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Lower Respiratory Tract

I. BRONCHITIS- inflammation of the mucous membrane of the bronchial tree

II. BRONCHOPNEUMONIA- bronchitis and pneumonia


IV. LARYNGITIS- inflammation of the larynx or voice box

Upper Respiratory Tract Infections

I. DIPHTHERIA- affects the pharynx, larynx, nose/nasal septum


Strains of the causative agent:

1. Gravis (severe)- produces the most severe and greatest number of fatal cases in Europe.

2. Mitis (mild)- produces lesions extending to the larynx and lungs but are rarely the cause
of death.

3. Intermedius (intermediate)- related to gravis but has the tendency to bleed.

- Microorganisms in the URT produce cytotoxins which usually start in the nose

- Types:

a. Nasal diphtheria

• With foul-smelling serosanguinous secretions from the nose

b. Faucial diphtheria

• Severe pharyngitis affecting the fauces caused by C. diphtheriae

c. Laryngeal diphtheria

• Most commonly found in children ages 2 to 5 years old

• Considered as the most severe and more fatal type due to anatomical reason

• Respiration is increased because less air is brought to the lungs due to the narrowing
of the air passages

• There is moderate hoarseness; the voice is diminished until it is finally absent.

d. Pharyngeal diphtheria

• More severe type

• Cervical lymph nodes become swollen

• Neck tissues are edematous that result in the appearance of a “bull’s neck”

• Has a marked degree of toxaemia

• Breath is usually fetid(smelly)

e. Wound or cutaneous diphtheria

• Affects the mucous membrane and break on the skin

- Diagnostics:

a. Nose and throat swab and culture

b. Checking of pseudomembrane
o Presence of a greyish white membrane (in laryngeal and pharyngeal diphth.)-
pathognomonic sign of diphtheria

o Do not attempt to remove the membrane because it may cause massive


o Increase fluid intake for 2-5 days.

- Modes of Transmission:

a. Direct contact

b. Indirect contact

- Clinical Manifestations:

1. Fatigue

2. Malaise

3. Slight sore throat

4. Febrile at 38’C

5. If extensive, febrile 40’C and above

6. Grayish-white pseudomembrane

7. Enlargement of lymph nodes

8. Breathing difficulty

9. Stridor- noise during exhalation

10. Husky voice

11. Increased hoarseness

12. Increased WBC and RBC counts

13. PE: increased tissue damage

14. Cervical adenitis

15. In severe cases, the entire neck becomes swollen with edema extending to the chest.

16. Nasal drainage/secretions

17. Swelling of the palate

- Treatment:

1. Penicillin

2. DAT or Diphtheria Antitoxin

a. Skin testing is necessary before the administration of antitoxin.

b. Fractional doses are given in positive cases, with the following schedule:

 0.05 ml (1:20 dilution) – SubQ

 0.05 ml (1:10 dilution) – SubQ

 0.10 ml undiluted – subQ

 0.20 ml undiluted – subQ

 0.50 ml undiluted – IM

 0.10 ml undiluted – IV

The above doses are given at 15 minutes interval if no reaction is

noted. If there is any, the remaining dose is given after an hour.
*** if no reactions, give through IV (desensitization)

3. Erythromycin- 40mg/kg bw in 4 doses x 7 to 10 days

4. Supportive therapy:

a. Maintenance of adequate nutrition

b. Maintenance of adequate fluid and electrolyte balance

c. Bed rest

d. Oxygen inhalation

e. In presence of laryngeal obstruction, emergency tracheostomy is usually done

- Nursing Management:

1. Provide small frequent feedings usually on a soft diet.

2. Give foods rich in Vitamins A and C to maintain the alkalinity of blood.

3. Ice collar

4. Proper isolation and disposal of respiratory discharges.

5. Patient must be advised to take absolute bed rest for at least 2 weeks.



- Modes of transmission: droplet

- Incubation period: few hours to several days

- May be caused by either bacterial or viral (self-limiting)


a. Adenoviruses

b. Influenza

c. Epstein-Barr

- BACTERIAL AGENT: streptococcus

- Clinical Manifestations:

1. Pain

2. Fever greater than 38’C

3. Dysphagia

4. Malaise secondary to increased BMR

5. Lymphadenopathy

6. Exudates from lymph

7. Hoarseness of voice

8. Tonsillitis leading to otitis media

9. Abdominal pain

10. Headache

11. Myalgia

12. Nausea and vomiting

13. Scarlatiniform rash or palatal petechiae

- Complications:

1. Peritonsillar abscesses/Quinsy

o Pus formation behind tonsils

o Associated with swelling and assymetric deviation of uvula

2. Painful swallowing

3. Thickening of voice

4. Drooling

5. Tonic contraction of masseter

6. Acute glomerulonephritis

7. Rheumatic fever

- Diagnostics:

a. Throat swab- gold standard for the diagnosis of Strep. pharyngitis

b. CBC

c. Isolation of microorganism

d. Culture

e. RADT- Rapid Antigen Detection Testing

- Treatment:

1. Antibiotics

a. Amoxicillin

b. Penicillin

c. Erythromycin

d. Cefuroxime

2. Antipyretics

- Surgical interventions:

a. I&D- Incision and Drainage

• If with sore throat, done in sitting position.

b. Tonsillectomy for chronic infection

- Discharge instructions:

a. Follow religiously therapeutic regimen.

b. Take warm saline gargles.

c. Take lozenges.

d. Antiseptics.

e. Be aware of possible complications.

f. Dispose discharges properly.

g. Perform proper hand washing.

h. No aspirin.

- Whooping cough

- Paroxysms of cough, highly contagious


- Repeated attacks of spasmodic coughing which consists of a series of explosive expirations,

typically ending in a long-drawn forced inspiration which produces the whoop and usually
followed by vomiting

- Gliary- substance that causes paroxysms.

- Incubation period: 7-14 days

- Spasmodic coughing causes:

1. Painful abdomen

2. Intraconjunctival haemorrhage

3. Umbilical hernia

- Always ends with a whoop every after expiration

- Modes of transmission:

a. Direct contact

b. Droplet

c. Ingestion

d. Indirect contact

- Microorganisms attach to ciliated epithelium (nasal cavity) then multiply

• Produce cytotoxins which start the infection process

• Excessive production of secretions

• Complications: Pneumonia; at risk for aspiration

- Types of Manifestations:

1. Classic/Catarrhal Stage: 7-14 days after exposure/ most communicable stage

a. Cough

b. Sneezing

c. Low grade fever

d. Runny nose

e. Mucoid rhinoria

f. Lacrimation

g. Dry bronchial cough

2. Paroxysmal Stage:

a. Episodes of paroxysms occur

b. Coryza and cough end with a whoop

c. Sneezing

d. Runny nose

e. Low grade fever

f. Rapid 5-10 coughs in one expiration

g. Cough is provoked by:

o Crying

o Eating

o Drinking

o Physical exertion

h. Convulsion due to intracranial haemorrhage

3. Convalescent Stage:

a. Gradual recovery from the disease

*** In adolescents with chronic cough, advise them to conduct sputum exam.

- Nursing Interventions:

a. Encourage mothers to have their children immunized with DPT (3 doses).

b. Nasopharyngeal culture via swab for diagnostics.

c. Observe respiratory isolation.

d. Have prophylactic treatment:

o Erythromycin


e. Increase oral fluid intake.

f. Nutrient intake.

g. Administer cough suppressants during night time to promote rest.

***attacks at night.

- Complications:

1. Interstitial pneumonia- inflammation of bronchioles secondary to invasion of


2. Atelectasis secondary to fluid accumulation in the pleural cavity

3. Convulsion due to hypoxemia

4. Umbilical hernia- common among children

5. Otitis media

6. Bronchopneumonia- inflammation of terminal bronchioles

7. Severe malnutrition and starvation due to persistent vomiting and inadequate sleep
and rest.



- Coryza, runny nose, colds

- Catarrhal in stage

- Purulent with secondary infection- may be either viral or bacterial in infectious process

• Coryza

common colds

acquired in crowded places

self-limiting disease

 occurs between 2-4 days

- Clinical manifestations:

a. Runny nose

b. Teary eyed

c. Sneezing

d. Coughing

e. Profused dishcarges

f. Erythematous and bloggy nose

• In severe cases,

1. Chills

2. Fever

3. Sore throat

4. Sinuses clogged with secretions

5. Hypernasality- congested paranasal sinuses

6. Low grade fever

7. Headache

8. Chacitis (?)

9. Sinusitis

10. Otitis media

- Causative agents:



*** cannot acquire immunity due to several strains causing coryza

- Modes of transmission:

a. Droplet

b. Coughing

c. Sneezing

d. Fomites

- Hyperactivity of goblet cells due to inflammation process

- No anticolds for treatment

- Medications:

1. Decongestants

2. Lozenges

- Nursing interventions:

1. Increase fluid intake especially when feeling dry.

2. Rest.

3. TSB if fever occurs.

4. Avoid crowded places.

5. Brisk walking- 30-35 minutes a day

- Exposure to allergens causes colds


- An acute viral infectious disease that affects the respiratory system

- Has many strains

- There are 4 or 5 vaccines available for this disease.

- A.K.A. Flu/La Grippe

- A highly contagious viral disease with the following prodromal manifestations:

1. Coryza

2. Fever

3. Headache

4. Malaise

- Causative agents: RNA CONTAINING MXOVIRUSES (Types A, A-prime, B, and C)

- Influenza A- outbreaks of influenza worldwide; 72 hours

- Modes of Transmission:

a. Direct contact

b. Airborne

- Rapid replication of viruses causes extensive infection at neighboring tissues

- Necrosis occurs due to cytotoxins

- Shedding of ulcer formation occurs

- Ciliated cells are the last to recover from wound healing

- Common manifestations:

1. Rhinorrhea

2. Cough

3. Colds

- Manifestations secondary to bacterial infection:

1. Sinusitis

2. otitis media

3. pneumonia

4. tracheobronchitis

- Clinical Manifestations:

1. Substernal burning

2. Sore throat

***Systemic Manifestations***

a. Fever

b. Chills
c. Malaise


e. Muscle aches

f. Fatigue

- Diagnostics:

a. History

b. CXR- diffusions and densities

c. Sputum exam- rule out viral or bacterial cause

d. CBC- decrease in WBC

- Treatment:

1. Immunization- Vaccine specific ABC Influenza

2. Antiviral drugs- prophylactic treatment for patients exposed to the disease

a. Amantadine

b. Remantadine

c. Remactane – reduces multiplication of viruses, and the manifestations

d. Ribavirin- e.g. Tamiflu, Octylamine

3. Analgesics- e.g. Acetaminophen

4. Antitussives- suppress cough

- Nursing Diagnoses:

1. Ineffective breathing pattern related to tenacious secretions from tracheobronchial


2. Ineffective airway clearance

3. Fluid volume deficit

4. Hyperthermia secondary to excessive pyrogen production

- Nursing interventions:

Tell the client the following things to do:

a. Stay at home

b. Drink plenty of fluids

c. Follow religiously therapeutic regimen

d. Sponge bath with tepid water

e. Isolate patient to decrease risk of infecting others

f. Limit strenuous activities

g. Watch out for complications

- Nursing discharge plan:

1. Emphasize importance of immunization.

2. Emphasize importance of resting particularly during the disease.

3. Increase fluid intake.

4. Take the appropriate meds (OTC).

5. Hygiene
Lower Respiratory Tract Infections


- An acute infectious disease caused by pneumococcus, associated by general toxaemia and a

consolidation of one or more lobes of either one or both lungs


- Protozoal agents usually affect HIV patients

- Most common microorganisms: BACTERIA, VIRUSES

- It is an acute nonspecific infection affecting the alveoli and tissue of the lungs

- Clinical manifestations:

1. Fever

2. Productive cough

3. Acute stabbing chest pain

4. Chills

5. SOB

6. Chest retractions with rusty sputum- pathognomonic signs

7. Diaphoresis

8. Convulsions

- Air sacs or alveoli are filled with exudates, inflammatory cells, and fibrin

- Five main causes of pneumonia:

1. Bacteria

2. Viruses

3. Mycoplasma

4. Fungi

5. Various chemicals

- Causative agents: G(+,-)




4. KLEBSIELA PNEUMONIAE or Friedlander’s bacilli

- G(+) : S. pneumonia

- G(-) : S. aureus, H. influenza, Klebsiela, Mycoplasmas, Fungi, Atypical mycobacterium,


- Classifications of Pneumonia

A. Community-acquired pneumonia- acquired in the course of one’s daily life --- at

work, at school, or at the gym; developed in less than 36 hours

o Most common cause: S. pneumonia

o Other causes:

1. H. influenza

2. Legionella
B. Nosocomial pneumonia- develops while the client is in the hospital

o Causative agents:

1. S. aureus

2. Klebsiela

3. P. aeruginosa

4. E. coli

5. Enterobacter group

C. Aspiration pneumonia- occurs when a foreign matter is inhaled into the lungs, most
commonly when a gastric content enters the lungs after vomiting

D. Pneumonia caused by opportunistic organisms- strikes people with compromised

immune system (AIDS/HIV), with TB, malnourishes

- Microorganisms inhaled or ingested cause the inflammation process.

- End result: exudate formation filled alveoli with serous fluids, PMNs

- Have CXR to assess for consolidation (hard tissues, alveoli), or having stabbing chest pain
with retractions.

- Nursing Diagnoses:

1. Impaired gas exchange

2. Impaired breathing pattern

3. Ineffective airway clearance

4. Activity intolerance

5. Sleep pattern disturbance

6. High risk for infection

7. Altered tissue perfusion

8. Altered nutrition: less than body requirements

9. Altered body temperature

- Diagnostics:

a. Gram staining- institutes proper antibiotic therapy

b. Sputum C&S- chooses effective antibiotics best for client

c. CBC- determines extent of infection

d. ABG- evaluates gas exchange

e. Pulse oximetry-measures oxygen saturation in arteries; NV: 95-100%

f. CXR- consolidation; TB

g. Fiber optic bronchoscopy- employed only if physician desires cytologic exam; last

- Treatment:

1. Antibiotics which are organism specific and eradicate causative agents

a. S. pneumonia:

o IV penicillin

o Amoxicillin

o Doxycycline
o Erythromycin

o Cefazolin

o Vancomycin

o Fluoroquinolones

b. S. aureus:

o Penicillinase resistant penicillin

o Vancomycin

o Methicillin

o Cephalexin

o Erythromycin

o Clindamycin

c. M. pneumonia:

o Erythromycin

o Azithromycin

o Doxycycline

o Clarithromycin

o Fluoroquinolones

d. Klebsiela:

o 3rd generation cephalosporins

o Aminoglycosides

o Metronidazole

o Imipenem cilastatin

e. P. carinii

o Climetropine

o TMP-SMZ/ Trimethoprim-Sulfamethoxazole

2. Other drugs:

a. Bronchodilators

b. Expectorants

c. Pain relievers

- Nursing interventions:

1. Increase fluid intake

2. Incentive spirometry

3. Suctioning if coughing is ineffective

4. Autotherapy- diffusion of gases along membranes

5. Chest physiotherapy

6. Proper disposal of secretions

7. Monitor vital signs closely and watch for danger signs like:
a. Marked dyspnea

b. Thread, small and irregular pulse

c. Delirium with extreme restlessness

d. Cold moist skin

e. Cyanosis and exhaustion

8. Control temperature by doing cooling measures.


- Chronic and recurrent

- A mycobacterial infection


- Formation of tubercles which tends to go caseation, necrosis, and/or calcification

- Mycobacterium bovis- from cows

- Mycobacterium africanum- from human

- Incubation period: 2-10 weeks

- Modes of transmission:

a. Droplet infection

b. Airborne

c. Direct contact

d. Indirect contact

e. Food contamination

f. Through skin lesion

- Risk for infection: affected by the following:

1. Characteristic of infectious person

2. Extent of air contamination

3. Duration of exposure

4. Susceptibility of the host

5. Number of microbes in the sputum

6. Frequency of coughing

7. Prolonged contact to persons with TB

8. Decreased socio-economic status

9. Homeless

10. Alcoholism

11. Injection drug users

12. HIV

- Classifications:

A. Class 0

 not been exposed to disease

 Negative reaction to tuberculin skin test

B. Class 1

 individual with positive exposure to TB

 no manifestations

 no treatments

 with prophylactic treatment

 Ghon complex

 Negative reaction to tuberculin skin test

C. Class II

 Positive to diagnostic procedures

 No symptoms experienced

 INH/Isoniazid is the prophylaxis

 Positive reaction to tuberculin skin test

 Negative bacteriologic studies

 Fibrocaseous cavitary lesion

D. Class III

 Frank case of TB

 SCC (short course chemotherapy)

1. INH

2. Rifampicin

3. Pyrazinamide

E. Class IV

 Post treated cases

 Not communicable

F. Class V

 Atypical cases

 Positive to S/S

 Negative to diagnosis

 Ethambutol- to prevent exhaustion

- Lungs are the areas of focus in this disease

- Clinical Manifestations:

1. Chest pain

2. Blood tinged sputum

3. Fatigue

4. Weight loss

5. Anorexia

6. Low grade afternoon fever/night fever- decreased resistance; increased virulence of

- Organisms encapsulate alveoli then hibernate in tissues

- Miliary TB- a.k.a extrapulmonary TB or disseminated tuberculosis

 Affects the meninges of the brain, bones, reproductive organs

- Tubercle formation in the cavitaries causing ulceration and shows haziness and no blood flow
in CXR, chees-like substance/Swiss cheese

- If TB becomes reactivated, it will become a full blown TB.

- Complications:

1. Empyema

2. Injury to visceral pleura causing effusion in the pleaural cavity

3. Bronchopleural fistula

4. Pneumothorax caused by ruptured visceral pleura, tension during coughing

5. Affectations:

a. GIT

b. GUT

c. Kidneys

d. Meninges- TB meningitis

e. Bones-

f. Bone marrows

- Diagnostics:

a. PPD Skin Test- done at the dorsal portion of the forearm

 Intradermally 0.5cc syringe

 Reading: 48-72 hours

 Result: Induration (elevated hardened skin)

Less than 5mm- negative

5-9mm- positive but asymptomatic

10-15mm- acquired at birth

15-18mm- common among Filipinos

b. Multiple puncture test- if positive, vesicle forms

c. Sputum exam

d. AFB analysis- confirmatory test for TB

e. CXR

f. C&S

g. Polymerase chain reaction- easily identifies TB from DNA

- Essentials prior to medication administration:

1. Liver function test

 Checks if patient has normal hepatic functions

 For Rifampicin, INH

2. Vision exam
 Determines optic neuritis

 For EMB, Myambutol

3. Audiometric exam

 Rhine’s and Webber’s tests

 Ototoxicity

 For aminoglycosides, streptomycin

- Treatment:

1. Isoniazid/INH- Anti-Koch’s

 First line of drug to treat TB

 ACOD (before meals once a day)

 Taken with Rifampicin (A/E: hepatotoxicity)

2. Rifampicin

 Taken with INH


3. Pyrazinamide or PZA

 Taken with INH and Rifampicin (SCC)

 Administration for the first 2 months of treatment

 Allows short term course of therapy

4. EMB, Myambutol

 Substitutes for INH

 Taken when patient is resistant to INH

 A/E: ototoxicity

5. Streptomycin

 Eradicates microorganisms

 Effective in treating mycobacterial infections

- DOTS- Directly Observed Treatment/Therapy Short course

- Nursing interventions:

1. Respiratory isolation

2. Cover nose and mouth when sneezing

3. Nutrition

4. Quit smoking

5. Compliance to therapeutic regimen

6. Rest

7. Sputum examination

8. Avoid crowded places

9. Immunizations

- Originated in China

- AH1N1- from Mexico

- Clinical Manifestations:

1. Cough

2. Chest pain

3. Fever

4. SOB

5. Hypoxia

6. DOB

- Epidemiologic Criteria:

1. Sudden onset of temperature 38’C and above

2. History of patient

3. Recent travel

4. Contacts

- Modes of transmission:

a. Direct contact

b. Droplet

c. Casual and social contacts

d. Fomites

- Treatment: no treatment. Empiric therapy.

- Diagnostics:

a. Serology- determines antibodies to new corona virus

b. CXR- interstitial pneumonia  consolidation

c. Pulse oximetry

d. CBC

e. Enzymatic studies- AST, ALT

f. Sputum exam

g. Blood culture

- Home care:

1. Prevention

a. Cover nose and mouth

b. Limit interaction outside home

c. Hand washing

d. Don’t share eating utensils with others


Functions of GIT:
1. Digestion

2. Absorption

3. Metabolism

4. Elimination

- Transient microorganisms are either ingested or resident

- Some are destroyed by HCl acid or resident flora


1. Colitis- inflammation of colon

2. Dysentery- frequency of watery stool

3. Enteritis- inflammation of the mucosal lining of the small intestine

4. Gastritis- inflammation of the lining of the stomach

5. Hepatitis- inflammation of the liver; caused by viral or toxic agents


- Via contaminated food and water

- Exotoxins released damage the mucosal lining of the stomach and small intestines

- Ulceration of the mucosa due to invasion of ulcers

- Enterotoxins- cause damage to the neighboring tissues

- Causative agents:

1. Staphylococcus

2. C. perfringens

3. C. botolinum- from contaminated canned goods

4. E. coli

5. Vibrio cholera

- Enter via micro/macrocirculation

- Water and fluid into the colon increase causing hypermotility

- Clinical manifestations:

1. Anorexia

2. N&V

3. Abdominal pain

4. Cramping

5. Borborygmic sounds

6. Diarrhea

7. Malaise

8. Headache

9. Weakness

10. Dry mucous membranes

11. Orthostatic hypotension

12. Tachycardia

13. Fever

- Types:

A. Traveller’s diarrhea- caused by E. coli and H. pylori

 Inc. Period: 48-72 hours

 Hyperexcretion of water into the lumen of large intestines

 Abrupt onset of diarrhea characterized by watery stool

 Mgt.: antidiarrheals- Loperamide (single dose)

B. Staphylococcal- from food poisoning or food inadequately cooked like:

1. Pasta

2. Noodles

 Manifestations:

a. Cramping abdominal pain

b. Intestinal obstruction- stimulates the vomiting center (area postrema) of

the brain by the enterotoxins causing VOMITING

c. Hypogastric pain

d. Diarrhea

 Mgt.: F&E replacement

C. Botulism

 Inc. Period: 1.5 hours- 8 days

 Enterotoxins affect the neuromuscular blockade and cause progressive


 Clinical Manifestations:

a. Diplopia- pupils dilate and fixate

b. Dysphagia

c. Progressive cephalocaudal paralysis/weakness

d. GI manifestation

e. Respiratory failure (possible complication)

 Mgt.:

a. Gastric lavage- induces patient vomit

b. Respiratory management and support

c. Antitoxins

D. Cholera


 Inc. period: 1-3 days

 Increased fluid production to the lumen of the small intestines

 Rice watery stool- pathognomonic sign

 Non odorous stool

 Manifestations:

a. Vomiting

b. Thirst

c. Oliguria

d. Muscle cramps

 Mgt. :

a. IVF

b. Tetracycline – 1


E. Salmonelliasis


 Inc. Period: 8-48 hours

 Superficial affectation on the mucosa of the intestine

 No ulcer formation

 Manifestations:

1. Abdominal pain

2. N&V

3. Low grade fever

4. Chills

5. Cramping

 Antibiotics:


2. Ciprofloxacin

F. Shigellosis or Bacillary Dysentery

 Bloody flux

 Caused by S. FISERI/DYSENTERAE (most fatal)

 Local tissue invasion: distal lumen

 Manifestations:

1. Diarrhea with severe abdominal pain

2. Tenesmus

 Mgt.:

1. F&E replacement

2. Correct acidosis

3. Antibiotics- TMP-SMZ, Ciprofloxacin

 Diagnostics:

1. Stool exam

2. Gram staining of vomitus

3. Serum toxin level- botulism

4. Assess serum osmolality- electrolytes and base balances

5. ABG analysis

6. Sigmoidoscopy

 Interventions:


1 tbsp. salt

1 tbsp. baking soda

4 tbsps. Granulated sugar

1L of water

Flavouring extract

2. IVF

3. Place on NPO

4. Institute bowel rest

5. Gastric lavage

6. Hand washing

7. Appropriate use of antidiarrheals


1. Herpes Zoster

2. Measles

3. Chicken pox