Interventions for Interventions for Clients with Infectious Clients with Infectious

Problems of the Problems of the Respiratory TractRespiratory Tract

RhinitisRhinitis Inflammation of the nasal mucosaInflammation of the nasal mucosa Infectious; Allergic; Infectious; Allergic; Rhinitis medicamentosa Allergic - often called “hay fever” or “allergies”Allergic - often called “hay fever” or “allergies”

Symptoms - headache, nasal irritation, Symptoms - headache, nasal irritation, sneezing, nasal congestion, rhinorrhea (watery sneezing, nasal congestion, rhinorrhea (watery drainage from the nose), and itchy, watery drainage from the nose), and itchy, watery eyes. eyes.

Interventions include:Interventions include:– Drug therapy: antihistamines Drug therapy: antihistamines and decongestants, antipyretics,and decongestants, antipyretics, antibioticsantibiotics– Complementary and alternative Complementary and alternative therapytherapy– Supportive therapySupportive therapy

RhinitisRhinitis

SinusitisSinusitis

Inflammation of the mucous membranes of the sinusesInflammation of the mucous membranes of the sinuses Swelling can obstruct the flow of secretions from the Swelling can obstruct the flow of secretions from the

sinuses, which may subsequently becomesinuses, which may subsequently become infected. infected. The disorder often accompanies or follows acute or chronic The disorder often accompanies or follows acute or chronic

allergic rhinitis. allergic rhinitis. Other conditions contributing to sinusitis include a deviated Other conditions contributing to sinusitis include a deviated

nasal septum, polyps, tumors, chronically inhaled air nasal septum, polyps, tumors, chronically inhaled air pollutants or cocaine, facial trauma, nasotracheal pollutants or cocaine, facial trauma, nasotracheal intubation, dental infection, or cystic fibrosisintubation, dental infection, or cystic fibrosis

The causative organism in sinus infection is usually The causative organism in sinus infection is usually Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Haemophilus influenzae, Diplococcus, Diplococcus, or or Bacteroides. Bacteroides. Anaerobic infections also can Anaerobic infections also can cause sinusitis. cause sinusitis.

Sinusitis most often develops in the maxillary and frontal Sinusitis most often develops in the maxillary and frontal sinuses. sinuses.

Complications include cellulitis, abscess, and meningitisComplications include cellulitis, abscess, and meningitis

SinusitisSinusitis

SinusitisSinusitis

The clinical manifestations of sinusitis The clinical manifestations of sinusitis include include – nasal swelling and congestion, nasal swelling and congestion, – headache, headache, – facial pressure, facial pressure, – pain (usually made worse by movement of the pain (usually made worse by movement of the

head to a dependent position), head to a dependent position), – tenderness on percussion over the involved area, tenderness on percussion over the involved area, – low-grade fever, low-grade fever, – cough, and purulent or bloody nasal drainagecough, and purulent or bloody nasal drainage

SinusitisSinusitis (Continued)(Continued)

Nonsurgical managementNonsurgical management– Broad-spectrum antibioticsBroad-spectrum antibiotics– AnalgesicsAnalgesics– DecongestantsDecongestants– Steam humidificationSteam humidification– Hot and wet packs over the sinus Hot and wet packs over the sinus

areaarea– Nasal saline irrigationsNasal saline irrigations

Surgical ManagementSurgical Management Antral irrigationAntral irrigation Caldwell-Luc procedureCaldwell-Luc procedure Nasal antral window procedureNasal antral window procedure Endoscopic sinus surgeryEndoscopic sinus surgery

Pharyngitis Pharyngitis

Sore throat is common inflammation Sore throat is common inflammation of the mucous membranes of the of the mucous membranes of the pharynx.pharynx.

Assess for odynophagia, dysphagia, Assess for odynophagia, dysphagia, fever, and hyperemia.fever, and hyperemia.

Strep throat can lead to serious Strep throat can lead to serious medical complications.medical complications.

Epiglottitis is a rare complication of Epiglottitis is a rare complication of pharyngitis.pharyngitis.

PharyngitisPharyngitis

Tonsillitis Tonsillitis Inflammation and infection of Inflammation and infection of

the tonsils and lymphatic tissues the tonsils and lymphatic tissues located on each side of the located on each side of the throatthroat

Contagious airborne infection, Contagious airborne infection, usually bacterialusually bacterial

AntibioticsAntibiotics Surgical interventionSurgical intervention

TonsillitisTonsillitis

Peritonsillar Peritonsillar AbscessAbscess

Complication of acute tonsillitisComplication of acute tonsillitis Pus behind the tonsil, causing Pus behind the tonsil, causing

one-sided swelling with one-sided swelling with deviation of the uvuladeviation of the uvula

Trismus and difficulty breathingTrismus and difficulty breathing Percutaneous needle aspiration Percutaneous needle aspiration

of the abscessof the abscess Completion of antibiotic regimenCompletion of antibiotic regimen

Laryngitis Laryngitis Inflammation of the mucous Inflammation of the mucous

membranes lining the larynx, possibly membranes lining the larynx, possibly including edema of the vocal cordsincluding edema of the vocal cords

Acute hoarseness, dry cough, Acute hoarseness, dry cough, difficulty swallowing, temporary voice difficulty swallowing, temporary voice loss (aphonia)loss (aphonia)

Voice rest, steam inhalation, Voice rest, steam inhalation, increased fluid intake, throat increased fluid intake, throat lozengeslozenges

Therapy: relief and preventionTherapy: relief and prevention

Influenza Influenza

““Flu” is a highly contagious acute Flu” is a highly contagious acute viral respiratory infection.viral respiratory infection.

Manifestations include severe Manifestations include severe headache, muscle ache, fever, headache, muscle ache, fever, chills, fatigue, weakness, and chills, fatigue, weakness, and anorexia.anorexia.

Vaccination is advisable.Vaccination is advisable. Antiviral agents may be effective.Antiviral agents may be effective.

Pneumonia Pneumonia Excess of fluid in the lungs resulting Excess of fluid in the lungs resulting

from an inflammatory processfrom an inflammatory process Inflammation triggered by infectious Inflammation triggered by infectious

organisms and inhalation of irritantsorganisms and inhalation of irritants Community-acquired infectious Community-acquired infectious

pneumoniapneumonia Nosocomial or hospital-acquiredNosocomial or hospital-acquired AtelectasisAtelectasis Hypoxemia Hypoxemia

PneumoniaPneumonia appearanceappearance

– flushed cheeks, flushed cheeks, – bright eyes, bright eyes, – anxious expression. anxious expression.

chest or pleuritic pain or discomfort, chest or pleuritic pain or discomfort, myalgia, myalgia, headache, headache, chills, fever, chills, fever, cough, cough, tachycardia, tachycardia, dyspnea, tachypnea, and sputum production. dyspnea, tachypnea, and sputum production. severe chest muscle weakness also may be severe chest muscle weakness also may be

present from sustained coughingpresent from sustained coughing

PneumoniaPneumonia Crackles are heard on auscultation when there is fluid in Crackles are heard on auscultation when there is fluid in

interstitial and alveolar areas. interstitial and alveolar areas. Wheezing may be heard as a result of inflammation and Wheezing may be heard as a result of inflammation and

exudate in the airways. exudate in the airways. Bronchial breath sounds are heard over areas of density or Bronchial breath sounds are heard over areas of density or

consolidation. consolidation. Tactile fremitus is increased over areas of pneumonia, and Tactile fremitus is increased over areas of pneumonia, and

percussion is dulled in these areas. percussion is dulled in these areas. Chest expansion may be diminished or unequal on Chest expansion may be diminished or unequal on

inspiration.inspiration. The client with pneumonia is likely to be hypotensive with The client with pneumonia is likely to be hypotensive with

orthostatic changes. A rapid, weak pulse may indicate orthostatic changes. A rapid, weak pulse may indicate hypoxemia, dehydration, or impending shock.hypoxemia, dehydration, or impending shock.

The nurse also inspects the skin for a rash, which may The nurse also inspects the skin for a rash, which may occur with occur with Mycoplasma Mycoplasma infection, cytomegalovirus infection infection, cytomegalovirus infection (CMV), or Rocky Mountain spotted fever(CMV), or Rocky Mountain spotted fever

Laboratory AssessmentLaboratory Assessment Gram stain, culture, and sensitivity Gram stain, culture, and sensitivity

testing of sputumtesting of sputum Complete blood countComplete blood count Arterial blood gas Arterial blood gas levellevel Serum blood, urea Serum blood, urea nitrogen levelnitrogen level ElectrolytesElectrolytes CreatinineCreatinine

Impaired Gas ExchangeImpaired Gas Exchange Interventions include:Interventions include:

– Cough enhancementCough enhancement– Oxygen therapyOxygen therapy– Respiratory monitoringRespiratory monitoring

Ineffective Airway Ineffective Airway ClearanceClearance

Interventions include:Interventions include:– Help client to cough and deep Help client to cough and deep

breathe at least every 2 hours.breathe at least every 2 hours.– Administer incentive spirometer—Administer incentive spirometer—

chest physiotherapy if complicated.chest physiotherapy if complicated.– Prevent dehydration.Prevent dehydration.

Ineffective Airway Ineffective Airway ClearanceClearance (Continued) (Continued)

– Monitor intake and output of fluids.Monitor intake and output of fluids.– Use bronchodilators, especially Use bronchodilators, especially

betabeta22 agonists. agonists.– Inhaled steroids are rarely used.Inhaled steroids are rarely used.

Potential for SepsisPotential for Sepsis• Primary intervention is prescription Primary intervention is prescription

of anti-infectives for eradication of of anti-infectives for eradication of organism causing the infection.organism causing the infection.

• Drug resistance is a problem, Drug resistance is a problem, especially among older people.especially among older people.

• Interventions for aspiration Interventions for aspiration pneumonia aimed at preventing lung pneumonia aimed at preventing lung

damage and treating infection.damage and treating infection.

Severe Acute Severe Acute Respiratory Respiratory

Syndrome (SARS)Syndrome (SARS) A virus from a family of virus A virus from a family of virus

types known as “coronaviruses”types known as “coronaviruses” Virus infection of cells of the Virus infection of cells of the

respiratory tract, triggering respiratory tract, triggering inflammatory responseinflammatory response

No known effective treatment for No known effective treatment for this infectionthis infection

Prevention of spread of infectionPrevention of spread of infection

Pulmonary TuberculosisPulmonary Tuberculosis Highly communicable disease Highly communicable disease

caused by caused by Mycobacterium Mycobacterium tuberculosistuberculosis

Most common bacterial infectionMost common bacterial infection Transmitted via aerosolizationTransmitted via aerosolization Initial infection multiplies freely in Initial infection multiplies freely in

bronchi or alveolibronchi or alveoli Secondary TBSecondary TB Increase related to the onset of HIVIncrease related to the onset of HIV

Pulmonary TuberculosisPulmonary Tuberculosis

Assessment Assessment

Diagnosis of TB considered Diagnosis of TB considered for any client with a for any client with a persistent cough or otherpersistent cough or other compatible symptoms (weight loss, compatible symptoms (weight loss,

anorexia, night sweats, anorexia, night sweats, hemoptysis, shortness of breath, hemoptysis, shortness of breath, fever, or chills)fever, or chills)

Bacillus Calmette-Guerin vaccine Bacillus Calmette-Guerin vaccine within previous 10 years produces within previous 10 years produces positive skin test, complicating positive skin test, complicating interpretation of TB test.interpretation of TB test.

Clinical Manifestations of Clinical Manifestations of TBTB

Progressive fatigueProgressive fatigue LethargyLethargy NauseaNausea AnorexiaAnorexia Weight lossWeight loss Irregular mensesIrregular menses Low-grade fever, night sweatsLow-grade fever, night sweats Cough, mucopurulent sputum, Cough, mucopurulent sputum,

blood streaksblood streaks

Diagnostic AssessmentDiagnostic Assessment Manifestation of signs and symptomsManifestation of signs and symptoms Positive smear for acid-fast bacillusPositive smear for acid-fast bacillus Confirmation of diagnosis by sputum Confirmation of diagnosis by sputum

culture of culture of M. tuberculosisM. tuberculosis Tuberculin test (Mantoux test) Tuberculin test (Mantoux test)

purified protein derivative given purified protein derivative given intradermally in the forearmintradermally in the forearm

Induration of 10 mm or greater Induration of 10 mm or greater diameter indicative of exposurediameter indicative of exposure

(Continued)(Continued)

Diagnostic AssessmentDiagnostic Assessment (Continued)(Continued)

Positive reaction does not mean Positive reaction does not mean that active disease is present, that active disease is present, but does indicate exposure to TB but does indicate exposure to TB or dormant disease.or dormant disease.

InterventionsInterventions Combination drug therapy strict Combination drug therapy strict

adherenceadherence IsoniazidIsoniazid RifampinRifampin PyrazinamidePyrazinamide Ethambutol or streptomycin Ethambutol or streptomycin Negative sputum culture indicative Negative sputum culture indicative

of client no longer being infectiousof client no longer being infectious

Health TeachingHealth Teaching Follow exact drug regimen.Follow exact drug regimen. Proper nutrition must be Proper nutrition must be

maintained.maintained. Reverse weight loss and severe Reverse weight loss and severe

lethargy.lethargy. Educate client about the disease.Educate client about the disease.

Lung AbscessLung Abscess

Localized area of lung destruction Localized area of lung destruction caused by liquefaction necrosis, caused by liquefaction necrosis, usually related to pyogenic bacteriausually related to pyogenic bacteria

Pleuritic chest painPleuritic chest pain InterventionsInterventions

– AntibioticsAntibiotics– Drainage of abscessDrainage of abscess– Frequent mouth care for Frequent mouth care for Candida Candida

albicansalbicans

Inhalation AnthraxInhalation Anthrax

Bacterial infection is caused by the Bacterial infection is caused by the gram-positive, rod-shaped organism gram-positive, rod-shaped organism Bacillus anthracisBacillus anthracis from from contaminated soil.contaminated soil.

Fatality rate is 100% if untreated.Fatality rate is 100% if untreated. Two stages are the prodromal stage Two stages are the prodromal stage

and the fulminant stage.and the fulminant stage. Drug therapy includes ciprofloxacin, Drug therapy includes ciprofloxacin,

doxycycline, and amoxicillin.doxycycline, and amoxicillin.

Pulmonary EmpyemaPulmonary Empyema A collection of pus in the pleural A collection of pus in the pleural

spacespace Most common cause: pulmonary Most common cause: pulmonary

infection, lung abscess, and infection, lung abscess, and infected pleural effusioninfected pleural effusion

Interventions include:Interventions include:– Emptying the empyema cavityEmptying the empyema cavity– Re-expanding the lungRe-expanding the lung– Controlling the infectionControlling the infection