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Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Respiratory

Alterations IV


Nursing Care of Clients With Lower Respiratory Tract Infections


Topics Discussed Here Are: 1. Pneumonia 2. Pulmonary Tuberculosis 3. Acute Tracheobronchitis 4. Severe Acute Respiratory Syndrome

It is an inflammation of the lung parenchyma caused by various microorganisms Classifications of Pneumonia o Community Acquired Pneumonia o Hospital Acquired Pneumonia o Aspiration Pneumonia It may develop as a primary acute infection / secondary to another respiratory / systemic condition

Community Acquired Pneumonia

Occurs in community setting or within the 1st 48 HOURS after hospitalization Commonly causative factors are as follows: 1. S. Pneumoniae 2. H. Influenzae 3. Legionella 4. Pseudomonas Aeruginosa 5. Other gram negative rods

Hospital Acquired Pneumonia

Nosocomial infection Defined as the onset of pneumonia symptoms more than 48 HOURS after admission in clients without evidence of infection at the right time of admission Client in the hospital are exposed to potential bacterial invasion

Aspiration Pneumonia
Refers to the pulmonary consequences resulting from entry of endogenous / exogenous substances into the lower airway RISK FACTORS Client with mucous / bronchial obstruction Smoking Immunocompromised clients Prolonged immobility Depressed cough reflex Incompetent epiglottis Client with NGT, ET Tube, use of suction machine Advanced age Improper isolation technique Systemic infection



DIAGNOSTIC PROCEDURES - Chest X-Ray - Sputum / Blood Cultures - Physical Examination

Bronchopneumonia / Lobar Pneumonia

Medical Management Pharmacologic Management Antibiotic / Anti-infectives Mucolytics Antipyretic Nasal Decongestants Antihistamines Nursing Management - Assess for SYMPTOMS such as: o Fever o Chills o Night Sweats o Respiratory Function Use of accessory muscles o Pleuritic-type pain o Fatigue o Coughing and Purulent Sputum RUSTY COLORED SPUTUM Productive COUGH - Conduct respiratory assessment (q4 Hours) - For elderly, assess for mental status, dehydration, excessive fatigue and heart failure


C Cou ra g ck h le s

For clients with methicillin resistance Methicillin Sensitive Staphylococcus Aureus (MRSA) Isolated in room, contact precaution

Nursing Responsibility - When transporting, clients must apply appropriate precaution - For VIRAL PNEUMONIA Support Management - Provide Health Education on prevention of pneumonia Vaccine for elderly clients o Pneumococcal Vaccine (65 Years Old) Possible Nursing Diagnoses - Ineffective airway clearance related to production of excessive secretions, copious tracheobronchial secretion - Altered thermoregulation: Hyperthermia related to inflammatory response Plan of Care - To promote airway clearance - To conserve energy and rest - To decreased body temperature Nursing Responsibility (LOL) - Suction clients secretions - Position client in high fowlers - Encourage client to increase fluid intake - Administer oxygen as ordered - Teach DBE (Deep Breathing Exercise) and Coughing Exercise - Perform Chest Physiotherapy (CPT) - Refer to respiratory therapist for nebulization - Provide postural drainage - Promote rest and conserve energy - Maintain nutrition - Provide health teachings with regards to the diagnosis, medication, treatment - Monitoring and managing for any complications - Provide discharge plan Evaluation - Demonstrate increased airway patency - Rest and conserve energy by limiting activity - Maintains adequate hydration knowledge on prevention and managing complications

Pulmonary Tuberculosis
Infection caused by mycobacterium tuberculosis Closely associated with poverty, malnutrition, overcrowding, substandard housing and inadequate health care Airborne transmission Clinical Manifestations - Low grade fever - Cough - Night Sweats - Fatigue - Weight loss - Hemoptysis Medical Management Pharmacologic Management (Administer for 6 12 months) Rifampicin Pyrazinamide Isoniazid Ethambutol



Nursing Responsibility (NO TO CPT) Perform complete history taking Performs assessment of respiratory function Assess for associated symptoms Palpate for any enlarged lymph nodes Administer anti-tuberculosis medications Provides health education on the different effects of medication ANTI-TUBERCULAR MEDICATIONS - Contraindicated to clients with LIVER DISEASE (Hepatotoxic Medications!!) - Single Drug Therapy combined with Isoniazid - Multi-drug Therapy

Aminoglycosides May cause ototoxicity and nephrotoxicity Factors to consider are the AGE, RENAL FUNCTION and DRUG DOSE Careful drug dosing is important when administering to younger and older clients Isoniazid Peripheral Neuropathy are common to clients who are malnourished; diabetic and alcoholic Hyperglycemia, Hyperkalemia, Hypophosphatemia and Hypocalcemia Hepatotoxicity is an adverse reaction of Isoniazid, Rifampicin and Streptomycin Clients taking in Isoniazid, Rifampicin and Streptomycin may develop: Head aches Blood dyscrasias Paresthesia GI Distress and; Ocular toxicity Nursing Responsibility - Educate the client taking Rifampicin that it turns their body fluids color ORANGE; soft contact lenses may be permanently discolored - Clients taking Ethambutol may develop dizziness, confusion, hallucinations and joint pain


Streptomycin may lead to many adverse reactions Ototoxicity, optic nerve toxicity, encephalopathy, angioedema, CNS and respiratory depression, nephrotoxicity and hepatotoxicity Isoniazid NO TO FOOD RICH IN TYRAMINE and HISTAMINE (Tuna, Red wine, Soy Sauce, Yeast Extract, Aged Cheese) it may result to HYPOTENSION: Head ache, flushing, light headedness, palpitations and dizziness WOF Drug to drug interaction Possible Nursing Diagnoses - Ineffective airway clearance related to copious tracheobronchial secretions - Knowledge deficit - Altered nutrition: Less than body requirements

Plan of Care
To promote patent airway To gain, acquire knowledge regarding the management of tuberculosis To promote adequate nutrition To prevent the spread of infection

Nursing Interventions
Promote airway clearance Advocating to treatment regimen Promoting adequate nutrition Health education on the different side effects of medication therapy

Nursing Responsibilities
Encourage to increase oral fluid intake Increase caloric intake During active phase, isolate the client and correctly explain the rationale to the client Administer due meds Monitor for any side effects Reinforce the implication of regimen Position client in high fowlers position Encourage to eat food rich in Vitamin C Instruct client to avoid going to crowded places

Maintain patent airway Demonstrate adequate knowledge Adherence to medication therapy

Acute Tracheobronchitis
Acute inflammation of the mucous membrane of the trachea and bronchial tree Common Causes of Tracheobronchitis: o Streptococcus Pneumoniae o H. Influenzae o Aspergillus Fungal infection RISK FACTORS: Infection


Inhalation of irritants, gases / air contaminants CLINICAL MANIFESTATIONS - Drug, irritating cough - Expectoration of scanty amount of mucoidal sputum - May report sternal pain due to coughing - Fever - Chills, night sweats, head ache, and general malaise - During the progression of infection, client may report Shortness of Breath - With noisy inspiration and expiration - Produce purulent sputum - Blood streaked secretion MEDICAL MANAGEMENT - Goal is to decreased TB irritations - Antibiotic therapy, analgesics, antipyretics - Expectorants - Cool vapor therapy - Steam inhalation - Heat therapy - Endotracheal intubations NURSING MANAGEMENT - Administer medications as ordered - Support measures: o Systemic hydration o DBE and Coughing exercises - Instruct client to rest - Administer steam inhalation, cool vapor

Severe Acute Respiratory Syndrome (SARS)

Caused by a viral respiratory illness Corona virus SARS related corona virus Transmitted via droplet touching a surface or object contaminated by droplet RISK FACTORS Travel to China, Hong Kong and Taiwan or close contacts with the traveler Presence of undiagnosed atypical pneumonia cases Employment involving close contact with virus CLINICAL MANIFESTATIONS 1st Stage (3 7 Days) 2nd Stage Flu-like symptoms Coughing DRY! Fever 38C Marked DOB Headache Lymphocytopenia Myalgia Thrombocytopenia Chills, anorexia C-Reactive Protein Frequent diarrhea Liver Enzymes
MEDICAL MANAGEMENT Antiviral Ribavirin Glucocorticoid Methylprednisone Mechanical Ventilator to support the client Supportive management DIAGNOSTIC TESTS Chest X-ray will reveal presence of patchy areas of interstitial congestion NURSING MANAGEMENT History taking, travel history of the client, the possibility of getting the virus Identify the risk factor needs to monitor Administer medications as ordered Assist the medical team in intubation Should place the client on isolation room Environmental cleaning and disinfection technique must be done Infection control measure Hand hygiene