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Infectious Dirorder

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Infectious Dirorder

  1. 1. Pulmonary T.B Pneumonia Lung Abscess Influenza Presenter: Shahina Amiry Sr. Instructor AKUSON
  2. 2. <ul><li>Definition: </li></ul><ul><li>TB is a bacterial infection caused by Mycobacterium tuberculosis. It most commonly affects the lungs, producing pulmonary TB. </li></ul><ul><li>Cause: </li></ul><ul><li> Gram +ve Mycobacterium </li></ul><ul><li>tuberculebacilli. </li></ul>06/07/09 www.health-nurses-doctors.com
  3. 3. Pathophysiology <ul><li>Susceptible person inhaled the organism </li></ul><ul><li>The organism settles in the alveoli and multiply </li></ul><ul><li>The organism may also transport through blood stream and lymph system to other parts of the body </li></ul><ul><li>The body immune system respond by initiating inflammatory process and phagocytes take place </li></ul><ul><li>The tissue reaction causes accumulation of the exudates into the alveoli and causes bronchopneumonia </li></ul>06/07/09 www.health-nurses-doctors.com
  4. 4. <ul><li>Granulomas are formed which transformed into the fibrous tissues </li></ul><ul><li>The bacteria and macrophages become necrotic and form the cheesy mass </li></ul><ul><li>Compromised and inadequate immune response, re-infection and activation of dormant bacteria develop active disease </li></ul><ul><li>Ghon tubercle ulcerate and cheesy material releases into bronchi and bacteria become airborne and cause active tuberculosis </li></ul><ul><li>Scar tissue form </li></ul>06/07/09 www.health-nurses-doctors.com
  5. 5. 06/07/09 www.health-nurses-doctors.com
  6. 6. Risk factors & Transmission <ul><li>Airborne droplet during coughing, sneezing, spitting, talking, laughing, singing. </li></ul><ul><li>History of TB, personally, or amongst friends or family. </li></ul><ul><li>Migration from a country with a high incidence of TB. </li></ul><ul><li>History of travel to an area with a high incidence of TB. </li></ul><ul><li>Alcohol and/or drug abuse. </li></ul><ul><li>Compromised immunity due to illness, e.g., HIV infection. </li></ul><ul><li>Malnutrition </li></ul><ul><li>Over crowd </li></ul>06/07/09 www.health-nurses-doctors.com
  7. 7. 06/07/09 www.health-nurses-doctors.com
  8. 8. SIGN AND SYMPTOM 06/07/09 www.health-nurses-doctors.com
  9. 9. Diagnostic test <ul><li>Tuberculin skin test QuantiFERON-TB Gold test </li></ul>06/07/09 www.health-nurses-doctors.com
  10. 10. Treatment: 06/07/09
  11. 11. <ul><li>Medications: </li></ul><ul><li>Primary Agents Secondary Agents </li></ul><ul><li>isoniazid* capreomycin </li></ul><ul><li>ethambutol cycloserine </li></ul><ul><li>pyrazinamide (PZA) ethionamide </li></ul><ul><li>rifampin kanamycin </li></ul><ul><li>Streptomycin para-aminosalicyclic acid (PSA) </li></ul><ul><li>*most frequently used </li></ul>06/07/09 www.health-nurses-doctors.com
  12. 12. Side Effects of Medication 06/07/09 www.health-nurses-doctors.com
  13. 13. NURSING PRIORITIES <ul><li>1. Achieve/maintain adequate ventilation/oxygenation. </li></ul><ul><li>2. Prevent spread of infection. </li></ul><ul><li>3. Support behaviors/tasks to maintain health. </li></ul><ul><li>4. Promote effective coping strategies. </li></ul><ul><li>5. Provide information about disease process/prognosis and </li></ul><ul><li>treatment needs. </li></ul>06/07/09 www.health-nurses-doctors.com
  14. 14. <ul><li>Diagnosis: </li></ul><ul><li>Infection, risk for spread/reactivation </li></ul><ul><li>Airway Clearance, ineffective </li></ul><ul><li>Nutrition: imbalanced, less than body requirment </li></ul><ul><li>Knowledge, deficient regarding condition, treatment, prevention, self-care, and discharge needs </li></ul>06/07/09 www.health-nurses-doctors.com
  15. 15. <ul><li>Infection, risk for spread/reactivation </li></ul><ul><li>Instruct patient to cough/sneeze and expectorate into tissue and to refrain from spitting. </li></ul><ul><li>Proper disposal of tissue and good hand washing techniques. </li></ul><ul><li>Identify individual risk factors for reactivation of tuberculosis </li></ul><ul><li>Awareness of transmission possibilities help patient take steps to prevent infection of others. </li></ul><ul><li>Note: AFB can pass through standard masks; therefore, particulate respirators are required. </li></ul>06/07/09 www.health-nurses-doctors.com
  16. 16. <ul><li>Assess respiratory function, e.g., breath sounds, rate, rhythm, and depth, and use of accessory muscles. </li></ul><ul><li>Note ability to expectorate mucus/cough effectively, document character, amount of sputum, presence of hemoptysis. </li></ul><ul><li>Place patient in semi- or high-Fowler’s position. </li></ul><ul><li>Assist patient with coughing and deep-breathing exercises. </li></ul><ul><li>Clear secretions from mouth and trachea; suction as necessary. </li></ul><ul><li>Maintain fluid intake of at least 2500 mL/day unless contraindicated </li></ul><ul><li>Provide oral care before and after respiratory treatments. </li></ul>06/07/09 www.health-nurses-doctors.com
  17. 17. Nutrition: imbalanced, less than body requirements <ul><li>Document patient’s nutritional status on admission </li></ul><ul><li>Encourage selection/ingestion of well-balanced meals. </li></ul><ul><li>Ascertain patient’s usual dietary pattern, likes/dislikes. </li></ul><ul><li>Encourage small, frequent meals with foods high in protein and carbohydrates. </li></ul><ul><li>Monitor I&O and weight periodically. </li></ul><ul><li>Investigate anorexia and nausea/vomiting, and note </li></ul><ul><li>possible correlation to medications. </li></ul><ul><li>Monitor frequency, volume, consistency of stools. </li></ul>06/07/09 www.health-nurses-doctors.com
  18. 18. <ul><li>Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered. </li></ul><ul><li>Aids in monitoring the effects of medications and patient’s response to therapy. </li></ul><ul><li>Monitor laboratory studies, e.g., sputum smear results; Liver function studies, e. g., AST/ALT. </li></ul>06/07/09 www.health-nurses-doctors.com
  19. 19. Discharge Teaching 06/07/09
  20. 20. 06/07/09 Summarization www.health-nurses-doctors.com
  21. 21. 06/07/09 www.health-nurses-doctors.com
  22. 22. PNEUMONIA <ul><li>Pneumonia is an Inflammation of alveoli and lungs parenchyma associated with a marked increase in interstitial and alveolar fluid. </li></ul>06/07/09 www.health-nurses-doctors.com
  23. 23. Causes and Risk factor <ul><li>Bacterial (s.aureus, streptococcus, hemophilus influenza, pseudomonas) </li></ul><ul><li>Viral </li></ul><ul><li>Fungi </li></ul><ul><li>head injury or general anesthesia </li></ul><ul><li>Exposure to chemicals </li></ul><ul><li>Tracheal intubation </li></ul><ul><li>Immuno-suppression(AIDS) </li></ul><ul><li>Aspiration of food, fluids or vomitus. </li></ul>06/07/09 www.health-nurses-doctors.com
  24. 24. <ul><li>Bedridden, paralyzed, or unconscious </li></ul><ul><li>Chronic diseases (diabetes & heart failure) </li></ul><ul><li>Chronic obstructive pulmonary disease. </li></ul><ul><li>Very young and very old </li></ul>06/07/09 www.health-nurses-doctors.com
  25. 25. Pathophysiology organism Susceptible host pneumonia Organism via blood 06/07/09 www.health-nurses-doctors.com
  26. 26. Pathophysiology <ul><li>Inhalation of pathogen and harmless bacteria enter into the lower reparatory tract </li></ul><ul><li>Inflammatory reaction occurs in the alveoli and produces an exudates that interfere with diffusion of oxygen and carbon dioxide. </li></ul><ul><li>The WBCs especially neutrophills migrate to alveoli and fill the air containing space </li></ul><ul><li>The area of the lungs are not adequately ventilated because of secretion and mucosal edema </li></ul><ul><li>Hypoventilation </li></ul><ul><li>Arterial hypoxemia </li></ul>06/07/09 www.health-nurses-doctors.com
  27. 27. 06/07/09 www.health-nurses-doctors.com
  28. 28. Sign and symptoms <ul><li>* Productive cough Fever & chills </li></ul><ul><li>Dyspnea Sweating </li></ul>06/07/09 www.health-nurses-doctors.com
  29. 29. Less common sign & symptoms <ul><li>Fatigue </li></ul><ul><li>Rapid breathing and heart beat </li></ul><ul><li>hemoptysis </li></ul><ul><li>Chest pain </li></ul><ul><li>Nausea, vomiting, and muscle aches </li></ul><ul><li>Loss of appetite </li></ul>06/07/09 www.health-nurses-doctors.com
  30. 30. Pneumonia by Location in the Lung <ul><li>Lobar Pneumonia </li></ul><ul><li>Bilateral Pneumonia </li></ul><ul><li>Segmental Pneumonia </li></ul><ul><li>Bronchopneumonia </li></ul><ul><li>Interstitial Pneumonia </li></ul><ul><li>Alveolar Pneumonia </li></ul><ul><li>Necrotizing Pneumonia </li></ul>06/07/09 www.health-nurses-doctors.com
  31. 31. Pneumonia by Origin of Infection <ul><li>Community-Acquired Pneumonia (CAP): </li></ul><ul><li>Most common causes of bacterial CAP is Streptococcus pneumonia </li></ul><ul><li>Hospital-Acquired Pneumonia. Staphylococcus aureus </li></ul><ul><li>Aspiration Pneumonia </li></ul>06/07/09 www.health-nurses-doctors.com
  32. 32. Diagnostic evaluation <ul><li>Medical history Physical examination </li></ul><ul><li>Chest X-ray CBC /ABGs </li></ul><ul><li>Culture of Sputum. </li></ul>06/07/09 www.health-nurses-doctors.com
  33. 33. Treatment <ul><li>Medical management </li></ul><ul><li>Hospitalization Antibiotic therapy </li></ul><ul><li>Nebulization </li></ul>06/07/09 www.health-nurses-doctors.com
  34. 34. Nursing Process <ul><li>Assessment: </li></ul><ul><li>History </li></ul><ul><li>Physical examination </li></ul>06/07/09 www.health-nurses-doctors.com
  35. 35. Nursing Diagnosis <ul><li>Ineffective airway clearance related to copious tracheobronchial secretions. </li></ul><ul><li>Impaired Gas Exchange related to altered oxygen-carrying capacity of blood </li></ul><ul><li>Activity intolerance relate to Imbalance between oxygen supply and demand. </li></ul><ul><li>Altered nutrition less than body requirement </li></ul>06/07/09 www.health-nurses-doctors.com
  36. 36. <ul><li>Respiratory Isolation </li></ul><ul><li>Promote airway patency </li></ul><ul><li>Maintain hydration </li></ul><ul><li>Perform chest protocol </li></ul><ul><ul><ul><ul><li>Deep breathing exercise </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Chest Physiotherapy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Use of spirometer </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Suction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Postural drainage </li></ul></ul></ul></ul>06/07/09 www.health-nurses-doctors.com
  37. 37. <ul><li>Maintain accurate intake and output. </li></ul><ul><li>Administer antipyretics and antibiotics on timely manner. </li></ul><ul><li>Encourage the low energy utilization activities. </li></ul><ul><li>Observe color of skin, mucous membranes, and nail beds, noting presence of peripheral cyanosis </li></ul>06/07/09 www.health-nurses-doctors.com
  38. 38. Instruct Parents on Discharge <ul><ul><li>About medication administration </li></ul></ul><ul><ul><li>Increase fluids intake </li></ul></ul><ul><ul><li>Humidified air </li></ul></ul><ul><ul><li>Signs and symptoms of respiratory distress </li></ul></ul><ul><ul><li>Postural drainage techniques </li></ul></ul><ul><ul><li>Follow care Complications </li></ul></ul>06/07/09 www.health-nurses-doctors.com
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  40. 40. Definition <ul><li>Lung abscess is Collection of pus within lungs. </li></ul>06/07/09 www.health-nurses-doctors.com
  41. 41. CAUSES <ul><li>Bacteria </li></ul><ul><li>Fungi </li></ul><ul><li>Commonest cause is aspiration </li></ul><ul><li>Unconscious or very drowsy because of sedation, anesthesia, alcohol or drug abuse, or a disease of the nervous system (CVA). </li></ul>06/07/09 www.health-nurses-doctors.com
  42. 42. Pathophysiology <ul><li>Lung infection (infectious agent) causes collection of pus </li></ul><ul><li>Pus form cavity that is formed by the necrosis of the lung tissues </li></ul><ul><li>Fibrosis tissue form around the abscess to wall it off </li></ul><ul><li>Erosion of abscess in the bronchial system causes fouls smell sputum </li></ul>06/07/09 www.health-nurses-doctors.com
  43. 43. Sign And symptoms <ul><li>Chills </li></ul><ul><li>Fever </li></ul><ul><li>Foul smell cough </li></ul><ul><li>Shivering </li></ul><ul><li>Night sweat </li></ul><ul><li>Purulent sputum </li></ul>06/07/09 www.health-nurses-doctors.com
  44. 44. Diagnostic Evaluation <ul><li>Medical history </li></ul><ul><li>Blood test </li></ul><ul><li>Chest x-ray </li></ul><ul><li>CT as needed </li></ul><ul><li>Sputum cultures </li></ul><ul><li>Bronchoscopy as needed to exclude cancer </li></ul>06/07/09 www.health-nurses-doctors.com
  45. 45. Management <ul><li>Antibiotics (penicillin, cephalosporin) </li></ul><ul><li>Oxygen may be given to patients who are having trouble breathing. </li></ul><ul><li>Drainage or aspiration of abscess through bronchoscopy. </li></ul><ul><li>Pulmonary resection (lobectomy) very rare </li></ul>06/07/09 www.health-nurses-doctors.com
  46. 46. Nursing Management <ul><li>Emphasize on compliance </li></ul><ul><li>Teach coughing exercise </li></ul><ul><li>Chest physiotherapy </li></ul><ul><li>Frequent mouth care </li></ul><ul><li>Provide adequate rest, good nutrition and increase fluid intake </li></ul><ul><li>High protein high caloric diet. </li></ul>06/07/09 www.health-nurses-doctors.com
  47. 47. INFLUENZA
  48. 48. <ul><li>Definition : </li></ul>06/07/09 www.health-nurses-doctors.com
  49. 49. Prevalence / Epidemiology <ul><li>2003 Large outbreak of influenza A(H5NI) or avian flu spread among poultry in Asia. </li></ul><ul><li>By 2004 humans had infected in nine countries. </li></ul><ul><li>Influenza differs from common cold primarily in its sudden onset and widespread occurrence in population. </li></ul>06/07/09 www.health-nurses-doctors.com
  50. 50. Types <ul><li>Influenza A ; </li></ul><ul><li>Responsible for regular outbreaks, including the one of 1918. Influenza A viruses also infect domestic animals (pigs, horses, chickens, ducks) and some wild birds </li></ul><ul><li>Influenza B: causes localized out, especially in residential communities like nursing homes. </li></ul><ul><li>Influenza C :common but cause fewer symptoms </li></ul>06/07/09 www.health-nurses-doctors.com
  51. 51. Causes / Risk Factors <ul><li>Spreads from person to person through respiratory droplets from coughing and sneezing </li></ul><ul><li>Occasionally from touching something with virus on it and then touching mouth or nose </li></ul>06/07/09 www.health-nurses-doctors.com
  52. 52. <ul><li>Adults may be able to infect others 1 day before getting symptoms and up to 7 days after getting sick </li></ul><ul><li>Immunocompromised </li></ul><ul><li>Resident of chronic care facility and health care worker </li></ul>06/07/09 www.health-nurses-doctors.com
  53. 53. Signs and Symptoms 06/07/09 www.health-nurses-doctors.com
  54. 54. Diagnostic Evaluation <ul><li>CBC, CXR </li></ul><ul><li>Throat swab for culture </li></ul>06/07/09 www.health-nurses-doctors.com
  55. 55. Management <ul><li>Interventions are based on manifestation as they arise. </li></ul><ul><li>Vaccination (70-90 effective) must be given in mid October </li></ul><ul><li>Antiviral drugs </li></ul><ul><li>Antibiotics </li></ul><ul><li>Anti-pyretic </li></ul>06/07/09 www.health-nurses-doctors.com
  56. 56. Nursing Management <ul><li>Highly contagious disease* </li></ul><ul><li>Respiratory isolation </li></ul><ul><li>Promote Rest </li></ul><ul><li>Adequate Hydration </li></ul><ul><li>Promote airway patency (chest Protocol) </li></ul><ul><li>Assess for high risk from complications of the flu such as people 65 years or older, people with chronic medical conditions, pregnant women and young children. </li></ul>06/07/09 www.health-nurses-doctors.com
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