Communicable Diseases

Caused by a pathogen that enters the

body, multiplies, and causes disease
Transmissible
Afflict the most vulnerable

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Communicable Diseases

Infectious
Communicable
Contagious

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Communicable Diseases

Host

Environment Agent

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4
Modes of Transmission

Direct
Congenital, Sexual, Direct Contact
Indirect
Fomite
Vector
Mechanical, Biological
Vehicle
Airborne, waterborne
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ASEPSIS AND INFECTION CONTROL
Asepsis- absence of disease producing
microorganisms

Medical Asepsis
“clean technique”
Reduces number of microorganisms

Surgical Asepsis
“sterile technique”
Includes all sterile procedure/techniques to
eliminate all microorganisms from an area
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Cleansing, Disinfection, Sterilization
Cleansing- removing visible dirt
Disinfection- reduce number of potential
pathogens but spores are not
necessarily destroyed
Sterilization- complete destruction of all
microorganisms including their spores

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Methods:
1. Steam (autoclave)
2. Gas (Ethylene oxide)
3. Radiation
4. Chemical
5. Boiling water

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Infection Control
Handwashing- single most important
infection control practice
Necessary elements:
Friction
Running water
Cleansing agent

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Removing protective devices:

1. Gloves
2. Mask
3. Gown
4. Goggles
5. Cap
6. Shoe cover

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the tiers of precaution

Standard precaution
Transmission-based precaution
Airborne precaution – droplet nuclei smaller
than 5 μm
High-Efficiency Particulate Air filter
Air-filtered room
Private room
Door is shut

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the tiers of precaution

Standard precaution
Transmission-based precaution
Droplet precaution – droplet nuclei larger
than 5 μm
Door may be open
Mask if within 3 feet
Limit transport
Private room

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the tiers of precaution

Standard precaution
Transmission-based precaution
Contact precaution
Gown and gloves
Dedicated equipment
Private room

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Principles of Sterility

A sterile object remains sterile only when

touched by another sterile object.
Only sterile objects may be placed on a
sterile field.
A sterile object becomes contaminated
by prolonged exposure to air.

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Principles of Sterility

A sterile object or field out of the range of

vision or an object held below a person’s
waist is contaminated.
When sterile surface comes in contact
with a wet, contaminated surface, the
sterile object or field becomes
contaminated

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Principles of Sterility

The edges of a sterile field are considered

contaminated.
Fluid flows in the direction of gravity.

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Respiratory System

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Respiratory System

Upper Respiratory
Tract
Lower Respiratory
Tract

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Respiratory System

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Respiratory System
 Lower Respiratory Tract
 Bronchioles
Terminal Bronchioles
Respiratory
Bronchioles
 Alveoli
Type I
Type II
Alveolar
Macrophages (Dust
Cells)

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Respiratory System
Lungs
Pleural Membrane
Parietal Pleura
Visceral Pleura

Lung Lobes and

Fissures

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Respiratory System
Pulmonary Ventilation
Inspiration and
Expiration

Cellular Respiration
External
Internal

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Respiratory System
Muscles of
Respiration

Quiet Respiration
Piston Action
Pump Handle Motion
Bucket Handle Motion

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Respiratory System
Mechanics
Forced Inspiration
Quiet Expiration
Forced Expiration

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Respiratory System

Lung Volumes
Tidal Volume (500 ml)
Inspiratory Reserve Volume (IRV = 2100-
3200 ml)
Expiratory Reserve Volume (ERV = 1200 ml)
Residual Volume (RV =1200 ml)

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Respiratory System

Lung Capacities
Inspiratory Capacity (=4000 ml)
Vital Capacity (= 4800 ml)
Functional Residual Capacity (=2000 ml)
Total Lung Capacity (=6000 ml)

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Respiratory System: Control

Respiratory Center
In the medulla and pons
Medullary rhythmicity area
Pneumotaxic area (>E)
Apneustic area (>I)

Cerebral Cortex

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Respiratory System: Control

Hering Breuer Reflex

Inhibits excessive lung expansion

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Respiratory System: Control

Chemoreceptors
Central
Peripheral
Aortic and carotid bodies

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Respiratory System: Control

Others
Temperature
Irritation of airways
Volition
Pain
Emotion
Anal Sphincter Stretching

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Assessment

Health History
chief complaint
impact on patient's life
if chronic, ongoing assessment of abilities
& quality of life
Signs & Symptoms

Dyspnea
difficulty breathing
due to decreased lung compliance or
increased airway resistance
Signs & Symptoms

Cough
from irritation of the membranes
chief protection against accumulation of
secretions
Signs & Symptoms

Sputum
reaction of lungs to any constantly
recurring irritant
profuse & with color usually is bacterial
thin & mucoid is viral
bad breath usually is respiratory in origin
Signs & Symptoms

Wheezing
heard with airway narrowing
high-pitched, mainly expiratory
Signs & Symptoms

Clubbing
distal phalanx of each finger is
bulbous & rounded
nail plate is more convex
usually due to chronic hypoxia
may be pulmonary or cardiac
Signs & Symptoms

Hemoptysis
expectoration of blood
underlying disease must be diagnosed
regardless of amount of blood
vs. Hematemesis
Signs & Symptoms

Cyanosis
a very late indicator of hypoxia
appears at 5g/dL of unoxygenated Hgb
best to observe color of tongue & lips
Physical Assessment

Nose & Sinuses

• check external nose for
lesions, asymmetry or
inflammation
• tilt head backward &
assess the mucosa
• inspect the septum &
turbinates
• palpate the sinuses
Physical Assessment

Pharynx & Mouth

• open mouth wide & take
a deep breath
• check tonsils, uvula &
post. pharynx
• tongue depressor is put
past midpoint of tongue
Physical Assessment

Thorax
check skin color & turgor
check for deformities
Physical Assessment

Thorax
Funnel Chest (Pectus
excavatum)
depression of lower
portion of the sternum
may compress the
heart
Physical Assessment

Thorax
Pigeon Chest (Pectus Carinatum)
due to displacement of the sternum
increase in AP diameter
Physical Assessment

Thorax
Barrel Chest
due to overinflation
of the lung
increase in AP
diameter
Physical Assessment

Thorax
Kyphoscoliosis
elevation of scapula
S-shaped spine
Physical Assessment

Respiratory Rates
normal RR: 12-18 bpm
Eupnea
Bradypnea
Tachypnea
Physical Assessment

Breathing Patterns
Hypoventilation
Hyperpnea (depth)
Hyperventilation (depth and rate)
Apnea
Physical Assessment

Breathing Patterns
Kussmaul's
Cheyne-stokes
Biot's (Cluster)
Apneustic
Physical Assessment

Thoracic Palpation
tenderness, masses
respiratory excursion
 costal margin if anterior
 level of 10th rib if posterior
Physical Assessment

Thoracic Palpation
tactile fremitus
 vibration of the chest
 patient asked to repeat "99", "eee"
 air impedes sound, solids conduct sound
Physical Assessment

Thoracic Percussion
to determine content of underlying structures
to estimate size & location of certain
structures within the thorax
dullness at left 3rd - 5th interspace is the heart
dullness at right 5th interspace to costal
margin is the liver
Physical Assessment

Thoracic Auscultation
Useful for assessing air flow
Used to evaluate presence of fluid or solid
obstruction
Allow patient to rest during examinations
Physical Assessment

Thoracic Auscultation
Adventitious Sounds
“additional” sounds
 Crackles (Rales)
 Wheezing
Diagnostics

Pulmonary Function Tests

Assess respiratory function and
dysfunction
Measures lung volumes and ventilatory
function
Studies mechanics of breathing and gas
exchange
Diagnostics

Arterial Blood Gas Studies

Measures PaO2, PaCO2, pH, HCO3
Obtained through an arterial puncture
Diagnostics
Sputum Studies
For diagnosis, drug sensitivity testing
To determine whether malignant cells are
present
Expectoration is the usual method
Obtained in the morning so specimens
accumulate overnight
Do not allow specimen to stand as this
may cause overgrowth
Diagnostics

Imaging Studies
Endoscopic Procedures
Bronchoscopy
Thoracoscopy
Respiratory System: Tests
Pulse Oximetry
Spirometry

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Diagnostics

Procedures
Thoracentesis
Biopsy
 Pleura
 Lung
 Lymph Node
Client Needs: Oxygenation

Interventions to promote oxygenation

Deep breathing and coughing exercises
Abdominal breathing
Pursed-lip brathing

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Client Needs: Oxygenation

Interventions to promote
oxygenation
Chest physiotherapy
a. Percussion
b. Vibration
c. Postural Drainage
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Client Needs: Oxygenation

Oxygen Therapy
Concentration and liter flow
per minute
Humidification

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Obstruction and Trauma

Epistaxis
Caused by rupture of tiny vessels in any area
of the nose
Most commonly over the anterior septum
where the following vessels enter:
 Kesselbach’s plexus
 Sphenopalatine artery (posterosuperior)
 Internal maxillary (lateral)
Obstruction and Trauma

Epistaxis (treatment)
Direct pressure
Silver nitrate, electrocautery
Packing
 May remain in place for 48 hours
Upper Respiratory Tract

Viral Rhinitis (Common Cold)

Sx: rhinorrhea
Highly contagious
Most common cause of absenteeism from
work and school
Most common cause is rhinovirus
Upper Respiratory Tract

Acute Sinusitis
Infection of the paranasal
sinuses
Usually due to drainage
obstruction
60% are bacterial
Upper Respiratory Tract

Chronic Sinusitis
• > 3 wks in adults, > 2 wks in children
• Same organisms as acute sinusitis
• Symptoms most pronounced in the
morning
Upper Respiratory Tract
Rhinitis
Inflammation and irritation of the mucus
membranes
non-allergic or allergic
Sx: rhinorrhea
Nursing
 Avoid the allergen
 Blow the nose before any medication in the
nasal cavity
Upper Respiratory Tract

Acute Pharyngitis
• Mostly viral
• The most common bacterial cause is
group A beta-hemolytic Streptococci
• Throat cultures, nasal swabs and blood
cultures may be necessary
Upper Respiratory Tract

Tonsillitis and Adenoiditis

• 3 tonsils: palatine, lingual and pharyngeal
• The pharyngeal tonsils are also called the
adenoids
• Grp A beta-hemolytic Streptococcus is the
most common causative organism

• Post-op: prone with head turned to the

side
Upper Respiratory Tract
Peritonsillar Abscess
• Collection of purulent exudate between the tonsil and
surrounding structures
• Believed to be tonsillitis which progressed to local
cellulitis and abscess
Upper Respiratory Tract

Laryngitis
• Inflammation of larynx
• Almost always viral if
infectious
• With voice changes
and cough
Obstruction and Trauma

Acute Laryngeal Edema

Allergic, traumatic, inflammatory
Hoarseness, shortness of breath
Interventions
 Epinephrine and corticosteroids
Obstruction and Trauma

Chronic Laryngeal Edema

Obstruction of lymph drainage
Hoarseness, shortness of breath
Interventions
 Artificial airway may be necessary
Obstruction and Trauma

Laryngospasm
Trauma or inflammatory
Intervention
 Oxygen
 Succinylcholine
Obstruction and Trauma

Laryngeal Paralysis
Most common complication of
thyroidectomy, one vocal cord only
Ineffective cough
Prevent aspiration
Obstruction and Trauma

Fractures of the Nose

Usually without serious consequences
Obstruction or disfigurement may result
Rule out a skull fracture if with rhinorrhea
Reduced 7-10 days after the injury
Obstruction and Trauma

Obstruction During Sleep

Most common is sleep apnea syndrome
3 Types
 Obstructive – the most common
 Central
 Mixed
Obstruction and Trauma

Obstruction During Sleep

Obstructive Sleep Apnea
Frequent and loud snoring
Breathing cessation for 10 seconds or
more
Five episodes per hour or more
Followed by awakening abruptly with a
loud snort as oxygen levels drop
Lower Respiratory Tract
Atelectasis
Closure or collapse of alveoli
Due to reduced alveolar
ventilation
May be due to secretions, any
obstruction, pressure
 Pneumo-, hemothorax
 Pleural effusion
Lower Respiratory Tract

Pulmonary Tuberculosis
Primarily an infection of the lung, it may
also involve other body parts
The agent is Mycobacterium tuberculosis
The leading cause of death from
infectious disease in the world
Lower Respiratory Tract

Pulmonary Tuberculosis (Diagnosis)

Mantoux Test
Chest X-ray
AFB sputum smear
Lower Respiratory Tract

Pulmonary Tuberculosis Treatment

6-12 months
Drugs
 H, INH – Isoniazid - Hepatotoxic
 R, RIF – Rifampicin – Hepatotoxic, discolors
 Z, PZA – Pyrazinamide – Most hepatotoxic
 E, EMB – Ethambutol - optic neuritis
 S, STM – Streptomycin - Ototoxic
Lower Respiratory Tract

Pneumonia
• Inflammation of
lung
parenchyma
caused by
infection
Lower Respiratory Tract
Pneumonia
CAP
 In community or first 48 hours of hospitalization
 S. pneumoniae is the most common cause
 Mycoplasma is common in older children and
young adults
 H. influenzae affects the elderly and those with
comorbids
 Viruses are the most common cause in infants
and children
Lower Respiratory Tract

Pneumonia
CAP
 In adults, the most common viruses are the
influenza, adenovirus, parainfluenza,
coronavirus and varicella-zoster
 In immunocompromized adults, CMV is the
most common
Lower Respiratory Tract

Pneumonia
HAP
 Nosocomial
 The most lethal nosocomial infection
 Commonly includes Enterobacter, E. coli,
Klebsiella, Pseudomonas and Staphylococcus
Lower Respiratory Tract

Pneumonia
In the immunocompromised host
 Pneumocystis carinii
 Fungal
 Mycobacterial

Aspiration
 S. pneumonia, H. influenzae, S. aureus
Pleura

Pleuritis
Inflammation of the pleura
Worse with deep breathing, coughing or
sneezing (respiratory movement)
Analgesics and find underlying cause
Turn to the affected side
Pleura

Pleural Effusion
Accumulation of fluid in the pleural space
The size of the effusion and the underlying
disease determine the severity
Most commonly due to infection or malignancy
Chemical pleurodesis, pleurectomy,
thoracentesis may be done
Pleura

Empyema
Localized collection of pus
May thicken pleura and restrict the lung
Usually complications of lung infection,
trauma or surgery
Requires 4-6 weeks of antibiotics
Thoracentesis, thoracostomy may be
done
Lower Respiratory Tract

Bronchitis
• Acute
– Fever, cough,
wheezing
• Chronic
– Cough worse in the
evening and morning
– Lasts 3 months for 2
consecutive years
Lower Respiratory Tract

Bronchitis
Treatment
 Bronchodilators, corticosteroids
 Postural drainage and chest percussion
Bronchiectasis

• Chronic and irreversible abnormal

dilatation of bronchi due to repeated
damage to bronchial wall
Bronchiectasis

Chronic wet cough with foul-smelling

sputum
Hemoptysis
Recurrent fever and chills
Antimicrobials, bronchodilators may be
given
Resection, lobectomy may be done
Emphysema

Abnormal enlargement of the air spaces

distal to the terminal bronchioles with
destruction of alveoli
Increased expiratory effort
Treatment: O2, bronchodilators,
antimicrobials
Smoking cessation
Lung transplant
Asthma

Chronic inflammatory disorder of the

bronchial airway
With periods of bronchospasm
Worse at night, with wheezing
Treated with bronchodilators and steroids
Treated in a step-wise manner

Status asthmaticus and intubation

COPD

Obstruction of air flow due to emphysema

or chronic bronchitis
Predisposing Factors:
 Cigarette smoking
 Pollution
 Occupational exposure to irritants
COPD

Treatment
 Bronchodilators
 Oxygen therapy; be careful not to depress
respiratory drive
Nursing Management
 Smoking cessation
 Diaphragmatic breathing
 Pursed-lip breathing
 Inspiratory muscle training
Acute Respiratory Failure

PaO2 < 50mm Hg, PaCO2 > 50 mm Hg,

pH <7.35
Causes:
 Decreased respiratory drive
 Dysfunction of the chest wall
 Dysfunction of lung parenchyma
 Others (anesthetics, pain)
Acute Respiratory Failure

Restlessness and dyspnea are early

Neurologic, tachycardia and tachypnea
are late
Assist with intubation and mechanical
ventilation
Acute Respiratory Distress
Syndrome
An inflammatory reaction triggers the
disease
Diffuse alveolar capillary damage, severe
pulmonary edema, respiratory failure
Becomes unresponsive to supplemental
oxygen and with “stiff lungs”
Acute Respiratory Distress
Syndrome
Acute Stage
 Lungs are red, boggy and heavy with diffuse
alveolar damage
Proliferative Stage
 Patchy areas of interstitial fibrosis
 Dyspnea occurring within 12-48 hours of
initiating event
Acute Respiratory Distress
Syndrome
Medical Management
 PEEP
 Antibiotics to prevent infection
 Treat hypovolemia due to leakage

 Under investigation; includes anti-

inflammatories and steroids
Pulmonary Hypertension

Systolic pulmonary artery pressure > 30

mm Hg
Mean Pulmonary Artery Pressure > 25 mm
Hg
Forms
 Primary – fatal within 5 years of diagnosis,
idiopathic
 Secondary – from existing cardiac or
pulmonary disorder (COPD)
Pulmonary Hypertension

Symptoms of Right-sided heart failure

Oxygen therapy
Vasodilators
Heart transplant
Pulmonary Heart Disease

Cor Pulmonale
Right ventricular enlargement secondary
to a pulmonary condition
Confusion and somnolence may be
present due to hypercapnia
Symptoms of underlying disease
Symptoms of heart failure
Pulmonary Heart Disease

Cor Pulmonale
Oxygen therapy and bronchodilators
Intubation and mechanical ventilation
Treatment of CHF
Pulmonary Edema

Life-threatening accumulation of fluid in

the lung tissues or alveolar spaces
Usually caused by CHF
Dyspneic with frothy, foamy secretions
Give oxygen and medications as
necessary
Morphine may be given to decrease
anxiety and control pain
Pneumoconioses

Disorders caused by inhalation of irritants

Usually occupational
Effects of substances depend on:
 Concentration
 Duration of exposure
 Ability to initiate an immune response
 Individual susceptibility
Pneumoconioses
• Silicosis
– Chronic, nodular, dense
pulmonary fibrosis
• Asbestosis
– Diffuse pulmonary fibrosis
• Black Lung Disease
– Coal Worker’s Pneumonia
– Cor pulmonale and
respiratory failure
Pneumoconioses

Management if always removal of irritant

from work environment
If unavoidable, institute protective
measures
Minimize exposure
Ensure ventilation
Bronchogenic Carcinoma

90-95% of all lung tumors

Tobacco smoking is the most important
factor
Sx: chronic cough, hoarseness,
dysphagia
CXR reveals a solitary peripheral nodule
and atelectasis
Mediastinal Tumors

Includes tumors of the thymus, lymph

nodes
May cause heart and lung symptoms,
chest pain, dyspnea
Treatment with radiation or chemotherapy
Chest Trauma

• Pneumothorax
– Traumatic
Pneumothorax
– Tension Pneumothorax
– Hemothorax
– Chest tube placement
(2nd or 4th /5th )
CTT
Respiratory Care Modalities

Non-invasive
Oxygen Therapy
Nebulizer
Postural Drainage
Breathing Retraining
 2-6 lpm
5-8 lpm
6-10 lpm
10-15 lpm
4-10 lpm
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Respiratory Care Modalities

Invasive
• Endotracheal
Intubation
• Tracheostomy
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Suctioning
Oropharyngeal
10-15 cm along side of mouth
Nasopharyngeal
Along floor
10-15 sec, rotate, 20-30 sec intervals, 5 min
total
Avoid complications
Hyperinflation
Hyperoxygenation

126