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Avian flu
1
• An infectious, contagious disease caused by influenza A viruses that normally affect birds
• Carried in the intestines of wild birds causing sickness, but highly contagious and deadly to birds. (chickens, ducks, turkeys)
• Human infection caused by contact with contaminated surfaces.
• Also called bird flu.
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Pathophysiology
• After attaching to the host cell, viral ribonucleic acid enters the cell and uses host components to replicate its genetic material and protein.
• Newly produced viruses invade other healthy cells.
• Viral invasion destroys host cells, impairing respiratory defenses.
5
Causes
• Highly pathogenic influenza A (H5N1) virus
• Isolated reports of human-to-human transmission.
6
Complications
• Conjunctivitis
• Pneumonia
• Acute respiratory distress
• Viral pneumonia
• Sepsis
• Organ failure
• Death
7
Assessment
• History: • Direct contact with contaminated surfaces.
• Physical findings: • Fever • Cough (dry or productive) • Sore throat • Difficulty breathing • Diarrhea • Runny nose • Headache • Muscle aches • Malaise
8
Treatment
• General:
• Fluid and electrolyte replacements
• Oxygen and assisted ventilation, if indicated
• Diet:
• Increased fluid intake
• Activity:
• Rest periods as needed.
9
Medications
• Oseltamivir (Tamiflu)
• Zanamivir (Relenza)
• Acetaminophen or aspirin
• Guaifenesin (Hytuss) or expectorant
• Antibiotics
10
Nursing considerations
• Nursing diagnoses:
• Acute pain
• Fatigue
• Hyperthermia
• Ineffective breathing pattern
• Risk for deficient fluid volume
• Risk for infection
11
Nursing interventions
• Give prescribed drugs.
• Follow standard precautions.
• Administer oxygen therapy, if warranted.
12
Patient teaching
• General:
• the disorder, diagnostic studies, and treatment
• importance of increased fluids to prevent dehydration.
13
Severe acute respiratory syndrome-SARS
• Severe viral infection that may progress to pneumonia
• Believed to be less infectious than influenza
• Incubation period estimated to range from 2 to 7 days.
• Not highly contagious when protective measures are used.
• Also known as SARS
14
Pathophysiology
• Coronaviruses cause diseases in pigs, birds, and other animals.
• A theory suggests that a coronavirus may have mutated, allowing transmission to and infection of humans.
15
Causes
• A new type of coronavirus known as SARS-associated coronavirus (SARSCoV).
16
Risk factors
• Close contact with exhaled droplets and bodily secretions from an infected person.
• Travel to endemic areas.
17
Incidence •
• SARS is more common in adults than children.
• Outbreaks are prevalent in China, Hong Kong, Toronto, Singapore, Taiwan, and Vietnam; many other countries report smaller numbers of cases.
• It affects all races.
• It affects both sexes equally.
18
Complications
• Respiratory difficulties
• Severe thrombocytopenia (low platelet count)
• Heart failure
• Liver failure
• Death
19
Assessment
• History:
• Contact with a person known to have SARS
• Travel to an endemic area
• Flulike symptoms
• Headache
• Diarrhea
• Nausea and vomiting
20
Physical findings
• Nonproductive cough
• Rash
• High fever
• Respiratory distress in later stages
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Laboratory- Imaging
• Antibodies to coronavirus are detected.
• Sputum Gram stain and culture isolates coronavirus.
• Platelet count may be low.
• Changes in chest X-rays indicate pneumonia (infiltrates).
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Treatment
• General:
• Symptomatic treatment
• Isolation for hospitalized patients
• Strict respiratory and mucosal barrier precautions
• Quarantine of exposed people to prevent spread
• Reporting of suspected cases to national health authorities
• Intubation and mechanical ventilation, if indicated.
25
Treatment
• Diet:
• As tolerated
• Activity:
• As tolerated
• Medications:
• Antivirals
• Combination of steroids and antimicrobials
• Oxygen therapy
26
Nursing considerations
• Nursing diagnoses:
• Activity intolerance
• Anxiety
• Fear
• Imbalanced nutrition: Less than body requirements
• Impaired gas exchange
• Risk for infection
27
Nursing interventions
• Give prescribed drugs.
• Encourage adequate nutritional intake.
• Observe, record, and report nature of rash.
• Maintain proper isolation technique.
• Collect laboratory specimens, as needed.
28
• Patient teaching: • General:
• the importance of frequent hand washing
• covering mouth and nose when coughing or sneezing
• avoiding close personal contact with friends and family
• the importance of not going to work, school, or other public places until 10 days after fever and respiratory symptoms resolve.
29
Patient teaching
• wearing a surgical mask when around other people
• not sharing towels, or bedding until they have been washed in soap and hot water
• using disposable gloves and household disinfectant to clean any surface that might have been exposed to the patient's body fluids.
30
Common cold
• Acute, usually afebrile viral infection
• Transmission through airborne respiratory droplets
• Communicable for 2 to 3 days after onset of symptoms
• Usually benign and self-limiting
31
Pathophysiology
• Rhinoviruses infect cells
• Infiltration with neutrophils, lymphocytes, plasma cells, and eosinophils
• Mucus-secreting glands become hyperactive
• Viral infection of the upper respiratory tract passages.
32
Causes
• More than 200 viruses, including rhinoviruses, coronaviruses, myxoviruses, adenoviruses, coxsackieviruses, and echoviruses
• Mycoplasma
33
Incidence
• The cold is the most common infectious disease.
• It's more prevalent in children, adolescent boys, and women.
34
Complications
• Secondary bacterial infection, causing sinusitis, otitis media, pharyngitis, or lower respiratory tract infection.
35
Assessment
• History:
• Exposure to persons with the common cold
• Sore throat
• Fatigue
• Malaise
• Myalgia
• Fever
36
• Physical findings:
• Nasal discharge that often irritates the nose
• Increased erythema of nasal and pharyngeal mucous membranes
• Nasal quality to voice
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• Diagnostic tests:
• There are no diagnostic tests for this disorder.
39
Treatment
• General: • Use of humidified inspired air • Increased fluid intake • Rest • Medications: • Acetylsalicylate acid • Ibuprofen • Acetaminophen • Antitussives
40
Nursing considerations Nursing diagnoses
• Acute pain
• Fatigue
• Hyperthermia
• Ineffective airway clearance
• Ineffective breathing pattern
41
Nursing interventions
• Give prescribed drugs.
• Relieve throat irritation with cough drops.
• A warm bath or heating pad can reduce aches and pains.
• Suggest a hot or cold steam vaporizer to relieve nasal congestion.
42
Patient teaching
• advice against overuse of nose drops or sprays
• how to avoid spreading colds
• proper hand-washing technique.
43
Influenza
• An acute, highly contagious infection of the respiratory tract
• Has capacity for antigenic variation
• Also called the grippe or flu
44
Pathophysiology
• The virus invades the epithelium of the respiratory tract, causing inflammation.
• After attaching to the host cell, viral ribonucleic acid enters the cell and uses host components to replicate its genetic material.
• Newly produced viruses invade other healthy cells.
45
Causes
• Infection transmitted by inhaling a respiratory droplet from an infected person
• Type A most prevalent, strikes annually with new serotypes, causes epidemics every 3 years.
• Type B strikes annually, causes epidemics every 4 to 6 years
• Type C endemic, causes only sporadic cases
46
Incidence
• Influenzae affects all age-groups, but the highest incidence is among school-age children.
• Influenza occurs most severely (may lead to death) in young children, elderly people, and those with chronic diseases.
47
Complications
• Pneumonia
• Myositis
• Exacerbation of chronic obstructive pulmonary disease
• Myocarditis
• Pericarditis
• Encephalitis
48
Assessment
• History
• Usually, recent exposure (typically within 48 hours) to a person with influenza
• No influenza vaccine received during the past season
• Headache
• Myalgia
• Fatigue, weakness
49
Physical findings
• Fever (usually higher in children) • Cough • Red, watery eyes; clear nasal discharge • Erythema of the nose and throat without exudate • Tachypnea, shortness of breath • With bacterial pneumonia, purulent or bloody
sputum • Cervical adenopathy and tenderness • Breath sounds may be diminished in areas of
consolidation
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Treatment
• General:
• Fluid and electrolyte replacements
• Oxygen and assisted ventilation, if indicated
• Diet:
• Increased fluid intake
• Activity:
• Rest periods, as needed
51
Medications
• Acetaminophen (Tylenol) or aspirin
• Guaifenesin (Mucinex) or expectorant
• Amantadine (Symmetrel)
• Antibiotics
52
Nursing considerations
• Nursing diagnoses:
• Acute pain
• Fatigue
• Hyperthermia
• Ineffective breathing pattern
• Ineffective health maintenance
• Risk for deficient fluid volume
• Risk for infection
53
Nursing interventions
• Give prescribed drugs.
• Follow standard precautions.
• Administer oxygen therapy, if warranted.
54
Patient teaching
• the disorder, diagnosis, and treatment
• mouthwash or warm saline gargles to ease sore throat
• importance of increased fluids to prevent dehydration
• warm bath or a heating pad to relieve myalgia
• proper hand-washing technique and tissue disposal to prevent the virus from spreading
• influenza immunization.
55
Varicella
• Overview:
• An acute, highly contagious viral infection
• Commonly known as chickenpox
56
Pathophysiology
• Localized replication of the virus occurs
• Diffuse and scattered skin lesions result with vesicles
• Incubation period lasts 13 to 17 days.
• Infection is communicable from 48 hours before lesions erupt until after vesicles are lost.
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Causes
• Varicella-zoster herpesvirus
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Incidence
• Chickenpox is most common in children ages 5 to 9 but can occur at any age.
• Disease occurs worldwide and is endemic in large cities with outbreaks occurring sporadically.
• Chickenpox equally affects all races and both sexes.
• Seasonal distribution varies; incidence is higher during late winter and spring.
59
Complications
• Infection of vesicles due to stratching
• Pneumonia
• Myocarditis
• Bleeding disorders
• Arthritis
• Nephritis
• Hepatitis
60
Assessment
• History:
• Recent exposure to someone with chickenpox
• Malaise
• Headache
• Anorexia
61
Physical findings
• Fever (38.3° to 39.4° C)
• small, erythematous macules on the trunk or scalp
• Vesicles becoming cloudy and breaking easily
• Rash that spreads to face and rarely to extremities
• Ulcers on mucous membranes of the mouth, conjunctivae of eyes.
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Treatment
• General:
• Strict isolation until all vesicles have crusted over.
• Diet:
• Increased fluid intake.
• Activity:
• Rest periods when fatigued.
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• Medications:
• Antipruritics
• Antibiotics
• Analgesics and antipyretics
• Acyclovir (Zovirax)
• Varicella zoster immune globulin
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Nursing considerations
• Fatigue
• Hyperthermia
• Impaired skin integrity
• Risk for imbalanced fluid volume
• Risk for infection
• Social isolation
67
Nursing interventions •
• Observe an immunocompromised patient for manifestations of complications, such as pneumonitis and meningitis, and report them immediately.
• Provide skin care comfort measures, • Administer varicella zoster immune globulin to
lessen the severity of the disease. • Institute strict isolation measures until all skin
lesions have crusted. • Prevent exposure to pregnant women.
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Patient teaching General
• disorder, diagnosis, and treatment
• how to correctly apply topical antipruritics
• importance of good hygiene and keeping child's fingernails trimmed
• importance of the child avoiding scratching the lesions
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Patient teaching General
• importance of the parents watching for and immediately reporting signs of complications (severe skin pain and burning possibly indicating a serious secondary infection)
• importance of not giving the child aspirin because of its association with Reye's syndrome
• When signs and symptoms of Reye's syndrome are seen immediately report them to a practitioner.
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Rubeola- Measles
• Acute, highly contagious infection causing a characteristic rash
• Can be severe or fatal in patients with impaired cell-mediated immunity
• Mortality highest in children younger than age 2 and in adults
• Also called measles or morbilli
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Pathophysiology
• Virus invades the respiratory system and spreads via the bloodstream and infects all types of white blood cells.
• Viremia develop, leading to infection of the entire respiratory tract.
• Risk factors:
• Lack of immunization
73
Causes
• Rubeola virus
• Spread by direct contact or by contaminated airborne respiratory droplets, with entry in the upper respiratory tract.
• Incidence:
• Rubeola affects mostly preschool children.
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Complications
• Secondary bacterial infection
• Autoimmune reaction
• Bronchitis
• Otitis media
• Pneumonia
• Encephalitis
76
Assessment
• History:
• Inadequate immunization and exposure to someone with measles in the past 14 days
• Photophobia
• Malaise
• Anorexia
• Hoarseness
77
Physical findings
• Temperature peaking at (39.4°C to 40.5° C)
• Periorbital edema
• Conjunctivitis
• Pruritic rash
• Severe cough
• Rhinorrhea
• Lymphadenopathy
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Treatment
• General:
• Respiratory isolation precautions
• Use of vaporizer
• Warm environment
• Skin care
• Diet:
• Small, frequent meals
• Increased fluid intake
80
• Activity:
• Rest until symptoms improve
• Medications:
• Antipyretics
81
Nursing considerations
• Nursing diagnoses:
• Activity intolerance
• Disturbed sensory perception (visual)
• Hyperthermia
• Imbalanced nutrition: Less than body requirements
• Impaired oral mucous membrane
• Impaired skin integrity
• Risk for infection
82
Nursing interventions
• Institute respiratory isolation measures for 4 days after rash onset.
• Follow standard precautions.
• Give prescribed drugs.
• Encourage bed rest during the acute period.
• If photophobia occurs, darken the room or provide sunglasses.
• To prevent disease spread, administer measles vaccine, as ordered and needed.
• Report measles cases to local public health authorities
83
Patient teaching
• General:
• the disorder, diagnosis, and treatment
• supportive measures, isolation, bed rest, and increased fluids
• instructions on cleaning a vaporizer
• early signs and symptoms of complications that should be reported.
84
Rubella
• Acute, mildly contagious viral disease that causes a distinctive maculopapular rash (resembling measles or scarlet fever) and lymphadenopathy
• Self-limiting with an excellent prognosis,
85
Pathophysiology • A ribonucleic acid virus enters the bloodstream,
usually through the respiratory route.
• The incubation period lasts 18 days,
• Causes:
• Rubella virus, spread by direct contact or contaminated airborne respiratory droplets
• Risk factors:
• Exposure to active case without immunization
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• Incidence:
• Rubella occurs worldwide.
• The disease is most common among children ages 5 to 9, adolescents, and young adults.
• Complications:
• Arthritis
• Postinfectious encephalitis
• Thrombocytopenic purpura
88
Assessment
• History: • Inadequate immunization, exposure to a person
with rubella infection within the previous 2 to 3 weeks, or recent travel to an endemic area without reimmunization.
• In a child, absence of prodromal symptoms • In an adolescent or adult, headache, malaise,
anorexia, sore throat, and cough preceding rash onset
• Polyarthralgias and polyarthritis (in some adults)
89
• Physical findings:
• Rash accompanied by low-grade fever [37.2° to 38.3° C])
• Mildly pruritic rash; typically begins on the face, and spreads rapidly, covering the trunk and limbs within hours.
• Small, red, petechial macules on the soft palate
• Conjunctivitis
• Suboccipital, postauricular, and postcervical lymph node enlargement
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Treatment • General:
• Skin care
• Isolation precautions
• Diet:
• Small, frequent meals
• Increased fluid intake
• Activity:
• Rest until fever subsides
• Medications:
• Antipyretics
• Analgesics
94
Nursing considerations
• Nursing diagnoses:
• Activity intolerance
• Acute pain
• Hyperthermia
• Impaired skin integrity
95
• Nursing interventions:
• Give prescribed drugs.
• Institute isolation precautions until 5 days after the rash disappears
• Keep the patient's skin clean and dry.
• Make sure that the patient receives care only from nonpregnant hospital workers who aren't at risk for rubella.
96
Patient teaching
• General:
• the disorder, diagnosis, and treatment
• ways to reduce fever
• importance of people with rubella avoiding pregnant women
• avoidance of aspirin in a child receiving rubella vaccine.
97
Scarlet fever
• A hypersensitivity reaction that usually follows streptococcal pharyngitis
• May follow other streptococcal infections, such as wound infections.
98
Pathophysiology
• After infection, an erythrogenic toxin is produced, resulting in a hypersensitivity reaction.
• Replication site is the tonsils and pharynx.
• Inflammatory reaction occurs.
99
Causes
• Group A beta-hemolytic streptococci transmitted by direct contact with infected person or droplet spread; indirectly by contact with contaminated articles.
100
Incidence
• The disease is most common in children ages 3 to 15, peaking in those ages 4 to 8.
• Infection rate is increased in overcrowded situations.
• Males and females are affected equally.
101
Complications
• Severe toxic illness • Septicemia • Rheumatic heart disease • Liver damage • Otitis media • Peritonsillar and retropharyngeal abscess • Sinusitis • Glomerulonephritis • Meningitis • Brain abscess
102
Assessment
• History: • Possible contact with person with a sore throat • Sore throat • Headache • Chills • Anorexia • Abdominal pain • Malaise • Likely high temperature [37.8° to 39.4° C]) • Characteristic rash 12 to 48 hours after onset of fever
103
Physical findings
• Inflamed and heavily coated tongue, progressing to strawberry-like tongue
• Tongue becomes beefy red, returning to normal by the end of week 2
• Red and edematous uvula, tonsils, and posterior oropharynx, with mucopurulent exudate
• Erythematous rash, appears first on the upper chest and back, spreading to the neck, abdomen, legs, and arms
• Rash resembling sunburn • Tachycardia
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Diagnostic test results
• Laboratory:
• Pharyngeal culture is positive for group A beta-hemolytic streptococci.
• Complete blood count reveals increased white blood cell count and eosinophilia during the second week.
106
Treatment
• General: • Appropriate skin care • Isolation for 24 hours after starting antibiotics • Diet: • Increased fluid intake • Activity: • Rest periods when fatigued • Medications: • Antibiotics • Antipyretics
107
Nursing considerations
• Nursing diagnoses:
• Acute pain
• Hyperthermia
• Impaired oral mucous membrane
• Impaired skin integrity
• Impaired swallowing
• Risk for infection
108
Nursing interventions
• Implement respiratory secretion precautions for 24 hours after starting antibiotic therapy.
• Offer frequent oral fluids and oral hygiene.
• Give prescribed drugs.
• Provide skin care to relieve discomfort from the rash.
• Provide warm liquids or cold foods to ease sore throat pain.
• Use a cool mist humidifier to keep the air moist and prevent the throat from getting too dry and more sore.
109
Patient teaching
• General: • the disorder, diagnosis, and treatment • the need to take oral antibiotics for the
prescribed length of time to prevent serious complications
• proper disposal of purulent discharge • follow-up care • when to notify the practitioner • drugs and possible adverse effects • prevention of scarlet fever and strep throat.
110
Tonsillitis
• Inflammation of the tonsils
• May be acute or chronic
• Typical viral infection: Mild and of limited duration
111
Pathophysiology
• The inflammatory response to cell damage by viruses or bacteria may result in hyperemia and fluid exudation.
112
Causes
• Bacterial infection (group A beta-hemolytic streptococci).
• Viral infection
113
Incidence
• Tonsillitis is more common in children than adults.
• Viral tonsillitis is more common than bacterial tonsillitis.
• Bacterial infection occurs more frequently in the winter.
114
• Age Factor:
• Tonsillitis commonly affects children between ages 5 and 10.
• Tonsils tend toward hypertrophy during childhood and atrophy after puberty.
115
Complications
• Chronic upper airway obstruction • Eating or swallowing disorders • Speech abnormalities • Febrile seizures • Otitis media • Cardiac valvular disease • Peritonsillar abscesses • Glomerulonephritis • Bacterial endocarditis • Cervical lymph node abscesses
116
Assessment
• History:
• Mild to severe sore throat
• Young child possibly stops eating
• Muscle and joint pain
• Malaise
• Headache
• Pain, commonly referred to the ears
117
Physical findings
• Fever
• Swollen, tender submandibular lymph nodes
• Generalized inflammation of pharyngeal wall
• Swollen tonsils exudating white or yellow fluid
• Purulent drainage with application of pressure to tonsils
• Uvula possibly edematous and inflamed
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Diagnostic test results
• Laboratory:
• A throat culture may reveal the infecting organism.
• A serum white blood cell count usually reveals leukocytosis.
122
Treatment
• General: • Symptom relief • Diet: • Adequate fluid intake • Activity: • Rest periods as needed • Medications: • Aspirin or acetaminophen • Antibiotics • Surgery: • tonsillectomy
123
Nursing considerations
• Nursing diagnoses:
• Acute pain
• Anxiety
• Impaired swallowing
• Ineffective breathing pattern
• Risk for aspiration
• Risk for deficient fluid volume
124
Nursing interventions
• Before surgery:
• Encourage oral fluids.
• Offer a child ice cream and flavored drinks and ices.
• Provide humidification.
• Encourage gargling to soothe the throat and remove debris from tonsillar crypts.
125
• After surgery:
• Maintain a patent airway.
• Prevent aspiration by side positioning.
• Encourage nonirritating oral fluids.
• Avoid milk products and salty or irritating foods.
• Provide analgesics for pain relief.
• Encourage deep-breathing exercises.
126
Patient teaching
• General:
• the disorder, diagnosis, and treatment
• importance of completing the entire course of antibiotics
• avoidance of irritants
• medications, dosages, and possible adverse effects
• possibility of throat discomfort and some bleeding after surgery
127
Otitis media
• Inflammation of the middle ear associated with fluid accumulation
• Acute, chronic, suppurative, or secretory
128
Causes
• Acute otitis media: disruption of eustachian tube patency.
• Secretory otitis media: viral infection, allergy, or barotrauma.
• Suppurative otitis media: bacterial infection with pneumococci, group A beta-hemolytic streptococci, staphylococci, and gram-negative bacteria.
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• Incidence:
• Otitis media occurs most commonly in infants and children.
• Otitis media peaks between ages 6 and 24 months.
• The incidence of otitis media subsides after age 3.
• The disease is most common during the winter months.
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Complications
• Spontaneous rupture of the tympanic membrane • Persistent perforation • Chronic otitis media • Mastoiditis • Meningitis • Abscesses, septicemia • Lymphadenopathy, leukocytosis • Permanent hearing loss • Vertigo
133
Assessment
• History:
• Upper respiratory tract infection
• Allergies
• Severe, deep ear pain
• Nausea, vomiting
• Recent air travel or scuba diving
134
Physical findings
• Mild to high fever
• Painless, purulent discharge in chronic suppurative otitis media
• Sneezing and coughing with upper respiratory tract infection
• Conductive hearing loss
135
Treatment • General:
• In acute secretory otitis media, Valsalva's maneuver several times per day.
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• Medications:
• Antibiotic therapy
• Aspirin or acetaminophen (Tylenol)
• Analgesics
• Sedatives (small children)
• Nasopharyngeal decongestant therapy
138
Nursing considerations Nursing diagnoses
• Acute pain
• Disturbed sensory perception (auditory)
• Disturbed sleep pattern
• Impaired verbal communication
• Risk for infection
• Risk for injury
139
Nursing interventions
• Answer all questions. • Encourage discussion of concerns about hearing
loss. • With hearing loss: • Provide clear, concise explanations. • Face the patient when speaking • Allow time for the patient what was said. • Provide a pencil and paper. • Alert the staff to the patient's communication
problem.
140
Patient teaching
• General:
• proper instillation of drops, and ear wash,
• drug administration, dosage, and possible adverse effects
• importance of taking antibiotics
• adequate fluid intake
• correct instillation of nasopharyngeal decongestants
141
Mumps
• An acute viral infection of one or both parotid glands and sometimes the sublingual or submaxillary glands
• Also called infectious or epidemic parotitis
142
Pathophysiology
• Virus replication occurs in the epithelium of the upper respiratory tract, leading to viremia.
• Infection of the central nervous system (CNS) or glandular tissues (or both) occurs.
143
Causes
• A paramyxovirus found in the saliva of an infected person.
• Transmission by droplets or by direct contact with the saliva of an infected person.
144
Incidence
• Mumps seldom occur in infants younger than age 1 because of passive immunity from maternal antibodies.
• About 50% of cases occur in young adults; the remainder occur in young children or immunocompromised adults.
• Peak incidence is during late winter and early spring.
145
Physical findings
• Swelling and tenderness of the parotid glands
• Simultaneous or subsequent swelling of one or more other salivary glands
146
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148
Complications
• Epididymo-orchitis
• Meningoencephalitis
• Sterility
• Pancreatitis
• Transient sensorineural hearing loss
• Arthritis
• Nephritis
• Spontaneous abortion (with contact during the first trimester)
149
Assessment
• History
• Inadequate immunization and exposure to someone with mumps within the preceding 2 to 3 weeks
• Myalgia
• Headache
• Fever
• Earache aggravated by chewing
150
• Diagnostic test results:
• Laboratory:
• Serologic test results show mumps antibodies.
151
Treatment • General: • Rest • Cold compresses for swollen glands • Diet: • Clear liquid to mechanical soft diet until able to
swallow • Increased fluid intake • Activity: • Bed rest until fever resolves • Rest periods when fatigued • Medications: • Analgesics • Antipyretics
152
Nursing considerations Nursing diagnoses
• Acute pain
• Deficient fluid volume
• Disturbed body image
• Hyperthermia
• Imbalanced nutrition: Less than body requirements
• Impaired swallowing
• Risk for infection
153
Nursing interventions
• Apply cool compresses to the neck area to relieve pain.
• Give prescribed drugs.
• Report all cases of mumps to local public health authorities.
• Disinfect articles soiled with nose and throat secretions.
154
Patient teaching General
• the disorder, diagnosis, and treatment
• the need to stay away from school or work from days 12 through 25 after exposure
• the importance of having children immunized with live attenuated mumps vaccine at age 15 months or older
• the need for bed rest during febrile period
• the need to avoid spicy, irritating foods and those that require much chewing (advise a soft diet)
• the need for family members to follow respiratory isolation precautions until symptoms subside.
155
Pertussis
• Highly contagious respiratory infection
• Typically causes an irritating cough that becomes paroxysmal
• Follows a 6- to 8-week course that includes three 2-week stages with varying symptoms
156
Pathophysiology
• The infecting organism adheres to ciliated epithelial cells and multiplies.
• The resulting local mucosal damage induces paroxysmal coughing, which enhances disease transmission.
157
Causes
• Nonmotile, gram-negative coccobacillus Bordetella pertussis
• Spreads indirectly through articles contaminated by respiratory secretions
• Typically transmitted by direct inhalation of contaminated droplets from someone in the acute disease stage.
158
Incidence
• Fifty percent of cases of pertussis are seen in underimmunized children younger than age 1.
• The disease commonly occurs in schools, nursing homes, and residential facilities.
• Epidemics occur every 3 to 5 years without seasonal variation.
159
Complications
• Increased venous pressure • Anterior eye chamber hemorrhage • Inguinal or umbilical hernia • Encephalopathy, seizures • Atelectasis or pneumonitis • In infants: apnea, anoxia • Otitis media • Pneumonia • Cerebral hemorrhage
160
Assessment
• History:
• Possible lack of immunization coupled with exposure to pertussis during previous 3 weeks.
161
Physical findings
• Low or normal body temperature
• Mild conjunctivitis
• Epistaxis during paroxysmal coughing
• Exhaustion and cyanosis after coughing spell
• Diminished breath sounds, upper airway wheezing
• Vomiting from repeated coughing
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Treatment
• General: • For infants and elderly patients: hospitalization with
vigorous supportive therapy and fluid and electrolyte replacement.
• Diet: • Adequate nutrition with small, frequent meals • Increased fluid intake • Activity: • Rest periods when fatigued • Medications: • Oxygen • Antibiotics
165
Nursing considerations Nursing diagnoses
• Activity intolerance • Acute pain • Anxiety • Deficient fluid volume • Impaired gas exchange • Ineffective airway clearance • Ineffective breathing pattern • Risk for infection • Risk for injury
166
Nursing interventions
• Maintain respiratory isolation (mask only) for 5 to 7 days after antibiotic therapy begins.
• Provide oxygen and moist air as ordered; if needed, assist respiration.
• Suction secretions as necessary.
• Elevate the head of the bed to ease breathing.
• Create a quiet environment to decrease coughing stimulation.
167
Patient teaching General
• the disease process and medical procedures
• need for the patient's close contacts to get medical care
• when to notify the practitioner
• importance of immunization and vaccinations and the need to notify the practitioner of adverse reactions to the vaccine.
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Diphtheria
• Acute, highly contagious, toxin-mediated infection that usually infects the respiratory tract — primarily the tonsils, nasopharynx, and larynx.
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• Pathophysiology:
• Proliferation of organism at site of implantation
• Endotoxin: produced, absorbed by the blood, and transported to the heart and central nervous system
• Causes:
• Corynebacterium diphtheriae, a gram-positive rod
• Transmission usually through intimate contact, airborne respiratory droplets, or a break in the skin
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• Incidence: • The disease is more prevalent during the colder
months. • More prevalent in children younger than age 15. • Complications: • Thrombocytopenia • Myocarditis • Neurologic involvement (primarily affecting motor
fibers but possibly also sensory neurons) • Renal involvement • Pulmonary involvement (bronchopneumonia
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Assessment
• History:
• Fever
• Sore throat
• Cough
• Vomiting
• Dysphagia
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Physical findings
• Hoarseness
• Thick, grayish green membrane over the mucous membranes of the pharynx, larynx, tonsils, soft palate, and nose
• Swelling of the palate
• Yellow spots or lesions (cutaneous)
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• Diagnostic test results:
• Laboratory:
• Throat culture or culture of other suspect lesions grows C. diphtheriae.
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Treatment
• General: • Symptomatic • Droplet precautions • Diet: • As tolerated • Activity: • As tolerated • Medications: • Diphtheria antitoxin • Antibiotics • Surgery: • Tracheotomy if airway obstruction occurs
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Nursing considerations Nursing diagnoses
• Hyperthermia
• Imbalanced nutrition: Less than body requirements
• Impaired skin integrity
• Ineffective airway clearance
• Ineffective breathing pattern
• Risk for imbalanced fluid volume
• Risk for infection
• Risk for injury
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Nursing interventions
• Enforce strict isolation techniques.
• Give prescribed drugs.
• Obtain cultures, as ordered.
• Report all cases to local public health authorities.
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Patient teaching
• General:
• proper disposal of nasopharyngeal secretions
• maintaining infection precautions until after two consecutive negative nasopharyngeal cultures — at least 1 week after drug therapy stops.
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