Avian flu - Gelisim...•A theory suggests that a coronavirus may have mutated, allowing...

Avian flu

• An infectious, contagious disease caused by influenza A viruses that normally affect birds

• Carried in the intestines of wild birds causing sickness, but highly contagious and deadly to birds. (chickens, ducks, turkeys)

• Human infection caused by contact with contaminated surfaces.

• Also called bird flu.

Pathophysiology

• After attaching to the host cell, viral ribonucleic acid enters the cell and uses host components to replicate its genetic material and protein.

• Newly produced viruses invade other healthy cells.

• Viral invasion destroys host cells, impairing respiratory defenses.

Causes

• Highly pathogenic influenza A (H5N1) virus

• Isolated reports of human-to-human transmission.

Complications

• Conjunctivitis

• Pneumonia

• Acute respiratory distress

• Viral pneumonia

• Sepsis

• Organ failure

• Death

Assessment

• History: • Direct contact with contaminated surfaces.

• Physical findings: • Fever • Cough (dry or productive) • Sore throat • Difficulty breathing • Diarrhea • Runny nose • Headache • Muscle aches • Malaise

Treatment

• General:

• Fluid and electrolyte replacements

• Oxygen and assisted ventilation, if indicated

• Diet:

• Increased fluid intake

• Activity:

• Rest periods as needed.

Medications

• Oseltamivir (Tamiflu)

• Zanamivir (Relenza)

• Acetaminophen or aspirin

• Guaifenesin (Hytuss) or expectorant

• Antibiotics

Nursing considerations

• Nursing diagnoses:

• Acute pain

• Fatigue

• Hyperthermia

• Ineffective breathing pattern

• Risk for deficient fluid volume

• Risk for infection

Nursing interventions

• Give prescribed drugs.

• Follow standard precautions.

• Administer oxygen therapy, if warranted.

Patient teaching

• General:

• the disorder, diagnostic studies, and treatment

• importance of increased fluids to prevent dehydration.

Severe acute respiratory syndrome-SARS

• Severe viral infection that may progress to pneumonia

• Believed to be less infectious than influenza

• Incubation period estimated to range from 2 to 7 days.

• Not highly contagious when protective measures are used.

• Also known as SARS

Pathophysiology

• Coronaviruses cause diseases in pigs, birds, and other animals.

• A theory suggests that a coronavirus may have mutated, allowing transmission to and infection of humans.

Causes

• A new type of coronavirus known as SARS-associated coronavirus (SARSCoV).

Risk factors

• Close contact with exhaled droplets and bodily secretions from an infected person.

• Travel to endemic areas.

Incidence •

• SARS is more common in adults than children.

• Outbreaks are prevalent in China, Hong Kong, Toronto, Singapore, Taiwan, and Vietnam; many other countries report smaller numbers of cases.

• It affects all races.

• It affects both sexes equally.

Complications

• Respiratory difficulties

• Severe thrombocytopenia (low platelet count)

• Heart failure

• Liver failure

• Death

Assessment

• History:

• Contact with a person known to have SARS

• Travel to an endemic area

• Flulike symptoms

• Headache

• Diarrhea

• Nausea and vomiting

Physical findings

• Nonproductive cough

• Rash

• High fever

• Respiratory distress in later stages

Laboratory- Imaging

• Antibodies to coronavirus are detected.

• Sputum Gram stain and culture isolates coronavirus.

• Platelet count may be low.

• Changes in chest X-rays indicate pneumonia (infiltrates).

Treatment

• General:

• Symptomatic treatment

• Isolation for hospitalized patients

• Strict respiratory and mucosal barrier precautions

• Quarantine of exposed people to prevent spread

• Reporting of suspected cases to national health authorities

• Intubation and mechanical ventilation, if indicated.

Treatment

• Diet:

• As tolerated

• Activity:

• As tolerated

• Medications:

• Antivirals

• Combination of steroids and antimicrobials

• Oxygen therapy

• Activity intolerance

• Anxiety

• Fear

• Imbalanced nutrition: Less than body requirements

• Impaired gas exchange

• Encourage adequate nutritional intake.

• Observe, record, and report nature of rash.

• Maintain proper isolation technique.

• Collect laboratory specimens, as needed.

• Patient teaching: • General:

• the importance of frequent hand washing

• covering mouth and nose when coughing or sneezing

• avoiding close personal contact with friends and family

• the importance of not going to work, school, or other public places until 10 days after fever and respiratory symptoms resolve.

Patient teaching

• wearing a surgical mask when around other people

• not sharing towels, or bedding until they have been washed in soap and hot water

• using disposable gloves and household disinfectant to clean any surface that might have been exposed to the patient's body fluids.

Common cold

• Acute, usually afebrile viral infection

• Transmission through airborne respiratory droplets

• Communicable for 2 to 3 days after onset of symptoms

• Usually benign and self-limiting

Pathophysiology

• Rhinoviruses infect cells

• Infiltration with neutrophils, lymphocytes, plasma cells, and eosinophils

• Mucus-secreting glands become hyperactive

• Viral infection of the upper respiratory tract passages.

Causes

• More than 200 viruses, including rhinoviruses, coronaviruses, myxoviruses, adenoviruses, coxsackieviruses, and echoviruses

• Mycoplasma

Incidence

• The cold is the most common infectious disease.

• It's more prevalent in children, adolescent boys, and women.

Complications

• Secondary bacterial infection, causing sinusitis, otitis media, pharyngitis, or lower respiratory tract infection.

Assessment

• History:

• Exposure to persons with the common cold

• Sore throat

• Fatigue

• Malaise

• Myalgia

• Fever

• Physical findings:

• Nasal discharge that often irritates the nose

• Increased erythema of nasal and pharyngeal mucous membranes

• Nasal quality to voice

• Diagnostic tests:

• There are no diagnostic tests for this disorder.

Treatment

• General: • Use of humidified inspired air • Increased fluid intake • Rest • Medications: • Acetylsalicylate acid • Ibuprofen • Acetaminophen • Antitussives

Nursing considerations Nursing diagnoses

• Acute pain

• Fatigue

• Hyperthermia

• Ineffective airway clearance

• Relieve throat irritation with cough drops.

• A warm bath or heating pad can reduce aches and pains.

• Suggest a hot or cold steam vaporizer to relieve nasal congestion.

Patient teaching

• advice against overuse of nose drops or sprays

• how to avoid spreading colds

• proper hand-washing technique.

Influenza

• An acute, highly contagious infection of the respiratory tract

• Has capacity for antigenic variation

• Also called the grippe or flu

Pathophysiology

• The virus invades the epithelium of the respiratory tract, causing inflammation.

• After attaching to the host cell, viral ribonucleic acid enters the cell and uses host components to replicate its genetic material.

• Newly produced viruses invade other healthy cells.

Causes

• Infection transmitted by inhaling a respiratory droplet from an infected person

• Type A most prevalent, strikes annually with new serotypes, causes epidemics every 3 years.

• Type B strikes annually, causes epidemics every 4 to 6 years

• Type C endemic, causes only sporadic cases

Incidence

• Influenzae affects all age-groups, but the highest incidence is among school-age children.

• Influenza occurs most severely (may lead to death) in young children, elderly people, and those with chronic diseases.

Complications

• Pneumonia

• Myositis

• Exacerbation of chronic obstructive pulmonary disease

• Myocarditis

• Pericarditis

• Encephalitis

Assessment

• History

• Usually, recent exposure (typically within 48 hours) to a person with influenza

• No influenza vaccine received during the past season

• Headache

• Myalgia

• Fatigue, weakness

Physical findings

• Fever (usually higher in children) • Cough • Red, watery eyes; clear nasal discharge • Erythema of the nose and throat without exudate • Tachypnea, shortness of breath • With bacterial pneumonia, purulent or bloody

sputum • Cervical adenopathy and tenderness • Breath sounds may be diminished in areas of

consolidation

Treatment

• General:

• Fluid and electrolyte replacements

• Oxygen and assisted ventilation, if indicated

• Diet:

• Activity:

• Rest periods, as needed

Medications

• Acetaminophen (Tylenol) or aspirin

• Guaifenesin (Mucinex) or expectorant

• Amantadine (Symmetrel)

• Antibiotics

• Acute pain

• Fatigue

• Hyperthermia

• Ineffective health maintenance

• Administer oxygen therapy, if warranted.

Patient teaching

• the disorder, diagnosis, and treatment

• mouthwash or warm saline gargles to ease sore throat

• importance of increased fluids to prevent dehydration

• warm bath or a heating pad to relieve myalgia

• proper hand-washing technique and tissue disposal to prevent the virus from spreading

• influenza immunization.

Varicella

• Overview:

• An acute, highly contagious viral infection

• Commonly known as chickenpox

Pathophysiology

• Localized replication of the virus occurs

• Diffuse and scattered skin lesions result with vesicles

• Incubation period lasts 13 to 17 days.

• Infection is communicable from 48 hours before lesions erupt until after vesicles are lost.

Causes

• Varicella-zoster herpesvirus

Incidence

• Chickenpox is most common in children ages 5 to 9 but can occur at any age.

• Disease occurs worldwide and is endemic in large cities with outbreaks occurring sporadically.

• Chickenpox equally affects all races and both sexes.

• Seasonal distribution varies; incidence is higher during late winter and spring.

Complications

• Infection of vesicles due to stratching

• Pneumonia

• Myocarditis

• Bleeding disorders

• Arthritis

• Nephritis

• Hepatitis

Assessment

• History:

• Recent exposure to someone with chickenpox

• Malaise

• Headache

• Anorexia

Physical findings

• Fever (38.3° to 39.4° C)

• small, erythematous macules on the trunk or scalp

• Vesicles becoming cloudy and breaking easily

• Rash that spreads to face and rarely to extremities

• Ulcers on mucous membranes of the mouth, conjunctivae of eyes.

Treatment

• General:

• Strict isolation until all vesicles have crusted over.

• Diet:

• Increased fluid intake.

• Activity:

• Rest periods when fatigued.

• Medications:

• Antipruritics

• Antibiotics

• Analgesics and antipyretics

• Acyclovir (Zovirax)

• Varicella zoster immune globulin

• Fatigue

• Hyperthermia

• Impaired skin integrity

• Risk for imbalanced fluid volume

• Social isolation

Nursing interventions •

• Observe an immunocompromised patient for manifestations of complications, such as pneumonitis and meningitis, and report them immediately.

• Provide skin care comfort measures, • Administer varicella zoster immune globulin to

lessen the severity of the disease. • Institute strict isolation measures until all skin

lesions have crusted. • Prevent exposure to pregnant women.

Patient teaching General

• disorder, diagnosis, and treatment

• how to correctly apply topical antipruritics

• importance of good hygiene and keeping child's fingernails trimmed

• importance of the child avoiding scratching the lesions

• importance of the parents watching for and immediately reporting signs of complications (severe skin pain and burning possibly indicating a serious secondary infection)

• importance of not giving the child aspirin because of its association with Reye's syndrome

• When signs and symptoms of Reye's syndrome are seen immediately report them to a practitioner.

Rubeola- Measles

• Acute, highly contagious infection causing a characteristic rash

• Can be severe or fatal in patients with impaired cell-mediated immunity

• Mortality highest in children younger than age 2 and in adults

• Also called measles or morbilli

Pathophysiology

• Virus invades the respiratory system and spreads via the bloodstream and infects all types of white blood cells.

• Viremia develop, leading to infection of the entire respiratory tract.

• Risk factors:

• Lack of immunization

Causes

• Rubeola virus

• Spread by direct contact or by contaminated airborne respiratory droplets, with entry in the upper respiratory tract.

• Incidence:

• Rubeola affects mostly preschool children.

Complications

• Secondary bacterial infection

• Autoimmune reaction

• Bronchitis

• Otitis media

• Pneumonia

• Encephalitis

Assessment

• History:

• Inadequate immunization and exposure to someone with measles in the past 14 days

• Photophobia

• Malaise

• Anorexia

• Hoarseness

Physical findings

• Temperature peaking at (39.4°C to 40.5° C)

• Periorbital edema

• Conjunctivitis

• Pruritic rash

• Severe cough

• Rhinorrhea

• Lymphadenopathy

Treatment

• General:

• Respiratory isolation precautions

• Use of vaporizer

• Warm environment

• Skin care

• Diet:

• Small, frequent meals

• Activity:

• Rest until symptoms improve

• Medications:

• Antipyretics

• Disturbed sensory perception (visual)

• Hyperthermia

• Impaired oral mucous membrane

• Institute respiratory isolation measures for 4 days after rash onset.

• Encourage bed rest during the acute period.

• If photophobia occurs, darken the room or provide sunglasses.

• To prevent disease spread, administer measles vaccine, as ordered and needed.

• Report measles cases to local public health authorities

Patient teaching

• General:

• supportive measures, isolation, bed rest, and increased fluids

• instructions on cleaning a vaporizer

• early signs and symptoms of complications that should be reported.

Rubella

• Acute, mildly contagious viral disease that causes a distinctive maculopapular rash (resembling measles or scarlet fever) and lymphadenopathy

• Self-limiting with an excellent prognosis,

Pathophysiology • A ribonucleic acid virus enters the bloodstream,

usually through the respiratory route.

• The incubation period lasts 18 days,

• Causes:

• Rubella virus, spread by direct contact or contaminated airborne respiratory droplets

• Risk factors:

• Exposure to active case without immunization

• Incidence:

• Rubella occurs worldwide.

• The disease is most common among children ages 5 to 9, adolescents, and young adults.

• Complications:

• Arthritis

• Postinfectious encephalitis

• Thrombocytopenic purpura

Assessment

• History: • Inadequate immunization, exposure to a person

with rubella infection within the previous 2 to 3 weeks, or recent travel to an endemic area without reimmunization.

• In a child, absence of prodromal symptoms • In an adolescent or adult, headache, malaise,

anorexia, sore throat, and cough preceding rash onset

• Polyarthralgias and polyarthritis (in some adults)

• Physical findings:

• Rash accompanied by low-grade fever [37.2° to 38.3° C])

• Mildly pruritic rash; typically begins on the face, and spreads rapidly, covering the trunk and limbs within hours.

• Small, red, petechial macules on the soft palate

• Conjunctivitis

• Suboccipital, postauricular, and postcervical lymph node enlargement

Treatment • General:

• Skin care

• Isolation precautions

• Diet:

• Small, frequent meals

• Activity:

• Rest until fever subsides

• Medications:

• Antipyretics

• Analgesics

• Acute pain

• Hyperthermia

• Nursing interventions:

• Institute isolation precautions until 5 days after the rash disappears

• Keep the patient's skin clean and dry.

• Make sure that the patient receives care only from nonpregnant hospital workers who aren't at risk for rubella.

Patient teaching

• General:

• ways to reduce fever

• importance of people with rubella avoiding pregnant women

• avoidance of aspirin in a child receiving rubella vaccine.

Scarlet fever

• A hypersensitivity reaction that usually follows streptococcal pharyngitis

• May follow other streptococcal infections, such as wound infections.

Pathophysiology

• After infection, an erythrogenic toxin is produced, resulting in a hypersensitivity reaction.

• Replication site is the tonsils and pharynx.

• Inflammatory reaction occurs.

Causes

• Group A beta-hemolytic streptococci transmitted by direct contact with infected person or droplet spread; indirectly by contact with contaminated articles.

Incidence

• The disease is most common in children ages 3 to 15, peaking in those ages 4 to 8.

• Infection rate is increased in overcrowded situations.

• Males and females are affected equally.

Complications

• Severe toxic illness • Septicemia • Rheumatic heart disease • Liver damage • Otitis media • Peritonsillar and retropharyngeal abscess • Sinusitis • Glomerulonephritis • Meningitis • Brain abscess

Assessment

• History: • Possible contact with person with a sore throat • Sore throat • Headache • Chills • Anorexia • Abdominal pain • Malaise • Likely high temperature [37.8° to 39.4° C]) • Characteristic rash 12 to 48 hours after onset of fever

Physical findings

• Inflamed and heavily coated tongue, progressing to strawberry-like tongue

• Tongue becomes beefy red, returning to normal by the end of week 2

• Red and edematous uvula, tonsils, and posterior oropharynx, with mucopurulent exudate

• Erythematous rash, appears first on the upper chest and back, spreading to the neck, abdomen, legs, and arms

• Rash resembling sunburn • Tachycardia

Diagnostic test results

• Laboratory:

• Pharyngeal culture is positive for group A beta-hemolytic streptococci.

• Complete blood count reveals increased white blood cell count and eosinophilia during the second week.

Treatment

• General: • Appropriate skin care • Isolation for 24 hours after starting antibiotics • Diet: • Increased fluid intake • Activity: • Rest periods when fatigued • Medications: • Antibiotics • Antipyretics

• Acute pain

• Hyperthermia

• Impaired oral mucous membrane

• Impaired swallowing

• Implement respiratory secretion precautions for 24 hours after starting antibiotic therapy.

• Offer frequent oral fluids and oral hygiene.

• Provide skin care to relieve discomfort from the rash.

• Provide warm liquids or cold foods to ease sore throat pain.

• Use a cool mist humidifier to keep the air moist and prevent the throat from getting too dry and more sore.

Patient teaching

• General: • the disorder, diagnosis, and treatment • the need to take oral antibiotics for the

prescribed length of time to prevent serious complications

• proper disposal of purulent discharge • follow-up care • when to notify the practitioner • drugs and possible adverse effects • prevention of scarlet fever and strep throat.

Tonsillitis

• Inflammation of the tonsils

• May be acute or chronic

• Typical viral infection: Mild and of limited duration

Pathophysiology

• The inflammatory response to cell damage by viruses or bacteria may result in hyperemia and fluid exudation.

Causes

• Bacterial infection (group A beta-hemolytic streptococci).

• Viral infection

Incidence

• Tonsillitis is more common in children than adults.

• Viral tonsillitis is more common than bacterial tonsillitis.

• Bacterial infection occurs more frequently in the winter.

• Age Factor:

• Tonsillitis commonly affects children between ages 5 and 10.

• Tonsils tend toward hypertrophy during childhood and atrophy after puberty.

Complications

• Chronic upper airway obstruction • Eating or swallowing disorders • Speech abnormalities • Febrile seizures • Otitis media • Cardiac valvular disease • Peritonsillar abscesses • Glomerulonephritis • Bacterial endocarditis • Cervical lymph node abscesses

Assessment

• History:

• Mild to severe sore throat

• Young child possibly stops eating

• Muscle and joint pain

• Malaise

• Headache

• Pain, commonly referred to the ears

Physical findings

• Fever

• Swollen, tender submandibular lymph nodes

• Generalized inflammation of pharyngeal wall

• Swollen tonsils exudating white or yellow fluid

• Purulent drainage with application of pressure to tonsils

• Uvula possibly edematous and inflamed

Diagnostic test results

• Laboratory:

• A throat culture may reveal the infecting organism.

• A serum white blood cell count usually reveals leukocytosis.

Treatment

• General: • Symptom relief • Diet: • Adequate fluid intake • Activity: • Rest periods as needed • Medications: • Aspirin or acetaminophen • Antibiotics • Surgery: • tonsillectomy

• Acute pain

• Anxiety

• Risk for aspiration

• Before surgery:

• Encourage oral fluids.

• Offer a child ice cream and flavored drinks and ices.

• Provide humidification.

• Encourage gargling to soothe the throat and remove debris from tonsillar crypts.

• After surgery:

• Maintain a patent airway.

• Prevent aspiration by side positioning.

• Encourage nonirritating oral fluids.

• Avoid milk products and salty or irritating foods.

• Provide analgesics for pain relief.

• Encourage deep-breathing exercises.

Patient teaching

• General:

• importance of completing the entire course of antibiotics

• avoidance of irritants

• medications, dosages, and possible adverse effects

• possibility of throat discomfort and some bleeding after surgery

Otitis media

• Inflammation of the middle ear associated with fluid accumulation

• Acute, chronic, suppurative, or secretory

Causes

• Acute otitis media: disruption of eustachian tube patency.

• Secretory otitis media: viral infection, allergy, or barotrauma.

• Suppurative otitis media: bacterial infection with pneumococci, group A beta-hemolytic streptococci, staphylococci, and gram-negative bacteria.

• Incidence:

• Otitis media occurs most commonly in infants and children.

• Otitis media peaks between ages 6 and 24 months.

• The incidence of otitis media subsides after age 3.

• The disease is most common during the winter months.

Complications

• Spontaneous rupture of the tympanic membrane • Persistent perforation • Chronic otitis media • Mastoiditis • Meningitis • Abscesses, septicemia • Lymphadenopathy, leukocytosis • Permanent hearing loss • Vertigo

Assessment

• History:

• Upper respiratory tract infection

• Allergies

• Severe, deep ear pain

• Nausea, vomiting

• Recent air travel or scuba diving

Physical findings

• Mild to high fever

• Painless, purulent discharge in chronic suppurative otitis media

• Sneezing and coughing with upper respiratory tract infection

• Conductive hearing loss

Treatment • General:

• In acute secretory otitis media, Valsalva's maneuver several times per day.

• Medications:

• Antibiotic therapy

• Aspirin or acetaminophen (Tylenol)

• Analgesics

• Sedatives (small children)

• Nasopharyngeal decongestant therapy

• Acute pain

• Disturbed sensory perception (auditory)

• Disturbed sleep pattern

• Impaired verbal communication

• Risk for injury

• Answer all questions. • Encourage discussion of concerns about hearing

loss. • With hearing loss: • Provide clear, concise explanations. • Face the patient when speaking • Allow time for the patient what was said. • Provide a pencil and paper. • Alert the staff to the patient's communication

problem.

Patient teaching

• General:

• proper instillation of drops, and ear wash,

• drug administration, dosage, and possible adverse effects

• importance of taking antibiotics

• adequate fluid intake

• correct instillation of nasopharyngeal decongestants

• An acute viral infection of one or both parotid glands and sometimes the sublingual or submaxillary glands

• Also called infectious or epidemic parotitis

Pathophysiology

• Virus replication occurs in the epithelium of the upper respiratory tract, leading to viremia.

• Infection of the central nervous system (CNS) or glandular tissues (or both) occurs.

Causes

• A paramyxovirus found in the saliva of an infected person.

• Transmission by droplets or by direct contact with the saliva of an infected person.

Incidence

• Mumps seldom occur in infants younger than age 1 because of passive immunity from maternal antibodies.

• About 50% of cases occur in young adults; the remainder occur in young children or immunocompromised adults.

• Peak incidence is during late winter and early spring.

Physical findings

• Swelling and tenderness of the parotid glands

• Simultaneous or subsequent swelling of one or more other salivary glands

Complications

• Epididymo-orchitis

• Meningoencephalitis

• Sterility

• Pancreatitis

• Transient sensorineural hearing loss

• Arthritis

• Nephritis

• Spontaneous abortion (with contact during the first trimester)

Assessment

• History

• Inadequate immunization and exposure to someone with mumps within the preceding 2 to 3 weeks

• Myalgia

• Headache

• Fever

• Earache aggravated by chewing

• Diagnostic test results:

• Laboratory:

• Serologic test results show mumps antibodies.

Treatment • General: • Rest • Cold compresses for swollen glands • Diet: • Clear liquid to mechanical soft diet until able to

swallow • Increased fluid intake • Activity: • Bed rest until fever resolves • Rest periods when fatigued • Medications: • Analgesics • Antipyretics

• Acute pain

• Deficient fluid volume

• Disturbed body image

• Hyperthermia

• Apply cool compresses to the neck area to relieve pain.

• Report all cases of mumps to local public health authorities.

• Disinfect articles soiled with nose and throat secretions.

• the need to stay away from school or work from days 12 through 25 after exposure

• the importance of having children immunized with live attenuated mumps vaccine at age 15 months or older

• the need for bed rest during febrile period

• the need to avoid spicy, irritating foods and those that require much chewing (advise a soft diet)

• the need for family members to follow respiratory isolation precautions until symptoms subside.

Pertussis

• Highly contagious respiratory infection

• Typically causes an irritating cough that becomes paroxysmal

• Follows a 6- to 8-week course that includes three 2-week stages with varying symptoms

Pathophysiology

• The infecting organism adheres to ciliated epithelial cells and multiplies.

• The resulting local mucosal damage induces paroxysmal coughing, which enhances disease transmission.

Causes

• Nonmotile, gram-negative coccobacillus Bordetella pertussis

• Spreads indirectly through articles contaminated by respiratory secretions

• Typically transmitted by direct inhalation of contaminated droplets from someone in the acute disease stage.

Incidence

• Fifty percent of cases of pertussis are seen in underimmunized children younger than age 1.

• The disease commonly occurs in schools, nursing homes, and residential facilities.

• Epidemics occur every 3 to 5 years without seasonal variation.

Complications

• Increased venous pressure • Anterior eye chamber hemorrhage • Inguinal or umbilical hernia • Encephalopathy, seizures • Atelectasis or pneumonitis • In infants: apnea, anoxia • Otitis media • Pneumonia • Cerebral hemorrhage

Assessment

• History:

• Possible lack of immunization coupled with exposure to pertussis during previous 3 weeks.

Physical findings

• Low or normal body temperature

• Mild conjunctivitis

• Epistaxis during paroxysmal coughing

• Exhaustion and cyanosis after coughing spell

• Diminished breath sounds, upper airway wheezing

• Vomiting from repeated coughing

Treatment

• General: • For infants and elderly patients: hospitalization with

vigorous supportive therapy and fluid and electrolyte replacement.

• Diet: • Adequate nutrition with small, frequent meals • Increased fluid intake • Activity: • Rest periods when fatigued • Medications: • Oxygen • Antibiotics

• Activity intolerance • Acute pain • Anxiety • Deficient fluid volume • Impaired gas exchange • Ineffective airway clearance • Ineffective breathing pattern • Risk for infection • Risk for injury

• Maintain respiratory isolation (mask only) for 5 to 7 days after antibiotic therapy begins.

• Provide oxygen and moist air as ordered; if needed, assist respiration.

• Suction secretions as necessary.

• Elevate the head of the bed to ease breathing.

• Create a quiet environment to decrease coughing stimulation.

• the disease process and medical procedures

• need for the patient's close contacts to get medical care

• when to notify the practitioner

• importance of immunization and vaccinations and the need to notify the practitioner of adverse reactions to the vaccine.

Diphtheria

• Acute, highly contagious, toxin-mediated infection that usually infects the respiratory tract — primarily the tonsils, nasopharynx, and larynx.

• Pathophysiology:

• Proliferation of organism at site of implantation

• Endotoxin: produced, absorbed by the blood, and transported to the heart and central nervous system

• Causes:

• Corynebacterium diphtheriae, a gram-positive rod

• Transmission usually through intimate contact, airborne respiratory droplets, or a break in the skin

• Incidence: • The disease is more prevalent during the colder

months. • More prevalent in children younger than age 15. • Complications: • Thrombocytopenia • Myocarditis • Neurologic involvement (primarily affecting motor

fibers but possibly also sensory neurons) • Renal involvement • Pulmonary involvement (bronchopneumonia

Assessment

• History:

• Fever

• Sore throat

• Cough

• Vomiting

• Dysphagia

Physical findings

• Hoarseness

• Thick, grayish green membrane over the mucous membranes of the pharynx, larynx, tonsils, soft palate, and nose

• Swelling of the palate

• Yellow spots or lesions (cutaneous)

• Diagnostic test results:

• Laboratory:

• Throat culture or culture of other suspect lesions grows C. diphtheriae.

Treatment

• General: • Symptomatic • Droplet precautions • Diet: • As tolerated • Activity: • As tolerated • Medications: • Diphtheria antitoxin • Antibiotics • Surgery: • Tracheotomy if airway obstruction occurs

• Hyperthermia

• Ineffective airway clearance

• Risk for imbalanced fluid volume

• Risk for injury

• Enforce strict isolation techniques.

• Obtain cultures, as ordered.

• Report all cases to local public health authorities.

Patient teaching

• General:

• proper disposal of nasopharyngeal secretions

• maintaining infection precautions until after two consecutive negative nasopharyngeal cultures — at least 1 week after drug therapy stops.

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