1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. CHAPTER 33 Care of Patients with Infectious Respiratory Problems

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Rhinitis Inflammation of nasal mucosa “Hay fever” or “allergies” Manifestations: Headache Nasal irritation Sneezing Nasal congestion Rhinorrhea

3. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Rhinitis (cont’d) Interventions: Drug therapy—antihistamines, leukotriene inhibitors, mast cell stabilizers, decongestants, antipyretics, antibiotics Complementary and alternative therapy—vitamin C, zinc Supportive therapy

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Sinusitis Inflammation of sinus mucous membranes Usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Diplococcus, Bacteroides

5. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Sinusitis (cont’d) Nonsurgical management: Broad-spectrum antibiotics Analgesics (pain and fever) Decongestants Steam humidification Hot/wet packs over sinus area Nasal saline irrigations Increased fluids

6. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Surgical Management Functional endoscopic sinus surgery (FESS)

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pharyngitis Sore throat is common inflammation of pharyngeal mucous membranes Odynophagia, dysphagia, fever, hyperemia Strep throat can lead to serious medical complications! Epiglottitis is rare complication

8. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Acute Epiglottitis

9. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Rapid Antigen Tests (RAT) Screening process for group A bet-hemolytic streptococcal antigen Results available in 15 min

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Tonsillitis Inflammation/infection of tonsils and lymphatic tissues Contagious airborne infection, usually bacterial Antibiotics for 7 to 10 days Surgical intervention

11. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Peritonsillar Abscess (PTA) Complication of acute tonsillitis Manifestations: Pus causing one-sided swelling with deviation of the uvula Trismus and difficulty breathing Bad breath, swollen lymph nodes Treatment: Percutaneous needle aspiration of abscess Antibiotics

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Peritonsillar Abscess (cont’d)

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Laryngitis Inflammation of mucous membranes lining the larynx; possible edema of vocal cords Acute hoarseness, dry cough, difficulty swallowing, temporary voice loss (aphonia)

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Laryngitis (cont’d) Treatment focused on relief and prevention—voice rest, steam inhalation, increased fluid intake, throat lozenges Reduce use of tobacco and alcohol

15. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Influenza Highly contagious acute viral respiratory infection Severe headache, muscle ache, fever, chills, fatigue, weakness, anorexia Vaccination is advisable Antiviral agents may be effective

16. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pandemic Influenza Mostly prevalent among animals and birds; virus can mutate becoming infectious to humans Example: H1N1 (swine flu) Strict isolation precautions Antiviral drugs oseltamivir (Tamiflu), zanamivir (Relenza)

17. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pneumonia Excess fluid in lungs resulting from inflammatory process Inflammation triggered by infectious organisms, inhalation of irritants Community-acquired infectious pneumonia Nosocomial or hospital-acquired

18. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pneumonia (cont’d) Atelectasis Hypoxemia History Physical assessment Clinical manifestations Psychosocial assessment

19. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Ventilator-Associated Pneumonia (VAP) Incidence increasing, especially with ET tubes in place for mechanical ventilation “Ventilator bundles” reduce incidence Hand hygiene Oral care Head of bed elevation

20. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Laboratory Assessment Gram stain, culture and sensitivity of sputum CBC ABGs Serum BUN Electrolytes Creatinine

21. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Imaging & Diagnostic Assessment Chest x-ray Pulse oximetry Transtracheal aspiration Bronchoscopy

22. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pneumonia: Community-Based Care Home care management Teaching for self-management Health care resources

23. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Severe Acute Respiratory Syndrome (SARS) From “coronaviruses” family Virus infection of respiratory tract cells, triggering inflammatory response No known effective treatment Must prevent spread of infection Strict airborne isolation Handwashing

24. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pulmonary Tuberculosis Highly communicable; caused by Mycobacterium tuberculosis Transmitted via aerosolization Secondary TB Incidence increase related to onset of HIV

25. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Clinical Manifestations Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks

26. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Assessment History Physical assessment Clinical manifestations

27. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Diagnostic Assessment Manifestation of signs/symptoms NAAT (results in 2 hr) Sputum smear for acid-fast bacillus Sputum culture of M. tuberculosis Tuberculin (Mantoux) test—PPD given intradermally in forearm Induration of 10 mm or greater diameter = positive for exposure

28. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Diagnostic Assessment (cont’d) Positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease.

29. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. PPD Skin Test

30. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Interventions Combination drug therapy with strict adherence: Isoniazid Rifampin Pyrazinamide Ethambutol Negative sputum culture = no longer infectious

31. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. TB: Community-Based Care Home care management Teaching for self-management Health care resources

32. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Lung Abscess Localized area of lung destruction Caused by liquefaction necrosis, usually related to pyogenic bacteria Pleuritic chest pain Interventions: Antibiotics Drainage of abscess Frequent mouth care for Candida albicans

33. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Inhalation Anthrax Bacterial infection caused by Bacillus anthracis from contaminated soil Fatality rate 100% if untreated Two stages: prodromal stage, fulminant stage Drug therapy: ciprofloxacin, doxycycline, amoxicillin

34. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pulmonary Empyema Collection of pus in pleural space Most common cause—pulmonary infection, lung abscess, infected pleural effusion Interventions: Empty empyema cavity Re-expand lung Control infection

35. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pulmonary Empyema (cont’d)