RESTRICTIVE DISORDERS (2)

Pneumonia

refers to an infection of the lungs, which can be caused by a variety of microorganisms, like viruses, bacteria, fungi, and parasites. It is a common illness, occurs in all age groups, and is a leading cause of death among the elderly and people who are suffering from long time illness. It is a very old disease well known to our ancestors

Hippocrates

the ancient Greek physician known as the father of Medicine had described the signs and symptoms of pneumonia accurately as early as 4th century B.C.

Acute pneumonia

Types of Pneumonia: It is a type which usually develops rapidly and lasts for 2 to3 weeks. It is spread easily and can cause symptoms very soon

Chronic pneumonia

Types of Pneumonia: These develop gradually over a period of weeks to months. This type pneumonia does not spread easily

Community acquired pneumonia

Types of Pneumonia: common seen in people with an underlying pathology. Streptococcus is the most common bacterial cause of this. This occurs most commonly in very young and very old people.

Hospital-acquired pneumonia

Types of Pneumonia: an infection that patients get while they're in the hospital. This means the infection is not present at the time a patient is admitted to the hospital

Aspiration pneumonia

Types of Pneumonia: an inflammation of the lungs and bronchial tubes caused by inhaling foreign material, usually food, drink, vomit, or secretions from the mouth into the lungs

Severe Acute Respiratory Syndrome (SARS)

Types of Pneumonia: highly contagious and deadly type of pneumonia which first occurred in 2002 after initial outbreaks in China. It is caused by a virus called as coronavirus

Chemical pneumonia

Types of Pneumonia: caused by chemical toxins such as pesticides, which may enter the body by inhalation or by skin contact

Streptococcus pneumoniae

The bacterium _________, a common cause of pneumonia

Fungal pneumonia

uncommon, but it may occur in individuals with reduced immune system due to AIDS or other medical problems

o Strep. Pneumoniae

o H. influenza

o E.coli

o Klebsiella

Pneumonia Etiology

o RUSTY/PRUNE JUICE-colored sputum (pathognomonic sign)

o Dyspnea

o Fever

o Pleuritic chest pain

o Crackles

Pneumonia S/Sx:

o CXR

o CBC (leukocytosis)

Pneumonia Dx

o ANTIBIOTICS

o Oxygen

o Force fluids

o CPT

o Nebulization

o Semi-fowler's position

Pneumonia Mngt

Pulmonary Tuberculosis

infectious disease primarily affecting the lung parenchyma, is most often caused by Mycobacterium tuberculosis. It may spread to almost any part of the body, including the meninges, kidney, bones, and lymph nodes

2 to 10 weeks

Pulmonary Tuberculosis initial infection usually occurs ______ after exposure.

• Close contact with someone who has active TB

• Immunocompromised status (eg, elderly, cancer, corticosteroid therapy, and HIV)

• Injection drug use and alcoholism

• People lacking adequate health care (eg, homeless or impoverished, minorities, children, and young adults)

• Preexisting medical conditions, including diabetes, chronic renal failure, silicosis, and malnourishment

• Immigrants from countries with a high incidence of TB (eg, Haiti, southeast Asia)

• Institutionalization (eg, long-term care facilities, prisons)

• Living in overcrowded, substandard housing

• Occupation (eg, health care workers, particularly those performing high-risk activities)

Pulmonary Tuberculosis Risk Factors

• Low-grade fever, cough, night sweats, fatigue, and weight loss

• Nonproductive cough, which may progress to mucopurulent sputum with hemoptysis

Pulmonary Tuberculosis Clinical Manifestations

• TB skin test (Mantoux test); QuantiFERON-TB Gold (QFT-G) test

• Chest x-ray

• Acid-fast bacillus smear

• Sputum culture

Pulmonary Tuberculosis Assessment and Diagnostic Methods

treated primarily with antituberculosis agents for 6 to 12 months. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse

Pulmonary Tuberculosis Medical Management

• First-line medications: isoniazid or INH (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol (Myambutol) daily for 8 weeks and continuing for up to 4 to 7 months

• Second-line medications: capreomycin (Capastat), ethionamide (Trecator), para aminosalicylate sodium, and cycloserine (Seromycin)

• Vitamin B (pyridoxine) usually administered with INH

Pulmonary Tuberculosis Pharmacologic Therapy

- Promoting Airway Clearance

- Advocating Adherence to Treatment Regimen

- Promoting Activity and Adequate Nutrition

- Preventing Spreading of TB Infection

Pulmonary Tuberculosis Nursing Management

miliary TB

spread or dissemination of TB infection to nonpulmonary sites of the body is known as

Pneumothorax

Accumulation of atmospheric air in pleural space which results in rise in intra-throracic pressure

SIMPLE pneumothorax

Breach in the visceral or parietal pleura

TENSION pneumothorax

Laceration or hole in the lungs

o Dyspnea

o Dec. or Absent breath sound on the affected side

o Dec. chest expansion

o Tracheal deviation to the unaffected side (CXR)

Pneumothorax S/Sx

Tracheal deviation to the unaffected side (CXR)

S/Sx Exclusive for TENSION pneumothorax

Thoracentesis

Pneumothorax Mngt

Chest tubes and drainage system

Aims to restore negative pressure of the pleural cavity and drain collected fluid/blood

o Suction control chamber

o Water seal chamber

o Closed collection chamber

Chest tubes and drainage system Components

o At least every 4 hours for:

✓ Excessive or abnormal drainage

✓ Cracking sound upon palpation for subcutaneous emphysema

✓ If lying on the affected side

▪ (put a rolled towel beside the tubing)

Chest tubes and drainage system Assessment of the site:

client's chest level

Keep the collection device below the

✓ Re-expansion of the lungs

✓ Obstruction

Oscillations or fluctuations on water seal ABSENCE

✓ Notify the MD for CXR

✓ Obstruction: (no milking and stripping)

▪ SQUEEZE (hand-over-hand)

Oscillations or fluctuations on water seal Mngt

NO BUBBLING

Chest tubes and drainage system

Presence of bubbling: Drainage Bottle

INTERMITTENT BUBBLING

Chest tubes and drainage system

Presence of bubbling: Water Seal Bottle

CONTINOUS GENTLE BUBBLING

Chest tubes and drainage system

Presence of bubbling: Suction Control Bottle

CONTINOUS BUBBLING

Chest tubes and drainage system

Abnormal bubbling: Water Seal Bottle

VIGOROUS BUBBLING

Chest tubes and drainage system

Abnormal bubbling: Suction Control Bottle

LEAKAGE

Chest tubes and drainage system

Abnormal bubbling: ALERT

CLAMP the tube and TAPE the leak (allowed for short periods)

Chest tubes and drainage system Management

can cause tension pneumothorax

Chest tubes and drainage system PROLONGED CLAMPING

✓ Re-expansion of the lungs

✓ Obstruction

Chest tubes and drainage system Absence of bubbling

o Water Seal Bottle

o Suction Control Bottle

✓ Cover with DRYSTERILE dressing

✓ If air is leaking ensure that the dressing is not occlusive

✓ If not available in the choices:

▪ Vaselinized gauze

▪ Petrolatum gauze

TUBE PULLED FROM THE SITE

✓ Submerge the end in 1in. of sterile saline or water

✓ Reconnect

TUBE DISCONNECTED or WATER SEAL BOTTLEBREAKS

blunt or penetrating

Chest trauma is classified as either

Blunt chest trauma

results from sudden compression or positive pressure inflicted to the chest wall

Penetrating trauma

occurs when a foreign object penetrates the chest wall.

Rib Fracture

Fracture resulting from direct blunt chest trauma

Pain at the site (increases withrespiration)

Rib Fracture S/Sx:

✓ Unite spontaneously

✓ High fowler's position

Rib Fracture Mngt

Flail chest

Fracture or 3 or more ribs resulting from direct blunt chest trauma

PARADOXICAL BREATHING

Flail chest S/Sx:

✓ Oxygen

✓ WOF respiratory distress

✓ High fowler's position

Flail chest Mngt