Unit II

UNIT IIDISEASES AFFECTING THE

RESPIRATORY SYSTEM

MARILYN P. ABERGAS, R.N., M.A.N.

A.VIRAL

Common Cold

H1N1

Influenza

B. BACTERIA Diptheria Pertussis PTB Pneumonia Streptococcal Sore throat

And Scarlet Fever

COMMON COLD – CORYZA

An acute usually afebrile viral infection caused by inflammation of the upper respiratory tract.

CAUSATIVE AGENT: filtrable virus Rhinovirus, Adenovirus

Incubation Period1-4 days

Mode of Transmission Airborne Droplet contact with

contaminated objects Hand to hand transmission or indirect

Portal of entry:Nasopharynx

SIGNS AND SYMPTOMS Frequent sneezing Headache,tearyeyes,watery eyes Myalgia Arthralgia Chills- early afternoon fever and

accpd. By chilly sensation Scratchy throat , runny nose Hacking,non-productive cough

SIGNS AND SYMPTOMS Hacking,non-productive cough Diminished sense of taste,smell

and hearing Blocked nasal passages with

continuous watery discharges

COMPLICATIONS: Sinusitis Otitis Media Bronchopneumonia

TREATMENT: Primary treatment Aspirin or

Acataminophen Fluids Decongestants Sorethroat

lozenges Steam inhalation

NURSING MANAGEMENT

1) Complete bed rest2) Administration of

antibiotic/doctors order3) Health education

INFLUENZA – LA GRIPPE “TRANGKASO“ FLU

Highly contagious infection of the respiratory tract that results from 3 types of myxovirus influenza.

Affects all age group, the incidence highest in school children, severity is greatest in the very young elderly people and those with chronic diseases.

CAUSATIVE ORGANISMS:

TYPE A – MOST prevalent, strikes every year

TYPE B – strikes annually found in smaller epidemics every 4-6 years

Type C – found in sporadic cases endemic

MODE OF TRANSMISSION through inhalation of a respiratory

droplet from an infected person or by indirect contact.

Source of infection – secretions from upper respiratory tract .

Period Of Communicability – until 5th day of illness

Incubation Period – 24-48 hours.

INFLUENZA Invades therespiratory mucosa

Damages ciliated epithelium of the trachea bronchial tree

Making it vulnerableto secondary infection

Severe reactions

Serosanguinous discharge

Complication

PATHOGNOMONIC SIGN

Onset is sudden, chilly sensation, hyperpyrexia

Headache Malaise Myalgia Hoarseness

Joint Pain

SIGNS AND SYMPTOMS Non-productive

cough and occationally laryngitis Conjunctivitis

Rhinitis Rhinorrhea

Pneumonia Reyes syndrome Myositis Myocarditis

COMPLICATIONS:

DIAGNOSTIC PROCEDUREBlood Examination

PREVENTION

VACCINATION

Educate the public and health care personnel in basic personal hygiene

Client should receive the vaccine annually

Active Immunization

1. Elderly2. People who have poor immunity3. Conditions such as D.M., Lung

Disease, Kidney disease, Heart disease, Liver disease

TREATMENT:Uncomplicated Influenzae

1. Bed rest2. Adequate fluid intake3. Aspirin or Acetaminolphen4. Guaifenesin or another expectorant

ANTIVIRAL THERAPYAmantadine Symmetrel

SPECIAL CONSIDERATIONS

1) Advise the pt. to use of mouthwashes.

2) Increase fluid intake3) Screen visitors 4) Teach the patient proper

disposal of tissue and proper handwashing technique to prevent the virus from spreading.

SPECIAL CONSIDERATIONS

5) Watch for s/s of developing pneumonia

Such as cracks,coughing accompanied by purulent bloody sputum.

DIPTHERIA

acute highly contagious toxin mediated infection caused by coryne bacterium diphteriae

Gram (+) rod that usually infects the respiratory primarily the tonsils, nasophayrnx, larynx usually producing a membranous pharyngitis

CAUSATIVE AGENT Corynebacterium Diphtheriae

(Klebs Loeffler Bacillus)

MODE OF TRANSMISSION Contact with patient or carrier or with articles soiled with discharges of infected persons.

INCUBATION PERIOD: 2-5 days

PERIOD OF COMMUNICABILITY 2-4 weeks in untreated patient 1-2 days in treated patient

SOURCE OF INFECTION Discharges from the nose, pharynx eyes or lesions on other parts of the body of infected persons.PATHOLOGY

PATHOGNOMONIC SIGNPseudomembrane

TYPES OF DIPHTHERIA

A. Nasal with serosanguinous secretions from the nose with foul smell

B. Tonsilar low fatality rateC. NasopharyngealD. Wound or cutaneous diphtheria

CLINICAL MANIFESTATIONS1) Feeling of fatigue2) Malaise3) Slight sorethroat and elevation of

temperature usually not exceeding 380C

4) Cervical Adenitis with tenderness of the glands occur

5) Inflammatory reactions is initiated by the body and exudate consisting of leukocytes and RBC and necrotic tissues begins to form

TRACHEOSTOMY~ opening created by incision

DIAGNOSTIC TEST Nose and Throat Swab Schick Test

– To determine the susceptibility or immunity in diphtheria

Moloney Test

– Hypersensitivity in diphtheria

COMPLICATIONSMyocarditis

– inflammation of the heart musclePolyneuritis

– paralysis of the soft palate paralysis of ciliary muscles of the eye,pharynx,larynx or extremitiesIntercurrent Infection

Acute Bronchopneumonia – respiratory failure esp. laryngeal type reactions tends to stagnate due to paralysis of the diaphragm

TREATMENT MODALITIES:Neutralization of Toxin

DAT ADS

Fractional desensitising dosesFractional doses are given in positive cases with the following cases:0.05 ml (1:20 dilution)

SQ0.05 ml (1:10 Dilution)0.10 ml undiluted SQ

TREATMENT MODALITIES:Neutralization of Toxin

DAT ADS

Fractional desensitising dosesFractional doses are given in positive cases with the following cases:0.20 ml undiluted

SQ0.50 ml undiluted IM0.10 mil undiluted IV

ANAPHYLACTIC SHOCK

Destruction of Microorganism Giving of Penicillin

Erythromycin 40 mg/kg BW in 4 doses x 7-10 days

SUPPORTIVE THERAPY

a) Maintenance of Adequate nutritionb) Maintenance of adequate fluid and

electrolyte balancec) Bed restd) Oxygen inhalation

NURSING MANAGEMENT

1) Bed rest for at least 2 weeks patient not permitted to bathe

2) Diet soft diet small frequent feeding is advised

3) Fruit Juices rich vit.C to maintain the alkalinity of the blood

4) Ice collar applied to the neck

PREVENTION Immunization

Mandatory DPT immunization of babies

NURSING MANAGEMENT

ORAL HYGIENE

PERTUSSISWHOOPING COUGH

Is a highly contagious respiratory infection usually caused by the non-motile gram (–) negative coccobacillus

CAUSATIVE AGENT

Bacterial infection Bordetella pertussis

7-14 days 7-10 days

INCUBATION PERIOD

MODE OF TRANSMISSION – direct and indirect contact

SOURCES OF INFECTION – secretions from the nose and throat of infected person contain the causative organism.

STAGES OF PERTUSSIS

1. Catarrhal stage or Invasive PeriodCoryza, sneezing lacrimation and dry bronchial coughCough becomes an irritating, hacking and nocturnal becoming more severe

This stage last for about 1-2 weeks

STAGES OF PERTUSSIS

2. Paroxysmal Stage 7th -14th dayCough becomes spasmodic and recurrent with excessive explosive outburst in series of rapid cough in one expirationEach cough characteristically ends in a loud crowing inspiratory whoop and chocking on mucus that causes vomiting

STAGES OF PERTUSSIS

2. Paroxysmal StageComplications

•Nose bleed•increase venous pressure•periorbitaledema•conjunctival haemorrhage •Rectal prolapse

STAGES OF PERTUSSIS

3. Convalescent stageParoxysmal coughing and vomiting gradually subside

Complications:•Pneumonia•Atelectasis•Convulsions•Bronchopneumonia – most dangerous complication

STAGES OF PERTUSSIS

3. Convalescent stageParoxysmal coughing and vomiting gradually subside

Complications:•Severe malnutrition – due to persistent vomiting.

DIAGNOSTIC PROCEDURE

Nasopharyngeal swabs Sputum culture Fluorescent Antibody screening of

nasopharyngeal smears provides quicker result than cultures but it is less reliable

WBC usually increased in children older than 6 months

MODALITIES OF TREATMENT1) Supportive Therapy

Fluid and electrolytes replacement

Adequate nutrition Oxygen Therapy in apnea

2) Antibiotic Erthromycin, Ampicillin to eliminate infection

3) Hyperimmune Convalescent serum gamma globulin are found effective

NURSING MANAGEMENT

Isolation and Medical asepsis should be carried out

During paroxysm the patient should NOT BE LEFT ALONE

Suctioning equipment should be ready at all times for emergency use to avoid obstruction of airway.

Sunshine and fresh air are important but the patient should be protected

NURSING MANAGEMENT

The child shld. be kept as quiet as possible since activity and excitement

Provide warm baths , keep the bed dry and free from soiled linens

I and O shld be monitored Abdominal binder

PREVENTION

Immunization DPT Active

TUBERCULOSIS

Koch’s disease, Phthisis, Consumption disease

Acute chronic infection caused by mycobacterium tuberculosis

ETIOLOGIC AGENT– Mycobacterium Tuberculosis

INCUBATION PERIOD – 2 -10 weeks

PERIOD OF COMMUNICABILITY– The patient is capable of discharching the organism all throughout life if he remains untreated highly communicable during its active phase

Mode of Transmission – Direct and indirect contact

SOURCES OF INFECTION– sputum ,blood from hemoptysis, nasal discharges and saliva

TYPES OF CAUSATIVE ORGANISM

Human inhalation – gains entrance in the body by inhaled through respiratory tractBovine – ingestion enters the body via GIT by the swallowing of the bacteria

CLASSIFICATION OF TB

Minimal○Slight lesion without demonstrable excavation confined to a small part of one or both lungs

Modeartely Advance○1 or both lungs may be involved

Far Advanced○Lesions more extensive than moderate

CLINICAL MANIFESTATION

Active Tuberculin Test is positive

X-ray of chest generally progressive

Inactive TB Symptoms of TB are absent

Sputum is absent for tubercle bacilli after repeated examination No evidence of cavity on chest X-ray

Afternoon rise in temperature High sweating Body malaise and weight loss Cough dry to productive Dyspnea- hoarseness of voice Hemoptysis – considered

pathognomonic to the disease Occasional chest pains Sputum positive for AFB

SIGNS AND SYMPTOMS

PRIMARY COMPLEX

Chest X-Ray Sputum Exam for Acid Fast Bacilli Tuberculin Testing

DIAGNOSTIC TEST

Mantoux test – PPD intradermal

Tine Test

MODALITIES OF TREATMENT

SCC – 6 monthsINH, Isoniazid, Rifampicin, PZA, Ethambutol

Intensive Phase – 2 months

Rifampicin 450 mg 1 hr before mealINH 300 mg

PZA 1,000- 1,500 mg / hr after break fast


Standard Regimen – 1 year

Streptomycin SO4

INH tablet

A. IsolationB. Administer medicine as orderedC. Check sputum always for blood or

purulent expectorationD. Encourage questions conversation

to air their feelingsE. Teach or educate patient all about

TBF. Encourage to stop smokingG. Proper disposal of sputumH. Plenty of rest and eat balanced

meals

NURSING MANAGEMENT

PREVENTION AND CONTROL

Submit all babies for BCG immunization

Avoid overcrowding Chest X-ray , tuberculin Test

PNEUMONIA

acute infection of the lung parenchyma

CAUSATIVE AGENTS Streptococcal pneumonia Staphylococcus Aureus Hemophillus influenza Klibsiela pneumonia

INCUBATION PERIOD1-3 days with sudden onset of shaking chills rapidly rising fever and stabbing chest pains aggravated by coughing and respiration

MODE OF TRANSMISSION Droplet infection from mouth, nose of an infected person

Indirect contact contaminated objects

CLASSIFICATION OF PNEUMONIA

CAP – Community Acquired Pneumonia – acquired in the course of Daily life

Hospital Acquired Pneumonia Aspiration Pneumonia – Foreign

matter is inhaled ( aspirated) into the lungs

Pneumonia caused by Opportunistic organism immune system

ANATOMICAL CLASSIFICATION OF

PNEUMONIA Broncho Pneumonia

– Lobular or Catarrhal Pneumonia

Lobar pneumonia (croupous Pneumonia)

Consolidation of the entire lobe manifested by chills, chest pain on breathing, cough with blood streaked sputum

ANATOMICAL CLASSIFICATION OF

PNEUMONIA Primary atypical pneumonia

(Virus pneumonia)Solidification of the lung that comes in patchesCough is often delayed in appearing greenish to whitish secretions

STAGES OF THE DISEASE

1) Stage of Lung Engorgement2) Red Hepatization3) GrayHepatization4) Stage of Resolution

○ Infammatory exudates is either absorbed by the blood stream or expectorated

DIAGNOSTIC TEST

Chest X – Ray Sputum Analysis Blood Serologic Exam


Humidified oxygen therapy for hypoxia

Mechanical ventilation respiratory failure

High caloric diet and adequate fluid intake

Analgesic to relieve pleuritic pain chest

Expectorant

Antimicrobial Therapy varies with the causative agentSupportive Management

NURSING MANAGEMENT

1) Maintain a patent airway2) Adequate oxygenation3) Deep breathing Excercises

PREVENTION Turning the patient from side to side Change wet clothing

DRUG OF CHOICE

Penicillin, Erythromycin

SCARLET FEVER STREPTOCOCCUS

SORETHROAT

Is an infection caused by GROUP A BETA HEMOLYTIC streptococcus

bacteria

CAUSATIVE AGENT

Group A Beta Hemolytic Streptococcus

MODE OF TRANSMISSION

Direct and Indirect Contact

INCUBATION PERIOD

– 2-5 days or 1 week

STAGES OF DISEASE

1. Invasive Stage

Fever and sorethroat2. Rash formation rashes start to appear already because Group A Beta Hemolytic releases toxins

Erythrogenic ToxinPastia Line – are minute red spot on skin fold

Trunk entire body involves the extremities

STAGES OF DISEASE

1. Invasive Stage


Tongue also exhibits specific characteristics sign 2 days it will have a white coating through which red and edematous

STAGES OF DISEASE

1. Invasive Stage


White strawberry tongue after 2 days the tongue desquamate red strawberry tongue later raspberry tongue

STAGES OF DISEASE

1. Invasive Stage


3. Desquamation peeling of the skin

DIAGNOSTIC TEST Throat Swab Dicks Test

– test to determine the susceptibility to scarlet fever Charlton Test– Hypersensitivity of the individual to scarlet fever antitoxin

TREATMENT

STREPTOCOCCAL SORETHROAT– Erythromycin

SCARLET FEVER – Penicillin

NURSING CARE

1) Oral Hygiene Use oral Antiseptic

2) Skin C are – Finger nails shld be short and clean

3) Do not apply alcohol4) Avoid use of laundry soap

Unit II

Education

Transcript of Unit II