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1

Communicable Diseases

Caused by a pathogen that enters thebody, multiplies, and causes disease

TransmissibleAfflict the most vulnerable

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Communicable Diseases

Host

AgentEnvironment

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4

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Modes of Transmission

DirectCongenital, Sexual, Direct Contact

IndirectFomiteVector

Mechanical, BiologicalVehicle

Airborne, waterborne

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ASEPSIS AND INFECTION CONTROL

Asepsis- absence of disease producingmicroorganisms

Medical Asepsisclean techniqueReduces number of microorganisms

Surgical Asepsissterile techniqueIncludes all sterile procedure/techniques toeliminate all microorganisms from an area

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Cleansing, Disinfection, SterilizationCleansing- removing visible dirtDisinfection- reduce number of potentialpathogens but spores are notnecessarily destroyed

Sterilization- complete destruction of allmicroorganisms including their spores

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Methods:1. Steam (autoclave)

2. Gas (Ethylene oxide)3. Radiation4. Chemical5. Boiling water

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Infection Control

Handwashing- single most importantinfection control practiceNecessary elements:

FrictionRunning water Cleansing agent

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Removing protective devices:

1. Gloves2. Mask

3. Gown4. Goggles5. Cap

6. Shoe cover

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the tiers of precaution

Standard precautionTransmission-based precaution

Airborne precaution droplet nuclei smaller than 5 mHigh-Efficiency Particulate Air filter Air-filtered roomPrivate roomDoor is shut

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the tiers of precaution

Standard precautionTransmission-based precaution

Droplet precaution droplet nuclei larger than 5 mDoor may be openMask if within 3 feetLimit transportPrivate room

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the tiers of precaution

Standard precautionTransmission-based precaution

Contact precautionGown and glovesDedicated equipmentPrivate room

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Principles of Sterility

A sterile object remains sterile only whentouched by another sterile object.Only sterile objects may be placed on asterile field.A sterile object becomes contaminatedby prolonged exposure to air.

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Principles of Sterility

A sterile object or field out of the range of vision or an object held below a personswaist is contaminated.When sterile surface comes in contactwith a wet, contaminated surface, thesterile object or field becomescontaminated

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Principles of Sterility

The edges of a sterile field are consideredcontaminated.Fluid flows in the direction of gravity.

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Respiratory System

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Respirat ory System

Upper RespiratoryTractLower RespiratoryTract

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Respiratory System

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Respiratory System

Lower Respiratory TractBronchioles

Terminal BronchiolesRespiratoryBronchioles

Alveoli

Type IType IIAlveolar Macrophages (DustCells)

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Respiratory Sys tem

LungsPleural Membrane

Parietal Pleura

Visceral Pleura

Lung Lobes and

Fissures

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Respiratory System

Pulmonary VentilationInspiration andExpiration

Cellular RespirationExternal

Internal

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Respiratory Sy stem

Muscles of Respiration

Quiet RespirationPiston ActionPump Handle Motion

Bucket Handle Motion

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Respiratory Sy stem

MechanicsForced InspirationQuiet Expiration

Forced Expiration

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Respiratory System

Lung VolumesTidal Volume (500 ml)Inspiratory Reserve Volume (IRV = 2100-3200 ml)Expiratory Reserve Volume (ERV = 1200 ml)Residual Volume (RV =1200 ml)

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Respiratory System

Lung CapacitiesInspiratory Capacity (=4000 ml)Vital Capacity (= 4800 ml)Functional Residual Capacity (=2000 ml)Total Lung Capacity (=6000 ml)

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Respiratory System: Control

Respiratory Center In the medulla and pons

Medullary rhythmicity areaPneumotaxic area (>E)Apneustic area (>I)

Cerebral Cortex

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Respiratory System: Control

Hering Breuer ReflexInhibits excessive lung expansion

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Respiratory System: Control

ChemoreceptorsCentralPeripheral

Aortic and carotid bodies

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Respiratory System: Control

OthersTemperatureIrritation of airwaysVolitionPainEmotionAnal Sphincter Stretching

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Assessment

Health Historychief complaint

impact on patient's lifeif chronic, ongoing assessment of abilities& quality of life

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Signs & Symptoms

Dyspneadifficulty breathing

due to decreased lung compliance or increased airway resistance

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Signs & Symptoms

Coughfrom irritation of the membranes

chief protection against accumulation of secretions

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Signs & Symptoms

Sputumreaction of lungs to any constantlyrecurring irritantprofuse & with color usually is bacterialthin & mucoid is viral

bad breath usually is respiratory in origin

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Signs & Symptoms

Wheezingheard with airway narrowing

high-pitched, mainly expiratory

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Signs & Symptoms

Clubbingdistal phalanx of each finger isbulbous & rounded

nail plate is more convexusually due to chronic hypoxiamay be pulmonary or cardiac

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Signs & Symptoms

Hemoptysisexpectoration of blood

underlying disease must be diagnosedregardless of amount of bloodvs. Hematemesis

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Physical Assessment

Nose & Sinuses check external nose for

lesions, asymmetry or

inflammation tilt head backward &

assess the mucosa inspect the septum &

turbinates palpate the sinuses

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Physical Assessment

Pharynx & Mouth open mouth wide & take

a deep breath

check tonsils, uvula & post. pharynx

tongue depressor is put past midpoint of tongue

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Physical Assessment

Thoraxcheck skin color & turgor

check for deformities

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Physical Assessment

ThoraxFunnel Chest (Pectus

excavatum)depression of lower portion of the sternum

may compress theheart

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Physical Assessment

ThoraxPigeon Chest (Pectus Carinatum)

due to displacement of the sternumincrease in AP diameter

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Physical Assessment

ThoraxKyphoscoliosis

elevation of scapulaS-shaped spine

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Physical Assessment

Respiratory Ratesnormal RR: 12-18 bpm

EupneaBradypneaTachypnea

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Physical Assessment

Breathing PatternsHypoventilation

Hyperpnea (depth)Hyperventilation (depth and rate)Apnea

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Physical Assessment

Breathing PatternsKussmaul's

Cheyne-stokesBiot's (Cluster)Apneustic

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Physical Assessment

Thoracic Palpationtenderness, massesrespiratory excursion

costal margin if anterior level of 10th rib if posterior

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Physical Assessment

Thoracic Palpationtactile fremitus

vibration of the chestpatient asked to repeat "99", "eee"air impedes sound, solids conduct sound

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Physical Assessment

Thoracic Percussionto determine content of underlying structuresto estimate size & location of certainstructures within the thoraxdullness at left 3rd - 5th interspace is the heartdullness at right 5th interspace to costalmargin is the liver

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Physical Assessment

Thoracic AuscultationUseful for assessing air flowUsed to evaluate presence of fluid or solidobstructionAllow patient to rest during examinations

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Physical Assessment

Thoracic AuscultationAdventitious Sounds

additional soundsCrackles (Rales)Wheezing

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Diagnostics

Pulmonary Function TestsAssess respiratory function and

dysfunctionMeasures lung volumes and ventilatoryfunction

Studies mechanics of breathing and gasexchange

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Diagnostics

Arterial Blood Gas StudiesMeasures PaO2, PaCO2, pH, HCO3Obtained through an arterial puncture

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Diagnostics

Sputum StudiesFor diagnosis, drug sensitivity testingTo determine whether malignant cells arepresentExpectoration is the usual methodObtained in the morning so specimens

accumulate overnightDo not allow specimen to stand as thismay cause overgrowth

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Diagnostics

Imaging StudiesEndoscopic Procedures

BronchoscopyThoracoscopy

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Respiratory System: Tests

Pulse OximetrySpirometry

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Diagnostics

ProceduresThoracentesisBiopsy

PleuraLungLymph Node

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Client Needs: Oxygenation

Interventions to promote oxygenationDeep breathing and coughing exercises

Abdominal breathingPursed-lip brathing

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Client Needs: Oxygenation

Interventions to promoteoxygenationChest physiotherapy

a. Percussionb. Vibrationc. Postural Drainage

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Client Needs: Oxygenation

Oxygen Therapy

Concentration and liter flowper minuteHumidification

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Obstruction and Trauma

EpistaxisCaused by rupture of tiny vessels in any areaof the nose

Most commonly over the anterior septumwhere the following vessels enter:

Kesselbachs plexus

Sphenopalatine artery (posterosuperior)Internal maxillary (lateral)

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Obstruction and Trauma

Epistaxis (treatment)Direct pressureSilver nitrate, electrocauteryPacking

May remain in place for 48 hours

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Upper Respiratory Tract

Viral Rhinitis (Common Cold)Sx: rhinorrheaHighly contagiousMost common cause of absenteeism fromwork and school

Most common cause is rhinovirus

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Upper Respiratory Tract

Acute SinusitisInfection of the paranasalsinuses

Usually due to drainageobstruction60% are bacterial

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Upper Respiratory Tract

Chronic Sinusitis > 3 wks in adults, > 2 wks in children Same organisms as acute sinusitis

Symptoms most pronounced in themorning

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Upper Respiratory Tract

RhinitisInflammation and irritation of the mucusmembranes

non-allergic or allergicSx: rhinorrheaNursing

Avoid the allergenBlow the nose before any medication in thenasal cavity

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Upper Respiratory Tract

Acute Pharyngitis Mostly viral The most common bacterial cause is

group A beta-hemolytic Streptococci Throat cultures, nasal swabs and blood

cultures may be necessary

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Upper Respiratory Tract

Tonsillitis and Adenoiditis 3 tonsils: palatine, lingual and pharyngeal The pharyngeal tonsils are also called the

adenoids Grp A beta-hemolytic Streptococcus is the

most common causative organism

Post-op: prone with head turned to theside

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Upper Respiratory Tract

Peritonsillar Abscess Collection of purulent exudate between the tonsil and

surrounding structures Believed to be tonsillitis which progressed to local

cellulitis and abscess

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Upper Respiratory Tract

Laryngitis Inflammation of larynx

Almost always viral if infectious With voice changes

and cough

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Obstruction and Trauma

Acute Laryngeal EdemaAllergic, traumatic, inflammatoryHoarseness, shortness of breathInterventions

Epinephrine and corticosteroids

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Obstruction and Trauma

Chronic Laryngeal EdemaObstruction of lymph drainageHoarseness, shortness of breathInterventions

Artificial airway may be necessary

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Obstruction and Trauma

LaryngospasmTrauma or inflammatoryIntervention

OxygenSuccinylcholine

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Obstruction and Trauma

Fractures of the NoseUsually without serious consequencesObstruction or disfigurement may resultRule out a skull fracture if with rhinorrheaReduced 7-10 days after the injury

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Obstruction and Trauma

Obstruction During SleepMost common is sleep apnea syndrome3 Types

Obstructive the most commonCentralMixed

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Obstruction and Trauma

Obstruction During SleepObstructive Sleep Apnea

Frequent and loud snoringBreathing cessation for 10 seconds or moreFive episodes per hour or moreFollowed by awakening abruptly with aloud snort as oxygen levels drop

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Lower Respiratory Tract

AtelectasisClosure or collapse of alveoliDue to reduced alveolar ventilationMay be due to secretions, anyobstruction, pressure

Pneumo-, hemothoraxPleural effusion

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Lower Respiratory Tract

Pulmonary TuberculosisPrimarily an infection of the lung, it mayalso involve other body partsThe agent is Mycobacterium tuberculosisThe leading cause of death frominfectious disease in the world

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Lower Respiratory Tract

Pulmonary Tuberculosis Treatment6-12 monthsDrugs

H, INH Isoniazid - HepatotoxicR, RIF Rifampicin Hepatotoxic, discolorsZ, PZA Pyrazinamide Most hepatotoxic

E, EMB Ethambutol - optic neuritisS, STM Streptomycin - Ototoxic

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Lower Respiratory Tract

Pneumonia Inflammation of

lung parenchymacaused by

infection

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Lower Respiratory Tract

PneumoniaCAP

In community or first 48 hours of hospitalization

S. pneumoniae is the most common causeMycoplasma is common in older children andyoung adultsH. influenzae affects the elderly and those withcomorbidsViruses are the most common cause in infantsand children

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Lower Respiratory Tract

PneumoniaCAP

In adults, the most common viruses are theinfluenza, adenovirus, parainfluenza,coronavirus and varicella-zoster In immunocompromized adults, CMV is the

most common

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Pl

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Pleura

PleuritisInflammation of the pleuraWorse with deep breathing, coughing or sneezing (respiratory movement)Analgesics and find underlying causeTurn to the affected side

Pl

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Pleura

Pleural EffusionAccumulation of fluid in the pleural spaceThe size of the effusion and the underlying

disease determine the severityMost commonly due to infection or malignancyChemical pleurodesis, pleurectomy,

thoracentesis may be done

Pl

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Pleura

EmpyemaLocalized collection of pusMay thicken pleura and restrict the lungUsually complications of lung infection,trauma or surgeryRequires 4-6 weeks of antibioticsThoracentesis, thoracostomy may bedone

L R i t T t

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Lower Respiratory Tract

Bronchitis Acute

Fever, cough,wheezing

Chronic Cough worse in the

evening and morning Lasts 3 months for 2

consecutive years

L R i t T t

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Lower Respiratory Tract

BronchitisTreatment

Bronchodilators, corticosteroidsPostural drainage and chest percussion

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B hi t i

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Bronchiectasis

Chronic wet cough with foul-smellingsputumHemoptysisRecurrent fever and chillsAntimicrobials, bronchodilators may begivenResection, lobectomy may be done

E h

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Emphysema

Abnormal enlargement of the air spacesdistal to the terminal bronchioles withdestruction of alveoli

Increased expiratory effortTreatment: O2, bronchodilators,antimicrobials

Smoking cessationLung transplant

Asthma

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Asthma

Chronic inflammatory disorder of thebronchial airwayWith periods of bronchospasm

Worse at night, with wheezingTreated with bronchodilators and steroidsTreated in a step-wise manner

Status asthmaticus and intubation

COPD

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COPD

Obstruction of air flow due to emphysemaor chronic bronchitisPredisposing Factors:

Cigarette smokingPollutionOccupational exposure to irritants

COPD

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COPD

TreatmentBronchodilatorsOxygen therapy; be careful not to depress

respiratory driveNursing Management

Smoking cessation

Diaphragmatic breathingPursed-lip breathingInspiratory muscle training

Acute Respiratory Failure

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Acute Respiratory Failure

PaO2 < 50mm Hg, PaCO2 > 50 mm Hg,pH

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Acute Respiratory Failure

Restlessness and dyspnea are earlyNeurologic, tachycardia and tachypneaare lateAssist with intubation and mechanicalventilation

Acute Respiratory Distress

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Syndrome

An inflammatory reaction triggers thediseaseDiffuse alveolar capillary damage, severepulmonary edema, respiratory failureBecomes unresponsive to supplementaloxygen and with stiff lungs

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Acute Respiratory Distress

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Syndrome

Medical ManagementPEEPAntibiotics to prevent infection

Treat hypovolemia due to leakage

Under investigation; includes anti-

inflammatories and steroids

Pulmonary Hypertension

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Pulmonary Hypertension

Systolic pulmonary artery pressure > 30mm HgMean Pulmonary Artery Pressure > 25 mm

HgForms

Primary fatal within 5 years of diagnosis,

idiopathicSecondary from existing cardiac or pulmonary disorder (COPD)

Pulmonary Hypertension

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Pulmonary Hypertension

Symptoms of Right-sided heart failureOxygen therapyVasodilatorsHeart transplant

Pulmonary Heart Disease

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Pulmonary Heart Disease

Cor PulmonaleRight ventricular enlargement secondaryto a pulmonary conditionConfusion and somnolence may bepresent due to hypercapniaSymptoms of underlying diseaseSymptoms of heart failure

Pulmonary Heart Disease

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Pulmonary Heart Disease

Cor PulmonaleOxygen therapy and bronchodilatorsIntubation and mechanical ventilationTreatment of CHF

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Pneumoconioses

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Pneumoconioses

Disorders caused by inhalation of irritantsUsually occupationalEffects of substances depend on:

ConcentrationDuration of exposureAbility to initiate an immune responseIndividual susceptibility

Pneumoconioses

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Pneumoconioses

Silicosis Chronic, nodular, dense

pulmonary fibrosis Asbestosis

Diffuse pulmonary fibrosis Black Lung Disease

Coal Workers Pneumonia Cor pulmonale and

respiratory failure

Pneumoconioses

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Pneumoconioses

Management if always removal of irritantfrom work environmentIf unavoidable, institute protectivemeasuresMinimize exposureEnsure ventilation

Bronchogenic Carcinoma

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Bronchogenic Carcinoma

90-95% of all lung tumorsTobacco smoking is the most importantfactor Sx: chronic cough, hoarseness,dysphagiaCXR reveals a solitary peripheral noduleand atelectasis

Mediastinal Tumors

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Mediastinal Tumors

Includes tumors of the thymus, lymphnodesMay cause heart and lung symptoms,

chest pain, dyspneaTreatment with radiation or chemotherapy

Chest Trauma

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Chest Trauma

Pneumothorax Traumatic

Pneumothorax

Tension Pneumothorax Hemothorax

Chest tube placement(2nd or 4 th /5 th )

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Respiratory Care Modalities

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Respiratory Care Modalities

Non-invasiveOxygen TherapyNebulizer Postural DrainageBreathing Retraining

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2-6 lpm5-8 lpm

6-10 lpm

10-15 lpm

4-10 lpm

Respiratory Care Modalities

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Respiratory Care Modalities

Invasive Endotracheal

Intubation Tracheostomy

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Suctioning

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Suct o g

Oropharyngeal10-15 cm along side of mouth

Nasopharyngeal

Along floor 10-15 sec, rotate, 20-30 sec intervals, 5 mintotal

Avoid complicationsHyperinflationHyperoxygenation