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8/6/2019 Respiratory Diseases Wk 5
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y is the inflammation of the lung parenchyma(terminal bronchioles, respiratorybronchioles, alveolar ducts, alveolar sac,and alveoli)
y it is classified according to its causativeagent;
y the incubation period depends on whattype of microorganism caused the disease;
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pneumonia usually arises from endogenousmicroflora of the person whose resistance
have been altered or from aspiration oforopharyngeal secretions;
patients with pneumonia may have anunderlying infection that impairs hostdefense;
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V iral Pneumoniax Influenza virusesx Parainfluenzax A denoviruses
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Fungal Pneumoniax A spergillus fumigatusx Pneumocystis carinii AIDS patients
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M ode of Transmission: Inhalation of respiratory secretions from
an infected individual;
A spiration of oropharyngeal secretions; Thru the bloodstream; From direct spread as a result of surgery
or trauma;
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y C linical M anifestations:Sudden onset of fever, high-grade with chills;Cough, productive;D yspnea;
Pleuritic chest pain aggravated by coughingor breathing;Tachypnea accompanied by grunting, nasalflaring, use of accessory muscles and fatigue;
Rapid, bounding pulse;
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yD iagnostic Evaluation:CBC
Chest X-ray to show presence of pneumonicinfiltrates and the extent of pneumonia.S
putumG
rams stain - may indicate offendingmicroorganism;Sputum culture and sensitivity may alsoconfirm offending microorganism;Blood culture to confirm the presence ofbacterial pneumonia;Immunologic test detecting microbial antigensin serum, sputum, and urine.
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M edical M anagement:
A ntimicrobial therapyx D epends on laboratory identification of
causative agents and its sensitivity;x For Bacterial pneumonia:
xPenicillinx Cefuroxime
x Ceftriaxonex Cotrimoxazolex A zithromycin
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x For V iral Pneumoniax M ost of the time it is self-limiting.x Symptomatic and supportive
management.
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O xygen therapy M ucolytic and other cough medicines Bronchodilators Steroid therapy
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N ursing D iagnosis: Impaired gas exchange Ineffective airway clearance
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y N ursing Interventions:A ssess px for cyanosis, dyspnea, hypoxia, and
confusion;A dminister oxygen as indicated at 1-2 L/min.Isolate the client.Put client is semi-Fowlers position.
Encourage the px to cough out secretions.Encourage increase fluid intake.Employ chest wall percussion and posturaldrainage.
A uscultate chest for crackles and rhonchi.M obilize client even on bed to improvesecretion clearance.
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C omplications: Pleural effusion parapneumonic effusion Cardiovascular collapse especially from
gram (-) bacteria/sepsis; Superinfection D elirium due to cerebral hypoxia; A telectasis
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y is a chronic bacterial infectioncharacterized by granuloma formation,necrosis, and calcification of involvedtissues;
y one of the leading cause of morbidity andmortality in the Philippines and other developing countries.
y fairly common among low-income,congested families;
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y approximately 10% (5 - 14%) of cases areASYM PTOMA TIC;
can be:
Minimal slight lesions withoutdemonstrable excavation and confined to
the apex;Moderately Advanced cavities less than 4cm involving one or both lungs;
Far Advanced lesions more extensive thanmoderately advanced TB;
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C ausative A gent: Mycobacteriumtuberculosis
x acid-fast bacilli, aerobic ;
y
IP:3
8 weeks;
y M ode of Transmission ;N asopharyngeal secretionsD rinking of infected cows milk D roplet nuclei infection
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TBC lassification according to A TS:
C lass 0 no TB exposure ; no infection ; (-) PP D;
C lass 1 (+) exposure ; no infection ; (-) PP D;
C lass 2 (+) exposure ; (+) PP D; no symptoms ;x Recent or actual TB infection ;
C lass 3 (+) exposure ; (+) PP D; (+) symptoms ; (+) CX R ;x Active TB ;
C lass 4 (+) exposure ; (+) PP D; no active disease ; (+) CX R ;x Previous PTB disease ;
C lass 5 (+) exposure ; (+) PP D; (+) CX R ; equivocal findings ; x PTBSuspect ;
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Multiple Drug-Resistance Tuberculosis(MDRTB) suspect in PTB class 3 patients
who are still sputum smear or sputumculture positive (+) despite 3 months ofadequate treatment;
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y C linical M anifestations:fever, low-grade, late afternoon or earlyevening;chillsanorexia
weight losschronic cough more than two weeks;nocturnal sweatingchest and back pains
dyspnea and hemoptysis
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y Diagnostic Examinations:Chest X-ray (PA - lateral and apicolordoticview)Sputum A FB 3 consecutive mornings; toidentify if the client is communicable;x Tell client not to eat or brush before collecting
sputum.x Client may gurgle tap water.x If client cannot expectorate, may nebulizer with
PN SS .
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Bronchoscopy M
antoux test or PPD
; exposure to TB; M ycobacterium TB Culture confirmatory; Liver Function Test AS T and A LT;
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1. First-line M edications - R IPES
R IFAM PIC IN (R IF) taken WITH food to prevent GI upset ;x causes hepatotoxicity (reddish-orange urine)
ISO N IAZ ID (IN H) taken on an E M PTY stomach for maximum absorption ;x causes PE R IPHER AL N EUROP A THY (char by numbness and tingling
sensation of hands and feet)x given with P YR IDO XIN E (V it. B6) ;x A void thyramine containing foods because they may cause reactionPYR AZ INAM IDE (PZA) causes hepatotoxicity and hyperuricemia ;x protect drug from light ;
ETHAM BUTOL (EM B) causes OPTI C N EUR ITIS characterized by blurring of
vision ;x not given in children less than 6 years old ;x A dminister with foodSTREPTOMYC IN must weigh px daily and monitor kidney function ;x causes OTOTO XIC ITY and N EPHROTO XIC ITY;x can be given to children less than 6 y/o ;x Obtain baseline audiometric test and repeat every 1 to 2 monyhs
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Second-line Drugs A mikacin Capreomycin Ciprofloxacin Cycloserine O floxacin Terizidone
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y N ursing Interventions:Isolate client for TW O WEEKS at the start ofA N TI-TB drugs.Provide px with adequate rest periods;Promote adequate nutritionA dvise to cover nose and mouth whensneezing and coughing;Provide frequent oral hygiene and handwashing;M onitor intake of medications;
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y Factors that contribute to thedevelopment of the disease:
PovertyO vercrowdingM alnutritionVitamin deficiencies ( A , D , C)D ecrease resistance due to existing infections(that threatens their immune system).
Children below 5yrs old who are prone toinfections due to factors found above.
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A cute viral infection affecting therespiratory system
Etiologic agent: myxoviruses, types A , A -prime, B, C
IP 24-48 hours
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PO C up to 5 th day of illness in children
MO T A irborne D irect contact droplet
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M anifestationsy Chilly sensationy Hyperpyrexiay M alaisey Sore throaty Coryzay Rhinorrhea
y M yalgiay headache
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D iagnostic procedures Blood exams O ropharyngeal swabbing
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M anagement N o specific treatment Symptomatic rest
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Preventive measure Immunization A voidance of crowded places
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y is an acute contagious viralinfection in the new millenniumthat originate in G uandongProvince of China;
y term coined by D r. Carlo Urbani
(WHO
) last 2002;y it causes severe form of atypical
pneumonia;
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y only has a 5% mortality rate in all cases
found around the world;
y significant history of travel to affected
areas such as G uandong, China; HongKong; Taiwan, and Singapore;
y at risk are individuals that are in closecontact with a SA RS patient (healthworkers, family members, care givers,classmates)
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y C ausative A gent: SA R S-corona virus.x a variant of the common cold
coronavirusx Virus survival outside body:
x 3 hours dry environment.
x 6 hours moist setting.
x Can be killed by exposure to sunlight.x M
utates easily.
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y IP: 1 - 13 days (ave. 2 5 days)
y M ode of Transmission:A irborne transmission
Indirect contact with inanimate objectscontaminated with nasopharyngeal andrespiratory secretions;
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y Diagnostic Examination :CXR shows atypical form of pneumonia;
CBC leucopenia and lymphopenia;Elevated lactate dehydrogenase.Elevated liver function test ( AS T and A LT)Viral Culture;Immunologic Test identify antibodies againstthe virus.
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M edical M anagement: Supportive management such as
ventilatory support; Use of A nti-viral agents, steroids, and large
doses of antibiotics are controversial;
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N ursing D iagnosis: Impaired airway clearance Ineffective breathing pattern High risk for injury: D eath
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y N ursing Interventions:ISO LA TE!!!Practice barrier method.Use complete PPE when caring for thepatient;
M onitor the patient for signs of respiratorydistress;A dvise relatives or anybody that were in closecontact with the patient to undergo
observation and quarantine;Educate the px and family about handwashing and handling linens and clothingproperly.
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y is an acute contagious bacterialinfection characterized by paroxysms ofrepeated cough and ends in awhooping sound;
y common in children LE SS THA N TWO YEA RS O LD .
y Causative A gent: Bordetella pertussis
y IP: 7 21 days;
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M ode of Transmission: D irect contact by airborne transmission Indirect contact thru nasopharyngeal
secretions;
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C linical M anifestations: Invasive Stage or catarrhal stage ;
x 7 14 days;x patient is highly contagious;x Fever x Watery eyes and sneezing
x N octurnal coughingx Restlessness or irritable
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Spasmodic Stage 4 12 weeks ;x Forceful successive coughing with
peculiar crowing sound or whoop;x 5 20 coughing;x Protrusion of tongue and eyeballs
during coughing;x Swollen face and neck;
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C onvalescent Stagex symptoms subsides;
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D iagnostic Examination: Cough plate or agar plate;
M edical M anagement: A ntibiotics Penicillin or Erythromycin; O 2 inhalation Prevent convulsions
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N ursing Interventions: ISO LA TE the client!!! provide a quiet and non-stimulating
environment; complete bed rest; small frequent feeding Prevention:
x D PT vaccination;
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y is an infestation of the skin produced byBURRO WIN G action of the parasite miteresulting in irritation and the formation ofvesicles or pustules;
y common in individuals living in areas ofpoverty where cleanliness is lacking;
y Causative A gent: Sarcoptes scabiei
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M ode of Transmission: Skin contact with an infected person; Indirect contact thru soiled bed linens and
clothing;
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C linical M anifestations: Intense itchiness especially at night ; Sites:
x Interdigital areasx Flexor surface of the wrist and palms;
x N ipplesx Umbilicusx A xillary foldsx G
roin or gluteal foldsx Penis and scrotum
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D iagnostic Examination: Presence on skin of female mites,
ova, and feces upon skin biopsy or scraping ;
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M edical M anagement: Permethrin 5% cream apply on the skin
below the neck; stay for at least 8 hours. Lindane solution (Kwell ) for bathing; Crotamiton (Eurax) ointment;
A nti-histamines to reduce itchiness.
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N ursing Interventions: Boiling of linens and clothes; Encourage to change clothing and bed
linen frequently Warm shower bath to remove scaling debris
or crusts;