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Chapter 33
Care of Patients with Infectious Respiratory
Problems
Mrs. Marion Kreisel MSN, RN
NU230 Adult Health 2
Fall 2011
Rhinitis
• Inflammation of the nasal mucosa
• Often called “hay fever” or “allergies”
• Interventions include:
• Drug therapy—antihistamines and
decongestants, (be careful with
decongestants, pts will keep using them
until all congestion is gone: can OD on
this med) antipyretics, antibiotics
• Complementary and alternative therapy
• Supportive therapy
Sinusitis
• Inflammation of the mucous
membranes of the sinuses
Sinusitis (Cont’d)
• Nonsurgical management:
• Broad-spectrum antibiotics
• Analgesics for pain and fever
• Decongestants
• Steam humidification
• Hot and wet packs over the
sinus area
• Nasal saline irrigations
Surgical Management
• Antral irrigation
• Caldwell-Luc procedure
• Nasal antral window
procedure
• Endoscopic sinus surgery
Pharyngitis
• Sore throat is common
inflammation of the mucous
membranes of the pharynx.
• Assess for odynophagia,
dysphagia, fever, and hyperemia.
• Strep throat can lead to serious
medical complications.
• Epiglottitis is a rare complication of
pharyngitis.
Acute Epiglottitis
Tonsillitis
• Inflammation and infection of the
tonsils and lymphatic tissues
located on each side of the throat
• Contagious airborne infection,
usually bacterial
• Antibiotics
• Surgical intervention
Peritonsillar Abscess
• Complication of acute tonsillitis
• Pus behind the tonsil, causing onesided swelling with deviation of the
uvula
• Trismus and difficulty breathing
• Percutaneous needle aspiration of
the abscess
• Completion of antibiotic regimen
Peritonsillar Abscess (Cont’d)
Laryngitis
• Inflammation of the mucous membranes lining
the larynx, possibly including edema of the vocal
cords
• Acute hoarseness, dry cough, difficulty
swallowing, temporary voice loss (aphonia)
• Voice rest, steam inhalation, increased fluid
intake, throat lozenges
• Therapy—relief and prevention
Influenza
• “Flu” is a highly contagious acute viral respiratory
infection.
• Manifestations include severe headache, muscle
ache, fever, chills, fatigue, weakness, and
anorexia.
• Vaccination is advisable.
• Antiviral agents may be effective.
Pneumonia
• Excess of fluid in the lungs resulting
from an inflammatory process
• Inflammation triggered by infectious
organisms and inhalation of irritants
• Community-acquired infectious
pneumonia
• Nosocomial or hospital-acquired
• Atelectasis
• Hypoxemia
Pneumonia
• History
• Physical assessment: weak,
nonproductive cough effort
• Clinical manifestations
• Psychosocial assessment
Laboratory Assessment
• Gram stain, culture, and sensitivity testing of
sputum
• Complete blood count
• Arterial blood gas level
• Serum blood urea nitrogen level
• Electrolytes
• Creatinine
• Imaging assessment and others
Treatment
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Priority to get antibiotic in pt asap.
Treat Pain
Treat Fever
Treat Cough
Pneumonia: Community-Based Care
• Home care management
• Health teaching
• Health care resources
Severe Acute Respiratory Syndrome
(SARS)
• A virus from a family of virus types known as
“coronaviruses”
• Virus infection of cells of the respiratory tract,
triggering inflammatory response
• No known effective treatment for this infection
• Prevention of spread of infection
Avian Influenza “Bird Flu”
• Concern of possible mutation of strain to
allow first bird-to-human infection
• Virus spreads in birds by oral-fecal
transmission
• Prevention
• If pt admitted to hospital immediate
Respiratory Isolation
Pulmonary Tuberculosis
• Highly communicable disease caused
by Mycobacterium tuberculosis
• Transmitted via aerosolization
• Secondary TB
• Increase related to the onset of HIV
Pulmonary Tuberculosis (Cont’d.)
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Clinical Manifestations of TB
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Progressive fatigue
Lethargy
Nausea
Anorexia
Weight loss
Irregular menses
Low-grade fever, night sweats
Cough, mucopurulent sputum, blood streaks
TB: Assessment
• History
• Physical assessment
• Clinical manifestations:
• Private Room
• Negative Air flow
• Acid Fasting Test
• Respiratory Isolation N-95 mask
Diagnostic Assessment
• Manifestation of signs and symptoms
• Positive smear for acid-fast bacillus
• Confirmation of diagnosis by sputum culture of M.
tuberculosis
• Tuberculin test (Mantoux test)—purified protein
derivative given intradermally in the forearm
• Induration of 10 mm or greater diameter
indicative of exposure
Diagnostic Assessment (Cont’d)
• Positive reaction does not mean that active
disease is present but does indicate exposure to
TB or dormant disease
Interventions
• Combination drug therapy with strict
adherence to prevent organism resistance:
• Isoniazid: Side effect is vision problems
(pg651 pharm book)
• Rifampin
• Pyrazinamide
• Ethambutol
• Teach patient to look for Yellow tinged skin or
yellow eyes (jaundice) Dark brown urine, &
bruise easilly.
• Negative sputum culture indicative of patient no
longer being infectious
TB: Community-Based Care
• Home care management
• Health teaching:
• Health care resources
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
Inhalation Anthrax
• Bacterial infection is caused by the gram-positive,
rod-shaped organism Bacillus anthracis from
contaminated soil.
• Fatality rate is 100% if untreated.
• Two stages are the prodromal stage and the
fulminant stage.
• Drug therapy includes ciprofloxacin, doxycycline,
and amoxicillin.
Pulmonary Empyema
• A collection of pus in the pleural space
• Most common cause—pulmonary infection, lung
abscess, and infected pleural effusion
• Interventions include:
• Emptying the empyema cavity
• Re-expanding the lung
• Controlling the infection
Pulmonary Empyema (Cont’d)
NCLEX
TIME
Question 1
How many cases of pneumonia occur in the
United States annually?
A.
B.
C.
D.
400,000 to 700,000
750,000 to 1 million
2 to 5 million
6 to 8 million
Question 2
Which is the most common manifestation of
pneumonia in the older adult patient?
A.
B.
C.
D.
Fever
Cough
Weakness
Confusion
Question 3
A patient is being examined because of
symptoms of pharyngitis. Which features
would indicate that the pharyngitis is of
viral origin?
A. High fever (over 101 F [38 C])
B. White blood cell count lower than
10,000/mm3
C. White blood cell count over 12,000/mm3
D. Abrupt onset
Question 4
A health care worker’s purified protein
derivative (PPD) test results are positive.
Previously the results had been negative.
This positive PPD indicates:
A. Exposure to TB
B. The presence of active tuberculosis (TB)
disease
C. Previous vaccination with bacillus
Calmette-Guérin (BCG)
D. An allergic reaction to the PPD serum
Question 5
A patient is experiencing fever, chills, night
sweats, and
weight loss. In addition, the patient’s point of
maximal
impulse (PMI) is noted to be displaced when
cardiac
palpation is performed, and the patient is
hypotensive.
These symptoms are indicative of:
A.
B.
C.
D.
Pneumonia
Tuberculosis
Influenza
Pulmonary empyema