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10th Edition Vtan)lo.\en Srp LEWi=. ro nck HEITKEMPER « HARDING KWONG ° ROBERTS BESEVIER i 2241 Riverport Lane St Loa, Migowrt 604 } DICAT SURGICAL NURSING, ASSESSMENT AND MANAGEMENT ISBN (sing OFCUNTEAL PROMLANS. OTH RDIION ‘Copyright © 2017 by Hsevie, ne, All rights reserved No ptt of this publication may be reproduced oF transmitted in any form or by any means electronic or mechani cling hatocopying, recording, oF any information storage and retrieval system, without Fey te ert tom the publisher, Deals on how to sek permission, further information about the sperms policies and our arrangements with onganizaions such as the Copyright Clearance ‘Genter an the Copyright Licensing Ageney, can be found at our website: www ‘THis book andthe individual contributions contained in it are protected under copyright by the Publisher {other than as may be nated herein), Notices Knowletge and best practice in this fed are constantly changing, As new research and experience broaden ar nesting ange in roca tho, poeson prac or meal sige ny necessary, Practitioners and researchers must always rely on thet own experience and knowledge in evaluating ‘and using any information, methods, compounds, or experiments described herein. In using such ‘oF methods they should be mindful of thei own safety and the set of others including ‘parties for whom they havea professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most “current information (i) on procedures featured or (i) by the manufacturer of each product to be ‘siministered, to verify the recommended dose or formula the method and duration of administration, “and contraindications. Its the responsibilty of practitioners, relying on their own experience and Arlee ofthe patents to make dgnoss, to determine dosages andthe bs rete for each ann to take all appropriate safety precautions, ais filles extent of he a niher the Publisher or the autor contributors oer, assume ‘any lability fr any injury and/or damage to persons or property asa matter of products lability, or otherwise, or from any use or operation of any methods, products instructions, or ideas in the material herein, ‘management of clinical problems / Sharon L. Lewis 1 Blsevier, Inc, (2017) | Includes bibliographical references and secTion s Problems. of (@ HEALTHY PEOPLE a Prevention of | Respiratory 1 spring infections ambient ai posure 102 and v0 ot pomutants manana nin hare ae Geta pre le and yearly flu vaccine 2s di ted 5 protective eauipmer «Wes proper personal pote ee ezupstion wth prolonged exposws 10 dust | % n symptom, lasts for up to r often present, although wutum. The presence of Jiable indicator of bacte- Cough, which is the most common 3 weeks, Clear mucoid secretions a dome patients produce purulent sp. Selored (eg. green) sputum i not atl fate ‘Ai infections Assocated symptoms may include headache, fever, malaise, hoarseness, myalgias dyspnea, and chest pain. Diagnosis of acute bronchitis isbasedon clinical assessment Assessment ay reveal normal breath sounds or crackles of wnezes, usually on expiration and with exertion. Consolidation {occurs when fuid accumulates in the lungs, suggestive of Deumonia, is absent with bronchitis. Chest x-rays would be ormal and ae therefore not indicated unless pneumonia is Suspected. (Chronic bronchitis is discussed in Chapter 28.) “The goal in acute bronchitis is to relieve symptoms and prevent pneumonia. Teeatment is supportive, inching cough Suppressants encouraging oral id intake, and using a humid- ifier Beagonist (bronchodilator) inhalers are useful fr patients swith wheezes. Generally antibiotics are not prescribed for treat- Inga viral infection, as they may cause side eects and promote antibiotic resistance. However antibiotics may be prescribed for Patients with underying chronic conditions and who have a prolonged infection associated with systemic symptoms. Patents shouldbe encouraged not to smoke, avoid second- hand smoke, and to frequently wash their hands. Ifthe acute bronchitisis due to an influenza virus, treatment with antiviral drugs, either zanamivir (Relenza) or oseltamivir (Tamifin), can be started. These drugs should be initiated within 48 hours of ‘onset of symptoms. «contagious infection ofthe respiratory tr ivebacilus Bordetella peruse The boc, cilia of the respiratory tract and release toxina he cia, causing inflammation and swelling The hasbeen sey increasing inthe United the largest increase noted in adult, nity resulting from childhood vaccina. ppertusis, tetanus) may diminish er(but still contagious) infection, The and Prevention (CDC) currently years and older who have not i nal (convalescent) stage lasts 2 tg oo a ra opr cough and weaknese "ag is characterized” aracteristic of pertussis is un The hallmare Cfpspiration after each cough preg le ent cousin? sound asthe patient tres to beg fe 1 ae fructed glottis. The “whoop” is oten np against an adults (especially those who have been vce intens ang rchitis, the cOughing is mor fequen qt Like acute Prmso occur with the coughing. Unik hoya Vomiting vith pertussis may last from 6 to 10 weeks, the cough ary treatment for pertussis is antibiotic, yay sos fe (enythromyein aitromycin Zithroma) yap macrofitpoms and prevent spread of the disease. The is infectious from the beginning ofthe tara ig pe ctiows ek after onset of symptoms oF until 5 day the third perapy has been initiated. Cough suppresany < arn tamines should not be used, since they are ineffective gy ann ce coughing episodes. Corticosteroid and broniyg ators are also not useful. viol PNEUMONIA Pneumonia is an acute infection of the lung parenchyma, Uni 1936, pneumonia was the leading cause of death inthe Unie States.! The discovery of sulfa drugs and penicillin was pivoul in the treatment of pneumonia. Since that time, rematlale progress has been made in the development of antibiotics o {reat pneumonia. However, despite newer antimicrobial agents pneumonia is still associated with significant morbidity ad, mortality rates. The CDC reports that pneumonia and inl cenza are the eighth leading cause of death in the United State Etiology ‘Normally, the airway distal to the larynx is protected from inf tion by various defense mechanisms. Mechanisms that create* mechanical barrier to microorganisms entering the tracho bronchial tree include air filtration, epiglottis closure over ie trachea, cough reflex, mucociliary escalator mechanism, ané reflex bronchoconstriction (see Chapter 25). Immune defers: mechanisms include secretion of immunoglobulins A and 6 and alveolar macrophages, Pneumonia is more likely to occur when defense mech pa become incompetent or are overwhelmed by the vit lence or quantity of infectious agents, Decreased conscious weakens the cough and epiglottal reflexes, which may ah aspiration of oropharyngeal contents into the lungs. Ta intubation bypasses normal filtration processes and inter a the cough reflex and mucociliary escalator mechanist™-At Fe tion. cigarette smoking, viral URIs, and normal chi’ Fa he ‘with aging can also impair the mucociliary me Ability to inhibit eee a uPPTESS_the immune ee nati etal growth, The risk factors for "anisms that cause pneumonia reach the hing by ti Inhabiaae 28Y Organisms that cause pneumonia are Tahatants ofthe pharynx in healthy adults tml of mixes preset nthe ma pneumoniae and fungal pneumonias I jeemttogenous spread from a primary infection ese dures 0 Examples are streptococci and Staphy! eus from infective endocarditis reper orot ples nc SEE SAF ae