Interventions for Clients with Interventions for Clients with Infectious Problems of the Infectious 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 Allergic - often called “hay fever” or

“allergies”“allergies”

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

Interventions include:Interventions include:– Drug therapy: antihistamines and Drug therapy: antihistamines and

decongestants, antipyretics, decongestants, antipyretics, antibioticsantibiotics

– Complementary and alternative Complementary and alternative therapytherapy

– Supportive therapySupportive therapy

SinusitisSinusitis Inflammation of the mucous Inflammation of the mucous

membranes of the sinusesmembranes of the sinuses Swelling can obstruct the flow of Swelling can obstruct the flow of

secretions from the sinuses, which secretions from the sinuses, which may subsequently becomemay subsequently become infected. infected.

The disorder often accompanies or The disorder often accompanies or follows acute or chronic allergic follows acute or chronic allergic rhinitis. rhinitis.

Other conditions contributing to Other conditions contributing to sinusitis include a deviated nasal sinusitis include a deviated nasal septum, polyps, tumors, chronically septum, polyps, tumors, chronically inhaled air pollutants or cocaine, inhaled air pollutants or cocaine, facial trauma, nasotracheal facial trauma, nasotracheal intubation, dental infection, or cystic intubation, dental infection, or cystic fibrosisfibrosis

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

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

SinusitisSinusitis The clinical manifestations of The clinical manifestations of

sinusitis include sinusitis include – nasal swelling and congestion, nasal swelling and congestion, – headache, headache, – facial pressure, facial pressure, – pain (usually made worse by pain (usually made worse by

movement of the head to a movement of the head to a dependent position), dependent position),

– tenderness on percussion tenderness on percussion over the involved area, over the involved area,

– low-grade fever, low-grade fever, – cough, and purulent or bloody cough, and purulent or bloody

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

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

Tonsillitis Tonsillitis

Inflammation and infection of the tonsils and Inflammation and infection of the tonsils and lymphatic tissues located on each side of the throatlymphatic tissues located on each side of the throat

Contagious airborne infection, usually bacterialContagious airborne infection, usually bacterial AntibioticsAntibiotics Surgical interventionSurgical intervention

Peritonsillar AbscessPeritonsillar Abscess

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

one-sided swelling with deviation one-sided swelling with deviation of the uvulaof 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, membranes lining the larynx, possibly including edema of possibly including edema of the vocal cordsthe vocal cords

Acute hoarseness, dry cough, Acute hoarseness, dry cough, difficulty swallowing, difficulty swallowing, temporary voice loss temporary voice loss (aphonia)(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 viral Flu” is a highly contagious acute viral

respiratory infection.respiratory infection. Manifestations include severe headache, Manifestations include severe headache,

muscle ache, fever, chills, fatigue, muscle ache, fever, chills, fatigue, weakness, and anorexia.weakness, and 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

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 breathe at Help client to cough and deep breathe at

least every 2 hours.least every 2 hours.– Administer incentive spirometer—chest Administer incentive spirometer—chest

physiotherapy if complicated.physiotherapy if complicated.– Prevent dehydration.Prevent dehydration.– Monitor intake and output of fluids.Monitor intake and output of fluids.

– Use bronchodilators, especially betaUse bronchodilators, especially beta22 agonists.agonists.

– Inhaled steroids are rarely used.Inhaled steroids are rarely used.

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 Increase related to the onset of

HIVHIV

Assessment Assessment

Diagnosis of TB considered for any client with a Diagnosis of TB considered for any client with a persistent cough or other compatible symptoms persistent cough or other compatible symptoms (weight loss, anorexia, night sweats, hemoptysis, (weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills)shortness of breath, fever, or chills)

Bacillus Calmette-Guerin vaccine within previous 10 Bacillus Calmette-Guerin vaccine within previous 10 years produces positive skin test, complicating years produces 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 Low-grade fever, night

sweatssweats Cough, mucopurulent Cough, mucopurulent

sputum, blood streakssputum, blood 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 Localized area of lung destruction caused by destruction caused by liquefaction necrosis, liquefaction necrosis, usually related to usually related to pyogenic bacteriapyogenic bacteria

Pleuritic chest painPleuritic chest pain InterventionsInterventions

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

for for Candida albicansCandida albicans

Inhalation AnthraxInhalation Anthrax

Bacterial infection is caused by the Bacterial infection is caused by the gram-positive, rod-shaped gram-positive, rod-shaped organism 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