Acute Respiratory Infections: Pneumonia, Pleurisy, Tuberculosis and Influenza

They are pulmonary infections with 15 days or less of evolution.

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 people older than 65 years.

Pneumonia

Pneumonia is an inflammation of the parenchyma of the lungs. The causative organisms include bacteria, viruses and fungi. Some of these organisms are:

  • Pneumococcus.
  • Hemolytic beta-streptococcus group A.
  • Staphylococcus.
  • Pseudomonas.
  • Influenza types A and B.
  • Cytomegalovirus.
  • Aspergillus fungiatus.
  • Pneumocystis carinii.

Common symptoms

The presentation of symptoms depends on the organism. The patient with viral pneumonia tends to have milder symptoms, while the patient with bacterial pneumonia may have chills and high fever.

Patients with cytomegalovirus, pneumocystis carinii or aspergillus will be seriously ill. The general symptoms of pneumonia include:

  • Hypoxia
  • Tachypnea.
  • Tachycardia.
  • Chest pain.
  • Discomfort.
  • Fever.
  • Confusion (especially in the elderly).

The care of the patient with pneumonia depends on the causal organism. The treatment of bacterial pneumonias includes antibiotics, antitussives, antipyretics and oxygen.

Antibiotics that can 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 medications such as Nizoral (ketoconozole). Additional therapies for the patient with pneumonia include providing fluid and nutritional needs, obtaining frequent vital signs and providing oral hygiene.

Supplemental oxygen and percussion and chest drainage should be performed as ordered by the doctor.

Caution in the treatment

Some medications used in the treatment of pneumonia require special attention:

Tetracycline should not be given to pregnant women or young children because of the damage that can be caused by the development of teeth and bones.

It is important to monitor the patient for signs of toxicity. The maximum and minimum serum levels are obtained according to the hospital protocol.

The maximum levels for garamycin are taken 30 minutes after the third or fourth dose. The minimum levels for garamycin are taken 30 minutes before the third or fourth dose. The therapeutic range for garamycin is 4-10 mcg / ml.

pleuresía

Pleurisy, an inflammation of the pleural sac, can be associated with upper respiratory tract infection, pulmonary embolism, thoracotomy, chest trauma or cancer. Symptoms include:

  • Acute pain in inspiration.
  • Cold.
  • Fever.
  • Tos.
  • Dyspnoea.

The chest radiograph reveals the presence of air or fluid in the pleural sac. The management of the client with pleurisy includes the administration of analgesics, antitussives, antibiotics and oxygen therapy.

The presence of a pleural effusion may require the patient to undergo thoracentesis. It is the responsibility of the nurse to prepare the client and to control the signs of complications related to the procedure.

The nurse should evaluate the client’s vital signs, particularly changes in breathing and blood pressure, which may reflect an impending discharge due to fluid loss or hemorrhage. The nurse should also observe the client for signs of pneumothorax.

Patient positions for a thoracocentesis

  • Sitting on the edge of the bed with your feet supported and with your head and arms resting on a padded table on the bed.
  • Sitting astride a chair with arms and head resting on the back of the chair
  • Lying on the unaffected side with the head of the raised bed 30 to 45 degrees (for patients who can not sit upright)

Tuberculosis

Tuberculosis (TB) is a highly contagious respiratory infection caused by Mycobacterium tuberculosis. It is transmitted through the respiratory tract.

The diagnosis includes administration of the Mantoux skin test, sometimes called Purified Protein Derivative (DPP), 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 previous positive skin test. A definitive diagnosis of TB is made if the sputum sample is positive for the tuberculosis bacillus.

Factors that can cause a falsely positive TB skin test include nontuberculous mycobacterium and inoculation with BCG vaccine.

Factors that can cause a falsely negative TB skin test include anergy (a weakened immune system), recent tuberculosis infection, age, vaccination with live virus, overwhelming tuberculosis, and poor testing technique.

The management of the patient with TB includes the use of ultraviolet light therapy and the administration of antimycobacterial drugs. Medication regimens may consist of several medications that include INH (isoniazid), Rifadin (rifampin), Myambutol (ethamubutol) and PZA (pyrazinamide).

The use of multiple pharmacological therapy has reduced the time of treatment to only six months for patients who meet the requirements; however, drug-resistant forms may require longer treatment periods.

Clients are no longer considered infectious after three negative sputum samples have been obtained. Surgical treatment may include a wedge resection or a lobectomy. Contacts in the home are treated with isoniazid.

Influenza

Influenza is an acute and highly contagious viral infection that mainly affects the upper respiratory tract and is sometimes complicated by the development of pneumonia.

Influenza is caused by one of the three types of Myxovirus influenzae. Infection with a strain produces immunity only to that strain, therefore, an annual vaccination is needed to protect against the projected strain that will prevail 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.

Treatment

The elderly, children and people with chronic diseases are more likely to develop serious complications; therefore, it is recommended that these patients receive annual immunization against influenza.

The vaccine is administered in the fall, before the start of annual outbreaks that occur in the winter months. Children two years and older and adults can receive the nasal vaccine.

The treatment of influenza aims to control symptoms and prevent complications. Bed rest and increased fluid intake are important interventions during the acute phase.

Decongestant nasal sprays, antitussives with codeine and antipyretics help the client feel more comfortable. Antibiotics are indicated if the client develops bacterial pneumonia.

Patients with influenza as well as unimmunized people who have been exposed to influenza may receive chemoprophylaxis if an outbreak occurs.

Antiviral medications such as Relenza (zanamivir) and Tamiflu (oseltamivir) are used both for 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 lessen the symptoms of the flu.