Helpful for nursing students

1. ACUTE RESPIRATORY
INFECTIONS
BY KOMAL UPRETI
B.Sc.(Nursing)
3rd semester,2nd year

2. CONTENT
INTRODUCTION
ACUTE RESPIRATORY INFECTION
1.SIGNS AND SYMPTOMS
2.EPIDEMIOLOGICAL DETERMINANTS
(A) Agent factors
(B) Host factors
(C) Mode of transmission
(D) Risk factors
3.CONTROL
4.PHYSICAL EXAMINATION

3.  PNEUMONIA
 ETIOLOGY OF PNEUMONIA
 CLASSIFICATION AND MANAGEMENT
1. No Pneumonia
2. Pneumonia
3. Severe Pneumonia
4. Very Severe Pneumonia
 HIGH RISK CHILDREN FOR PNEUMONIA
 COMPLICATION OF PNEUMONIA
 TREATMENT FOR PNEUMONIA
 IMMUNIZATION FOR PNEUMONIA

4. INTRODUCTION
Infections of respiratory tract are
perphaps the most common human
aliment. While they are a source of
discomfort ,disability and loss of time
for most adults, they are a substantial
cause of morbidity and mortality in
young children and the elderly.

5. • Many of these infection run their
natural course in older children and
in adults without complications.
However, in young infants,small
children and in the elderly or in the
persons with impaired respiratory
tract reserves, it increases the
morbidity and mortality rates

7. ACUTE RESPIRATORY
INFECTIONS
• Acute respiratory infections(ARI) may cause
inflammation of the respiratory tract
anywhere from nose to alveoli, with a wide
range of combination of signs and symptoms.
• ARI are classified on the basis of site of
infection:
(a) Acute Upper Respiratory infection(AURI)
(b) Acute Lower Respiratory infection(ALRI)

8. • The URTI include common cold,
pharyngitis and otits media
• The LRTI include
epiglottitis,laryngitis,laryngotracheit
is, bronchitis, bronchiolitis and
pneumonia.

9. SIGNS AND SYMPTOMS
• Running nose
• Cough
• Sore throat
• Difficulty in breathing
• Ear problem
• Fever
• Cold

10. EPIDEMIOLOGICAL
DETERMINANTS
(A) AGENT FACTORS
1. BACTERIA
(a) Boredetella pertusis
(b) Corynebacterium diphtheriae
(c) Haemophilus influenzae
(d) Klebsiella pneumoniae
(e) Legionella pneumophila
(f) Staphylococcus pyogens
(g) Streptococcus pneumoniae
(h) Streptococcus pyogens

11. `
2. VIRUS
(a) Enteroviruses
(b) Influenza A,B,C
(c) Adenoviruses
(d) Measles
(e) Parainfluenza 1,2,3
(f) Respiratory syncytial virus
(g) Rhinoviruses
(h) Coronavirus

12. HOST FACTORS
Small children(age group of 0-5 years)
Adult women
Under 3 years of boys are affected more
often and severely
Malnutrition,anaemia,immune deficiences
decrease normal resistance to infection.
Allergies ,cardiac abnormalities,cystic
fibrosis,weaken respiratory defense
mechanism of the individuals.

13. RISK FACTORS
• Many risk factors for respiratory tract infections
have been identified. They include not only the
climatic conditions but also the housing,level of
industralization and socio-economic development.
• In developing countries; overcrowded
dwellings,poor nutrition,low birth weight and
intense indoor smoke pollution.
• Maternal cigarette smoking increasing the risk of
respiratory tract infection .

14. • Infection more common in preschool children
attending day care centres.
• Infection tend to be more common in urban
communities than in rural communities.
• Local mortality rates are particularly affected
by the extent of influenza epidemics.

15. CONTROL
• Improving primary medical care services.
• Better methods for early detection and
treatment.
• Poor hygeine and sanitation
• Wash hands with soap and water
• Cover mouth and nose while coughing and
sneezing
• Health education

16. PHYSICAL EXAMINATION
• Count the breath in one minute
• Look for chest indrawing
• Look for wheeze
• Check for severe malnutrition
• Fever or lowbody temperature
• Abnormal sleep and difficult to wake
• Cyanosis(sign of hypoxia)

18. PNUEMONIA
• Inflammation of the lung parenchyma and is
associated with the consilidation of the
alveolar spaces.
or
• Inflammation of the lungs caused by bacterial
or viral infections in which air sac filled with
pus and may become solid.

19. Developed world
* viral infections
* low morbidity and mortality
Developing world
* common cause of death
* bacteria in 65%

20. ARI Case management by WHO
* 84% reduction in mortality
* Respiratory rate,recession,ability to drink
* cheap,oral and effective antibiotics( co-
trimoxazole ,
amoxycillin)
* Maternal Education

21. Types of pneumonia
• Segments affected from pneumonia
• BRONCHIAL PNEUMONIA
• LOBAR PNEUMONIA
• SEGMENTAL PNEUMONIA
• BILATERAL PNEUMONIA
…

22. • INTERSTITIAL PNEUMONIA
• ALVEOLAR PNEUMONIA
• NECROTIZING PNEUMONIA

23. ETIOLOGY
 Vary according to- Age, Immune status
 Community acquired
(a) Developing countries
- Streptococcus pneumoniae
- Haemophillus influenzae
- Staphylococcus aureus
- Viruses (40%)
- Others: Mycoplasma,Chlamydia,Moraxella

24. (b) Developed countries
- Viruses
- Bacterial(5-10%)

27. ETIOLOGY ACCORDING TO AGE
 In Neonates
Caustive organisms: E.Coli
Group B Sterptococcus
Klebsiella
Staphylococcus aureus
 In Infants
Caustive organisms: Pneumococcus
Chlamydia

28.  In Children 1-5 years
Caustive organisms: Respiratory viruses
Pneumococcus
Haemophillus influenza
Staphylococcus aureus
 In 5-18 years
Causative organisms: Pneumococcus
Haemophillus influenza
Type B

30. CLASSIFICATION AND
MANAGEMENT
1. No Pneumonia
Cough, No tachypnea
* MANAGEMENT
-Home care
-Soothe the throat and relieve cough
-Consult the physician if within 5 days it is
not improving

31. 2. Pneumonia
Cough, tachypnea, No rib or sternal retraction,
able to drink, No cyanosis
* Management
- Home care
- Antibiotic for 5 days
- Soothe the throat and releive cough
- Consult again the physician if not cure within 2 days

32. 3. Severe Pneumonia
Cough, tachypnea, rib and sternal retraction,
No cyanosis, Able to drink, Nasal flaring,
Grunting
* Management
- Admit in hospital
-Give recommended antibiotics( IM injections of
Benzy Penicillin or Ampicillin or Chloramphenicol)
-Manage airway
-Treat fever (if present)

33. 4. Very Severe Pneumonia
Cough, tachypnea, chest wall retraction,
Unable to drink, convulsions, Cyanosis,
Malnutrition
* MANAGEMENT
-Admit in hospital
-Give antibiotics
-Oxygen therapy
-Manage airway
-Treat fever

35. HIGH RISK CHILDREN FOR
PNEUMONIA
• Significant risk factors
-Younger age(2-6 months)
-Low parental education
-Smoking at home
-Low birth weight
-Weaning from breast at < 6 months
-A negative history of
diphtheria,pertusis,tetanus
vaccination

36. -Anaemia
-Malnutrition
-Over crowding

37. COMPLICATIONS OF
PNEUMONIA
• Emphysema
• Lung abscess
• Pneumothorax
• Pleural effusion
• Respiratory failure
• Metastatic septic lesions

38. TREATMENT
• ANTIBIOTICS
* Under 5 years
First line treatment- AMOXICILLIN
Alternatives- coamoxiclav, Cefaclor,
Macrolides
* Over 5 years
First line treatment- AMOXICILLIN
Alternatives- Macrolides or
Flucloxacillin + Amoxicillin

39. • ANTIBIOTICS FOR SEVERE
PNEUMONIA
* Co-amoxiclav; Cefotaxine; Cefuroxime
* oxygen therapy
*Hydration= 50-80 ml/kg/day
* Temperature control
* Airway obstruction management
* chest drain – for fluid or pus collection in
lungs

40. IMMUNIZATION
• Vaccines hold promise of saving millions
of children from dying of pneumonia.
• MEASLES VACCINE(0.5
ml/subcutaneous)
• HIB VACCINE
• PNEUMOCOCCAL PNEUMONIA
VACCINE(PPV)

41. CASE STUDY
• In INDIA during the year 2013 about 31.7
million cases of ARI were reported.
• During 2013 about 3,278 people died of
ARI
2,597 died of pneumonia
• Pneumonia was responsible for about 18% of
all under 5 years death in INDIA