unit ii
DESCRIPTION
2nd Lecture in our NCM 104 CD class.TRANSCRIPT
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
MODALITIES OF TREATMENT
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
MODALITIES OF TREATMENT
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
Fever and sorethroat2. Rash formation rashes start to appear already because Group A Beta Hemolytic releases toxins
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
Fever and sorethroat2. Rash formation rashes start to appear already because Group A Beta Hemolytic releases toxins
White strawberry tongue after 2 days the tongue desquamate red strawberry tongue later raspberry tongue
STAGES OF DISEASE
1. Invasive Stage
Fever and sorethroat2. Rash formation rashes start to appear already because Group A Beta Hemolytic releases toxins
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