Chapter 25 & 26

Care of Patients with Infectious Respiratory Problems and Respiratory Emergencies

Pneumonia

Definition

  • Pneumonia: A condition characterized by excessive fluid in the lungs due to an inflammatory process. The inflammation is typically triggered by infectious organisms or the inhalation of irritants.

Types of Pneumonia

  • Community-acquired pneumonia (CAP): Infection acquired outside of a hospital or healthcare setting.

  • Hospital-acquired pneumonia (HAP): Infection that occurs 48 hours or more after admission to a hospital.

  • Ventilator-associated pneumonia (VAP): A type of HAP that develops in individuals who are on mechanical ventilation.

Assessment
History and Physical

  • Risk Factors:
      - Swallowing problems
      - Aspiration history
      - Living conditions and work environment
      - Previous respiratory illnesses including chronic respiratory problems
      - Vaccination history for flu/pneumonia

General Appearance

  • Symptoms include:
      - Fatigue
      - Anxiety
      - Flushed cheeks

Respiratory Assessment

  • Signs of respiratory distress:
      - Dyspnea
      - Chills and/or fever
      - Productive cough

  • Auscultation Findings:
      - Presence of crackles

Vital Signs Testing

  • Common findings:
      - Elevated temperature (e.g., 102°F)
      - Increased heart rate (tachycardia)
      - Increased respiratory rate (tachypnea)
      - Pleural pain
      - General malaise

Symptoms of Pneumonia

  • Typical symptoms include:
      - Cough
      - Chills
      - Tachycardia
      - Tachypnea
      - Dyspnea
      - Pleural pain
      - Malaise

  • Productive Cough: Often produces sputum that may be yellow, blood-streaked, or rusty, indicating an infection.

Laboratory and Diagnostic Procedures

  • Diagnostic tests may include:
      - Sputum Culture: To identify causative organisms.
      - Chest X-ray: Important for visualization of lung conditions.
      - Arterial Blood Gases (ABGs): To assess respiratory function.
      - Complete Blood Count (CBC): Helps in evaluating the presence of infection.
      - Blood Cultures: Timing of collection is critical for accurate diagnosis.
      - Serum Electrolytes, BUN, and Creatinine: To assess overall health status.

Imaging and Diagnostics

  • Importance of Chest X-ray:
      - It may not display acute changes but is vital for diagnosis, especially in elderly patients.

  • Other imaging techniques:
      - Pulse oximetry
      - Transtracheal aspiration
      - Bronchoscopy
      - Thoracentesis

Nursing Interventions

  • Goals: Improve gas exchange and respiratory function.

  • Interventions include:
      - Administering oxygen therapy
      - Encouraging incentive spirometry
      - Preventing airway obstruction by maintaining patency
      - Encouraging fluid intake
      - Administering bronchodilators when indicated
      - Initiating antibiotic therapy to treat infection
      - Monitoring vital signs regularly

Tuberculosis

Overview

  • Tuberculosis (TB): Highly communicable disease caused by Mycobacterium tuberculosis, primarily transmitted through aerosolized droplets from close contact with an infected individual.

  • Secondary TB: Refers to the reactivation of TB in individuals previously infected.

  • Prevalence: The CDC (2023) notes approximately 13 million individuals with latent TB in the U.S. Oklahoma has an incidence rate of 16.1 per 100,000.

Risk Factors

  • High-risk groups:
      - Individuals with frequent contact with untreated infected persons
      - Those with compromised immune systems (e.g., HIV)
      - People residing in crowded settings (prisons, shelters)
      - Homeless individuals
      - Injection drug users or heavy alcohol consumers
      - Lower socioeconomic groups and foreign immigrants from less affluent countries

Clinical Manifestations

  • Symptoms:
      - Progressive fatigue and lethargy
      - Nausea and anorexia
      - Weight loss
      - Irregular menstrual cycles
      - Low-grade fever and night sweats
      - Chronic cough with mucopurulent or blood-streaked sputum

Diagnosis

  • Diagnostic Tests:
      - TB Skin Test (Mantoux): PPD administered intradermally; positive reaction indicated by an induration of 10 mm or greater suggests exposure to TB but does not confirm active disease.
      - Sputum Cultures: Collection of three specimens on different days for acid-fast bacillus identification.
      - Chest X-ray: Important part of the diagnostic assessment.
      - NAA Test: Provides results in approximately 2 hours.

Nursing Interventions

  • Treatment Regimen:
      - Combination drug therapy adherence is crucial, typically involving RIPE regimen: Rifampin, Isoniazid, Pyrazinamide, Ethambutol.
      - Maintain negative sputum culture for non-infectious status.
      - Patients often need respiratory isolation until they produce a negative sputum sample.

Community-Based Care Management

  • Home care: Emphasis on self-management and adhering strictly to drug regimens.

  • Support: Directly Observed Therapy (DOT) is recommended to monitor compliance.

  • Confidentiality: Respecting patient confidentiality throughout treatment is vital.

Lung Abscess

Definition

  • Lung Abscess: A localized area of lung destruction usually caused by liquefaction necrosis due to pyogenic bacteria.

Clinical Presentation

  • Symptoms:
      - Pleuritic chest pain

Nursing Interventions

  • Treatment Options:
      - Administering appropriate antibiotics
      - Surgical drainage if necessary
      - Providing frequent mouth care to prevent Candida albicans infections.

Empyema

Definition

  • Empyema: The presence of pus in the pleural space, commonly resulting from pulmonary infections, lung abscesses, or infected pleural effusions.

Nursing Interventions

  • Treatment Goals:
      - Empty the empyema cavity
      - Facilitate lung re-expansion
      - Control and treat the associated infection.

Pulmonary Embolism (PE)

Overview

  • Definition: A pulmonary embolism occurs when a blood clot(s) travels to the lungs, blocking blood flow.

  • Pathophysiology: It develops from deep vein thrombosis (DVT) that detaches and travels to the pulmonary arteries.

  • Risk Factors: Include immobilization, surgery, malignancy, and coagulopathy.

Prevention Strategies for VTE (Venous Thromboembolism)

  • Early mobilization, leg exercises, and mechanical prophylaxis where appropriate

  • Administering anticoagulants as indicated.

Key Features

  • Symptoms may include sudden onset of shortness of breath, chest pain, coughing (possibly blood-streaked), and palpitations.

Diagnostic Testing

  • Utilization of imaging (CT pulmonary angiography), blood tests (D-dimer), and clinical assessment forms part of the diagnostic approach.

Management and Treatment of PE

  • Management strategies include anticoagulation, thrombolytics if warranted, and supportive care.