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