Day 4
Acute Bronchitis
Etiology/pathophysiology○ Inflammation of the trachea and
bronchial tree
-causes congestion of the mucous
membranes
-retention of thick secretions○ Usually secondary to upper respiratory
infection○ Exposure to inhaled irritants
Acute Bronchitis
Clinical manifestations/assessment○ Productive cough; wheezes○ Dyspnea; chest pain○ Low-grade fever○ Malaise; headache
Acute Bronchitis Assessment
Subjective
-fatigue
-malaise
-headache
-chest tightnessObjective:
○ VS ○ Lung auscultation
-presence of adventitious sounds
Acute Bronchitis
Diagnostic TestsChest xraySputum culture
Acute Bronchitis Medical Management Goal: prevent further infectious complications Physician may order:
Sputum cultures Medications
Antitussives Antipyretics Bronchodilators Antibiotics
Acute Bronchitis
Nursing InterventionsGoal : facilitate recovery and prevent secondary infectionsAccomplished by:
○ Bed rest to conserve energy○ Vaporizer○ Encourage fluids○ Patient Teaching :
-medications, preventive measures, s/sx
recurrence , when to call MD
Legionnaires’ Disease
Etiology/pathophysiology -Legionella pneumophila
-Thrives in water reservoirs:
-air conditioners, humidifiers
-Life-threatening pneumonia
-respiratory failure
-renal failure
-bacteremic shock
-ultimately death
Legionnaires’ Disease
Clinical manifestations/assessment○ Elevated temperature
-102-105 degrees F○ Headache○ Nonproductive cough○ Diarrhea○ General malaise
Legionnaires’ Disease
Assessment
Subjective:
-dyspnea
-headache
-chest pain on inspiration
Legionnaires’ Disease
Objective: Note: Watch progression closely-may
need immediate intervention!○ Difficult and rapid respirations○ Crackles or wheezes○ Tachycardia○ Signs of shock○ Hematuria renal failure
Legionnaires’ Disease
Diagnostic TestsBlood culturesSputum culturesSample of pulmonary tissue/fluidRadiographic studies
Legionnaires’ Disease Medical management
○ Oxygen○ Mechanical ventilation, if necessary○ Renal Dialysis, if necessary○ IV therapy – hydration, antibx○ Antibiotics – Erythromycin, Rifampin○ Antipyretics○ Analgesics○ Vasopressors – dopamine, dobutamine to tx.
s/sx shock
Legionnaires’ Disease Nursing Interventions
Bedrest, I&OIV ManagementFrequent skilled assessmentOxygen / ventilator managementPt. / Family Education
-purpose of respiratory support
-procedures
-monitoring temperature
-fluids intake
Emotional support
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
-Acute respiratory infection
-coronavirus Spreads:
-close contact with people
-via droplets of air.
-touching objects that are
contaminated with the virus.
SARS CLINICAL MANIFESTATIONS
-Fever > 10o.4° F (38 degrees C).
-HA
-feeling of discomfort all over
-muscle aches.After 2-7 days:
-dry cough
-SOB
-hypoxia20% of SARS patients:
- require intubation and mechanical ventilation.
SARS
LAB. AND DIAGNOSTIC TESTS
CBC, blood cultures Chest Xray Nasopharyngeal/oropharyngeal swabs
Nasopharyngeal aspirate . Bronchoalveolar lavage
-secretions from the lower respiratory tract. Reverse transcription polymerase chain reaction
-serum, stool, and nasal secretions.
LUNG INFILTRATES
NASOPHARYNGEAL SWAB
SARS
Clients at risk:
-Travel within the last 10 days of
symptom onset
- China, Hong Kong, Taiwan, Toronto,
etc.
-Close contact within 10 days of symptom onset with a person suspected of having SARS.
SARS Medical Management Start treatment ASAP
-based on the symptoms
-even before the cause is confirmed. Respiratory Isolation -disposable particulate respirator
mask Antiviral meds Antibiotics Corticosteroids
SARS
Nursing InterventionNotify local public health dept.Respiratory isolationMeticulous hand hygiene
Prognosis80-90% show recovery after 6-7 days10-20% develop severe breathing
problems -require mechanical ventilator
PARTICULATE RESPIRATOR MASK
Anthrax Etiology/pathophysiology
○ Bacillus anthracis
-a spore-forming bacteria○ Spread:
- by direct contact with
bacteria/spores
Anthrax○ Three types:
Cutaneous Anthrax –
-most common
-Bacteria/spore enters the skin through cut or abrasion
-Treated with antibiotics
Anthrax. GI Anthrax –
-ingestion of organism from eating
undercooked foods
-unless treated early, may die from
sepsis
Inhalational Anthrax
-most deadly
-spores inhaled deeply into lungs
-immune cells sent to fight the infection carry
some bacteria back to the lymph system
-spreading to other organs
ANTHRAX
DIAGNOSTIC TESTSCXRRapid DNA testBlood for cultureCutaneous Anthrax
-culture from lesion’s vesicular fluid
ANTHRAX
Medical managementAntibiotics
-Cipro, PCN, Vibramycin
-60 day coursePost exposure –prophylaxis
Etiology/Pathophysiology Mycobacterium Tuberculosis
-identified in 1882 by Dr. Robert Koch.
-chronic pulmonary and extra
pulmonary infectious disease
-acquired by inhalation of a dried
droplet nucleus containing a tubercle
bacillus
-lodges in thealveolar structure of the
lung.
TB Tuberculosis -INFECTION is different from active tuberculosis DISEASE. -Infection always precedes active disease. -Infection is characterized by Mycobacterium in the tissue of the host -Free of symptoms -Demonstrates the presence of antibodies.
TB
Transmission
-inhalation of minute dried-droplet
nuclei
-coughed or sneezed into the air by the
person whose sputum contains virulent
tubercle bacilli. Most people exposed to TB do NOT
become infected.
TB
Improvements in living conditions, sanitation, and drug therapy.
-past 2 decades, TB rates rose again. -Particularly prevalent among people with HIV
infection
Status of the host’s immune system is the major determinant for the development of active TB
TB TRANSMISSION
Hospitals employees
- high occupational risk for contracting
TB. Macrophages in the lung ingest the TB
bacteria
-engulf the bacteria
-do NOT kill them, but wall them off in
tiny hard capsules called tubercles.
POSITIVE TB skin test
TB TRANSMISSION
Most people who become infected with the TB organism do not progress to active disease
-remain asymptomatic and
noninfectious
-will have a positive TB skin test
CLINICAL MANIFESTATIONS Weight loss. Productive cough. Later in the disease:
-recurring fever with chills
-night sweats
-hemoptysis
ASSESSMENT
SUBJECTIVE:
-Loss of weight and muscle strength.
OBJECTIVE:
Sputum
-amount
-color
-characteristics
DIAGNOSTIC TESTSMantoux tuberculin skin test -negative skin test is < 5 mm induration. -read 48-72 hours - positive reaction -detects infection 2-10 weeks after exposure to the tubercle bacillus.Chest x-ray.Sputum specimen -mycobacterial organisms - three positive acid-fast smears - presumptive diagnosis of TB -need for treatment.
DIAGNOSIS
If TB test is positive
-send to MD
-MD will re-evaluate
-determine need for CXR, sputum and
blood cultures, etc.
Public health authority must be notified of all patients with TB by MD
TB Medical Management Drug therapy
-Infectiousness rapidly declines once
drugs are prescribed. Tuberculosis isolation is necessary for
pts. with pulmonary TB or laryngeal TB.
-positive sputum smear
-chest x-ray suggestive of active TB.
TB
Medical Management - adult TB patient remains in isolation for
the entire hospital stay.
-treatment is lengthy
- 6-9 months
-longer for extra-pulmonary disease.
TB
Medical Management multiple drugs
-one drug is given, the patient may
become resistant to it.
-combination of at least 4 drugs is
prescribed
-prevents the emergence of organisms
resistant to the other.
MEDICAL MANAGEMENT, cont. first-line drugs and second-line drugs. The first-line drugs are:
Isoniazid (INH)Rifampin (rifampcin)Rifampin + Isoniazid (Rifamate); Pyrazinamide; ethambutol; and Streptomycin.Priftin
-new drug for TB
-longer half-life so can be taken less
frequently.
NURSING INTERVENTIONS - Isolation. - Room with negative air pressure
-air flows into, rather than, out of the
room
-doors and windows must be closed
to maintain the airflow
-room air should be exhausted
directly to the outside, not circulated
to other rooms. - Particulate Respirator Masks
TB
Patient Teaching -cover their noses and mouths when
coughing or sneezing.
-good hand washing!!!
-support the patient’s medication compliance with therapy
-stress the importance of the medication
regimen
- need for prolonged treatment.
TB
Patient Teaching
- medications and their side effects
-prevent complications and illness transmission
-when to call the PCP
-maintain fluid and nutritional
requirements
TB
Nursing Diagnoses include:Ineffective breathing pattern, r/t
pulmonary infection process
Risk for infection (patient contacts), r/t viable Mycobacterium TB in respiratory secretions