBC lassification according to A TS:

C lass 0 no TB exposure ; no infection ; (-) PP D;

C lass 1 (+) exposure ; no infection ; (-) PP D;

C lass 2 (+) exposure ; (+) PP D; no symptoms ;x Recent or actual TB infection ;

C lass 3 (+) exposure ; (+) PP D; (+) symptoms ; (+) CX R ;x Active TB ;

C lass 4 (+) exposure ; (+) PP D; no active disease ; (+) CX R ;x Previous PTB disease ;

C lass 5 (+) exposure ; (+) PP D; (+) CX R ; equivocal findings ; x PTBSuspect ;


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Multiple Drug-Resistance Tuberculosis(MDRTB) suspect in PTB class 3 patients

who are still sputum smear or sputumculture positive (+) despite 3 months ofadequate treatment;


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y C linical M anifestations:fever, low-grade, late afternoon or earlyevening;chillsanorexia

weight losschronic cough more than two weeks;nocturnal sweatingchest and back pains

dyspnea and hemoptysis


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y Diagnostic Examinations:Chest X-ray (PA - lateral and apicolordoticview)Sputum A FB 3 consecutive mornings; toidentify if the client is communicable;x Tell client not to eat or brush before collecting

sputum.x Client may gurgle tap water.x If client cannot expectorate, may nebulizer with

PN SS .


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Bronchoscopy M

antoux test or PPD

; exposure to TB; M ycobacterium TB Culture confirmatory; Liver Function Test AS T and A LT;


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1. First-line M edications - R IPES

R IFAM PIC IN (R IF) taken WITH food to prevent GI upset ;x causes hepatotoxicity (reddish-orange urine)

ISO N IAZ ID (IN H) taken on an E M PTY stomach for maximum absorption ;x causes PE R IPHER AL N EUROP A THY (char by numbness and tingling

sensation of hands and feet)x given with P YR IDO XIN E (V it. B6) ;x A void thyramine containing foods because they may cause reactionPYR AZ INAM IDE (PZA) causes hepatotoxicity and hyperuricemia ;x protect drug from light ;

ETHAM BUTOL (EM B) causes OPTI C N EUR ITIS characterized by blurring of

vision ;x not given in children less than 6 years old ;x A dminister with foodSTREPTOMYC IN must weigh px daily and monitor kidney function ;x causes OTOTO XIC ITY and N EPHROTO XIC ITY;x can be given to children less than 6 y/o ;x Obtain baseline audiometric test and repeat every 1 to 2 monyhs


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Second-line Drugs A mikacin Capreomycin Ciprofloxacin Cycloserine O floxacin Terizidone


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y N ursing Interventions:Isolate client for TW O WEEKS at the start ofA N TI-TB drugs.Provide px with adequate rest periods;Promote adequate nutritionA dvise to cover nose and mouth whensneezing and coughing;Provide frequent oral hygiene and handwashing;M onitor intake of medications;


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y Factors that contribute to thedevelopment of the disease:

PovertyO vercrowdingM alnutritionVitamin deficiencies ( A , D , C)D ecrease resistance due to existing infections(that threatens their immune system).

Children below 5yrs old who are prone toinfections due to factors found above.


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A cute viral infection affecting therespiratory system

Etiologic agent: myxoviruses, types A , A -prime, B, C

IP 24-48 hours


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PO C up to 5 th day of illness in children

MO T A irborne D irect contact droplet


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M anifestationsy Chilly sensationy Hyperpyrexiay M alaisey Sore throaty Coryzay Rhinorrhea

y M yalgiay headache


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D iagnostic procedures Blood exams O ropharyngeal swabbing


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M anagement N o specific treatment Symptomatic rest


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Preventive measure Immunization A voidance of crowded places


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y is an acute contagious viralinfection in the new millenniumthat originate in G uandongProvince of China;

y term coined by D r. Carlo Urbani

(WHO

) last 2002;y it causes severe form of atypical

pneumonia;


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y only has a 5% mortality rate in all cases

found around the world;

y significant history of travel to affected

areas such as G uandong, China; HongKong; Taiwan, and Singapore;

y at risk are individuals that are in closecontact with a SA RS patient (healthworkers, family members, care givers,classmates)


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y C ausative A gent: SA R S-corona virus.x a variant of the common cold

coronavirusx Virus survival outside body:

x 3 hours dry environment.

x 6 hours moist setting.

x Can be killed by exposure to sunlight.x M

utates easily.


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y IP: 1 - 13 days (ave. 2 5 days)

y M ode of Transmission:A irborne transmission

Indirect contact with inanimate objectscontaminated with nasopharyngeal andrespiratory secretions;


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y Diagnostic Examination :CXR shows atypical form of pneumonia;

CBC leucopenia and lymphopenia;Elevated lactate dehydrogenase.Elevated liver function test ( AS T and A LT)Viral Culture;Immunologic Test identify antibodies againstthe virus.


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M edical M anagement: Supportive management such as

ventilatory support; Use of A nti-viral agents, steroids, and large

doses of antibiotics are controversial;


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N ursing D iagnosis: Impaired airway clearance Ineffective breathing pattern High risk for injury: D eath


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y N ursing Interventions:ISO LA TE!!!Practice barrier method.Use complete PPE when caring for thepatient;

M onitor the patient for signs of respiratorydistress;A dvise relatives or anybody that were in closecontact with the patient to undergo

observation and quarantine;Educate the px and family about handwashing and handling linens and clothingproperly.


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y is an acute contagious bacterialinfection characterized by paroxysms ofrepeated cough and ends in awhooping sound;

y common in children LE SS THA N TWO YEA RS O LD .

y Causative A gent: Bordetella pertussis

y IP: 7 21 days;


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M ode of Transmission: D irect contact by airborne transmission Indirect contact thru nasopharyngeal

secretions;


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C linical M anifestations: Invasive Stage or catarrhal stage ;

x 7 14 days;x patient is highly contagious;x Fever x Watery eyes and sneezing

x N octurnal coughingx Restlessness or irritable


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Spasmodic Stage 4 12 weeks ;x Forceful successive coughing with

peculiar crowing sound or whoop;x 5 20 coughing;x Protrusion of tongue and eyeballs

during coughing;x Swollen face and neck;


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C onvalescent Stagex symptoms subsides;


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D iagnostic Examination: Cough plate or agar plate;

M edical M anagement: A ntibiotics Penicillin or Erythromycin; O 2 inhalation Prevent convulsions


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N ursing Interventions: ISO LA TE the client!!! provide a quiet and non-stimulating

environment; complete bed rest; small frequent feeding Prevention:

x D PT vaccination;


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y is an infestation of the skin produced byBURRO WIN G action of the parasite miteresulting in irritation and the formation ofvesicles or pustules;

y common in individuals living in areas ofpoverty where cleanliness is lacking;

y Causative A gent: Sarcoptes scabiei


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M ode of Transmission: Skin contact with an infected person; Indirect contact thru soiled bed linens and

clothing;


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C linical M anifestations: Intense itchiness especially at night ; Sites:

x Interdigital areasx Flexor surface of the wrist and palms;

x N ipplesx Umbilicusx A xillary foldsx G

roin or gluteal foldsx Penis and scrotum


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D iagnostic Examination: Presence on skin of female mites,

ova, and feces upon skin biopsy or scraping ;


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M edical M anagement: Permethrin 5% cream apply on the skin

below the neck; stay for at least 8 hours. Lindane solution (Kwell ) for bathing; Crotamiton (Eurax) ointment;

A nti-histamines to reduce itchiness.


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N ursing Interventions: Boiling of linens and clothes; Encourage to change clothing and bed

linen frequently Warm shower bath to remove scaling debris

or crusts;

respiratory diseases wk 5

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