Care of Patients with Infectious Respiratory Problems

Question 1

Rhinitis:

Answer 1

Inflammation of nasal mucosa

“Hay fever” or “allergies”

Question 2

Manifestations- allergic rhinitis

Answer 2

Headache
Nasal irritation and congestion
Sneezing and rhinorrhea

Question 3

Manifestations – viral / bacterial rhinitis

Answer 3

Same as allergic rhinitis

Also systemic – sore/ dry throat, low-grade fever, malaise

Question 4

Interventions of Rhinitis

Answer 4

Antihistamines, leukotriene inhibitors, mast cell stabilizers
Decongestants
Antipyretics
Antibiotics
Supportive therapy
Complementary and alternative therapy – vitamin C, zinc

Question 5

Sinusitis:

Answer 5

Inflammation of sinus mucous membranes

Usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Diplococcus, Bacteroides

Question 6

Manifestations of Sinusitis:

Answer 6

Pain 
Purulent nasal drainage
Fever
Erythema
Swelling
Fatigue
Dental pain
Ear pressure

Question 7

Nonsurgical management of Sinusitis:

Answer 7

Broad-spectrum antibiotics
Analgesics (pain and fever)
Decongestants
Steam humidification
Hot/wet packs over sinus area
Nasal saline irrigations
Increased fluids

Question 8

Pharyngitis:

Answer 8

Sore throat is common inflammation of pharyngeal mucous membranes
Odynophagia, dysphagia, fever, hyperemia
Viral versus Bacterial

Question 9

Strep throat can lead to serious medical complications!

Answer 9

Screen with Rapid Antigen Test (RAT)
Results in 15 minutes
-Epiglottitis is rare complication

Question 10

Tonsillitis :

Answer 10

Inflammation/infection of tonsils and lymphatic tissues
Contagious airborne infection, usually bacterial
Antibiotics for 7-10 days
Surgical intervention

Question 11

Peritonsillar Abscess (PTA)

Answer 11

-Complication of acute tonsillitis
-Manifestations:
Pus causing one-sided swelling with deviation of the uvula
Trismus and difficulty breathing
Bad breath, swollen lymph nodes

Question 12

Peritonsillar Abscess (PTA): Treatment

Answer 12

Percutaneous needle aspiration of abscess

Antibiotics

Question 13

Laryngitis

Answer 13

Inflammation of mucous membranes lining the larynx; possible edema of vocal cords

Question 14

Signs & symptoms of Laryngitis:

Answer 14

Acute hoarseness, dry cough, difficulty swallowing, temporary voice loss (aphonia)

Question 15

Laryngitis Treatment focused on relief and prevention:

Answer 15

Voice rest, steam inhalation, increased fluid intake, throat lozenges
Reduce use of tobacco and alcohol

Question 16

Influenza

Answer 16

Highly contagious acute viral respiratory infection

Question 17

Influenza Signs& Symptoms

Answer 17

Severe headache, muscle ache, fever, chills, fatigue, weakness, anorexia

Question 18

Influenza: Vaccination is advisable

Who?

Answer 18

People older 50 yearly vaccines because they are at risk

Question 19

Influenza: Antiviral agents may be effective if

Answer 19

started within 24-48 hours of symptoms

Question 20

Pandemic Influenza:

Answer 20

“Spanish Influenza”
Mostly prevalent among animals and birds; virus can mutate, becoming infectious to humans
Example: H1N1 (swine flu)

Question 21

Pandemic Influenza: Treatment

Answer 21

Strict isolation precautions
Antiviral drugs
-Oseltamivir (Tamiflu), zanamivir (Relenza)

Question 22

Pneumonia:

Answer 22

• Excess fluid in lungs resulting from inflammatory process
• Inflammation triggered by infectious organisms, inhalation of irritants
• Inflammation occurs in interstitial spaces, alveoli
• WBC’s to infection site

Question 23

Pneumonia S&S:

Answer 23

Reduces gas exchange, leads to hypoxia
Septicemia
Atelectasis- alveolar collapse

Question 24

Risk for Pneumonia:

Answer 24

Community-acquired infectious pneumonia

Nosocomial or Health care-acquired

Question 25

Pneumonia: Community-acquired infectious pneumonia:

Answer 25

Older adult; never received vaccine or >5 years Did not receive influenza previous year Chronic health problems Exposure to influenza or respiratory viral Tobacco use/ secondhand, alcohol

Question 26

Pneumonia: Nosocomial

Answer 26

Older adult, chronic lung disease Gram-negative colonization (mouth, throat, stomach) Altered LOC, recent aspiration, poor nutrition Presence of ET tube, NG, Trach Immunocompromised, mechanical ventilation (VAP)

Question 27

Clinical Manifestations of Pneumonia:

Answer 27

``` Increased respiratory rate- dehydration Dyspnea Hypoxemia Cough Purulent Vital signs Lung sounds Myalgia Tripod position ```

Question 28

Interventions of Pneumonia:

Answer 28

``` Hand washing Sterile water for NG Aspiration precautions Oxygen Incentive spirometry Smoking education ```

Question 29

Lab assessments for Pneumonia:

Answer 29

``` Gram stain, culture and sensitivity of sputum CBC ABGs Serum BUN Electrolytes Creatinine ```

Question 30

Imaging & Diagnostic Assessment fir Pneumonia:

Answer 30

Chest x-ray Pulse oximetry Transtracheal aspiration Bronchoscopy

Question 31

Pneumonia: Community-Based Care

Answer 31

``` Home care management Teaching for self-management Health care resources Prevention -Immunization of appropriate persons ```

Question 32

Pulmonary Tuberculosis:

Answer 32

Highly communicable; caused by Mycobacterium tuberculosis Transmitted via aerosolization Secondary TB Increased incidence secondary to HIV infection

Question 33

Manifestation of TB

Answer 33

``` Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks ```

Question 34

Diagnostic assessment of TB:

Answer 34

Manifestation of signs/symptoms NAA (Nucleic acid amplification) test (results in 2 hr) Sputum smear for acid-fast bacillus Sputum culture confirms it Tuberculin (Mantoux) test – PPD (Purified Protein derivative) given intradermally in forearm: if +, then chest x-ray Induration of 10 mm or greater diameter = Positive for exposure

Question 35

PPD Skin test

Answer 35

Positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease

Question 36

Interventions of TB:

Answer 36

Combination drug therapy with strict adherence: Isoniazid Rifampin Pyrazinamide Ethambutol Negative sputum culture = No longer infectious

Question 37

Notes on TB medications

Answer 37

INH- empty stomach, avoid ETOH, dark urine yellow skin = liver toxicity Rifampin – red/ orange urine, additional contraceptive, ETOH, liver toxicity PZA – water, sunscreen, ETOH, liver toxicity EMB – ETOH, vision changes, water

Question 38

Pertussis:

Answer 38

Respiratory infection – Bordetella pertussis Contagious, respiratory droplets Childhood to adult

Question 39

When Pertussis occurs:

Answer 39

Catarrhal stage- Common cold- mild cough Paroxysmal- Severe coughing ‘fits’- “whooping” cough Recovery - Can last for months

Question 40

Diagnosis for Pertussis

Answer 40

Sputum cultures

Question 41

Greatest risk for developing TB:

Answer 41

contact with untreated, HIV, crowded areas prisoners, shelters, mental health, homeless, drug abusers, lower socioeconomic, foreign

Question 42

TB is the most common

Answer 42

-bacterial infection 2nd TB reactivated when defenses lowered especially older adults or HIV Acid-base bacilli AFB

Question 43

Active TB transmitted by

Answer 43

cough, laugh, sneeze, whistle, sings= droplets are airborne