y

is the inflammation of the lung parenchyma (terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sac, and alveoli) it is classified according to its causative agent; the incubation period depends on what type of microorganism caused the disease;

pneumonia usually arises from endogenous microflora of the person whose resistance have been altered or from aspiration of oropharyngeal secretions; patients with pneumonia may have an underlying infection that impairs host defense;

Bacterial Pneumonia

x Streptococcus pneumoniae x Staphylococcus aureus x Gram-negative Bacteria Klebsiella, Pseudomonas, or Escherichia; x Hemophilus influenzae x Atypical Pneumonia walking pneumonia x Legionella pneumophila x Mycoplasma pneumoniae x Chlamydia trachomatis

 Viral Pneumonia

x Influenza viruses x Parainfluenza x Adenoviruses

 Fungal Pneumonia

x Aspergillus fumigatus x Pneumocystis carinii AIDS patients

Mode of Transmission:
Inhalation of respiratory secretions from

an infected individual; Aspiration of oropharyngeal secretions; Thru the bloodstream; From direct spread as a result of surgery or trauma;

Clinical Manifestations:
Sudden onset of fever, high-grade with chills; Cough, productive; Dyspnea; Pleuritic chest pain aggravated by coughing or breathing; Tachypnea accompanied by grunting, nasal flaring, use of accessory muscles and fatigue; Rapid, bounding pulse;

Diagnostic Evaluation:
CBC Chest X-ray to show presence of pneumonic infiltrates and the extent of pneumonia. Sputum Grams stain - may indicate offending microorganism; Sputum culture and sensitivity may also confirm offending microorganism; Blood culture to confirm the presence of bacterial pneumonia; Immunologic test detecting microbial antigens in serum, sputum, and urine.

Medical Management:
Antimicrobial therapy x Depends on laboratory identification of causative agents and its sensitivity; x For Bacterial pneumonia:
x x x x x Penicillin Cefuroxime Ceftriaxone Cotrimoxazole Azithromycin

x For Viral Pneumonia x Most of the time it is self-limiting. x Symptomatic and supportive management.

 Oxygen therapy Mucolytic and other cough medicines Bronchodilators Steroid therapy

Nursing Diagnosis:
Impaired gas exchange Ineffective airway clearance

Nursing Interventions:
Assess px for cyanosis, dyspnea, hypoxia, and confusion; Administer 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 postural drainage. Auscultate chest for crackles and rhonchi. Mobilize client even on bed to improve secretion clearance.

Complications:
Pleural effusion parapneumonic effusion Cardiovascular collapse especially from

gram (-) bacteria/sepsis; Superinfection Delirium due to cerebral hypoxia; Atelectasis

is a chronic bacterial infection characterized by granuloma formation, necrosis, and calcification of involved tissues; one of the leading cause of morbidity and mortality in the Philippines and other developing countries. fairly common among low-income, congested families;

approximately 10% (5 - 14%) of cases are ASYMPTOMATIC;

can be:

Minimal slight lesions without demonstrable excavation and confined to the apex; Moderately Advanced cavities less than 4 cm involving one or both lungs; Far Advanced lesions more extensive than moderately advanced TB;

Causative Agent: Mycobacterium tuberculosis

x acid-fast bacilli, aerobic;

IP:

3 8 weeks;

Mode of Transmission;
Nasopharyngeal secretions Drinking of infected cows milk Droplet nuclei infection

TB Classification according to ATS:

Class 0 no TB exposure; no infection; (-) PPD; Class 1 (+) exposure; no infection; (-) PPD; Class 2 (+) exposure; (+) PPD; no symptoms;
x Recent or actual TB infection;

Class 3 (+) exposure; (+) PPD; (+) symptoms; (+) CXR;

x Active TB;

Class 4 (+) exposure; (+) PPD; no active disease; (+) CXR;

x Previous PTB disease;

Class 5 (+) exposure; (+) PPD; (+) CXR; equivocal findings;

x PTB Suspect;

Multiple Drug-Resistance Tuberculosis (MDRTB) suspect in PTB class 3 patients who are still sputum smear or sputum culture positive (+) despite 3 months of adequate treatment;

Clinical Manifestations:
fever, low-grade, late afternoon or early evening; chills anorexia weight loss chronic cough more than two weeks; nocturnal sweating chest and back pains dyspnea and hemoptysis

Diagnostic Examinations:
Chest X-ray (PA - lateral and apicolordotic view) Sputum AFB 3 consecutive mornings; to identify 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 PNSS.

 Bronchoscopy Mantoux test or PPD; exposure to TB; Mycobacterium TB Culture confirmatory; Liver Function Test AST and ALT;

1. First-line Medications -

RIPES

RIFAMPICIN (RIF) taken WITH food to prevent GI upset; x causes hepatotoxicity (reddish-orange urine) ISONIAZID (INH) taken on an EMPTY stomach for maximum absorption; x causes PERIPHERAL NEUROPATHY (char by numbness and tingling sensation of hands and feet) x given with PYRIDOXINE (Vit. B6); x Avoid thyramine containing foods because they may cause reaction PYRAZINAMIDE (PZA) causes hepatotoxicity and hyperuricemia; x protect drug from light; ETHAMBUTOL (EMB) causes OPTIC NEURITIS characterized by blurring of vision; x not given in children less than 6 years old; x Administer with food STREPTOMYCIN must weigh px daily and monitor kidney function; x causes OTOTOXICITY and NEPHROTOXICITY; x can be given to children less than 6 y/o; x Obtain baseline audiometric test and repeat every 1 to 2 monyhs

Second-line Drugs
Amikacin Capreomycin Ciprofloxacin Cycloserine Ofloxacin Terizidone

Nursing Interventions:
Isolate client for TWO WEEKS at the start of ANTI-TB drugs. Provide px with adequate rest periods; Promote adequate nutrition Advise to cover nose and mouth when sneezing and coughing; Provide frequent oral hygiene and hand washing; Monitor intake of medications;

Factors that contribute to the development of the disease:

Poverty Overcrowding Malnutrition Vitamin deficiencies (A, D, C) Decrease resistance due to existing infections (that threatens their immune system). Children below 5yrs old who are prone to infections due to factors found above.

Acute viral infection affecting the respiratory system Etiologic agent: myxoviruses, types A, Aprime, B, C IP 24-48 hours

POC up to 5th day of illness in children

MOT Airborne Direct contact droplet

Manifestations y Chilly sensation y Hyperpyrexia y Malaise y Sore throat y Coryza y Rhinorrhea y Myalgia y headache

Diagnostic procedures Blood exams Oropharyngeal swabbing

Management No specific treatment Symptomatic rest

Preventive measure Immunization Avoidance of crowded places

y is

an acute contagious viral infection in the new millennium that originate in Guandong Province of China; coined by Dr. Carlo Urbani (WHO) last 2002;

y term

y it

causes severe form of atypical pneumonia;

only has a 5% mortality rate in all cases found around the world; significant history of travel to affected areas such as Guandong, China; Hong Kong; Taiwan, and Singapore; at risk are individuals that are in close contact with a SARS patient (health workers, family members, care givers, classmates)

Causative Agent: SARS-corona virus.

x a variant of the common cold coronavirus x Virus survival outside body: x 3 hours dry environment. x 6 hours moist setting. x Can be killed by exposure to sunlight. x Mutates easily.

IP: 1 - 13 days (ave. 2 5 days)

Mode of Transmission:
Airborne transmission Indirect contact with inanimate objects contaminated with nasopharyngeal and respiratory secretions;

Clinical Manifestations:
Fever, moderate- to- high-grade fever. Chills. Flu-like manifestations. Cough, productive or non-productive. Sudden episode of dyspnea.

Diagnostic Examination

CXR shows atypical form of pneumonia; CBC leucopenia and lymphopenia; Elevated lactate dehydrogenase. Elevated liver function test (AST and ALT) Viral Culture; Immunologic Test identify antibodies against the virus.

Medical Management:
Supportive management such as

ventilatory support; Use of Anti-viral agents, steroids, and large doses of antibiotics are controversial;

Nursing Diagnosis:
Impaired airway clearance Ineffective breathing pattern High risk for injury: Death

Nursing Interventions:
ISOLATE!!! Practice barrier method. Use complete PPE when caring for the patient; Monitor the patient for signs of respiratory distress; Advise relatives or anybody that were in close contact with the patient to undergo observation and quarantine; Educate the px and family about hand washing and handling linens and clothing properly.

is an acute contagious bacterial infection characterized by paroxysms of repeated cough and ends in a whooping sound; common in children LESS THAN TWO YEARS OLD. Causative Agent: Bordetella pertussis IP: 7 21 days;

y y

Mode of Transmission:
Direct contact by airborne transmission Indirect contact thru nasopharyngeal

secretions;

Clinical Manifestations:
Invasive Stage or catarrhal stage; x 7 14 days; x patient is highly contagious; x Fever x Watery eyes and sneezing x Nocturnal coughing x Restlessness or irritable

 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;

 Convalescent Stage

x symptoms subsides;

Diagnostic Examination:
Cough plate or agar plate;

Medical Management:
Antibiotics Penicillin or Erythromycin; O2 inhalation Prevent convulsions

Nursing Interventions:

ISOLATE the client!!! provide a quiet and non-stimulating

environment; complete bed rest; small frequent feeding Prevention: x DPT vaccination;

is an infestation of the skin produced by BURROWING action of the parasite mite resulting in irritation and the formation of vesicles or pustules;

common in individuals living in areas of poverty where cleanliness is lacking;

Causative Agent: Sarcoptes scabiei

Mode of Transmission:
Skin contact with an infected person; Indirect contact thru soiled bed linens and

clothing;

Clinical Manifestations:
Intense itchiness especially at night; Sites:

x Interdigital areas x Flexor surface of the wrist and palms; x Nipples x Umbilicus x Axillary folds x Groin or gluteal folds x Penis and scrotum

Diagnostic Examination:

Presence on skin of female mites,

ova, and feces upon skin biopsy or scraping;

Medical Management:
Permethrin 5% cream apply on the skin

below the neck; stay for at least 8 hours. Lindane solution (Kwell) for bathing; Crotamiton (Eurax) ointment; Anti-histamines to reduce itchiness.

Nursing Interventions:
Boiling of linens and clothes; Encourage to change clothing and bed

linen frequently Warm shower bath to remove scaling debris or crusts;