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Lower respiratory tract infections ppt

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Lower respiratory tract infections ppt

  3. 3. INTRODUCTION• Lower respiratory tract infection comprises an array of diseases ranging from bronchitis to pneumonia.• Non-pneumonic LRTI is described as lower respiratory tract symptoms in a patient who has no history of these or any other chest signs related with infection, by all of the major respiratory viral groups.
  6. 6. DEFINITION:• Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to lungs
  7. 7. TYPES:• There are two types of bronchitis1.Acute bronchitis2.Chronic bronchitis
  8. 8. Acute bronchitis• Acute (i.e. recent onset) bronchitis is an inflammation of the lower respiratory passages (bronchi).
  9. 9. Chronic bronchitis• Chronic bronchitis is defined as a cough that occurs every day with sputum production that lasts for at least 3 months, two years in a row.
  10. 10. CAUSES:• Viral infection that causes the inner lining of the bronchial tubes to become inflamed and undergo the changes that occur with any inflammation in the body.
  11. 11. • Bacteria can also cause bronchitis (a few examples include, Mycoplasma, Pneumococcus, Klebsiella, Haemophilus).• Chemical irritants (for example, tobacco smoke, gastric reflux solvents) can cause acute bronchitis
  12. 12. RISK FACTORS:• Smokers• People who are exposed to a lot of second-hand smoke• People with weakened immune systems• The elderly and infants• People with gastroesophageal reflux disease (GERD)• Those who are exposed to irritants at work
  14. 14. • Coughing• Production of clear, white, yellow, grey, or green mucus (sputum)• Shortness of breath• Wheezing• Fatigue• Fever and chills• Chest pain or discomfort• Blocked or runny nose
  16. 16. Physical examination
  17. 17. Pulmonary function tests
  18. 18. Spirometry
  19. 19. Peak flow monitoring (PFM)
  20. 20. Pulse oximetry
  21. 21. X-ray
  22. 22. MEDICAL MANAGEMENT:• Ibuprofen or acetaminophen• Cough suppressant E.g. Delsym, Robitussin Cough, Dextromethorphan• Steroid medicine
  23. 23. • Nasal decongestants: like Naphazoline, Phenylephrine Oxymetazoline , Propylhexedrine, Phenylpropanolamine• Antiviral medicine Like amantadine, oseltamivir• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by bacteria
  24. 24. PREVENTION:• Avoid alcohol• Avoid irritants in the air• Drink more liquids• Get more rest• Eat healthy foods• Use a humidifier or vaporizer
  25. 25. • Avoiding people who are sick with colds or the flu• Getting a yearly flu vaccine• Getting a pneumonia vaccine (especially for those over 60 years of age)• Washing hands regularly• Avoiding cold, damp locations or areas with a lot of air pollution• Wearing a mask around people who are coughing and sneezing
  26. 26. NURSING MANAGEMENT• Monitor for adverse effects of bronchodilators- tremulousness, tachycardia, cardiac arrhythmias, central nervous system stimulation, hypertension.• Monitor oxygen saturation at rest and with activity.• Eliminate all pulmonary irritants, particularly cigarette smoke. Smoking cessation usually reduces pulmonary irritation, sputum production, and cough. Keep the patient’s room as dust-free as possible.
  27. 27. • Use postural drainage positions to help clear secretions responsible for airway obstruction.• Teach controlled coughing.• Encourage high level of fluid intake (8 to 10 glasses; 2 to 2.5 L daily) within level of cardiac reserve.• Give inhalations of nebulized saline to humidify bronchial tree and liquefy sputum. Add moisture (humidifier, vaporizer) to indoor air.
  28. 28. • Avoid dairy products if these increase sputum production.• Encourage the patient to assume comfortable position to decrease dyspnoea.• Use pursed lip breathing at intervals and during periods of dyspnoea to control rate and depth of respiration and improve respiratory muscle coordination.• Discuss and demonstrates relaxation exercises to reduce stress, tension, and anxiety.
  29. 29. • Encourage frequent small meals if the patient is dyspnoeic; en a small increase in abdominal contents may press on diaphragm and impede breathing.• Offer liquid nutritional supplements to improve caloric intake and counteract weight loss.• Avoid foods producing abdominal discomfort.• Encourage use of portable oxygen system for ambulation for patients with hypoxemia and marked disability.
  30. 30. PNEUMONIA
  31. 31. DEFINITION• Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid.
  32. 32. TYPES:• Bacterial pneumonia
  33. 33. Viral pneumonia
  34. 34. Mycoplasma pneumonia
  35. 35. Aspiration pneumonia
  36. 36. Fungal pneumonia
  37. 37. Hospital acquired pneumonia
  38. 38. Community acquired pneumonia
  39. 39. CAUSES:• Bacterial• Viral• Fungal• Nosocomial and others
  40. 40. RISK FACTORS• Smoke.• Abuse alcohol.• Have other medical conditions, such as chronic obstructive pulmonary disease (COPD), emphysema, asthma, or HIV/AIDS.• Are younger than 1 year of age or older than 65
  41. 41. • Have a weakened or impaired immune system.• Take medicines for gastroesophageal reflux disease (GERD).• Have recently recovered from a cold or influenza infection.• Are malnourished.• Have been recently hospitalized in an intensive care unit.
  42. 42. • Have been exposed to certain chemicals or pollutants.• Are Native Alaskan or certain Native American ethnicity.• Have any increased risk of breathing mucus or saliva from the nose or mouth, liquids, or food from the stomach into the lungs.
  43. 43. SIGN AND SYMPTOMS• Cough• Rusty or green mucus (sputum) coughed up from lungs• Fever• Fast breathing and shortness of breath• Shaking chills
  44. 44. • Chest pain that usually worsens when taking a deep breath (pleuritic pain)• Fast heartbeat• Fatigue and feeling very weak• Nausea and vomiting• Diarrhoea• Sweating• Headache• Muscle pain
  46. 46. Blood tests
  47. 47. Sputum culture
  48. 48. Pulse oximetry
  49. 49. chest CT scan
  50. 50. bronchoscopy
  51. 51. Pleural fluid culture
  52. 52. Thoracentesis
  54. 54. SURGICAL MANAGEMENT• Thoracotomy
  55. 55. Chest Tubes
  56. 56. COMPLICATIONS OF PNEUMONIA:• Abscesses• Respiratory Failure• Bacteraemia• Empyema and Pleural Effusions• Collapsed Lung
  57. 57. NURSING MANAGEMENT• Maintain a patent airway and adequate oxygenation.• Obtain sputum specimens as needed.• Use suction if the patient can’t produce a specimen• Provide a high calorie, high protein diet of soft foods
  58. 58. • To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly.• To control the spread of infection, dispose secretions properly.• Provide a quiet, calm environment, with frequent rest periods.
  59. 59. • Monitor the patient’s ABG levels, especially if he’s hypoxic.• Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours.• Monitor fluid and intake output.• Evaluate the effectiveness of administered medications.• Explain all procedures to the patient and family
  60. 60. PREVENTION• Good Hygiene and Preventing Transmission• Changing Hospital Practices• Vaccines• Viral Influenza Vaccines (Flu Shot)• Pneumococcal Vaccines• Vitamins
  62. 62. DEFINITION• Pulmonary tuberculosis is a chronic infectious inflammation of the lung, as well as a special pneumonia.
  63. 63. CAUSES AND RISK FACTORS• Alcoholism• IV drug abuse• Crowded living conditions• Homelessness• Poverty
  64. 64. • Immigration from certain countries• Low body weight• Certain medical treatments (such as corticosteroid treatment or organ transplants)
  65. 65. SIGN AND SYMPTOMS• Cough (usually cough up mucus)• Coughing up blood• Excessive sweating, especially at night• Fatigue• Fever• Unintentional weight loss
  66. 66. Other symptoms that may occur withthis disease:• Breathing difficulty• Chest pain• Wheezing
  67. 67. ASSESSMENT AND DIAGNOSTIC FINDINGS• Biopsy of the affected tissue (rare)• Bronchoscopy• Chest CT scan• Chest x-ray• Interferon-gamma blood test such as the QFT-Gold test to test for TB infection• Sputum examination and cultures• Thoracentesis
  68. 68. Tuberculin skin test
  69. 69. MEDICAL MANAGEMENT• 1st line drugsDRUG DOSEIsoniazide (INH) 300 mg/dayRifampicin 600 mg/dayPyrazinamide 1500 mg/day 25 mg/kg/dayEthambutol 1200 mg/day 15-25 mg/kg/dayStreptomycin 0.75—1gm/day 25 mg/kg/day
  70. 70. 2nd line drugsAmikacin (AG) 15 mg/kg/dayAminosalicylic acid 8-12 gm/dayCapreomycin 15 mg/kg/dayCiprofloxacin 1500 mg/day (divided)Clofazimine 200 mg/dayCycloserine 500-1000 mg/day (divided)Ethionamide 500-750 mg/dayLevofloxacin 500 mg/dayRifabutin 300 mg/day
  71. 71. Current recommended treatment forpulmonary TB has three regimens—• 6 Month Regimen—virtually 100% effective, more expensive. (usually only used in pulmonary TB)
  72. 72. First 2 monthsDRUG DOSEIsoniazide—300mg 1 tablet daily (300mg)Rifampicin—300mg 2 tablets daily (600mg)Pyrazinamide—500mg 3 tablets daily (1500mg)Ethambutol—400mg 3 tablets daily (1200mg)
  73. 73. Next 4 monthsDRUG DOSEIsoniazide—300mg 1 tablet daily (300mg)Rifampicin—300mg 2 tablets daily (600mg)Pyridoxine—10mg 1 tablet daily (10mg) for 6 months
  74. 74. 9 Months Regimen• First 2 monthsDRUG DOSEIsoniazide—300mg 1 tablet daily (300mg)Rifampicin—300mg 2 tablets daily (600mg)Ethambutol—400mg 3 tablets daily (1200mg)
  75. 75. Next 7 monthsDRUG DOSEIsoniazide—300mg 1 tablet daily (300mg)Rifampicin—300mg 2 tablets daily (600mg)Pyridoxine—10mg 1 tablet daily (10mg)
  76. 76. 12 Months Regimen—inexpensiveand reasonably effective.• Regimen 1—effectiveness is nearly 100% Injection 1gm (IM)—Twice Streptomycin Weekly Tablet Isoniazide 15 mg/kg/day Tablet Pyridoxine 1 tablet of 10mg daily
  77. 77. Regimen 2—very cheap,effectiveness is 80-90%Isoniazide 1 tablet daily (300mg)Tablet Thiocetazone 1 tablet daily (150mg)Pyridoxine 1 tablet daily (10mg)
  78. 78. Prophylactic Dose• Isoniazide is indicated for the prophylactic use of TB, the dose is 300mg/day (5mg/kg/day) or 900mg twice weekly for 6 months in most cases and 12 months in case of immuno-compromised patients
  79. 79. ADVERSE EFFECT OF DRUGSIsoniazide Peripheral NeuropathyRifampicin Cholestatic jaundice + renal toxicity + Flu like syndromePyrazinamide Hepatotoxicity + Hyper- UricaemiaEthambutol Retinobulbar optic neuritis
  80. 80. Prevention
  82. 82. NURSING MANAGEMENT• Ineffective Airway Clearance may be related to excessive, thickened mucous secretions, possibly evidenced by presence of rhonchi, tachypnea, and ineffective cough.• Acute pain related to localized inflammation and persistent cough.
  83. 83. • Imbalance nutrition less than body requirement related to frequent cough, anorexia and fatigue.• Risk for infection related to inadequate primary defences and decreased cilliary action• Anxiety related to outcome of diseases as evidenced by poor concentration on work, isolation from others, rude behaviour
  84. 84. • Activity Intolerance related to imbalance between O2 supply and demand, possibly evidenced by reports of fatigue, dyspnoea, and abnormal vital sign response to activity.• Knowledge deficit regarding the treatment modalities and prognosis
  85. 85. ABSTRACT• Lower respiratory tract infection and rapid expansion of an abdominal aortic aneurysm: a case report
  86. 86. SUMMARY: