1. Interventions for Clients with Infectious Problems of the Respiratory Tract

2. Rhinitis Inflammation of the nasal mucosa Inflammation 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, sneezing, nasal congestion, rhinorrhea (watery drainage from the nose), and itchy, watery eyes. Symptoms - headache, nasal irritation, sneezing, nasal congestion, rhinorrhea (watery drainage from the nose), and itchy, watery eyes. Interventions include: Interventions include: –Drug therapy: antihistamines and decongestants, antipyretics, antibiotics –Complementary and alternative therapy –Supportive therapy

4. Sinusitis Inflammation of the mucous membranes of the sinuses Inflammation of the mucous membranes of the sinuses Swelling can obstruct the flow of secretions from the sinuses, which may subsequently become infected. Swelling can obstruct the flow of secretions from the sinuses, which may subsequently become infected. The disorder often accompanies or follows acute or chronic allergic rhinitis. The disorder often accompanies or follows acute or chronic allergic rhinitis. Other conditions contributing to sinusitis include a deviated nasal septum, polyps, tumors, chronically inhaled air pollutants or cocaine, facial trauma, nasotracheal intubation, dental infection, or cystic fibrosis Other conditions contributing to sinusitis include a deviated nasal septum, polyps, tumors, chronically inhaled air pollutants or cocaine, facial trauma, nasotracheal intubation, dental infection, or cystic fibrosis The causative organism in sinus infection is usually Streptococcus pneumoniae, Haemophilus influenzae, Diplococcus, or Bacteroides. Anaerobic infections also can cause sinusitis. The causative organism in sinus infection is usually Streptococcus pneumoniae, Haemophilus influenzae, Diplococcus, or Bacteroides. Anaerobic infections also can cause sinusitis. Sinusitis most often develops in the maxillary and frontal sinuses Sinusitis most often develops in the maxillary and frontal sinuses

6. Sinusitis The clinical manifestations of sinusitis include The clinical manifestations of sinusitis include –nasal swelling and congestion, –headache, –facial pressure, –pain (usually made worse by movement of the head to a dependent position), –tenderness on percussion over the involved area, –low-grade fever, –cough, and purulent or bloody nasal drainage

7. Sinusitis (Continued) Nonsurgical management Nonsurgical management –Broad-spectrum antibiotics –Analgesics –Decongestants –Steam humidification –Hot and wet packs over the sinus area –Nasal saline irrigations

8. Surgical Management Antral irrigation Antral irrigation Caldwell-Luc procedure Caldwell-Luc procedure Nasal antral window procedure Nasal antral window procedure Endoscopic sinus surgery Endoscopic sinus surgery

9. Pharyngitis Sore throat is common inflammation of the mucous membranes of the pharynx. Sore throat is common inflammation of the mucous membranes of the pharynx. Assess for odynophagia, dysphagia, fever, and hyperemia. Assess for odynophagia, dysphagia, fever, and hyperemia. Strep throat can lead to serious medical complications. Strep throat can lead to serious medical complications. Epiglottitis is a rare complication of pharyngitis. Epiglottitis is a rare complication of pharyngitis.

12. Tonsillitis Inflammation and infection of the tonsils and lymphatic tissues located on each side of the throat Inflammation and infection of the tonsils and lymphatic tissues located on each side of the throat Contagious airborne infection, usually bacterial Contagious airborne infection, usually bacterial Antibiotics Antibiotics Surgical intervention Surgical intervention

13. Peritonsillar Abscess Complication of acute tonsillitis Complication of acute tonsillitis Pus behind the tonsil, causing one-sided swelling with deviation of the uvula Pus behind the tonsil, causing one-sided swelling with deviation of the uvula Trismus and difficulty breathing Trismus and difficulty breathing Percutaneous needle aspiration of the abscess Percutaneous needle aspiration of the abscess Completion of antibiotic regimen Completion of antibiotic regimen

16. Laryngitis Inflammation of the mucous membranes lining the larynx, possibly including edema of the vocal cords Inflammation of the mucous membranes lining the larynx, possibly including edema of the vocal cords Acute hoarseness, dry cough, difficulty swallowing, temporary voice loss (aphonia) Acute hoarseness, dry cough, difficulty swallowing, temporary voice loss (aphonia) Voice rest, steam inhalation, increased fluid intake, throat lozenges Voice rest, steam inhalation, increased fluid intake, throat lozenges Therapy: relief and prevention Therapy: relief and prevention

17. Influenza “Flu” is a highly contagious acute viral respiratory infection. “Flu” is a highly contagious acute viral respiratory infection. Manifestations include severe headache, muscle ache, fever, chills, fatigue, weakness, and anorexia. Manifestations include severe headache, muscle ache, fever, chills, fatigue, weakness, and anorexia. Vaccination is advisable. Vaccination is advisable. Antiviral agents may be effective. Antiviral agents may be effective.

18. Pneumonia Excess of fluid in the lungs resulting from an inflammatory process Excess of fluid in the lungs resulting from an inflammatory process Inflammation triggered by infectious organisms and inhalation of irritants Inflammation triggered by infectious organisms and inhalation of irritants Community-acquired infectious pneumonia Community-acquired infectious pneumonia Nosocomial or hospital-acquired Nosocomial or hospital-acquired Atelectasis Atelectasis Hypoxemia Hypoxemia

23. Impaired Gas Exchange Interventions include: Interventions include: –Cough enhancement –Oxygen therapy –Respiratory monitoring

24. Ineffective Airway Clearance Interventions include: Interventions include: –Help client to cough and deep breathe at least every 2 hours. –Administer incentive spirometer—chest physiotherapy if complicated. –Prevent dehydration. –Monitor intake and output of fluids. –Use bronchodilators, especially beta 2 agonists. –Inhaled steroids are rarely used.

25. Pulmonary Tuberculosis Highly communicable disease caused by Mycobacterium tuberculosis Highly communicable disease caused by Mycobacterium tuberculosis Most common bacterial infection Most common bacterial infection Transmitted via aerosolization Transmitted via aerosolization Initial infection multiplies freely in bronchi or alveoli Initial infection multiplies freely in bronchi or alveoli Secondary TB Secondary TB Increase related to the onset of HIV Increase related to the onset of HIV

27. Assessment Diagnosis of TB considered for any client with a persistent cough or other compatible symptoms (weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills) Diagnosis of TB considered for any client with a persistent cough or other compatible symptoms (weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills) Bacillus Calmette-Guerin vaccine within previous 10 years produces positive skin test, complicating interpretation of TB test. Bacillus Calmette-Guerin vaccine within previous 10 years produces positive skin test, complicating interpretation of TB test.

28. Clinical Manifestations of TB Progressive fatigue Progressive fatigue Lethargy Lethargy Nausea Nausea Anorexia Anorexia Weight loss Weight loss Irregular menses Irregular menses Low-grade fever, night sweats Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks Cough, mucopurulent sputum, blood streaks

30. Diagnostic Assessment Manifestation of signs and symptoms Manifestation of signs and symptoms Positive smear for acid-fast bacillus Positive smear for acid-fast bacillus Confirmation of diagnosis by sputum culture of M. tuberculosis Confirmation of diagnosis by sputum culture of M. tuberculosis Tuberculin test (Mantoux test) purified protein derivative given intradermally in the forearm Tuberculin test (Mantoux test) purified protein derivative given intradermally in the forearm Induration of 10 mm or greater diameter indicative of exposure Induration of 10 mm or greater diameter indicative of exposure(Continued)

31. Diagnostic Assessment (Continued) Positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease. Positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease.

32. Interventions Combination drug therapy strict adherence Combination drug therapy strict adherence Isoniazid Isoniazid Rifampin Rifampin Pyrazinamide Pyrazinamide Ethambutol or streptomycin Ethambutol or streptomycin Negative sputum culture indicative of client no longer being infectious Negative sputum culture indicative of client no longer being infectious

33. Health Teaching Follow exact drug regimen. Follow exact drug regimen. Proper nutrition must be maintained. Proper nutrition must be maintained. Reverse weight loss and severe lethargy. Reverse weight loss and severe lethargy. Educate client about the disease. Educate client about the disease.

34. Lung Abscess Localized area of lung destruction caused by liquefaction necrosis, usually related to pyogenic bacteria Localized area of lung destruction caused by liquefaction necrosis, usually related to pyogenic bacteria Pleuritic chest pain Pleuritic chest pain Interventions Interventions –Antibiotics –Drainage of abscess –Frequent mouth care for Candida albicans

36. Inhalation Anthrax Bacterial infection is caused by the gram-positive, rod-shaped organism Bacillus anthracis from contaminated soil. Bacterial infection is caused by the gram-positive, rod-shaped organism Bacillus anthracis from contaminated soil. Fatality rate is 100% if untreated. Fatality rate is 100% if untreated. Two stages are the prodromal stage and the fulminant stage. Two stages are the prodromal stage and the fulminant stage. Drug therapy includes ciprofloxacin, doxycycline, and amoxicillin. Drug therapy includes ciprofloxacin, doxycycline, and amoxicillin.

38. Pulmonary Empyema A collection of pus in the pleural space A collection of pus in the pleural space Most common cause: pulmonary infection, lung abscess, and infected pleural effusion Most common cause: pulmonary infection, lung abscess, and infected pleural effusion Interventions include: Interventions include: –Emptying the empyema cavity –Re-expanding the lung –Controlling the infection