NCM 112 LEC Topic 13 Respiratory Infectious Diseases

NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~
Respiratory Infectious Diseases

PNEUMONIA
- Other names: Lung-fever, pneumonitis, disease, lobar-pneumonia, & croupous pneumonia
- Pneumonia is an infection in 1 or both lungs.
- The infection causes inflammation in the air sacs in the lungs, w/c are called alveoli. The alveoli fill
w/ fluid or pus, making it difficult to breathe.
- There are several types of Pneumonia-causing microbes:

 Bacterial pneumonia (Streptococcus pneumoniae, Haemophilus influenzae, S. aureus,
Mycoplasma pneumoniae, Chlamydophilia pnemoniae, Legionella pneumophilia)
 Viral pneumonia (influenza virus)
 Fungal pneumonia (Coccidiodomycosis, Histoplasmosis, Blastomycosis)
- Community-Acquired Pneumonia (CAP) - Ventilator-associated Pneumonia (VAP)

 Person gets ill outside of a hospital or  Subset of Hospital-Acquired
health care setting Pneumonia
- Hospital-Acquired Pneumonia (HAP)  Develops when person is connected
 ‘Nosocomial Pneumonia’ to a ventilator
 Person already sick in hospital - Aspiration Pneumonia
 Usually more serious (since sick pts. have  From foods, drinks, gastric contents
weakened immune systems)
Lobar Pneumonia (STAGES)

1. Congestion – days 1-2; blood vessels & alveoli
fill w/ excess fluid
2. Red Hepatization – days 3-4; exudate (rbcs,
neutrophils, fibrin) fills air spaces making them
more solid and has liver-like appearance
3. Gray Hepatization – days 5-7; still firm; color
changes bcs. rbcs in exudate breaks down
4. Resolution – days 8-3 wks; exudate is digested,
ingested, or coughed up
- Viral & bacterial Pneumonia can spread to others through inhalation of airborne droplets from a
sneeze or cough.
 Also these types of Pneumonia can be transferred by coming into contact w/ surfaces or objects
that are contaminated w/ pneumonia – causing bacteria or viruses.
Vocabulary:
Miliary tuberculosis – it is a potentially life-threatening type of tuberculosis that occurs when a large number of the
bacteria travel through the bloodstream and spread throughout the body.
Caseous Necrosis – cheese-like necrosis; since the dead tissue looks soft, white, & looks like a cheese
- Fungal Pneumonia from the environment

 It doesn’t spread from person to person
- Working hard to breathe/breathing quickly

- CXR - Sputum exam
- Blood tests such as CBC - Pulse Oximetry
- Dyspnea – SOB - Muscle aches

- Chest pain - Abdominal pain
- Productive cough – pus or bloody sputum - Cold in the head/throat
- Rusty sputum - Nausea & vomiting
- Fever w/ shivering
Common Nursing Diagnoses

 Ineffective Airway Clearance
o due to presence of thick retained secretions
 Impaired Gas Exchange
o Pneumonia can prevent the lungs from moving enough oxygen into the bloodstream & alters
gas exchange
 Ineffective Breathing Pattern
o This is r/t compensatory tachypnea due to an inability to meet metabolic demands. Changes in
breathing pattern occur bcs. affected alveoli can’t effectively exchange O2 & CO2, as a result of
chest pain, & increased body temp.
 Risk for Infection
o There is an existing infection that may gain access to the systemic circulation & further worsen
the condition
 Acute pain
o The effort of the respiratory muscles during coughing produces pain
 Activity Intolerance
o The loss of appetite & reduction in O2 level in the blood causing weakness
 Hyperthermia
o The successful invasion of microorganisms in the body will trigger the body to produce febrile
episode
o Since there is inflammation of the lung parenchyma, fever develops as a part of the signs of an
infection
 Risk for Deficient Fluid Volume
o Fever can reduce the fluid volume
 Risk for Imbalanced Nutrition: Less than Body Requirements r/t loss of appetite
 Deficient Knowledge about the management of Pneumonia
 Deficient Fluid Volume r/t fever, sweating, and rapid RR
Vocabulary:
- Treatment depends on the germs that cause it.

- Bacterial Pneumonia – usually treated w/ antibiotics
- Viral Pneumonia – antibiotics are not used to fight viruses (in some cases antibiotics may be given to
fight a bacterial infection that’s also present)
- Fungal Pneumonia – antifungal medication is prescribed if a fungus is the cause of the pneumonia.
- Others: antipyretic, mucolytics, expectorant
- Depends on the type & severity - Cough suppressants

- Antibiotic administration - Pain medications
PULMONARY TUBERCULOSIS
- Other names: Consumption, Phthisis, White Death, Poor Man’s Disease, Koch’s Disease, King's evil
- Tuberculosis is an infectious disease w/c attacks humans of all ages & can infect nearly every part
of the human body.
- It is tuberculosis of the lungs, makes up the vast majority of the cases. It is an ancient disease.
Neolithic skeletons (4500 B.C.) & Egyptian Mummies (1000 B.C.) have been found w/ tubercular lesions
on their bones.
- Myobacterium tuberculosis (enters the body via inhalation)
- Signs of infection after exposure to TB

- Mostly asymptomatic or have flu like symptoms
- About 3 wks. after initial infection, the CELL-MEDIATED IMMUNITY occurs
 Immune cells surrounds the site of TB infection creating a granuloma, in
attempt to wall off the bacteria & prevent it from spreading, then the
tissue inside it dies w/c is referred to as ‘caseous
necrosis’
- Airborne/droplet
 TB bacteria are spread through the air from one person to another
 The TB bacteria are put into the air when a person w/ TB disease of the lungs or throat, coughs,
speaks, or sings
 People nearby may breathe in these bacteria & become infected (CDC)
- TB is NOT spread by:
 Shaking someone’s hand
 Sharing food/drink
 Touvhing bed linens or toilet seats
 Sharing toothbrushes
 Kissing
Vocabulary:
- Mantoux tuberculin Skin Test (TST) or the TB blood test or PPD test
- Acid-Fast-Bacili (AFB) on a sputum smear or other specimen
- Posterior-anterior chest radiograph
- Gene Xpert
- Symptoms of TB disease depends on where in the body the TB bacteria are growing (TB bacteria
usually grow in the lungs [Pulmonary TB])
- S/Sx of Active TB:
 Coughing that lasts for 3 or more wks.  Fatigue
 Chest pain/pain w/ breathing or coughing  Night sweats
 Loss of appetite  Fever
 Chills  Coughing up blood
 Unintentional weight loss
- Latent infection: single drug for long time (Isoniazid for 9 months)
- Active infection: drug combinations of anti-TB antibiotics (Isoniazid, Rifampin, Ethambutol,
Pyrazinamide) w/c results in pts. to be non-infectious within a few weeks
Common Nursing Diagnoses

 (similar w/ Pneumonia for Pulmonary TB)
 For Extrapulmonary TB
o Nursing diagnosis will be variable depending on the signs & symptoms presented
SITE REGIMEN RECOMMENDATION/LEVEL OF EVIDENCE

CNS 2HRZE/10HR Strong Recommendation, high quality evidence
Bone and Joints 2HRZE/10HR Strong Recommendation, moderate quality evidence
Lymph node 2HRZE/4HR Strong Recommendation, moderate quality evidence
Pericardium 2HRZE/4HR Strong Recommendation, low quality evidence
Pleura 2HRZE/4HR Strong Recommendation, moderate quality evidence
Liver 2HRZE/4HR Strong Recommendation, moderate quality evidence
GI, Peritoneum 2HRZE/4HR Strong Recommendation, moderate quality evidence
Kidney, Genitourinary 2HRZE/4HR Strong Recommendation, low quality evidence
CATEGORY INDICATIONS REGIMEN

New Pulmonary TB
Category I New Miliary TB 2HRZE/4HR
New EPTB (except CNS/bone or joints)
Category Ia CNS TB, TB of bones or joints 2HRZE/10HR
Category II Retreatment of Rif susceptible PTB & EPTB (except CNS/bones or 2HRZES/1HRZE/5HRE
Vocabulary:
joints)
Category IIa Retreatment of Rif susceptible CNS, bones, joints 2HRZES/1HRZE/9HRE
EBOLA VIRUS DISEASE

- Other names: Ebola, also known as Ebola Virus Disease (EVD) or Ebola, Hemorrhagic Fever (EHF)
- It is a viral hemorrhagic fever of humans & is a rare but severe, often fatal illness in humans.
- EVD is caused by four of five viruses in the genus Ebola virus, family Filoviridae, order
Mononegavirales
- The four disease-causing viruses in humans are as follows:
 Bundibugyo Ebola virus (BDBV)
 Zaire Ebola virus/Ebola virus (EBOV)
 Sudan Ebola virus (SUDV)
 Taï Forest Ebola virus (TAFV)
- Primary Source of Infection

- Secondary Source of Infection
 Direct contact
 Indirect Contact
- DRY Symptoms
 Fever
 Aches & pains such as severe headache, muscle & joint pain, & abdominal (stomach) pain
 Weakness & fatigue
- WET Symptoms
 GI symptoms including diarrhea & vomiting (may contain blood)
 Abdominal (stomach) pain
 Unexplained hemorrhaging, bleeding (nose/mouth), or bruising
- Symptoms can start within 2 to 21 days of contact w/ an infected person or dead body
Nursing Diagnoses
 Acute Pain r/t abdominal pain, headache, muscle and joint pain
o The loss of appetite & reduction fluid and electrolytes
 Hyperthermia
episode
 Risk for Imbalanced Nutrition: Less Than Body Requirements r/t loss of appetite
Vocabulary:
 Deficient Knowledge about management of Pneumonia

 Fluid Volume and electrolyte imbalances r/t fever, sweating, LBM, and vomiting
- No vaccine for Ebola Virus Disease is available.

- There is no specific treatment for this disease.
- The standard treatment for Ebola virus Disease includes an intensive supportive therapy:
 Balancing the patient’s fluids & electrolytes
 Maintaining their oxygen status & blood pressure
 Treating them for any other infections
MERS – COV
- Camel Flu
- Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a novel
coronavirus that was first identified in Saudi Arabia in 2012.
- MERS-Cov is a beta coronavirus w/c has not been identified in humans before & is different from
other coronaviruses (including SARS-Cov) that have been found in humans or animals
- It is a zoonotic virus, meaning it is transmitted between animals & people, & it is contactable
through direct or indirect contact w/ infected animals.
- Fever - Chills - Most common: fever, cough, SOB

- Joint pain - Headache - Less common: diarrhea, vomiting
- Common cold - SOB - Advanced cases: pneumonia, renal failure
Nursing Diagnoses
 Ineffective Airway Clearance due to presence of thick retained secretions
 Impaired Gas Exchange
o Secretions can prevent the lungs from moving enough O2 into the bloodstream and alters gas
exchange
 Ineffective Breathing Pattern r/t compensatory tachypnea due to an inability to meet metabolic
demands.
o It is experienced by many pts. w/ pneumonia
o Changes in breathing pattern occur because affected alveoli can’t effectively exchange O2 &
CO2, as a result of chest pain, & increased body temp.
 Risk for Infection
o There is an existing infection that may gain access to the systemic circulation & further worsen
the condition
Vocabulary:
 Acute pain
o The effort of the respiratory muscles during coughing produces pain/abdominal pain
o The loss of appetite & reduction in O2 level in blood causing weakness
 Hyperthermia
episode
 Risk for Imbalanced Nutrition: Less Than Body Requirements r/t loss of appetite/vomiting/LBM
 Deficient Knowledge about management of MERS-Cov
 Deficient Fluid Volume and Electrolytes r/t fever, sweating, and rapid RR, vomiting and LBM
- There is currently NO SPECIFIC TREATMENT for the disease.

- The treatment is supportive
INFLUENZA
- “The Flu”
- An acute viral infection affecting respiratory system caused by an influenza virus.
- Highly contagious respiratory disease caused by
influenza virus
- Types of Influenza virus: Influenza types A & B are
responsible for the annual regional flu epidemics (flu
season). While type C may cause mild illness but not
epidemics/pandemics.
- Person-to-Person
 Respiratory droplets (propelled when talking, coughing, sneezing, and can land in eyes, nose,
mouth or it can be inhaled)
 Aerosolized particles
- Touching a contaminated surface (prior to washing the hands, you touch your eyes, nose, mouth)
- Individuals are most likely to spread the virus to others 1 day before symptom onset until 5-7 days
after becoming sick
- So, people are at increased risk of contracting the virus if they have close contact w/ infected individuals
or if you’re in small spaces w/ large groups of people especially if not vaccinated against influenza.
1. Contract virus
2. Multiply & spread throughout the upper respiratory tract
3. Immune system launches inflammatory response: tracheobronchial redness & swelling and mucus
discharge (to trap & expel these pathogens)
Vocabulary:
- In certain cases, the disease can become more severe & spread to nearby area leading to complications:
 Sinus or ear infections
 Pneumonia (if the pathogens manage to invade the lower respiratory tract) w/c weakens the
immune system & makes the individual more susceptible to secondary bacterial infection
- Clients at high risk of having complications:
 Children <5 y/o
 Adult >65 y/o
 Pregnant
 Person w/ chronic heart/lung disease
- Symptoms are present 4 days after exposure & last about a week
- Upon auscultation, BS is typically normal
- Headache - Body aches
- Fever - Nasal discharge
- Chills - Sore throat
- Fatigue & weakness - cough
- In Influenza Type B: symptoms include nausea, vomiting, & diarrhea
- Obtaining client’s history

- Physical Assessment
- Influenza outbreak in the community
- Diagnostic tests include:
 Viral culture provides results in 3-10 days
 RT-PCR
 Rapid Molecular Assay
 Both of these can detect viral RNA & more accurate bcs. it has high sensitivity &
specificity
 It can also differentiate between Influenza A & B
 Rapid Influenza Diagnostic Tests (RIDTs)
 Can detect some viral antigens
 Some differentiate between Influenza A & B bcs. it has low sensitivity & specificity
 Faster results (most commonly used)
- NO CURE for Influenza

- Treatment involves supportive care to reduce symptoms: rest, hydration, medications (analgesics,
antipyretics, antihistamines) & antiviral medications (zanamivir, oseltamivir, peramivir) to prevent
release of virus from infected cells
- Most effective way to prevent influenza: vaccinations
Vocabulary:
FLU
- Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and
sometimes the lungs.
- Sore throat - Fever

- Dry cough - Chills
- Rhinitis - Headache
Nursing Diagnoses
 (Similar w/ viral Pneumonia)
- There is currently no specific treatment for the disease. Treatment is supportive.

- Antiviral treatment is recommended as early as possible for any patient w/ confirmed or suspected
influenza who:
 is hospitalized;
 has severe, complicated, or progressive illness; or
 is at higher risk for influenza complications.
CORONAVIRUS
- “Corona” is a latin word that means of “Crown”

- This virus consists of a core of genetic materials surrounded by envelope protein spikes. This spike
gives the appearance of the crown.
- Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to
more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) & Severe Acute
Respiratory Syndrome (SARS-CoV).
- Common Human Coronaviruses are:

 229E (alpha coronavirus)
 NL63 (alpha coronavirus)
 OC43 (beta coronavirus)
 HKU1 (beta coronavirus)
- Other Human Coronaviruses are:
 MERS-CoV (The beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
 SARS-CoV (The beta coronavirus that causes Severe Acute Respiratory Syndrome, or SARS)
 Covid-19
Vocabulary:
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
 Approximately 8098 cases in 29 countries as of July 31, 2003
 At least 774 deaths
 1,707 cases (21%) have been health care workers
 Cause : SARS CoV  Super spreading events important in transmission process

 Highly infectious  No reports of transmission occurring before onset of
 Mainly affects adults symptoms
 Evidence of person to person transmission

 Close contact with body fluids (especially respiratory droplets)
 Contaminated hands, clothes, equipment; environment may also be important
 high fever (temperature greater than 100.4°F [>38.0°C])

 headache
 an overall feeling of discomfort body aches
 10 %- 20 % of patients have diarrhea
 After 2 to 7 days, SARS patients may develop a dry cough PNEUMONIA
 CDC worked closely with WHO and other partners in a global effort to address the SARS outbreak of
2003. For its part, CDC took the following actions:
o Activated its Emergency Operations Center to provide round-the-clock coordination and
response
o Committed more than 800 medical experts and support staff to work on the SARS response.
MIDDLE EAST RESPIRATORY SYNDROME (MERS)

 Viral respiratory disease caused by a Corona virus
 First Case: Saudi Arabia April 2012
 Attributed to camels and bats
 Fever  SOB  Kidney Failure

 Cough  Diarrhea  Asymptomatic
 There is no specific antiviral treatment recommended for MERS-CoV infection

 Individuals w/ MERS can seek medical care to help relieve symptoms
 For severe cases, current treatment includes care to support vital organ functions
Vocabulary:
COVID-19
 Wuhan, China  Caught attention of medical community because it

 December 2019 was then a mysterious “virus-caused” pneumonia
 Chinese seafood & poultry market  Declared an epidemic in January 2020 in Wuhan
 Initially thought to have come from bats,  Declared a Global Health Emergency by the
w/c was sold at the market World Health Organization in the same month,
 Causes flu like symptoms w/ cases growing in numerous countries
 On February 11, 2020, the World Health Organization announced an official name for the
disease: coronavirus disease 2019, abbreviated
COVID-19. ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and
‘D’ for disease.
 The virus that causes COVID-19, SARS-CoV-2, is a
coronavirus.
 The word corona means crown and refers to the
appearance that coronaviruses get from the spike
proteins sticking out of them.
 Coronaviruses are a family of viruses

 The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
 Fever or chills  New loss of taste or smell

 Cough  Sore throat
 SOB or DOB  Congestion or runny nose
 Fatigue  Nausea or vomiting
 Muscle or body aches  Diarrhea
 Headache
 Contact & droplet transmission

 Airborne transmission
 Fomite transmission
 The time in w/c the virus multiplies inside the body, leading to a viral load that will cause symptoms to
appear.
 COVID-19 incubates between 2 to 14 days.
Vocabulary:
 Complete blood count w/ platelet counts  CoVid – 19 Antigen Test

 Clotting factors  CoVid – 19 RT-PCR Test
 Inflammatory Markers  Chest CT Scan
o Ferritin
o Lactate Dehydrogenase
o C- Reactive Protein
 ABG
 CXR
–
 Oxygenation
o High flow oxygenation cannula
o Non- invasive positive pressure ventilation
o Intubation
 Proning
 Hemoperfusion
 Medications:
o Remdesivir (antiviral)
o Tocilizumab (immunosuppressive)
o Dexamethasone (anti- inflammatory)
o Antibiotics (prevent sepsis secondary to bacterial infections)
o Adjunct therapy for covid symptoms (paracetamol, mucolytic, vitamins, & antiseptic mouthwash)
 Get Vaccinated  Wash your hands often

 Wear a mask  Cover coughs & sneezes
 Stay 6 feet away from others  Clean & disinfect
 Avoid crowds & poorly ventilated spaces  Monitor your health daily
Nursing Diagnoses
 (Similar w/ viral Pneumonia)
- There is currently no specific treatment for the disease. Treatment is supportive.

- Antiviral treatment is recommended as early as possible for any patient w/ confirmed or suspected
influenza who:
 is hospitalized;
 has severe, complicated, or progressive illness; or
 is at higher risk for influenza complications.
Vocabulary:

NCM 112 LEC Topic 13 Respiratory Infectious Diseases

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NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~

Respiratory Infectious Diseases

- There are several types of Pneumonia-causing microbes:

- Community-Acquired Pneumonia (CAP) - Ventilator-associated Pneumonia (VAP)

Lobar Pneumonia (STAGES)

- Fungal Pneumonia from the environment

- Working hard to breathe/breathing quickly

- Dyspnea – SOB - Muscle aches

Common Nursing Diagnoses

- Treatment depends on the germs that cause it.

- Depends on the type & severity - Cough suppressants

- Myobacterium tuberculosis (enters the body via inhalation)

- Signs of infection after exposure to TB

Common Nursing Diagnoses

SITE REGIMEN RECOMMENDATION/LEVEL OF EVIDENCE

CATEGORY INDICATIONS REGIMEN

EBOLA VIRUS DISEASE

- Primary Source of Infection

 Deficient Knowledge about management of Pneumonia

- No vaccine for Ebola Virus Disease is available.

- Fever - Chills - Most common: fever, cough, SOB

- There is currently NO SPECIFIC TREATMENT for the disease.

- Obtaining client’s history

- NO CURE for Influenza

- Sore throat - Fever

- There is currently no specific treatment for the disease. Treatment is supportive.

- “Corona” is a latin word that means of “Crown”

- Common Human Coronaviruses are:

 Cause : SARS CoV  Super spreading events important in transmission process

 Evidence of person to person transmission

 high fever (temperature greater than 100.4°F [>38.0°C])

MIDDLE EAST RESPIRATORY SYNDROME (MERS)

 Fever  SOB  Kidney Failure

 There is no specific antiviral treatment recommended for MERS-CoV infection

 Wuhan, China  Caught attention of medical community because it

 Coronaviruses are a family of viruses

 Fever or chills  New loss of taste or smell

 Contact & droplet transmission

 Complete blood count w/ platelet counts  CoVid – 19 Antigen Test

 Get Vaccinated  Wash your hands often

- There is currently no specific treatment for the disease. Treatment is supportive.

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