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Interventions for Clients with
Infectious Problems of the
Respiratory Tract
Rhinitis
Inflammation of the nasal mucosa
 Infectious; Allergic; Rhinitis
medicamentosa
 Allergic - often called “hay fever” or
“allergies”


Symptoms - headache, nasal irritation,
sneezing, nasal congestion, rhinorrhea
(watery drainage from the nose), and
itchy, watery eyes.

Interventions include:
– Drug therapy: antihistamines and
decongestants, antipyretics,
antibiotics
– Complementary and alternative
therapy
– Supportive therapy
Sinusitis






Inflammation of the mucous membranes
of the sinuses
Swelling can obstruct the flow of
secretions from the sinuses, which may
subsequently become infected.
The disorder often accompanies or follows
acute or chronic allergic rhinitis.
Other conditions contributing to sinusitis
include a deviated nasal septum, polyps,
tumors, chronically inhaled air pollutants
or cocaine, facial trauma, nasotracheal
intubation, dental infection, or cystic
fibrosis
The causative organism in sinus infection
is usually Streptococcus pneumoniae,
Haemophilus influenzae, Diplococcus, or
Bacteroides. Anaerobic infections also can
cause sinusitis.
Sinusitis most often develops in the
maxillary and frontal sinuses
Sinusitis

The clinical manifestations of sinusitis
include
– nasal swelling and congestion,
– headache,
– facial pressure,
– pain (usually made worse by
movement of the head to a
dependent position),
– tenderness on percussion over
the involved area,
– low-grade fever,
– cough, and purulent or bloody
nasal drainage
Sinusitis

(Continued)
Nonsurgical management
– Broad-spectrum antibiotics
– Analgesics
– Decongestants
– Steam humidification
– Hot and wet packs over the sinus area
– Nasal saline irrigations
Surgical Management




Antral irrigation
Caldwell-Luc procedure
Nasal antral window procedure
Endoscopic sinus surgery
Pharyngitis
Sore throat is common inflammation
of the mucous membranes of the
pharynx.
 Assess for odynophagia, dysphagia,
fever, and hyperemia.
 Strep throat can lead to serious
medical complications.
 Epiglottitis is a rare complication of
pharyngitis.

Tonsillitis




Inflammation and infection of the tonsils and lymphatic
tissues located on each side of the throat
Contagious airborne infection, usually bacterial
Antibiotics
Surgical intervention
Peritonsillar Abscess





Complication of acute tonsillitis
Pus behind the tonsil, causing
one-sided swelling with deviation
of the uvula
Trismus and difficulty breathing
Percutaneous needle aspiration of
the abscess
Completion of antibiotic regimen
Laryngitis




Inflammation of the mucous
membranes lining the larynx,
possibly including edema of the
vocal cords
Acute hoarseness, dry cough,
difficulty swallowing, temporary
voice loss (aphonia)
Voice rest, steam inhalation,
increased fluid intake, throat
lozenges
Therapy: relief and prevention
Influenza




“Flu” is a highly contagious acute viral respiratory
infection.
Manifestations include severe headache, muscle
ache, fever, chills, fatigue, weakness, and
anorexia.
Vaccination is advisable.
Antiviral agents may be effective.
Pneumonia
Excess of fluid in the lungs resulting
from an inflammatory process
 Inflammation triggered by infectious
organisms and inhalation of irritants
 Community-acquired infectious
pneumonia
 Nosocomial or hospital-acquired
 Atelectasis
 Hypoxemia

Impaired Gas Exchange

Interventions include:
– Cough enhancement
– Oxygen therapy
– Respiratory monitoring
Ineffective Airway Clearance

Interventions include:
– Help client to cough and deep breathe at least
every 2 hours.
– Administer incentive spirometer—chest
physiotherapy if complicated.
– Prevent dehydration.
– Monitor intake and output of fluids.
– Use bronchodilators, especially beta2 agonists.
– Inhaled steroids are rarely used.
Pulmonary Tuberculosis
Highly communicable disease caused
by Mycobacterium tuberculosis
 Most common bacterial infection
 Transmitted via aerosolization
 Initial infection multiplies freely in
bronchi or alveoli
 Secondary TB
 Increase related to the onset of HIV

Assessment


Diagnosis of TB considered for any client with a persistent
cough or other compatible symptoms (weight loss,
anorexia, night sweats, hemoptysis, shortness of breath,
fever, or chills)
Bacillus Calmette-Guerin vaccine within previous 10 years
produces positive skin test, complicating interpretation of
TB test.
Clinical Manifestations of TB




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Progressive fatigue
Lethargy
Nausea
Anorexia
Weight loss
Irregular menses
Low-grade fever, night
sweats
Cough, mucopurulent
sputum, blood streaks
Diagnostic Assessment
Manifestation of signs and symptoms
 Positive smear for acid-fast bacillus
 Confirmation of diagnosis by sputum
culture of M. tuberculosis
 Tuberculin test (Mantoux test)
purified protein derivative given
intradermally in the forearm
 Induration of 10 mm or greater
diameter indicative of exposure

(Continued)
Diagnostic Assessment
(Continued)

Positive reaction does not mean that
active disease is present, but does
indicate exposure to TB or dormant
disease.
Interventions
Combination drug therapy strict
adherence
 Isoniazid
 Rifampin
 Pyrazinamide
 Ethambutol or streptomycin
 Negative sputum culture indicative of
client no longer being infectious

Health Teaching
Follow exact drug regimen.
 Proper nutrition must be maintained.
 Reverse weight loss and severe
lethargy.
 Educate client about the disease.

Lung Abscess



Localized area of lung
destruction caused by
liquefaction necrosis, usually
related to pyogenic bacteria
Pleuritic chest pain
Interventions
– Antibiotics
– Drainage of abscess
– Frequent mouth care for
Candida albicans
Inhalation Anthrax
Bacterial infection is caused by the
gram-positive, rod-shaped organism
Bacillus anthracis from contaminated
soil.
 Fatality rate is 100% if untreated.
 Two stages are the prodromal stage
and the fulminant stage.
 Drug therapy includes ciprofloxacin,
doxycycline, and amoxicillin.

Pulmonary Empyema
A collection of pus in the pleural
space
 Most common cause: pulmonary
infection, lung abscess, and infected
pleural effusion
 Interventions include:

– Emptying the empyema cavity
– Re-expanding the lung
– Controlling the infection
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