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This chapter is from the book

This chapter is from the book

Acute Respiratory Infections

Acute respiratory infections, such as pneumonia, are among the most common causes of death from infectious diseases in the United States. Pneumonia is the fifth major cause of death in persons over age 65.

Pneumonia

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

  • Pneumococcus

  • Group a beta hemolytic streptococcus

  • Staphylococcus

  • Pseudomonas

  • Influenza types A and B

  • Cytomegalovirus

  • Aspergillus fungiatus

  • Pneumocystis carinii

Presenting symptoms depend on the causative organism. The client with viral pneumonia tends to have milder symptoms, whereas the client with bacterial pneumonia might have chills and fever as high as 103°. Clients with cytomegalovirus, pneumocystis carinni, or aspergillus will be acutely ill. General symptoms of pneumonia include

  • Hypoxia

  • Tachypnea

  • Tachycardia

  • Chest pain

  • Malaise

  • Fever

  • Confusion in the elderly

Care of the client with pneumonia depends on the causative organism. The management of bacterial pneumonias includes antibiotics, antitussives, antipyretics, and oxygen. Antibiotics that may be ordered include penicillin G, tetracycline, garamycin, and erythromycin. Viral pneumonias do not respond to antimicrobial therapy but are treated with antiviral therapy. Fungal pneumonias are treated with antifungal antibiotic therapy. Additional therapies for the client with pneumonia include providing for fluid and nutritional needs, obtaining frequent vital signs, and providing oral hygiene.

Pleurisy

Pleurisy, an inflammation of the pleural sac, can be associated with upper respiratory infection, congestive heart failure, chest trauma, or cancer. Symptoms include

  • Sharp pain on inspiration

  • Chills

  • Fever

  • Cough

  • Dyspnea

Chest x-ray reveals the presence of air or fluid in the pleural sac. Management of the client with pleurisy includes the administration of analgesics, antitussives, antibiotics, and oxygen therapy. The presence of pleural effusion can require the client to have a thoracentesis. It is the nurse’s responsibility to prepare the client and monitor for signs of complications related to the procedure. The nurse should assess the client’s vital signs, particularly changes in respirations and blood pressure, which can reflect impending shock from fluid loss or bleeding. The nurse should also observe the client for signs of a pneumothorax.

Tuberculosis

Tuberculosis (TB) is a highly contagious respiratory infection caused by the mycobacterium tuberculosis. It is transmitted by droplets from the respiratory tract. Airborne precautions, as outlined by the Centers for Disease Control (CDC), should be used when caring for the client with tuberculosis.

Diagnosis includes the administration of the Mantoux skin test, which is read in 48–72 hours. The presence of a positive Mantoux test indicates exposure to TB but not infection. A chest x-ray should be ordered for those with a prior positive skin test. A definite diagnosis of TB is made if the sputum specimen is positive for the tubercle bacillus.

Management of the client with TB includes the use of ultraviolet light therapy and the administration of antimycobacterial drugs. Medication regimens can consist of several drugs, and treatment can last up to 2 years. Clients should be told that they are no longer infectious after 2–4 weeks of treatment. Surgical management may include a wedge resection or lobectomy.

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