Download 05. Interventions for Clients with Infectious Problems of the

Interventions for Clients
with Infectious Problems
of the Respiratory Tract
Rhinitis
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Inflammation of the nasal mucosa
Infectious; Allergic; Rhinitis medicamentosa
Allergic - often called “hay fever” or “allergies”
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Symptoms - headache, nasal irritation, sneezing,
nasal congestion, rhinorrhea (watery drainage
from the nose), and itchy, watery eyes.
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Interventions include:
– Drug therapy: antihistamines
and decongestants, antipyretics,
antibiotics
– Complementary and alternative
therapy
– Supportive therapy
Rhinitis
Sinusitis
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Inflammation of the mucous membranes of the sinuses
Swelling can obstruct the flow of secretions from the sinuses, which
may subsequently become infected.
The disorder often accompanies or follows acute or chronic allergic
rhinitis.
Other conditions contributing to sinusitis include a deviated nasal
septum, polyps, tumors, chronically inhaled air pollutants or
cocaine, facial trauma, nasotracheal intubation, dental infection, or
cystic fibrosis
The causative organism in sinus infection is usually Streptococcus
pneumoniae, Haemophilus influenzae, Diplococcus, or Bacteroides.
Anaerobic infections also can cause sinusitis.
Sinusitis most often develops in the maxillary and frontal sinuses.
Complications include cellulitis, abscess, and meningitis
Sinusitis
Sinusitis
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The clinical manifestations of sinusitis include
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nasal swelling and congestion,
headache,
facial pressure,
pain (usually made worse by movement of the head
to a dependent position),
– tenderness on percussion over the involved area,
– low-grade fever,
– cough, and purulent or bloody nasal drainage
Sinusitis
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(Continued)
Nonsurgical management
– Broad-spectrum antibiotics
– Analgesics
– 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
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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.
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Pharyngitis
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
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Tonsillitis
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
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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
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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.
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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
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Pneumonia
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appearance
– flushed cheeks,
– bright eyes,
– anxious expression.
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chest or pleuritic pain or discomfort,
myalgia,
headache,
chills, fever,
cough,
tachycardia,
dyspnea, tachypnea, and sputum production.
severe chest muscle weakness also may be present from
sustained coughing
Pneumonia
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Crackles are heard on auscultation when there is fluid in interstitial
and alveolar areas.
Wheezing may be heard as a result of inflammation and exudate in
the airways.
Bronchial breath sounds are heard over areas of density or
consolidation.
Tactile fremitus is increased over areas of pneumonia, and
percussion is dulled in these areas.
Chest expansion may be diminished or unequal on inspiration.
The client with pneumonia is likely to be hypotensive with
orthostatic changes. A rapid, weak pulse may indicate hypoxemia,
dehydration, or impending shock.
The nurse also inspects the skin for a rash, which may occur with
Mycoplasma infection, cytomegalovirus infection (CMV), or Rocky
Mountain spotted fever
Laboratory Assessment
Gram stain, culture, and sensitivity testing
of sputum
 Complete blood count
 Arterial blood gas
level
 Serum blood, urea
nitrogen level
 Electrolytes
 Creatinine
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Impaired Gas Exchange
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Interventions include:
– Cough enhancement
– Oxygen therapy
– Respiratory monitoring
Ineffective Airway Clearance
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Interventions include:
– Help client to cough and deep breathe at
least every 2 hours.
– Administer incentive spirometer—chest
physiotherapy if complicated.
– Prevent dehydration.
Ineffective Airway Clearance
(Continued)
– Monitor intake and output of fluids.
– Use bronchodilators, especially beta2
agonists.
– Inhaled steroids are rarely used.
Potential for Sepsis
• Primary intervention is prescription of
anti-infectives for eradication of
organism causing the infection.
• Drug resistance is a problem, especially
among older people.
• Interventions for aspiration pneumonia
aimed at preventing lung
damage and treating infection.
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
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Pulmonary Tuberculosis
Highly communicable disease caused
by Mycobacterium tuberculosis
 Most common bacterial infection
 Transmitted via aerosolization
 Initial infection multiplies freely in
bronchi or alveoli
 Secondary TB
 Increase related to the onset of HIV
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Pulmonary Tuberculosis
Assessment
Diagnosis of TB considered
for any client with a
persistent cough or other
compatible symptoms (weight loss,
anorexia, night sweats, hemoptysis,
shortness of breath, fever, or chills)
 Bacillus Calmette-Guerin vaccine
within previous 10 years produces
positive skin test, complicating
interpretation of TB test.
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Clinical Manifestations of TB
Progressive fatigue
 Lethargy
 Nausea
 Anorexia
 Weight loss
 Irregular menses
 Low-grade fever, night sweats
 Cough, mucopurulent sputum, blood
streaks
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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
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(Continued)
Diagnostic Assessment
(Continued)
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Positive reaction does not mean that
active disease is present, but does
indicate exposure to TB or dormant
disease.
Interventions
Combination drug therapy strict
adherence
 Isoniazid
 Rifampin
 Pyrazinamide
 Ethambutol or streptomycin
 Negative sputum culture indicative of
client no longer being infectious
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Health Teaching
Follow exact drug regimen.
 Proper nutrition must be maintained.
 Reverse weight loss and severe
lethargy.
 Educate client about the disease.
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Lung Abscess
Localized area of lung destruction
caused by liquefaction necrosis,
usually related to pyogenic bacteria
 Pleuritic chest pain
 Interventions
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– Antibiotics
– Drainage of abscess
– Frequent mouth care for Candida
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.
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Pulmonary Empyema
A collection of pus in the pleural
space
 Most common cause: pulmonary
infection, lung abscess, and infected
pleural effusion
 Interventions include:
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– Emptying the empyema cavity
– Re-expanding the lung
– Controlling the infection