“PNEUMONIA”

Definition of Pneumonia

Pneumonia is a serious infection or inflammation of one or both lungs.

Description of Pneumonia

Pneumonia is an inflammatory process involving the respiratory bronchioles,

alveolar spaces and walls, and lobes caused primarily by specific organisms(bacteria,
viruses, fungi, parasites, mycoplasma, or chemical irritants).So, it can be also classified
as bacterial or nonbacterial.

Etiology & Incidence

1. Causative organisms in bacterial pneumonia Causative organisms in bacterial

pneumonia include: include:
* Streptococcus pneumoniae (hemolytic type A)
*accounts for 90% of cases. accounts for 90% of cases.
*Staphylococcus aureus
* Haemophilus influenzae (type B)
*Klebsiella pneumoniae, Pseudomias aeruginosa, Escherichia coli,Enterobacter,
and other gram-negative enteric bacilli.
2. Causes of nonbacterial pneumonia include:
*Mycoplasma pneumonia
*Influenza viruses, parainfluenza viruses, and
*other viral infections other viral infections

Diagnostic Tests

Sputum samples can be collected and examined under the microscope. If the
pneumonia is caused by bacteria, they can often be detected by this examination. A
sample sputum can be grown in special incubators, and the offending bacteria can be
subsequently identified. It is important to understand that sputum specimen must
contain little saliva from the mouth and be delivered to the laboratory fairly quickly.
Otherwise, overgrowth of non-infecting bacteria may predominate.
Bronchoscopy is a procedure in which thin, flexible, lighted viewing tube is thin,
flexible, lighted viewing tube is inserted into the nose and mouth after alocal anesthetic
is administered. The breathing passages can then be directly examined by the doctor,
and specimen from the infected part of the lung can be obtained.
A blood test that measures white blood cell (WBC) . An individual’s white blood
cell count can often give a hint as to the severity of the pneumonia and whether it is
caused by bacteria or a virus.
Signs and Symptoms

Most people who develop pneumonia initially have symptoms of a cold

followed by a high fever (sometimes as high as 104 degrees Fahrenheit), shaking
chills, and a cough with sputum production. The sputum is usually discolored and
sometimes bloody. Patients may become short of breath. Chest pain may develop if the
outer aspects of may develop of the lung are involved. This pain is usually sharp and
worsens when taking a deep breath, known as pleuritic pain .
In other cases of pneumonia, there can be a slow onset of symptoms. A
worsening cough, headaches, and muscle aches may be the only symptoms. In some people
with pneumonia, coughing is not a major symptom because the infection is located in areas of
the lung away from the larger airway. At times, the individual's skin color may change and
become dusky or purplish(a condition known as “cyanosis”) due to their blood poorly
oxygenated.
Children and babies who develop pneumonia often do not have any pneumonia, specific signs
of a chest infection, but develop a fever, appear quite ill and become lethargic. Elderly people
may also have few symptoms with pneumonia.

Common Clinical manifestation

*Dullness on percussion of chest consolidation

*Bronchial breath sounds auscultated over consolidated lung fields
* Fever; sudden onset over 100 F
*Shaking chills (with bacterial pneumonia)
*chest pain
*Dyspnea
*Hacking cough
*Anxiety and confusion

Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia
usually resolves over time. If the lungs become infected with a secondary bacterial infection,
the doctor will prescribe an appropriate antibiotic to eliminate the bacterial infection.
Mycoplasma pneumonia is often treated with antibiotics, such as erythromycin,
clarithromycin (Biaxin), tetracycline or clarithromycin (Biaxin), tetracycline or azithromycin
(Zithromax).
In addition to the pharmaceutical intervention, the doctor will recommend bedrest, plenty of
fluids, therapeutic coughing, cough suppressants, pain breathing exercises, proper diet, pain
relievers and fever reducers, such as aspirin (not for children) . In severe cases, oxygen therapy
and artificial ventilation may be required.
The course of pneumonia varies. Recovery time depends upon the organism involved,
the general health of the person and how promptly medical attention was obtained. A majority
of sufferers recover completely within a few weeks, with residual coughing persisting between
six and eight weeks after the infection has gone.
Prevention of Pneumonia
*Practice good hygiene.
*Get an influenza shot each fall.
*Get a pneumonococcal vaccine.
*Practice good preventive measures by eating a proper diet.
regular exercise and plenty of sleep.
*Do not smoke.

Prepared by:
MARY ROSE ELARDO G.
BSN3-H/GRP.26
 “PERTUSSIS”
What is Pertussis?

Pertussis , also known as whooping cough, Caused by the bacterium Bordetella

pertussis (or B. pertussis). Highly contagious bacterial infection, Characterized by
severe coughing spells that end in a "whooping" sound when the person breathes in.

Pertusis is a devastating contagious disease of childhood, particularly infancy

Bordetella pertussis, gram (-), coccobacil, recovered by Bordet & Gengou (1906)

Epidemiology

 Pertusis is highly contagious, transmitted by intimate respiratory contact

 No effective transplacental immunity
 seasonal variation

Signs & Symptoms of Pertussis

 The first symptoms of pertussis are similar to those of a common cold
 runny nose
 sneezing
 mild cough
 low-grade fever
 Elevated white blood cell count with a lymphocytosis
 Confirmed with laboratory testing
 Incubation period : 7-13 days
 The initial symptom are nonspecific
 Fever is absent or low

Mild coryza like symptoms, and a mild dry cough. The cough progresses in
frequency & severity
2 weeks after onset, spells of paroxysmal coughing are recognized à whoop, vomiting,
cyanosis, the eyes roll back, the child may appear semiconscious (2-6 wks)
In convalescence the cough gradually disappear over a month or more
Lethal complication à bronchopneumonia and encephalopathy

Diagnosis

Clinical picture of full-blown pertussis

Culture of nasopharyngeal mucus by using transnasal swab during the catarrhal stage
Laboratory Tests for Pertussis

Culture is “Gold Standard”

PCR
DFA
Serological testing
Lab tests may be negative for patients with pertussis
Culture results may not be available for 7-10 days

Who gets pertussis?

Although pertussis can occur at any age, it's most severe in unimmunized children and
in infants under 1 year of age
About 40% of all pertussis infections occur in children less than 1 year old, and only
15% occur in children over 15 years old
Half of all deaths from pertussis occur in infants under age 1, and serious complications
are more common in this group

Child with Pertussis

Child demonstrating the characteristic “whooping" cough of Pertussis.  It is difficult for

him to stop coughing and to get air.  The "whooping" sound that follows the cough is
typical and means that the child is trying to catch his breath before the next round of
coughing

Complications of Pertussis in infants

Infants with pertussis are at highest risk

59% hospitalization
12% Pneumonia
1% Seizures
0.2% Encephalopathy
0.7% Death

Complications

Respiratory problems : atelectasis, bronchopneumonia, emphysema,

pneumothorax (rare). 90% of deaths resulted from pulmonary complications
Effects on CNS (most frequent in young infants) : anoxia and/or cerebral
hemorrhage à encephalopathy, convulsions, visual disturbances, paralyses. Permanent
sequelae à mental retardation and pareses
Malnutrition
Minor complications : otitis media, epistaxis, petechiae, subconjunctival bleeding
Prognosis

With good care the prognosis is excellent

Life-threatening complications of pertussis
Choking
Pneumonia (occurs in about 10% of cases)
Collapsed lung
Seizures (happens about 2% of the time)
Potentially result in permanent epilepsy
Inadequate oxygen supply to the brain
Patients breathing slows down or stops completely
Cerebral hemorrhage

Pertussis Duration

Pertussis can cause prolonged symptoms

The child usually has 1 to 2 weeks of common cold symptoms first
This is followed by approximately 2 to 4 weeks of severe coughing, though the coughing
spells can sometimes last even longer
The last stage consists of another several weeks of recovery with gradual resolution of
symptoms
In some children, the recovery period may last for months

How is Pertussis spread?

Pertussis is highly contagious.

Humans are the only reservoir
The bacteria spread from person to person through tiny drops of fluid from an infected
person's nose or mouth.
These may become airborne when the person sneezes, coughs, or laughs.
Other people then can become infected by inhaling the drops or getting the drops on
their hands and then touching their mouths or noses.
Infected people are most contagious during the earliest stages of the illness (usually 7-
10 days), but can be as long as 21 days

How is Pertussis Treated?

If you suspect that your child has pertussis, he or she will need to visit the doctor
The doctor will make a diagnosis by first taking a history and doing a thorough physical
exam
He or she might take samples of mucus from your child's nose and throat to determine
whether your child has a pertussis infection
If your child has pertussis, it will be treated with antibiotics, usually for 2 weeks
Some children with pertussis need to be treated in a hospital
Infants and younger children are more likely to be hospitalized because they're at
greater risk for complications such as pneumonia
In infants younger than 6 months of age, pertussis can even be life-threatening

Treatment

Supportive : adequate nutrition and hydration

Cough suppressants in low doses
Erythromycin 20-40 mg/kg/day for 14 days
Family members : a full course of erythromycin to prevent further disease and
subsequent spread
Immunity

After an attack of pertussis, lifelong immunity

The second attacks may have been parapertussis, viruses or chlamydia

Can Pertussis be prevented?

Whole cell pertussis vaccine (DTP)

Pertussis can be prevented with the pertussis vaccine, which is part of the DTaP
(diphtheria, tetanus, acellular pertussis) immunization.
This vaccine is 70-90% effective
DTaP immunizations are routinely given in five doses before a
child's sixth birthday
The vaccination cannot be given to persons seven years of age or older
Immunity from the childhood vaccination series lasts for about ten years
Before a vaccine was available in the 1930’s, pertussis killed 5,000 to 10,000 people in
the United States each year. Now, the pertussis vaccine has reduced the annual
number of deaths to less than 30

Prepared by:
MARY ROSE ELARDO G.
BSN3-H/GRP.26
 “CHOLERA”
DEFINITION

- is an acute bacterial enteric disease of the GIT characterized by profuse

diarrhea, vomiting, massive loss of fluid and electrolytes that could result to
hypovolemic shock, acidosis, and death.

ETIOLOGIC AGENT
• Vibrio Cholerae/ Vibrio coma
– slightly curved rods (coma shaped), gram (-) and motile with a single
polar flagellum.

– survive well at ordinary temperature and can grow well in temperature

ranging from 22-40oC.
– can survive longer in refrigerated foods.
– develop an enterotoxin, choleragen, as they grow in the intestinal tract.

INCUBATION PERIOD
– 2 hours to 5 days; usually 1 – 3 days
PERIOD OF COMMUNICABILITY
– communicable during stool positive stage, few days after
recovery
– Carrier may have the organism for several months

MODE OF TRANSMISSION

1. Fecal transmission passes via oral route from contaminated water, milk, and other foods.

2. The organisms are transmitted through ingestion of food or water contaminated

with stool or vomitus of patient.

3. Flies, soiled hands, and utensils also serve to transmit the infection.

CLINICAL MANIFESTATIONS

1. Acute, profuse, watery diarrhea

2. pale gray (“rice-water”) stool with slightly fishy odor
3. Vomiting

4. Diarrhea – fluid loss: 1 – 30 liters/day (dehydration and electrolyte loss)

5. Poor tissue turgor; sunken eyes
6. Cold skin, wrinkled fingers and toes - “Washer-woman’s-hand”
7. Imperceptible radial pulses; Unobtainable BP
8. Cyanosis
 9. Hoarse voice; Aphonia (whisper voice)
10. Rapid and deep breathing
11. Diminished peripheral circulation; Consciousness is still present.
12. Oliguria, then anuria
13. Normal temperature at onset of disease; Subnormal temperature in later stage,
esp. when in shock
14. In deep shock – diarrhea stops
15. Death – may occur 4 hours after onset; usually 1st or 2nd day if not properly
treated

PRINCIPAL DEFICITS

1. EXTRACELLULAR VOLUME IN THE LOSS OF INTESTINAL FLUID

a. Washer-woman’s-hand, restlessness, & excessive thirst

b. Circulatory collapse or shock

2. METABOLIC ACIDOSIS

– due to loss of large volume of bicarbonate-rich stool that results in rapid

respiration with intervals of apnea (Kussmaul respiration)

3. HYPOKALEMIA
– due to massive loss of K in stool.

4. RENAL FAILURE
– due to prolonged, untreated shock or unrelieved hypovolemia

5. CONVULSIONS AND TETANY

– due to loss of Mg

6. HYPOGLYCEMIA – due to untreated stupor for several days (in children)

7. CORNEAL SCARRING – occur in stuporous patient who has lost the “wink
reflex.”

8. ACUTE PULMONARY EDEMA may follow hydration in cases of uncorrected

metabolic acidosis

DIAGNOSTIC EXAMS

1. Rectal swab
2. Dark field or phase microscopy
3. Stool exam
MODALITIES OF TREATMENT

Correct basic abnormalities without delay:

Restoring circulating blood volume and blood electrolytes to normal levels
1. IV treatment: Rapid IV infusion of alkaline saline solution containing Na, K, Cl,
and CO3 ions in proportions comparable to that in water-stool
2. Oral therapy rehydration: ORESOL, HYDRITES (if pt is not vomiting)
3. Maintenance of the volume of fluid and electrolyte lost after rehydration. Carefully
note Intake & Output measurement.
4. Antibiotics
a. Tetracycline: 500 mg q for adults and 125 mg/kg body weight q 6hrs for
72hrs for children
b. Furazolidone: 100 mg for adults and 125 mg/kg for children given q
6hrs for 72hrs.
c. Chloramphenicol: 500 mg for adults and 18 mg/kg for children q 6hrs
for 72hrs.
d. Cotrimoxazole: 8mg/kg for 72hrs.

NURSING MANAGEMENT

Medical aseptic protective care must be provided.

1. Hand washing is imperative.
2. Enteric isolation must be observed.
3. Accurately record v/s.
4. Accurately measure I & O.
5. Provide a thorough and careful personal hygiene.
6. Properly dispose excreta.
7. Apply concurrent disinfection.
8. Properly prepare food.
9. Observe environmental sanitation.
10. Weigh the patient.
11. Give appropriate diet according to stage of recovery.

Can cholera be prevented?

Developed countries have

– widespread water-treatment plants;
– food-preparation facilities that usually practice sanitary protocols; and
– most people have access to toilets and hand-washing facilities
thus, preventing disease outbreaks,
including cholera.
Prevention

• hand washing
• avoiding areas and people with cholera
• drinking treated water or similar safe fluids
• eating cleaned and well-cooked food
•  There are vaccines available that can help prevent cholera, although they are not
available in the U.S. and their effectiveness ranges from 50%-90%

KEY FACTS
• There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths
due to cholera every year.
• Up to 80% of cases can be successfully treated with oral rehydration salts.
• Effective control measures rely on prevention, preparedness and response.
• Provision of safe water and sanitation is critical in reducing the impact of cholera and
other waterborne diseases.
• Oral cholera vaccines are considered an additional means to control cholera, but should
not replace conventional control measures.

Prepared by:
MARY ROSE ELARDO G.
BSN3-H/GRP.26