Respiratory System Disorders: Influenza, Larynx Cancer, Pneumonia, and Tuberculosis MS unit6 (2)

Influenza (Flu)

• Overview: Influenza, commonly known as the flu, is a highly common viral infection. Because it is a virus, treatment is primarily focused on symptom management.
• Symptoms:
  • The hallmark symptoms include high fever and muscle aches.
  • Respiratory symptoms include headache, sneezing, and coughing.
  • Pharyngitis (sore throat) is also common.
• Nursing Interventions:
  • Encourage an increase in fluid intake.
  • Provide analgesics and antipyretics for pain and fever.
  • Emphasize rest to allow the patient's immune system to function effectively.
  • Maintain good oral care.
  • Utilize humidity to soothe the respiratory tract.
• Medications:
  • Antitussives: Cough suppressants may be ordered, specifically for nighttime use, to ensure the patient can rest without being interrupted by coughing.
  • Oseltamivir ($Tamiflu$): This is a common antiviral medication. The generic name, Oseltamivir, contains the suffix "-vir," indicating its use for viruses.
  • Administration: It must be taken within $48$ hours of symptom onset to be effective.
  • Purpose: It is designed to decrease both the duration and the severity of symptoms.
  • Side Effects: In pediatric and geriatric populations, it can cause significant psychiatric issues or behavioral changes (described as patients getting "wild").
• Prevention:
  • Vaccination: Annual flu vaccinations are recommended.
  • Hygiene: Handwashing is the number one method to prevent the spread of infection.
  • Public Health Guidelines: Avoid sharing drinks. If positive for the flu or immunocompromised, avoid crowded areas during peak flu season.
• Complications: A major complication of influenza is pneumonia.

COVID-19 (Coronavirus Disease $2019$)

• Overview: COVID-$19$ shares many similarities with the flu regarding preventative measures, such as vaccination and isolation, as well as symptom-based treatment.
• Complications: COVID-$19$ is frequently associated with the development of pneumonia.
• Precautions: Healthcare providers must stay updated on current $CDC$ recommendations, which may vary between droplet and airborne precautions depending on the situation.

Malignant Disorders: Larynx Cancer

• Anatomy: The larynx is also known as the "voice box."
• Symptoms:
  • Persistent hoarseness that lasts for more than $2$ weeks.
  • General laryngitis symptoms.
  • The sensation of a lump in the throat.
• Risk Factors:
  • Tobacco and alcohol use.
  • Environmental pollution (e.g., historical exposure to mosquito-spraying pesticides).
  • Vocal cord abuse (overuse of the vocal cords).
• Treatment and Management: Treatment is individualized based on the stage and location of the cancer, as well as patient comorbidities.
  • Partial Laryngectomy: Partial removal of the larynx; the patient retains some use of their voice.
  • Total Laryngectomy: Complete removal of the larynx; the patient will have no natural voice.
  • Radical Neck Dissection: Often accompanies a total laryngectomy; involves removing a large portion of the neck tissue. This is highly disfiguring and carries a significant psychological toll.

Tracheostomy and Post-Surgical Care

• Overview: A tracheostomy is a tube inserted into a stoma to create an airway. This bypasses the upper respiratory tract.
• Physiological Changes: Because the upper airway is bypassed, the air entering the lungs is no longer filtered, warmed, or moistened (lack of humidity).
• Nursing Care:
  • Suctioning: Newly placed tracheostomies require frequent and regular suctioning.
  • Cleaning: Proper skill in cleaning and suctioning is fundamental to patient safety.
  • Coughing Protocol: If a patient with a tracheostomy coughs, the provider should not cover the mouth but should hold a washcloth or gauze in front of the stoma (without occluding it) to catch secretions.
  • Hygiene: During showers, the stoma must be protected with a cap or shield. Never spray anything into the stoma.
• Rehabilitation: Depending on the surgery, patients may learn to swallow and eat. Speech depends on the specific type of surgery and available assistive devices.

Acute Bronchitis

• Definition: Inflammation of the bronchi (the tree-like branches within the lungs).
• Causes: It can be caused by viral or bacterial infections. Often, an upper respiratory infection ($URI$) spreads down to the lower tract.
• Symptoms:
  • A productive cough (the body's response to get inflammation out).
  • Fever, chills, and malaise (a general "lazy" or unwell feeling).
  • The cough can be painful.
• Diagnosis: Diagnosed via chest X-ray and sputum cultures to rule out other infections.
• Treatment:
  • Antibiotics: Used if the cause is bacterial.
  • Symptom Management: Cool mist humidifiers or warm showers.
  • Pharmacology: Expectorants are used during the day to help the patient "cough it out," while cough suppressants are used at night to facilitate rest.
  • Supportive Care: Increased fluids, nutrition, and rest.

Bronchiectasis

• Definition: Permanent scarring and inflammation of the bronchial airways. The airway becomes scarred, dilated, and develops "flabby" areas.
• Pathophysiology: Chronic inflammation leads to pooling of secretions in scarred areas. These stagnant secretions (compared to a "pond" vs. a "river") become a breeding ground for infection.
• Causes: Often associated with chronic disorders like asthma or Cystic Fibrosis ($CF$).
• Symptoms:
  • Copious amounts of foul-smelling sputum.
  • Frequent lower respiratory tract infections.
• Treatment:
  • Bronchodilators: Used to open the airways.
  • Medications: Antibiotics for bacterial infections, mucolytics, and expectorants.
  • Chest Physiotherapy ($CPT$): Using cuffed hands to strike the chest and back to break up secretions. A percussion vest (which looks like a life jacket with hoses) may be used at home to perform this automatically.

Pneumonia

• Bacterial Pneumonia: Primarily caused by Streptococcus pneumoniae (pneumococcal pneumonia). This is common in community-acquired cases and is treated with high-dose antibiotics.
• Viral Pneumonia: Often follows the flu or COVID-$19$. Patients are typically less acutely ill but remain sick for a longer duration. This is sometimes called "walking pneumonia."
• Fungal Pneumonia: Caused by agents like Candida or Aspergillus. Pneumocystis jirovecii is a specific fungal pneumonia that acts as a major opportunistic infection for patients with $HIV/AIDS$.
• Aspiration Pneumonia: Occurs when food, emesis, or secretions are inhaled into the lungs.
  • At-Risk Populations: Elderly patients or those with a decreased level of consciousness ($LOC$).
  • Prevention: Sit patients up during meals and for at least $30$ minutes after. Feed slowly on the strong side of the mouth. Check for "pocketing" of food in the cheeks. Patients must be $NPO$ before surgery to prevent aspiration during anesthesia.
• Ventilator-Associated Pneumonia ($VAP$): Occurs in intubated patients who cannot swallow their secretions. Meticulous oral care is essential to prevent bacteria in the mouth from traveling to the lungs.
• Chemical Pneumonia: Caused by inhaling toxic gases, often in industrial environments. Occupational nurses manage safety protocols for these exposures.
• General Symptoms:
  • Fever, chills, and productive cough with rhonchi.
  • Fatigue and malaise.
  • Chest pain (often caused by muscle spasms from excessive coughing).
  • Dyspnea (shortness of breath).
• Elderly Specific Symptoms: Hypoxia (low oxygen) is a major risk. Symptoms include pallor, lethargy, and a change in $LOC$ (disorientation/confusion). Confusion in the elderly should trigger an oxygen saturation check before assuming a $UTI$ or dementia.
  • Example: A patient with an oxygen saturation of $85\%$ may present as suddenly confused.
• Diagnosis:
  • Chest X-ray: Air appears black; fluid, structures, or masses appear white.
  • Cultures: Sputum and blood cultures.
  • Labs: $CBC$ with differential.
  • EKG: To rule out myocardial infarction when chest pain is present.
• Interventions: Turn, Cough, Deep Breathe ($TCDB$), use of an incentive spirometer, rest, and oxygen therapy.
• Complications: Pleurisy and pleural effusions.

Tuberculosis ($TB$)

• Etiology: Caused by Mycobacterium tuberculosis. It can affect the whole body but primarily targets the lungs.
• Screening and Diagnosis:
  • $TB$ Skin Test ($Mantoux$ or $PPD$): An intradermal injection used to create a "blip."
  • Reading the Results: Must be read between $48$ and $72$ hours. The provider measures the induration (the hard bump), not the redness.
  • Positive Thresholds: Depending on risk factors, a positive result is defined as an induration of $5\,mm$, $10\,mm$, or $15\,mm$.
  • Two-Step Testing: Required for some employments; the two injections must be administered at least $1$ week apart (ideally $1$ to $3$ weeks).
  • Sputum Culture: Acid-Fast Bacilli ($AFB$) testing.
  • Chest X-ray: Can show calcified lesions.
  • Blood Test: Quantiferon-Gold test (may cost around $\$40$ if not covered by insurance).
• Symptoms: Hemoptysis (coughing up blood), afternoon fever, night sweats, anorexia (loss of appetite), and unexplained weight loss.
• Isolation: Requires Airborne Precautions. This includes a negative pressure room and the use of an $N95$ small particulate respirator (which requires fit testing).
• Medical Management:
  • Common drugs include $INH$ (isoniazid), Rifampin, and Ethambutol.
  • Treatment duration is typically $6$ to $9$ months, but can last years.
  • Nursing Considerations: These meds are hepatotoxic. Providers must monitor Liver Function Tests ($LFTs$), including $AST$ and $ALT$, and assess for jaundice in the sclera.
  • Patient Education: Secretions (urine, etc.) will turn a reddish-orange color. Patients require two negative sputum tests before they can stop wearing a mask in public.
• Vaccination: The $BCG$ vaccine is given in other countries/military. Those who have received it will test positive on a $PPD$ skin test.

Restrictive Disorders

• Pleurisy (Pleuritis): Inflammation of the pleura.
  • Symptoms: Sharp pain upon inhalation, coughing, or sneezing. Friction rubs may be heard upon auscultation.
  • Treatment: $NSAIDs$ for inflammation. Patients must be encouraged to use an incentive spirometer despite pain to prevent atelectasis (collapsed alveoli) and pneumonia.
• Pleural Effusion: Excess fluid in the pleural space.
  • Treatment: Thoracentesis (removal of fluid via needle) or a chest tube.
• Empyema: A collection of pus in the pleural space ($p$ in empyema stands for pus). It is a complication of pneumonia or $TB$ and requires antibiotics.
• Pulmonary Fibrosis (Interstitial Lung Disease): A hardening or scarring of the lung tissue.
  • Pathophysiology: Alveoli become thick and scarred, resulting in permanent, irreversible loss of adequate gas exchange.
  • Causes: Autoimmune disorders (Lupus, Rheumatoid Arthritis), chronic inflammation, or heredity.
  • Symptoms: Shortness of breath, fatigue, crackles, and clubbing (due to chronic oxygen deprivation).
  • Treatment: Supportive care including steroids, immunosuppressants, supplemental oxygen, and smoking cessation.