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7/28/2019 lowerrespiratorytractinfectionsppt-130317015624-phpapp01

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LOWER RESPIRATORY

TRACT INFECTIONS

MANALI H SOLANKIF.Y.M.SC.NURSING

J G COLLEGE OF NURSING


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TERMINOLOGY:

BRONCHITIS

PNEUMONIA

PULMONARY TUBERCULOSIS

HAEMOPTISIS

HAEMATEMESIS


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INTRODUCTION

Lower respiratory tract infection

comprises an array of diseases ranging

from bronchitis to pneumonia.

Non-pneumonic LRTI is described as

lower respiratory tract symptoms in a

patient who has no history of these or anyother chest signs related with infection,

by all of the major respiratory viral

groups.


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ANATOMY AND PHYSIOLOGY

OF RESPIRATORY SYSTEM


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BRONCHITIS:


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DEFINITION:

Bronchitis is an inflammationof the bronchial tubes, the

airways that carry air to lungs


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TYPES:

There are two types of bronchitis

1.Acute bronchitis2.Chronic bronchitis


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Acute bronchitis

Acute (i.e. recent onset) bronchitis is

an inflammation of the lowerrespiratory passages (bronchi).


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Chronic bronchitis

Chronic bronchitis is defined

as a cough that occurs every

day with sputum productionthat lasts for at least 3

months, two years in a row.


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CAUSES:

Viral infection that causes the

inner lining of the bronchial tubes

to become inflamed and undergothe changes that occur with any

inflammation in the body.


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Bacteria can also cause bronchitis (a

few examples include, Mycoplasma,

Pneumococcus, Klebsiella,Haemophilus).

Chemical irritants (for example,

tobacco smoke, gastric reflux

solvents) can cause acute bronchitis


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RISK FACTORS:

Smokers

People who are exposed to a lot of

second-hand smoke

People with weakened immune systems

The elderly and infants

People with gastroesophageal refluxdisease (GERD)

Those who are exposed to irritants at work


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SIGN AND SYMPTOMS


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Coughing

Production of clear, white, yellow,grey, or green mucus (sputum)

Shortness of breath

Wheezing

Fatigue

Fever and chills Chest pain or discomfort

Blocked or runny nose


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ASSESSMENT AND

DIAGNOSTIC FINDINGS

Patient history


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Physical examination


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Pulmonary function tests


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Spirometry


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Peak flow monitoring (PFM)


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Pulse oximetry


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X-ray


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MEDICAL MANAGEMENT:

Ibuprofen or acetaminophen

Cough suppressantE.g. Delsym, Robitussin Cough,

Dextromethorphan

Steroid medicine


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Nasal decongestants: like Naphazoline,

Phenylephrine Oxymetazoline ,

Propylhexedrine, Phenylpropanolamine

Antiviral medicine

Like amantadine, oseltamivir

Antibiotics: Antibiotics may be given to

help treat or prevent an infection caused

by bacteria


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PREVENTION:

Avoid alcohol

Avoid irritants in the air

Drink more liquids Get more rest

Eat healthy foods

Use a humidifier or vaporizer


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Avoiding people who are sick with colds or

the flu

Getting a yearly flu vaccine

Getting a pneumonia vaccine (especially

for those over 60 years of age)

Washing hands regularly

Avoiding cold, damp locations or areas

with a lot of air pollution

Wearing a mask around people who are

coughing and sneezing


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NURSING MANAGEMENT

Monitor for adverse effects of bronchodilators-

tremulousness, tachycardia, cardiac

arrhythmias, central nervous system stimulation,

hypertension. Monitor oxygen saturation at rest and with

activity.

Eliminate all pulmonary irritants, particularly

cigarette smoke. Smoking cessation usually

reduces pulmonary irritation, sputum production,

and cough. Keep the patients room as dust-free

as possible.


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Use postural drainage positions to help

clear secretions responsible for airway

obstruction. Teach controlled coughing.

Encourage high level of fluid intake (8 to

10 glasses; 2 to 2.5 L daily) within level ofcardiac reserve.

Give inhalations of nebulized saline to

humidify bronchial tree and liquefysputum. Add moisture (humidifier,

vaporizer) to indoor air.


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Avoid dairy products if these increase

sputum production.

Encourage the patient to assumecomfortable position to decrease

dyspnoea.

Use pursed lip breathing at intervals andduring periods of dyspnoea to control rate

and depth of respiration and improve

respiratory muscle coordination.

Discuss and demonstrates relaxation

exercises to reduce stress, tension, and

anxiety.


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Encourage frequent small meals if the patient is

dyspnoeic; en a small increase in abdominal

contents may press on diaphragm and impede

breathing.

Offer liquid nutritional supplements to improve

caloric intake and counteract weight loss.

Avoid foods producing abdominal discomfort.

Encourage use of portable oxygen system for

ambulation for patients with hypoxemia and

marked disability.


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PNEUMONIA


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DEFINITION

Pneumonia is an inflammation of the

lungs caused by bacteria, viruses, or

chemical irritants. It is a seriousinfection or inflammation in which the

air sacs fill with pus and other liquid.


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TYPES:

Bacterial pneumonia


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Viral pneumonia


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Mycoplasma pneumonia


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Aspiration pneumonia


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Fungal pneumonia


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Hospital acquired pneumonia


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Community acquired pneumonia


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CAUSES:

Bacterial

Viral

Fungal

Nosocomial and others


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RISK FACTORS

Smoke.

Abuse alcohol.

Have other medical conditions, such as

chronic obstructive pulmonary disease

(COPD), emphysema, asthma, or

HIV/AIDS.

Are younger than 1 year of age or older

than 65


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Have a weakened or impaired immune system.

Take medicines for gastroesophageal refluxdisease (GERD).

Have recently recovered from a cold or influenza

infection.

Are malnourished.

Have been recently hospitalized in an intensive

care unit.


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Have been exposed to certain

chemicals or pollutants. Are Native Alaskan or certain Native

American ethnicity.

Have any increased risk of breathingmucus or saliva from the nose or

mouth, liquids, or food from the

stomach into the lungs.


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SIGN AND SYMPTOMS

Cough

Rusty or green mucus (sputum) coughed up from lungs

Fever

Fast breathing and shortness of breath Shaking chills


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Chest pain that usually worsens when

taking a deep breath (pleuritic pain)

Fast heartbeat

Fatigue and feeling very weak

Nausea and vomiting

Diarrhoea

Sweating

Headache

Muscle pain

ASSESSMENT AND DIAGNOSTIC


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FINDINGS

Chest x ray


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Blood tests


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Sputum culture


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Pulse oximetry


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chest CT scan


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bronchoscopy


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Pleural fluid culture

Th t i


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Thoracentesis

MEDICAL MANAGEMENT


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MEDICAL MANAGEMENT

MACROLIDES

TETRACYCLINES

FLUOROQUINOLONES


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SURGICAL MANAGEMENT

Thoracotomy

Chest Tubes


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Chest Tubes

COMPLICATIONS OF PNEUMONIA:


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COMPLICATIONS OF PNEUMONIA:

Abscesses

Respiratory Failure

Bacteraemia Empyema and Pleural Effusions

Collapsed Lung


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NURSING MANAGEMENT

Maintain a patent airway and adequate

oxygenation.

Obtain sputum specimens as needed.

Use suction if the patient cant produce a

specimen

Provide a high calorie, high protein diet of

soft foods

T t i ti d i


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To prevent aspiration during

nasogastric tube feedings, check the

position of tube, and administerfeedings slowly.

To control the spread of infection,

dispose secretions properly.

Provide a quiet, calm environment,

with frequent rest periods.

M it th ti t ABG l l


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Monitor the patients ABG levels,

especially if hes hypoxic.

Assess the patients respiratory status.Auscultate breath sounds at least every 4

hours.

Monitor fluid and intake output. Evaluate the effectiveness of administered

medications.

Explain all procedures to the patient andfamily

PREVENTION


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PREVENTION

Good Hygiene and Preventing

Transmission

Changing Hospital Practices

Vaccines

Viral Influenza Vaccines (Flu Shot)

Pneumococcal Vaccines Vitamins


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PULMONARY TUBERCULOSIS


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DEFINITION

Pulmonary tuberculosis is a chronic

infectious inflammation of the lung, as

well as a special pneumonia.


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CAUSES AND RISK FACTORS

Alcoholism

IV drug abuse

Crowded living conditions Homelessness

Poverty


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Immigration from certain countries

Low body weight

Certain medical treatments (such ascorticosteroid treatment or organ

transplants)


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SIGN AND SYMPTOMS

Cough (usually cough up mucus)

Coughing up blood

Excessive sweating, especially at night

Fatigue

Fever

Unintentional weight loss


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Other symptoms that may occur with

this disease: Breathing difficulty

Chest pain

Wheezing



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FINDINGS

Biopsy of the affected tissue (rare)

Bronchoscopy

Chest CT scan

Chest x-ray

Interferon-gamma blood test such as the

QFT-Gold test to test for TB infection

Sputum examination and cultures

Thoracentesis


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Tuberculin skin test


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MEDICAL MANAGEMENT

1st line drugs

DRUG DOSEIsoniazide (INH) 300 mg/dayRifampicin 600 mg/dayPyrazinamide 1500 mg/day 25 mg/kg/dayEthambutol 1200 mg/day 15-25

mg/kg/dayStreptomycin 0.751gm/day 25 mg/kg/day

2nd line drugs


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2nd line drugs

Amikacin (AG) 15 mg/kg/dayAminosalicylic acid 8-12 gm/dayCapreomycin 15 mg/kg/dayCiprofloxacin

1500 mg/day (divided)

Clofazimine 200 mg/dayCycloserine 500-1000 mg/day

(divided)Ethionamide 500-750 mg/dayLevofloxacin 500 mg/dayRifabutin 300 mg/day

Current recommended treatment for


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Cu e t eco e ded t eat e t o

pulmonary TB has three regimens

6 Month Regimenvirtually 100% effective,

more expensive. (usually only used inpulmonary TB)

Fi t 2 th


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First 2 months

DRUG DOSEIsoniazide300mg 1 tablet daily (300mg)Rifampicin300mg 2 tablets daily (600mg)Pyrazinamide

500mg 3 tablets daily (1500mg)

Ethambutol400mg 3 tablets daily (1200mg)


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Next 4 months

DRUG DOSEIsoniazide300mg 1 tablet daily (300mg)Rifampicin300mg 2 tablets daily (600mg)Pyridoxine10mg 1 tablet daily (10mg) for 6

months

9 M th R i


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9 Months Regimen

First 2 months

DRUG DOSEIsoniazide300mg 1 tablet daily (300mg)Rifampicin

300mg

2 tablets daily (600mg)

Ethambutol400mg 3 tablets daily(1200mg)


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Next 7 months

DRUG DOSEIsoniazide300mg 1 tablet daily (300mg)Rifampicin300mg 2 tablets daily

(600mg)Pyridoxine10mg 1 tablet daily (10mg)

12 Months Regimen

inexpensive


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and reasonably effective.

Regimen 1effectiveness is nearly 100%

InjectionStreptomycin 1gm (IM)TwiceWeeklyTablet Isoniazide 15 mg/kg/dayTablet Pyridoxine 1 tablet of 10mg daily

Regimen 2

very cheap,


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effectiveness is 80-90%

Isoniazide 1 tablet daily(300mg)

Tablet Thiocetazone 1 tablet daily (150mg)Pyridoxine 1 tablet daily (10mg)


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Prophylactic Dose

Isoniazide is indicated for the prophylacticuse of TB, the dose is 300mg/day

(5mg/kg/day) or 900mg twice weekly for 6

months in most cases and 12 months incase of immuno-compromised patients

ADVERSE EFFECT OF DRUGS


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ADVERSE EFFECT OF DRUGS

Isoniazide Peripheral NeuropathyRifampicin Cholestatic jaundice +

renal toxicity + Flu like

syndromePyrazinamide Hepatotoxicity + Hyper-

UricaemiaEthambutol Retinobulbar optic neuritis

Prevention


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DIETARY MANAGEMENT


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DIETARY MANAGEMENT


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NURSING MANAGEMENT

Ineffective Airway Clearance may berelated to excessive, thickened mucous

secretions, possibly evidenced by

presence of rhonchi, tachypnea, andineffective cough.

Acute pain related to localizedinflammation and persistent cough.

Imbalance nutrition less than body


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Imbalance nutrition less than body

requirement related to frequent cough,

anorexia and fatigue.

Risk for infection related to inadequate

primary defences and decreased cilliaryaction

Anxiety related to outcome of diseases asevidenced by poor concentration on work,

isolation from others, rude behaviour

Activity Intolerance related to


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Activity Intolerance related to

imbalance between O2 supply and

demand, possibly evidenced byreports of fatigue, dyspnoea, and

abnormal vital sign response to

activity.

Knowledge deficit regarding thetreatment modalities and prognosis


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ABSTRACT

Lower respiratory tract infection and rapidexpansion of an abdominal aortic

aneurysm: a case report


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SUMMARY:


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BIBLIOGRAPHY:


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