Acute Respiratory Infections
Acute respiratory infections, such as pneumonia, are among the most common causes of death from infectious diseases in the United States. Pneumonia is a major cause of death in persons over age 65.
Pneumonia is an inflammation of the parenchyma of the lungs. Causative organisms include bacteria, viruses, and fungi. Some of these organisms are listed here:
- Group A beta hemolytic streptococcus
- Influenza types A and B
- Aspergillus fungiatus
- Pneumocystis carinii
Presenting symptoms depend on the causative organism. The client with viral pneumonia tends to have milder symptoms, whereas the client with bacterial pneumonia might have chills and fever as high as 103°. Clients with cytomegalovirus, pneumocystis carinii, or aspergillus will be acutely ill. General symptoms of pneumonia include
- Chest pain
- Confusion (especially in the elderly)
Care of the client with pneumonia depends on the causative organism. The management of bacterial pneumonias includes antibiotics, antitussives, antipyretics, and oxygen. Antibiotics that may be ordered include penicillin G, tetracycline, garamycin, and erythromycin. Viral pneumonias do not respond to antimicrobial therapy but are treated with antiviral medication, such as Symmetrel (amantadine). Fungal pneumonias are treated with antifungal medication such as Nizoral (ketoconozole). Additional therapies for the client with pneumonia include providing for fluid and nutritional needs, obtaining frequent vital signs, and providing oral hygiene. Supplemental oxygen and chest percussion and drainage should be performed as ordered by the physician.
Pleurisy, an inflammation of the pleural sac, can be associated with upper respiratory infection, pulmonary embolus, thoracotomy, chest trauma, or cancer. Symptoms include
- Sharp pain on inspiration
Chest x-ray reveals the presence of air or fluid in the pleural sac. Management of the client with pleurisy includes the administration of analgesics, antitussives, antibiotics, and oxygen therapy. The presence of pleural effusion can require the client to have a thoracentesis. It is the nurse’s responsibility to prepare the client and monitor for signs of complications related to the procedure. The nurse should assess the client’s vital signs, particularly changes in respirations and blood pressure, which can reflect impending shock from fluid loss or bleeding. The nurse should also observe the client for signs of a pneumothorax.
Nursing Skill: Positioning the client for a thoracentesis
- Sitting on the edge of the bed with feet supported and with the head and arms resting on a padded over bed table
- Sitting astride a chair with the arms and head resting on the back of the chair
- Lying on the unaffected side with the head of the bed elevated 30 to 45 degrees (for clients unable to sit upright)
Tuberculosis (TB) is a highly contagious respiratory infection caused by the mycobacterium tuberculosis. It is transmitted by droplets from the respiratory tract. Airborne precautions, as outlined by the Centers for Disease Control (CDC), should be used when caring for the client with tuberculosis.
Diagnosis includes the administration of the Mantoux skin test, sometimes referred to as the Purified Protein Derivative (PPD), which is read in 48–72 hours. The presence of a positive Mantoux test indicates exposure to TB but not active infection. A chest x-ray should be ordered for those with a prior positive skin test. A definite diagnosis of TB is made if the sputum specimen is positive for the tubercle bacillus. Factors that can cause a false positive TB skin test include nontuberculous mycobacterium and inoculation with BCG vaccine. Factors that can cause a false negative TB skin test include anergy (a weakened immune system), recent TB infection, age, vaccination with live viruses, overwhelming TB, and poor testing technique. Management of the client with TB includes the use of ultraviolet light therapy and the administration of antimycobacterial drugs. Medication regimens can consist of several drugs including INH (isoniazid), Rifadin (rifampin), Myambutol (ethamubutol), and PZA (pyrazinamide). The use of multiple drug therapy has reduced treatment time to as little as six months for clients who are compliant; however, drug resistant forms may require longer treatment periods. Clients are no longer considered infectious after three negative sputum samples have been obtained. Surgical management may include a wedge resection or lobectomy. Household contacts are treated with isoniazid.
Influenza is an acute highly contagious viral infection that primarily affects the upper respiratory tract and is sometimes complicated by the development of pneumonia. Influenza is caused by one of three types of Myxovirus influenzae. Infection with one strain produces immunity to only that strain; therefore, annual immunization is needed to protect against the strain projected to be prevalent that year.
Symptoms of influenza include
- Chills and fever greater than 102° F.
- Sore throat and laryngitis
- Runny nose
- Muscle aches and headache
Complications associated with influenza include pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD), and myositis. More serious complications include pericarditis and encephalitis. The elderly, children, and those with chronic illness are more likely to develop severe complications; therefore, it is recommended that these clients receive annual influenza immunization. The vaccine is given in the fall, prior to the onset of annual outbreaks that occur in the winter months. The vaccine is produced in eggs, so it should not be given to anyone who is allergic to egg protein. Children age two and older as well as adults can receive the nasal vaccine.
Treatment of influenza is aimed at controlling symptoms and preventing complications. Bed rest and increased fluid intake are important interventions during the acute phase. Decongestant nasal sprays, antitussives with codeine, and antipyretics help make the client more comfortable. Antibiotics are indicated if the client develops bacterial pneumonia. Clients with influenza as well as nonimmunized persons who have been exposed to influenza might receive chemoprophylaxis if an outbreak occurs. Antiviral medication such as Relenza (zanamivir) and Tamiflu (oseltamivir) are used in both the prevention and treatment of influenza A and B and can be used to reduce the duration and severity of symptoms. Symmetrel (amantadine) or Flumadine (rimantadine) are also used to prevent or decrease symptoms of the flu.