Infectious Dirorder

Pulmonary T.BPneumonia

Lung AbscessInfluenza

Presenter: Shahina AmirySr. Instructor AKUSON

Definition:TB is a bacterial infection caused by

Mycobacterium tuberculosis. It most commonly affects the lungs, producing pulmonary TB.

Cause: Gram +ve Mycobacterium tuberculebacilli.

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PathophysiologySusceptible person inhaled the organism

The organism settles in the alveoli and multiply

The organism may also transport through blood stream and lymph system to other parts of the

body

The body immune system respond by initiating inflammatory process and phagocytes take place

The tissue reaction causes accumulation of the exudates into the alveoli and causes

bronchopneumonia04/12/23 3www.health-nurses-doctors.com

Granulomas are formed which transformed into the fibrous tissues

The bacteria and macrophages become necrotic and form the cheesy mass

Compromised and inadequate immune response, re-infection and activation of dormant bacteria develop active disease

Ghon tubercle ulcerate and cheesy material releases into bronchi and bacteria become airborne and cause active

tuberculosis

Scar tissue form 04/12/23 4www.health-nurses-doctors.com

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Risk factors & TransmissionAirborne droplet during coughing, sneezing, spitting,

talking, laughing, singing. History of TB, personally, or amongst friends or

family. Migration from a country with a high incidence of TB.History of travel to an area with a high incidence of

TB.Alcohol and/or drug abuse.Compromised immunity due to illness, e.g., HIV

infection.Malnutrition Over crowd04/12/23 6www.health-nurses-doctors.com

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SIGN AND SYMPTOM

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Diagnostic test

Tuberculin skin test QuantiFERON-TB Gold test04/12/23 9www.health-nurses-doctors.com

Treatment:

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Medications: Primary Agents Secondary Agents

isoniazid* capreomycin

ethambutol cycloserine

pyrazinamide (PZA) ethionamide

rifampin kanamycin

Streptomycin para-aminosalicyclic acid (PSA)

*most frequently used

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Side Effects of Medication

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NURSING PRIORITIES

1. Achieve/maintain adequate ventilation/oxygenation.2. Prevent spread of infection.3. Support behaviors/tasks to maintain health.4. Promote effective coping strategies.5. Provide information about disease process/prognosis and

treatment needs.

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Diagnosis:Infection, risk for spread/reactivationAirway Clearance, ineffective Nutrition: imbalanced, less than body requirmentKnowledge, deficient regarding condition,

treatment,prevention, self-care, and discharge needs

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Infection, risk for spread/reactivation

Instruct patient to cough/sneeze and expectorate into tissue and to refrain from spitting.

Proper disposal of tissue and good hand washing techniques.

Identify individual risk factors for reactivation of tuberculosis

Awareness of transmission possibilities help patient take steps to prevent infection of others.

Note: AFB can pass through standard masks; therefore, particulate respirators are required.

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Assess respiratory function, e.g., breath sounds, rate, rhythm, and depth, and use of accessory muscles.

Note ability to expectorate mucus/cough effectively, document character, amount of sputum, presence of hemoptysis.

Place patient in semi- or high-Fowler’s position.

Assist patient with coughing and deep-breathing exercises.

Clear secretions from mouth and trachea; suction as necessary.

Maintain fluid intake of at least 2500 mL/day unless contraindicated

Provide oral care before and after respiratory treatments.04/12/23 16www.health-nurses-doctors.com

Nutrition: imbalanced, less than body requirements

Document patient’s nutritional status on admissionEncourage selection/ingestion of well-balanced

meals.

Ascertain patient’s usual dietary pattern, likes/dislikes.

Encourage small, frequent meals with foods high in protein and carbohydrates.

Monitor I&O and weight periodically.

Investigate anorexia and nausea/vomiting, and note possible correlation to medications. Monitor frequency, volume, consistency of stools.

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Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.

Aids in monitoring the effects of medications and patient’s response to therapy.

Monitor laboratory studies, e.g., sputum smear results; Liver function studies, e. g., AST/ALT.

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Discharge Teaching Discharge Teaching

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Summarization

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PNEUMONIA Pneumonia is an Inflammation of alveoli and

lungs parenchyma associated with a marked increase in interstitial and alveolar fluid.

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Causes and Risk factor

Bacterial (s.aureus, streptococcus, hemophilus influenza, pseudomonas)

ViralFungihead injury or general

anesthesia Exposure to chemicals Tracheal intubationImmuno-suppression(AIDS)Aspiration of food, fluids or

vomitus.04/12/23 23www.health-nurses-doctors.com

Bedridden, paralyzed, or unconscious

Chronic diseases (diabetes & heart failure)

Chronic obstructive pulmonary disease.

Very young and very old

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Pathophysiology

organism

Susceptible host

pneumonia

Organism via blood

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PathophysiologyInhalation of pathogen and harmless bacteria enter into the lower reparatory tract

Inflammatory reaction occurs in the alveoli and produces an exudates that interfere with diffusion of oxygen and carbon dioxide.

The WBCs especially neutrophills migrate to alveoli and fill the air containing space

The area of the lungs are not adequately ventilated because of secretion and mucosal edema

Hypoventilation

Arterial hypoxemia04/12/23 26www.health-nurses-doctors.com

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Sign and symptoms

*Productive cough Fever & chills

Dyspnea Sweating

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Less common sign & symptoms

FatigueRapid breathing and heart beat hemoptysisChest painNausea, vomiting, and muscle

achesLoss of appetite

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Pneumonia by Location in the Lung

Lobar PneumoniaBilateral PneumoniaSegmental PneumoniaBronchopneumoniaInterstitial PneumoniaAlveolar PneumoniaNecrotizing Pneumonia

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Pneumonia by Origin of Infection

Community-Acquired Pneumonia (CAP): Most common causes of bacterial CAP is

Streptococcus pneumonia Hospital-Acquired Pneumonia. Staphylococcus

aureus Aspiration Pneumonia

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Diagnostic evaluationMedical history Physical

examination

Chest X-ray CBC /ABGs

Culture of Sputum.

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TreatmentMedical management

Hospitalization Antibiotic therapy

Nebulization

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Nursing ProcessAssessment:HistoryPhysical examination

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Nursing DiagnosisIneffective airway clearance related to copious

tracheobronchial secretions.

Impaired Gas Exchange related to altered oxygen-carrying capacity of blood

Activity intolerance relate to Imbalance between oxygen supply and demand.

Altered nutrition less than body requirement

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Respiratory Isolation

Promote airway patency

Maintain hydration

Perform chest protocolDeep breathing exerciseChest PhysiotherapyUse of spirometerSuctionPostural drainage

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Maintain accurate intake and output.

Administer antipyretics and antibiotics on timely manner.

Encourage the low energy utilization activities.

Observe color of skin, mucous membranes, and nail beds, noting presence of peripheral cyanosis

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Instruct Parents on DischargeAbout medication administrationIncrease fluids intakeHumidified airSigns and symptoms of respiratory distress

Postural drainage techniquesFollow care Complications

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Definition Lung abscess is Collection of pus within lungs.

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CAUSESBacteria FungiCommonest cause is aspirationUnconscious or very drowsy because of

sedation, anesthesia, alcohol or drug abuse, or a disease of the nervous system (CVA).

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Pathophysiology

Lung infection (infectious agent) causes collection of pus

Pus form cavity that is formed by the necrosis of the lung tissues

Fibrosis tissue form around the abscess to wall it off

Erosion of abscess in the bronchial system causes fouls smell sputum

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Sign And symptomsChillsFeverFoul smell coughShivering Night sweatPurulent sputum

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Diagnostic Evaluation

Medical history Blood test Chest x-rayCT as neededSputum cultures Bronchoscopy as needed to

exclude cancer

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Management

Antibiotics (penicillin, cephalosporin)

Oxygen may be given to patients who are having trouble breathing.

Drainage or aspiration of abscess through bronchoscopy.

Pulmonary resection (lobectomy) very rare

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Nursing ManagementEmphasize on complianceTeach coughing exercise Chest physiotherapyFrequent mouth careProvide adequate rest, good nutrition and

increase fluid intakeHigh protein high caloric diet.

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Definition :

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Prevalence / Epidemiology

2003 Large outbreak of influenza A(H5NI) or avian flu spread among poultry in Asia.

By 2004 humans had infected in nine countries.

Influenza differs from common cold primarily in its sudden onset and widespread occurrence in population.

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Types Influenza A ; Responsible for regular

outbreaks, including the one of 1918. Influenza A viruses also infect domestic animals (pigs, horses, chickens, ducks) and some wild birds

Influenza B: causes localized out, especially in residential communities like nursing homes.

Influenza C:common but cause fewer symptoms

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Causes / Risk Factors Spreads from person to person

through respiratory droplets from coughing and sneezing

Occasionally from touching something with virus on it and then touching mouth or nose

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Adults may be able to infect others 1 day before getting symptoms and up to 7 days after getting sick

Immunocompromised

Resident of chronic care facility and health care worker

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Signs and Symptoms

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Diagnostic Evaluation

CBC, CXRThroat swab for culture

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ManagementInterventions are based on manifestation as

they arise. Vaccination (70-90 effective) must be given in

mid OctoberAntiviral drugs AntibioticsAnti-pyretic

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Nursing ManagementHighly contagious disease*Respiratory isolationPromote RestAdequate HydrationPromote airway patency (chest Protocol)Assess for high risk from complications of the flu

such as people 65 years or older, people with chronic medical conditions, pregnant women and young children.

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