Epidemiology

Diseases of the » High morbidity during autumn and winter months.

Respiratory System
Incubation Period
» 2-5 days

 Upper respiratory tract infection Mode of Transmission

» Common cold » Direct contact with droplet/airborne
» Laryngitis » Indirect via contact with contaminated fomites
» Pharyngitis
» Diphtheria Signs and Symptoms
 Lower respiratory tract infection » Nasal congestion, coryza, sneezing, malaise,
» Influenza teary/watery eyes, sore throat, low grade fever, nasal
» SARS pruritus, chills, headache
» Whooping cough
» Acute Tracheobronchitis Diagnosis
» Pneumonia » Symptomatic
» Legionellosis
» Tuberculosis Complication
» Paragonimiasis » Secondary bacterial
infection

Treatment
» Supportive
» Decongestant, expectorant, antipyretic, NSAIDs,
Acetminophen, AH

Nursing Interventions
» Reduce environmental irritants
» Inc fluid intake
» Gargle with warm water and salt
» Advise bed rest
» Note: overuse of topical nasal decongestants can
produce rhinitis medicamentosa or rebound rhinitis
which can cause more severe manifestations.

Prognosis
» Generally good

PHARYNGITIS
» Inflammation of the pharynx
and or tonsils
» Also sore throat, strep throat
» 40-60% of cases are of viral
COMMON COLD and 5-40% of are bacterial in
» Also viral rhinitis origin
» Refers to an afebrile, infectious, acute inflammation
of the mucous membrane of the nasal cavity. Pathophysiology
» contagious, especially indoors, and places where » Bacteria directly invade the
groups of people congregate pharyngeal mucosa, causing
» Sometimes called ‘rhinovirus’ or ‘coronavirus’ a local inflammatory
infections. response. Other viruses,
» Experts estimate that the average person has more such as rhinovirus, can
than fifty colds during a lifetime. An individual who cause irritation of
has a cold usually recovers without special treatment. pharyngeal mucosa secondary to nasal secretion.
» Despite popular belief, cold temperatures and Streptococcal infections are characterized by local
exposure to cold, rainy weather do not increase the invasion and release of extracellular toxins and
incidence and severity of the common cold. proteases. The body responds by triggering an
inflammatory response in the pharynx. This results in
Etiologic Agents pain, fever, vasodilation, edema and tissue damage,
» Picornavirus manifested by redness and swelling in the tonsillar
» RSV pillars, uvula and soft palate. A creamy exudates
» Parainfluenza virus may be present in the tonsillar pillars. In addition, M
» Adenovirus protein fragments of certain serotypes of GABHS are
similar to myocardial sarcolemma antigens and are
Pathophysiology linked to rheumatic fever and subsequent heart valve
» The cold virus attaches itself to the lining of the damage. Acute glomerulonephritis may result from
nasal passages and sinuses. Infected cells release antibody-antigen complex deposition in glomeruli.
histamine resulting in swelling, congestion
(stuffiness), and increased production of mucus.
Epidemiology
» The peak incidence of pharyngitis occurs in the Etiologic Agents
school-aged child aged 4-7 years. » Rhinoviruses
» One in 400 cases of untreated GABHS infections can » Parainfluenza viruses
be expected to result in acute rheumatic fever. This » Respiratory syncytial virus(RSV)
rate is higher in less developed countries and might » Adenoviruses
actually be lower in the Western world. » Influenza viruses
» Measles virus
Mode of Transmission » Mumps virus
» Airborne, contact with » Bordetella pertussis
saliva or contaminated » Varicella-zoster virus(VZV)
fomites
Pathophysiology
Signs and Symptoms » When the etiology of acute laryngitis is infectious,
» Sore throat white blood cells remove microorganisms during the
» Headache healing process. The vocal folds then become more
» Fever edematous, and vibration is adversely affected. The
» Dysphagia phonation threshold pressure may increase to a
» N&V degree that generating adequate phonation pressures
» Swollen, tender in a normal fashion becomes difficult, thus eliciting
lymph nodes hoarseness. Frank aphonia results when a patient
» White-purple cannot overcome the phonation threshold pressure
exudate required to set the vocal folds in motion.
» The membranous covering of the vocal folds is
Diagnosis usually red and swollen. The lowered pitch in
» History, PE laryngitic patients is a result of this irregular
» Rapid strep test thickening along the entire length of the vocal fold.
(RST)
» Strep culture (STCX) Epidemiology
» Common in 18-40years old
Complications » Because acute laryngitis is usually self-limited and
» Rheumatic fever treated with conservative measures, significant
» Glomerulonephritis morbidity and mortality are not encountered.
» Sinusitis
» Otitis media Signs and Symptoms
» Mastoiditis » Hoarseness, dry cough, weak voice

Treatment Diagnosis
» Penicillin PO » PE, G/S, C & S
» Cephalosporins
» Macrolides (Clarithromycin, Azithromycin) Complication
» Lozenges » Respiratory distress
» Supportive (Aspirin, Acetaminophen at 3 to 6 hr
intervals) Treatment
» Symptomatic for
Nursing Interventions viral laryngitis
» Maintain best rest
» Administer meds as ordered (usually for at least 10d) Nursing Interventions
» Provide warm saline gargle » Rest voice
» Stress importance of completing the therapeutic » Moist air vaporizer
regimen » Warm saline gargle
» Provide liquid or soft diet » Supportive
» May give cool beverage and flavored frozen desserts » Limit caffeine and alcohol intake
such as popsicles to soothe the throat » Advise to stop smoking
» Inc fluid intake (2-3 L if with laryngeal secretions)
Prognosis
» Generally good but poor if sequelae is present ACUTE TRACHEOBRONCHITIS
» An acute inflammation of the mucous membranes of
LARYNGITIS the trachea and the bronchial tree; often follows
» One of the most common conditions identified in the infection of the URT.
larynx. » Also called bronchitis
» An inflammation of the larynx manifests in both » Acute bronchitis is responsible for the hacking cough
acute and chronic forms. and phlegm production that sometimes accompany
» Acute laryngitis has an abrupt onset and is usually an upper respiratory infection.
self-limited. » Mild, self-limiting disorder
» The etiology of acute laryngitis includes vocal
misuse, exposure to noxious agents such as dust, Etiologic Agents
smoke, chemicals and other pollutants, or infectious » Mycoplasma pneumoniae
agents leading to upper respiratory tract infections. » Chlamydia pneumoniae
The infectious agents are most often viral but » Streptococcus pneumoniae
sometimes bacterial. » Moraxella catarrhalis
» The onset of infection may be associated with » Haemophilus influenzae
exposure to sudden temperature changes, dietary » Aspergillus sp.
deficiencies, malnutrition, or an immunosuppressed
state. Pathophysiology
» Introduction of the pathogen/s into the body initiates Prognosis
an inflammatory response that includes the » Good with prompt treatment
constriction of the bronchioles leading to the onset of
signs and symptoms.

Epidemiology DIPHTHERIA
» 9th most common outpatient illness in US » An acute contagious
disease characterized by
Incubation Period generalized toxemia
» 10 days coming from a localized
inflammation process
Mode of Transmission known as
» Airborne pseudomembrane caused
by Corynebacterium
Signs and Symptoms diphtheriae or Klebs Loffler bacillus.
» Soreness and a feeling of constriction in the chest
» Congestion Pathophysiology
» SOB » The bacteria produce a powerful toxin which can
» Slight fever and chills spread through the body and cause serious, often life
» Overall malaise – threatening complications. The toxin can damage
» Noisy inspiration and expiration (inspiratory stridor the heart muscles and cause heart failure or paralyze
and expiratory wheeze) the breathing muscles. The membrane that forms
» Dry, hacking and nonproductive cough that is worse over the tonsils can also move deeper into the throat
at night and becomes productive/purulent (yellowish- and block the airway.
grey or green mucus or sputum) in 2 to 3 days
Epidemiology
Diagnosis » Phil stat: .02/100,000 population
» Pulmonary Function Test (PFT) » Incidence highest in children and low socio-
 Test used to evaluate lung mechanics, gas economic groups
exchange, and acid-base disturbance
through spirometric measurements, lung Incubation Period
volumes, and arterial blood gas levels » 2-5 days
» Pulse oximetry
 Noninvasive test that registers the oxygen Communicable period
saturation of the client’s hgb » Variable; until bacilli are no
 Recorded as percentage: normal value is longer present (3 negative
96%-100% cultures of discharge from the
 Reading can alert the nurse to hypoxemia nose and nasopharynx, skin
before clinical signs occur and other lesions); usually 2 weeks but can be as
 A sensor is placed on the client’s finger, long as 4 weeks
toe, nose, ear lobe or forehead to measure
oxygen saturation, which then is displayed Mode of Transmission
on the monitor » Direct (droplet) or intimate contact
 Do not select an extremity with an » Indirect via contact with articles
impediment to blood flow
 Results lower than 91% necessitate Signs and Symptoms
immediate tx » Pseudomembrane – grayish
» CXR white, leathery consistency
» CBC » Serous foul odor secretion;
dryness/excoriation on the
Complications upper lip/nares
» Pneumonia, Cor Pulmonale, Emphysema, » Dysphagia
» bull-neck appearance(cervical lymph nodes), neck
Treatment edema
» Antibiotics » Barking dry cough; sore throat
» Bronchodilators
» Supportive Diagnosis
» Expectorant » Nose and throat swab
» Note: AH usually are not prescribed because they » Shick’s test: for susceptibility to diphtheria
can cause excessive drying and make secretions » Moloney’s test: for hypersensitivity to diphtheria
more difficult to expectorate
Complications
Nursing Interventions » Due to toxemia
» Increase fluid intake ♪ Toxic myocarditis; neuritis; toxic nephritis
» Get plenty of rest » Due to intercurrent infection
» Use of steam inhalators/nebulizer ♪ Bronchopneumonia; respiratory failure
» Maintain cool temperature
» Maintain environment free from dust and pollutants Treatment
» Avoid smoking » Diphtheria antitoxin (IM or IV) + PenG (IV/IM) or
» Monitor signs of dehydration, such as sunken Erythromycin (PO/IV)
fontanel, nonelastic skin turgor, decreased and
concentrated U/O, dry mucous membranes, and Nursing Considerations
decreased tear production
» Ensure strict isolation for the hospitalized child, until Treatment
3 (-) cultures » Amantadine HCl/Symmetrel PO
» CBR x 2weeks » Oseltamivir/Tamiflu
» Maintain F&E balance » Rimantadine/Flumadine
» Active immunization: as DTP IM for prevention » Zanamivir/Relenza
» Administer diphtheria antitoxin as prescribed (after a
skin test to rule out sensitivity to horse serum) Nursing Interventions
» AB as prescribed » Administer medications as ordered
» Provide suction and humidified oxygen as needed » CBR
» Provide tracheostomy care if with tracheostomy » Maintain adequate hydration and nutrition
» DON’T administer aspirin

Prognosis Prevention
» Depends on the size and location of the membrane » Active immunization:
and on early treatment with antitoxin; the longer the » Fluarix,Fluvirin,Fluzone –IM
delay, the higher the death rate. » FluMist – Nasal admin
» The death rate is 10%; recovery from the illness is
slow. Prognosis
» Good unless complicated

INFLUENZA SARS
» An acute, contagious viral » Or Severe Acute Respiratory
infection. Syndrome
» Occurs in isolated cases, » A serious, potentially life-threatening
epidemics and pandemics. viral infection caused by a previously
» Severity is greatest in the very young, the elderly, unrecognized virus from the
and those with chronic diseases. Coronaviridae family. This
» New strains of influenza virus emerge at regular virus has been named the
intervals and are named according to their SARS-associated
geographic origin. coronavirus (SARS-CoV).
Pathophysiology » First discovered in the
» Following respiratory Southern Province of
transmission, the virus Guangdong in Mid
attaches to and penetrates November 2002 by Dr.
respiratory epithelial cells Carlo Urbani.
in the trachea and bronchi.
Viral replication occurs, Pathophysiology
which results in the » From its reservoir (chickens, ducks), the virus may
destruction of the host have mutated, allowing transmission to and infection
cell. Viremia does not occur. The virus is shed in of humans, perhaps facilitated by the proximity in
respiratory secretions for 5-10 days. which humans and livestock live in rural southern
» Caused by Influenza virus (A, B, C). China.

Epidemiology Epidemiology
» Influenza A brings about severe pandemics every 10- » Infected 8000 people
15 years resulting from an antigenic shift with worldwide
epidemics of lesser intensity every 2-3 years » Phil stat: 93 SARS suspect; 12
associated with antigenic drift. SARS cases; 2 deaths
» Phil stat: 641/100,000
population
Mode of Transmission
» Person-person by droplet
» Direct or indirect

Period of Communicability
» Most infectious 24hours prior to onset and during Incubation Period
period of peak s/s. Viral shedding ceases within » 2-10days
7days of onset of illness.
Mode of Transmission
Incubation Period » Droplet; close contact; airborne
» 1-3days
Signs and Symptoms Signs and Symptoms
» Fever; chills; HA; fatigue; weakness; anorexia; sore » Fever ›38 degrees; body aches; cough; sore throat;
throat; body aches; redness of pharyngeal mucosa; dyspnea; diarrhea
tachycardia; cervical lymph nodes may be enlarged;
cough; rhinorrhea Diagnosis
» History; symptomatic; PCR; IF; ELISA
Diagnosis » Data: thrombocytopenia; abnormal LFT
» CBC (leukopenia); viral culture; PCR;IF
Treatment
Complications » Supportive
» Hemorrhagic pneumonia; encephalitis; Reye’s Nursing Considerations
syndrome; myocarditis; SIDS » Meticulous infection control behavior
» Amplified protection (use of N-95 respirator, goggles » Active immunization: as DTP IM
and full-garment covering) during intubation, » Note: infants do not receive maternal immunity to
extubation, suctioning, manual bagging pertussis
» Droplet precaution isolation
» Control visitors Prognosis
» Serious; mortality greatest in young infants
WHOOPING COUGH/ PERTUSSIS PNEUMONIA
» Characterized by repeated
attacks of spasmodic » Inflammation of the lung parenchyma or pulmonary
coughing with series of tissue associated with exudate in the alveolar lumen
explosive expirations ending which can be caused bacteria, virus, and parasites.
in long drawn forceful » May be hospital- or community acquired
inspiration. » Hospital-acquired: Psedomonas pneumonia;
» Caused by Bordetella Staphylococcal pneumonia; Klebsiella pneumonia
pertussis. » Community-acquired: Steptococcal/ Pneumococcal
pneumonia; Haemophilus influenzae; Legionnaaire’s
Pathophysiology disease; Mycoplasmal pneumonia; viral pneumonia;
» Humans are the sole reservoir for B. pertussis. It Chlamydial pneumonia
attaches to and damages ciliated respiratory
epithelium. Pathophysiology
» Bacteria typically enter the lung with
Epidemiology inhalation, though they can reach the lung
» Phil stat: 0.9/100,000 population through the bloodstream if other parts of the
» Highest risk in infants and young children body are infected. Often, bacteria live in parts
of the upper respiratory tract and are
Incubation Period continually being inhaled into the alveoli.
» 5-21days (usually 10d) Once inside the alveoli, bacteria travel into the
spaces between the cells and also between
Period of Communicability adjacent alveoli through connecting pores.
» Greatest during the catarrhal This invasion triggers the immune system to
stage (when discharge from respond by sending white blood cells
respiratory secretions occur) responsible for attacking microorganisms to
the lungs. The neutrophils engulf and kill the
Mode of Transmission offending organisms but also release cytokines
» Droplet; direct or indirect contact which result in a general activation of the
immune system. This results in the fever,
Signs and Symptoms chills, and fatigue common in bacterial and
» Catarrhal stage: slight fever in PM; colds; watery fungal pneumonia. The neutrophils, bacteria,
nasal discharge; teary eyes; nocturnal coughing(1-2 and fluid leaked from surrounding blood
weeks) vessels fill the alveoli and result in impaired
» Paroxysmal/Spasmodic stage: 5-10 successive oxygen transportation.
forceful coughing ending with inspiratory whoop; Epidemiology
involuntary micturation and defecation; choking » Ubiquitous; incidence depends on EA
spells; cyanosis; respiratory distress and tongue
protrusion Incubation Period
» Convalescence stage: 4th-6th week; diminish in » 1-3days (pneumococcal)
frequency and severity
Mode of Transmission
Diagnosis » Droplet; direct person to person
» CBC (leukocytosis & thrombocytosis)
» CXR Signs and Symptoms
» Culture (Bordet Gengou agar plate) » Rusty sputum; pleuritic chest pain (pneumococcal)
» Lobar pneumonia (consolidation of entire lobe):
Complications chills in older children; convulsion in infants; rapid
» bronchopneumonia; atelectasis or emphysema rise in temperature; chest pain; hacking cough
(secondary to mucous plugs); hemorrhage; umbilical » Bronchopneumonia: spiking temperature;
hernia; encephalopathy; otitis media; brain damage- restlessness; convulsion; rapid and shallow
asphyxia respiration; vomiting and diarrhea

Treatment
» Erythromycin/Penicillin/Chloromycetin

Nursing Interventions
» Parenteral fluids
» Prone position during attack
» Abdominal binder
» Isolation especially during the catarrhal stage; if
child is hospitalized, institute droplet precaution
» Administer AB therapy as ordered
» Gentle aspiration of tenacious secretions Diagnosis
» Prevent exposure to smoke, dust and sudden changes » PE; Sputum typing; serology;
in temperature which can cause coughing spasms » Elevated WBC count and ESR
» Monitor CP status and pulse oximeter
» Administer Pertussis immune globulin as prescribed Complication
» Emphysema; pericarditis; otitis media
 » Source: freshwater (lakes, stream, thermally polluted
Treatment waters, potable water)
» Pen G, Erythromycin, Co-trimoxazole, Trimethoprim
sulfamethoxazole
Incubation Period
Prevention » 2-10 days
» Active immunization (polysacch pneumococcal vax)
for high risk children; chemoprophylaxis with Mode of Transmission
phenoxymethyl penicillin » Inhalation of aerosolized contaminated water in
aeg’s home, workplace or location of medical
therapy
Nursing Interventions » Person-to-person contact does not occur; the risk of
» Administer medications (AB, antipyretics, infection is increased by the presence of other
bronchodilators, cough suppressants, mucolytic conditions
agents, expextorants) as prescribed
» Administer oxygen as prescribed Signs and Symptoms
» Monitor respiratory status » Influenza-like symptoms with a high fever; cough;
» Maintain high fluid intake, up to 3L/day to thin progressive respiratory distress with associated
secretions, unless C/I chills; myalgia; GI, CNS and renal manifestations;
» CBR sometimes diarrhea
» Encourage coughing and deep breathing and use of » Respiratory failure and death can occur
incentive spirometer
» Place client in semi-fowler’s position to facilitate Diagnosis
breathing and lung expansion » Clinical assessment: acute febrile illness w/ alveolar
» Change the client’s position frequently and ambulate infiltration and w/o clinical response to penicillins,
as tolerated to mobilize secretions cephalosporins and aminoglycosides
» Monitor pulse oximetry » Isolation and culture of EA in charcoal yeast extract
» Prevent the spread of infection by HW and the agar (CYEA) from RT secretions; IF
proper disposal of secretions » Detection of Ag in urine

Prognosis Treatment
» Mortality highest in aeg with bacteremia or » Azithromycin IV
meningitis » Rifampin may be added for immunocompromised
aeg or if without prompt response to IV
Azithromycin
LEGIONELLOSIS » Additional supportive tx
» A form of bacterial
pneumonia that may Nursing Considerations
occur in sporadic » Follow standard precautions
isolated cases or as » Decontamination of potable water by
localized epidemic hyperchlorination or superheating (71-76degrees)
affecting groups of
people. Progressively severe pneumonia frequently
occurs soon thereafter.
» Caused by Legionella pneumophila, which got its TUBERCULOSIS (PTB)
name in 1976, when many people who went to a » Also Phthisis/Consumption/
Philadelphia convention of the American Legion Primary Koch’s
suffered from an outbreak of the disease, a type of » A highly communicable
pneumonia. disease that primarily
» Sources of the microorganism include contaminated affects the lung
cooling tower water and warm stagnant water parenchyma. It also may be
supplies, including water vaporizers, water transmitted to other parts of
sonicators, whirlpool spas, and showers. the body, including the
meninges, brain, intestines,
Pathophysiology kidneys, bones, and lymph
» Legionella pneumophila is a gram-negative nodes.
pleomorphic bacillus and fastidious organism. This » Mycobacterium tuberculosis is a non-motile, non-
bacterium multiplies rapidly in macrophages in the sporulating, acid-fast rod that secretes niacin; when
bronchi of susceptible individuals. However, the bacillus reaches the susceptible site, it multiplies
activated macrophage restricts the growth of these freely
bacteria. Once inside, the bacteria are surrounded by » Because M. tuberculosis is an aerobic bacterium, it
a phagolysosome. This becomes a vesicle within primarily affects the pulmonary system, especially
which the bacteria multiply. They produce a 39kDa the upper lobes, where the oxygen content is highest
metalloprotease into culture fluids, which is » TB has an insidious onset, and many clients are not
cytotoxic for some cultured tissue cells. L. aware of symptoms until the disease is well
pneumophila also produces a novel cytotoxin advanced.
consisting of small peptides, which are acidic and » Improper or noncompliant use of tx programs may
heat resistant. L. penumphila may also have a unique cause the development of mutations in the bacilli,
iron scavenging system. resulting in multi-drug resistant strains of
tuberculosis (MDT-TB)
Epidemiology » The goal of tx is to prevent transmission, control
» Occurs most commonly in adults and symptoms, and prevent progression of the disease
immunocompromised aeg; rare in children
Pathophysiology
»  A susceptible person inhales TB bacilli and becomes Mode of Transmission
infected. The bacteria are transmitted thru the » Airborne; occasionally by ingestion of contaminated
airways to the alveoli, where they are deposited and milk (M. bovis) ; direct contamination of open
begin to multiply. The bacilli also are transported via wounds (pathologists and laboratory personnel;
the lymph system and bloodstream to other parts of transplacental.
the body. The body’s immune system responds by » When an infected individual coughs, laughs, sneezes,
initiating an inflammatory reaction. Phagocytes or sings, droplet nuclei containing tuberculosis
engulf many of the bacteria, and TB-specific bacteria enter the air and may be inhaled by others
lymphocytes lyse the bacilli and normal tissue. This » Note: after the infected individual had received anti-
tissue reaction results in accumulation of exudate in TB meds for 2-3 weeks, the risk of transmission is
alveoli, causing bronchopneumonia. The initial greatly reduced
infection usually occurs 2-10 weeks after exposure.
Signs and Symptoms
Epidemiology » Primary complex or TB in children or Primary
» Phil stat: PTB – 6th leading cause of morbidity and Koch’s: non-contagious; fever; cough; anorexia; wt
mortality (based on Field Health Services loss; easy fatigability
Information System or FHSIS 2003); 142.2/100,000 » Adult: low grade afternoon fever; chills; night
population sweats; anorexia; weight loss; fatigability; back
pain; chest pain; dry cough; greenish sputum;
Incubation Period hemoptysis
» 4-12weeks to the formation of primary lesion » Miliary TB: very ill

Period of Communicability Risk Factors

» Communicable only if associated with open lesions » Children younger than 5 y/o
of PTB, draining sinuses or renal involvement; as » Drinking unpasteurized milk if the cow is infected
long as bacilli are found in sputum, exudate or urine; with bovine tuberculosis
children with active TB are rarely contagious » Homeless individuals
because of low bacterial output and sputum is often » Individuals in crowded areas such as long-term care
swallowed; aeg is non-infectious within 2-4 weeks of facility, prison and mental health facility
starting adequate therapy. » Older clients
» Close contact with sputum(+) aeg
Classification of TB (American Thoracic » Impaired defense: HIV infection; drug-induced;
Society,2000) malnutrition
» Individuals who abuse alcohol or is an IV drug user
» Class 0: no TB exposure, not infected (no history of » Other disease states: Hodgkin’s lymphoma; DM;
exposure, reaction to tuberculin test, not significant) leukemia; severe kidney disease; prolonged
treatment with corticosteroids
» Class 1: TB exposure, no evidence of infection
♪ (+) exposure to adult/adolescent w/ active TB Diagnosis
♪ (-) signs and symptoms of TB » Sputum exam: sputum
♪ (-) Mantoux tuberculin test specimen obtained by
♪ (-) chest radiograph expectoration or tracheal
suctioning to assist in the
» Class 2: TB infection - preclinical state of TB ID of the organism; obtain
♪ (+/-) history of exposure early morning sterile specimen from suctioning or
♪ (+) Mantoux tuberculin test expectoration; instruct the client to rinse the mouth
♪ (-) signs and symptoms of TB with water before collection; obtain 15 ml of sputum;
♪ (-) chest radiograph instruct client to take several deep breaths and cough
deeply to obtain sputum; obtain sputum before client
» Class 3: clinically active TB disease(a child who has begins AB therapy; transport the specimen to the
active TB has 3 or more of the ff criteria) laboratory immediately and assist client with mouth
♪ (+) history of exposure care
♪ (+) Mantoux » CXR: cavitation of lungs
♪ (+) signs and symptoms: 1 or more of the  Provides info regarding the anatomical
following should be (+): cough/wheezing ›2weeks, location and appearance of the lungs
fever ›2weeks, painless cervical and other  Preprocedure: remove all jewelries and
lymphadenopathies, poor weight gain, failure to other metal objects from the chest area;
make a quick return to normal after an infection assess the client’s ability to inhale and hold
(measles, tonsilitis, whooping cough), or failure to breath; question women regarding
respond to appropriate antibiotic treatment pregnancy or the possibility of pregnancy
(pneumonia, otitis media)  Postprocedure: help the client get dressed
♪ (+) abnormal chest radiograph suggestive of TB » Tuberculin test: to det exposure to bacilli
♪ (+) lab findings suggestive of TB ( histological, » Mantoux test: involves 0.1cc injection of PPD ID
cytological, biochemical, and or molecular) and 48-72hours reading; check for
induration/elevation
» Class 4: TB inactive » Note: an area of induration measuring 10mm or more
♪ (+/-) previous chemotherapy in diameter indicates the individual has been exposed
♪ (+) radiographic evidence of calcification to TB; for individuals with HIV infection, a reaction
♪ (+) Mantoux of 5mm or more is considered positive
♪ (-) signs and symptoms suggestive of TB
♪ (-) smear/culture of M. tb Diagnosis of TB requires two separate methods.
Tuberculin skin testing is a method of screening for
» Class 5: suspected disease, diagnosis pending exposure to TB infection. A person who was infected
with TB will have developed a hypersensitivity to the
TB bacteria even if they did not develop the disease. A » The room should have at least 6 exchanges of fresh
purified protein derived from the bacteria is injected air per hour and should be ventilated to the outside
into the skin. The skin area is inspected 48 to 72 hours environment, if possible
later for a bump. A positive test implies that TB » The nurse wears a particulate respirator (a special
infection has occurred. Skin tests are not 100 percent individually fitted mask) when caring for the client
accurate and they do not always indicate the presence and a gown when the possibility of clothing
of active disease. contamination exists
Diagnosis of TB is established by the ID of the » Always thoroughly wash hands before and after
bacteria in sputum or other body fluids and tissues in caring for the client
conjunction with an abnormal chest X ray and the » If the client needs to leave the room for a test or
presence of TB symptoms. Once TB has been procedure, the client is required to wear a mask
diagnosed, further testing is required to determine » Respiratory isolation is discontinued once the client
which drugs would be most appropriate to treat the is no longer considered infectious
particular strain of TB bacteria.
Prevention
Lung tissue » BCG vaccination anytime after birth
calcification, resulting » Note: BCG does not protect aeg from acquiring
from pulmonary initial PTB but is presumed to protect from severe
tuberculosis, appears as forms like TB meningitis and miliary TB.
yellow patches within the
chest area of this human X Prognosis
ray. When airborne » Depends on type of TB (young infants and
phlegm contaminated with adolescents are at greatest risk)
the bacillus Mycobacterium » Serious in miliary TB and TB meningitis
tuberculosis is inhaled,
nodular lesions, called
tubercles, may form in the PARAGONIMIASIS
lungs and spread through » Trematodes of the
the nearest lymph node. Paragonimus genus cause
paragonimiasis, a parasitic
Treatment (DOTS) – based on RA 1135 disease that strikes carnivores,
» Category I causing a subacute to chronic
♪ New PTB, (+) sputum smear, (+) parenchymal inflammatory disease of the
involvement (CXR), “malala”; or (-) SS with lung. Of the 10 or more
extensive CXR Paragonimus species that are
♪ 2 mos intensive phase (RIPE), 4 mos human pathogens, only 8
maintenance phase (RI) cause significant infections in
» Category II humans. The most common is
♪ Relapses, failures, others the Oriental lung fluke,
♪ 3 mos intensive phase (RIPES), 1 mo (RIPE) , 5 Paragonimus westermani. The
mos maintenance(RIE) adult trematode is reddish-
» Category III brown and ovoid. Adults have
♪ (+) sputum but minimal 2 muscular suckers, an oral
♪ 2 mos intensive phase (RIPE), 4 mos maintenance sucker situated anteriorly and
(RI) a ventral sucker at mid-body
Note: Intensive phase is aimed at reducing on the ventral surface. The
communicability while maintenance phase is aimed at eggs, golden brown and
killing the bacilli and preventing resistance asymmetrically ovoid, have a thick shell with an
operculum.
Nursing Considerations/Interventions
» Directly-Observed Treatment Shortcourse (DOTS): Pathophysiology
the aeg is required to take his medications in the » When humans ingest raw infected crustaceans, larval
presence of a health care provider to ensure flukes develop in the small intestine; penetrate the
compliance to treatment regimen intestinal wall into the peritoneal cavity 30 minutes
» Administer medications as ordered; rest; isolation; to 48 hours after excysting. They then migrate into
diet high in CHON, vitamins A & C. the abdominal wall or liver, where they undergo
» Side effects and adverse reactions of drugs further development. Approximately 1 week later,
♪ Rifampicin: body fluid discoloration; hepatotoxic; adult flukes reenter from the abdominal cavity and
nephrotoxic; permanent discoloration of contact penetrate the diaphragm to reach the pleural space
lenses and lungs. Flukes mature, a fibrous cyst wall
♪ Isoniazid: peripheral neuropathy; avoid alcohol develops around them, and then egg deposition starts
(hepa/nephrotoxic) 5-6 weeks after infection. Lung flukes may live 20
♪ Pyrazinamide: monitor signs and symptoms of years or more.
hepatotoxicity, hyperuricemia
♪ Ethambutol: report visual disturbance; hepatotoxic; Epidemiology
not recommended for children » Geographic distribution: Cotabato, Davao, Leyte,
♪ Streptomycin: report oliguria (nephrotoxic); Samar and Sorsogon
ototoxic; neurotoxic » Source: sputum; excreta of humans, dogs and cats
» The client with active TB is placed in respiratory
isolation precautions in a negative-pressure room; to Incubation Period
maintain negative pressure, the door must be tightly » Variable
closed
Mode of Transmission
» Ingestion of raw, pickled or improperly cooked
freshwater crabs or crayfish
» Not directly transmissible from person to person

Signs and Symptoms

» Pulmonary: chronic cough; hemoptysis; dyspnea;
pleural effusion; pneumothorax
» Extrapulmonary
♪ Brain & spinal cord: convulsions; headache; visual
disturbance; mental deterioration
♪ Peritoneum: peritonitis w/ intestinal adhesion;
vomiting

Diagnosis
» ID eggs in sputum, stool, pleural effusion, CSF;
Western blot; CXR

Complication
» Bronchiectasis: chronic abnormal dilation of bronchi
and destruction of bronchial walls leading to multiple
respiratory complications

Treatment
» Praziquantel PO
» Supportive

Pulmonary
paragonimiasis in a
21-year-old woman
presenting with blood-
tinged sputum and
chest pain four weeks
after eating uncooked
pickled crab. (A)
Chest radiograph
shows a
pneumothorax and
multiple aggregated
cysts in the right
upper lobe (arrow).

(B) High-resolution
CT scan obtained at the
level of the right upper
lobar bronchus shows
worm cysts in the
subpleural region of the
right upper lobe
containing worm(s)
(open arrow) and
showing a solar eclipse
effect.

Nursing Consideration
» Isolation not needed
» Avoid eating raw, pickled or improperly cooked
freshwater crabs

Prognosis
» Good unless extrapulmonary involvement is present