NCM 112

LOWER RESPIRATORY TRACT INFECTIONS

Submitted to:
Myka Allene Catoto, RN

Submitted by:
John Lester A. Ligutom BSN 3

September 17, 2020

1. In table form, compare and contrast the lower respiratory tract infections according to causes, risk factors, clinical manifestations,
management (medical and nursing), and significance of preventive health care.

Lower Cause Risk Factors Management Significance of

inflamma Preventive health
tory tract care
infection
s
Bronchiti  Viruses  Cigarette  Drinking plenty of warm  Don't smoke.
s  Bacterial infections smoke. People who liquids.  Insist that
smoke or who live  Rest. others do not
with a smoker are at  Don't smoke. Stay away smoke in your
higher risk of both from all kinds of smoke. home.
acute bronchitis and  If you have a moist,  Stay away
chronic bronchitis. productive cough (with from or try to
mucus), note how often reduce your
 Low
you cough, as well as time around
resistance. This may
the color and amount of things that
result from another
the sputum (mucus). irritate your
acute illness, such as
Report this to your airway (nose,
a cold, or from a
doctor. throat, and
chronic condition
 Use a humidifier. lungs).
that compromises
 Try herbal teas or Irritants can
your immune
lemon water with 1-2 include dust,
system. Older
tablespoons of honey to mold, pet
adults, infants and
provide comfort. dander, air
young children have
 Relieve body aches by pollution,
greater vulnerability
taking aspirin or smoke, and
to infection.
acetaminophen. cleaners.
 Exposure to  Follow your doctor's  If you catch a
 irritants on the instructions on ways to cold, get
job. Your risk of help you clear your plenty of rest.
developing mucus.  Take your
bronchitis is greater  If you have a cough that medicine
if you work around is severe or keeps you exactly the
certain lung irritants, from sleeping, your way your
such as grains or doctor may prescribe a doctor tells
textiles, or are cough medicine to you.
exposed to chemical suppress (or quiet) your  Eat a healthy
fumes. cough. diet.
 If you have a dry cough  Wash your
Gastric reflux. Repeated
or difficulty coughing hands often.
bouts of severe heartburn
out the mucus, your Use soap and
can irritate your throat
doctor may also water. If you
and make you more prone
prescribe an are not able
to developing bronchitis
expectorant to help to use soap
loosen and cough out and water,
the mucus. use a hand
sanitizer that
contains
alcohol.
 Make sure
you are up-to-
date on the
flu and
pneumonia va
ccines.

Pneumon Bacteria and viruses are - Condition that Medical Management: Preventive measures
ia the main causes of produce mucus or  blood culture. Blood for Pneumonia:
pneumonia. Pneumonia-causing  bronchial culture is performed for  Pneumococca
germs can settle in the alveoli obstruction and identification of the l vaccine. This
and multiply after a person interfere with causal pathogen and vaccine can
breathes them normal lung prompt administration prevent
in. Pneumonia can be drainage of antibiotics in patients pneumonia in
contagious. The bacteria and - Immunosuppresse in whom CAP is strongly healthy
viruses that cause d patients suspected. patients with
pneumonia are usually inhaled. - Smoking  Administration an efficiency
- Prolonged of macrolides. Macrolid of 65% to
immobility es are recommended 85%.
- Depressed cough for people with drug-  Staff
reflex resistant S. education. To
- NPO status, pneumoniae. help prevent
placement of tube  Hydration is an HAP, the CDC
- Supine position important part of the (2004)
- Alcohol regimen because fever encouraged
intoxication and tachypnea may staff
- Advanced age result in insensible fluid education and
losses. involvement
 Administration of in infection
antipyretics. Antipyretic prevention.
s are used to treat fever  Infection and
and headache. microbiologic
 Administration surveillance. I
of antitussives. Antitussi t is important
ves are used for to carefully
treatment of the observe the
associated cough. infection so
 Bed rest. Complete rest that there
is prescribed until signs could be an
 of infection are appropriate
diminished. application of
 Oxygen prevention
administration. Oxygen techniques.
can be given if  Modifying
hypoxemia develops. host risk for
 Pulse oximetry. Pulse infection. The
oximetry is used to infection
determine the need for should never
oxygen and to evaluate be allowed to
the effectiveness of the descend on
therapy. any host, so
 Aggressive respiratory the risk must
measures. Other be decreased
measures include before it can
administration of high affect one.
concentrations of
oxygen, endotracheal
intubation,
and mechanical
ventilation.

Nursing Management:
 To improve airway
patency:
 Removal of
secretions. Secretions
should be removed
because retained
secretions interfere
 with gas exchange and
may slow recovery.
 Adequate hydration of
2 to 3 liters per day
thins and loosens
pulmonary secretions.
 Humidification may
loosen secretions and
improve ventilation.
 Coughing exercises. An
effective, directed
cough can also improve
airway patency.
 Chest
physiotherapy. Chest
physiotherapy is
important because it
loosens and mobilizes
secretions.
 To promote rest and
conserve energy:
 Encourage avoidance of
overexertion and
possible exacerbation
of symptoms.
 Semi-Fowler’s
position. The patient
should assume a
comfortable position to
promote rest and
 breathing and should
change positions
frequently to enhance
secretion clearance and
pulmonary ventilation
and perfusion.
 To promote fluid
intake:
 Fluid intake. Increase in
fluid intake to at least
2L per day to replace
insensible fluid losses.
 To maintain nutrition:
 Fluids with electrolytes.
This may help provide
fluid, calories, and
electrolytes.
 Nutrition-enriched
beverages. Nutritionally
enhanced drinks and
shakes can also help
restore proper
nutrition.
 To promote patient’s
knowledge:
 Instruct patient and
family about the cause
of pneumonia,
management of
symptoms, signs, and
 symptoms, and the
need for follow-up.
 Instruct patient about
the factors that may
have contributed to the
development of the
disease.

Tubercul  Close contact. Having  Close contact with Medical Management: To prevent

osis close contact with infected client Pulmonary tuberculosis is transmission of
someone who has an treated primarily with tuberculosis, the
 Immunocompromi antituberculosis agents for 6 to
active TB. following should
 Low immunity. Immunoc sed status 12 months. be implemented.
ompromised status like  Substance abuse  First line  Identification
those with HIV, cancer, or treatment. Firs and
transplanted organs  Pre-existing t-line agents treatment. Ea
increases the risk of medical condition for the rly
acquiring tuberculosis. or special treatment treatment of identification
 Substance abuse. People tuberculosis and
 Immigration to
who are IV/injection drug are isoniazid treatment of
countries with high
users and alcoholics have (INH), rifampin persons with
incidence of TB
a greater chance of (RIF), active TB.
acquiring tuberculosis.  Living in crowded ethambutol  Prevention. Pr
 Inadequate health places (EMB), and evention of
care. Any person without pyrazinamide. spread of
adequate health care like  Healthcare worker  Active TB. For infectious
the homeless, most adults droplet nuclei
impoverished, and the with active TB, by source
minorities often develop the control
active TB. recommended methods and
dosing includes by reduction
the of microbial
administration contaminatio
of all four drugs n of indoor
daily for 2 air.
months,  Surveillance. 
followed by 4 Maintain
months of INH surveillance
and RIF. for TB
 Latent infection
TB. Latent TB is among health
usually treated care workers
daily for 9 by routine,
months. periodic
 Treatment tuberculin
guidelines. Rec skin testing.
ommended
treatment
guidelines for
newly
diagnosed
cases of
pulmonary TB
have two parts:
an initial
treatment
phase and a
continuation
phase.
 Initial
phase. The
initial phase
consists of a
multiple-
medication regi
men of INH,
rifampin,
pyrazinamide,
and
ethambutol
and lasts for 8
weeks.
 Continuation
phase. The
continuation
phase of
treatment
include INH
and rifampin or
INH and
rifapentine,
and lasts for an
additional 4 or
7 months.
 Prophylactic
isoniazid. Prop
hylactic INH
treatment
involves taking
 daily doses for
6 to 12
months.
 DOT. Directly
observed
therapy may be
selected,
wherein an
assigned
caregiver
directly
observes the
administration
of the drug.

Nursing Management:
 Promoting airway
clearance. The nurse
instructs the patient
about correct positionin
g to facilitate drainage
and to increase fluid
intake to promote
systemic hydration.
 Adherence to the
treatment regimen. The
nurse should teach the
patient that TB is a
communicable disease
 and taking medications
is the most effective
means of preventing
transmission.
 Promoting activity and
adequate nutrition. The
nurse plans
a progressive activity
schedule that focuses
on increasing activity
tolerance
and muscle strength
and a nutritional plan
that allows for small,
frequent meals.
 Preventing spreading of
tuberculosis
infection. The nurse
carefully instructs the
patient about
important hygienic
measures including mo
uth care, covering the
mouth and nose when
coughing and sneezing,
proper disposal of
tissues,
and handwashing.
 Acid-fast bacillus
isolation. Initiate AFB
 isolation immediately,
including the use of a
private room with
negative pressure in
relation to surrounding
areas and a minimum of
six air changes per
hour.
 Disposal. Place a
covered trash can
nearby or tape a lined
bag to the side of the
bed to dispose of used
tissues.
 Monitor adverse
effects. Be alert for
adverse effects of
medications.
 .

Pleurisy Bacterial Infection  Inflammatory MEDICAL MANAGEMENT:  You can’t

bowel disease,  Discover the underlying prevent
including Crohn’s cause pleurisy, but
disease and you can
 Monitor for signs and
ulcerative colitis reduce your
 Lymphangiole symptoms of pleural risk by
iomyomatosis effusion: SOB, pain, promptly
 (disease of the treating
lung) decrease chest wall conditions
 Lymphoma or excursion that may
cancer of the  Prescribed Analgesics cause it. You
lung such should also
as mesothelioma  NSAIDS: Indomethacin quit smoking
 Medications (Indocin) tobacco,
such as isoniazid using
(Laniazid, NSG MANAGEMENT: electronic
Nydrazid),  Provide comfort cigarettes,
hydralazine and smoking
1. Turn patient to sides:
(Apresoline), or marijuana.
affected area
procainamide
(Pronestyl, 2. Splinting while coughing
Procanbid)
 Pancreatitis
 Rheumatic
disease

Acute viruses that cause colds and  Cigarette MEDICAL MANAGEMENT:  Avoid

bronchiti the flu often cause acute smoke. People who  Chest physiotherapy to cigarette
s bronchitis. smoke or who live mobilize secretions, if smoke. Cigarett
with a smoker are at indicated. e smoke
higher risk of both  Hydration to liquefy increases your
acute bronchitis and secretions. risk of chronic
chronic bronchitis. bronchitis.
NSG MANAGEMENT:
 Low  Get
 Encourage mobilization
resistance. This may of secretion through vaccinated. Ma
result from another ambulation, coughing, and ny cases of
 acute illness, such as deep breathing. acute bronchitis
a cold, or from a  Ensure adequate fluid result from
chronic condition intake to liquefy influenza, a
that compromises secretions and prevent virus. Getting a
your immune dehydration caused by yearly flu
system. Older fever and tachypnea. vaccine can
adults, infants and  Encourage rest, help protect
young children have avoidance of bronchial you from
greater vulnerability irritant, and a good diet to getting the flu.
to infection. facilitate recovery. You may also
 Instruct the patient to want to
 Exposure to complete the full course of consider
irritants on the prescribed antibiotics and vaccination that
job. Your risk of explain the effect of meals protects against
developing on drug absorption. some types of
bronchitis is greater  Caution the patient on pneumonia.
if you work around using over-the-counter
certain lung irritants,  Wash your
cough suppressants,
such as grains or antihistamines, and hands. To
textiles, or are decongestants, which may reduce your risk
exposed to chemical cause drying and retention of catching a
fumes. of secretions. However, viral infection,
cough preparations wash your
 Gastric
containing the mucolytic hands
reflux. Repeated frequently and
bouts of severe guaifenesin may be
appropriate. get in the habit
heartburn can of using
irritate your throat  Advise the patient that
a dry cough may persist alcohol-based
and make you more hand sanitizers.
prone to developing after bronchitis because of
bronchitis. irritation of airways.  Wear a
 Suggest avoiding dry surgical
environments and using a mask. If you
humidifier at bedside. have COPD, you
Encourage smoking might consider
cessation. wearing a face
 Teach the patient to mask at work if
recognize and immediately you're exposed
report early signs and to dust or
symptoms of acute fumes, and
bronchitis. when you're
going to be
among crowds,
such as while
traveling.

Empyem - Streptococcus pneumoni - Unresolved Medical management: - Draining the

a ae pneumonia,  Objective: drain the fluid is
- Staphylococcus aureus usually due to S. fluid and achieve a essential to
(since Empyema can develop aureus (and complete expansion of prevent
after pneumonia) particularly a lung the lungs simple
abscess) can lead empyema
 Antibiotics (in large
to infection that progressing to
spreads to the doses) complicated
pleural space  Needle aspiration or frank
(space between volume is small and the empyema
the lining of the fluid is not too purulent (tube
chest cavity and or thick thoracostomy
the lung). .
- bronchiectasis,  Tube Thoracostomy:
airway-obstructing loculated or complicated
 cancer, thoracic
surgery, pleural effusion
penetrating  On chest drainage via
wounds, and thoracotomy: removal of
secondary spread thickened pleura, pus,
from a distant and debris and other
focus (particularly underlying diseased
a subphrenic pulmonary tissue
abscess) are all
possible Nursing Management:
mechanisms of  Educate: 
disease
development. o Lung expanding
- Occasionally an breathing exercises
empyema may
arise as primary o R: restore normal
pathology respiratory function 
(especially if due o Drainage system and
to Mycobacteria or drain site
Nocardia
infection).

Pulmonary - Pulmonary edema is - Coronary artery Medical management:  Control your

Edema a condition caused by disease  Objective: correct blood
excess fluid in the - Cardiomyopathy the underlying pressure. High
lungs. - Heart valve problems cause  blood pressure
In most cases, heart - High blood pressure (hypertension)
problems cause pulmonary (hypertension). - Cardiac in origin: can lead to
edema.  - Acute respiratory improvement of serious conditions
distress syndrome left ventricular such as a stroke,
function---
 (ARDS) cardiovascular
- High altitudes vasodilators, disease and
- Nervous system inotropic kidney failure. In
conditions medications, many cases, you
- Adverse drug reaction contractility can lower your
- Negative pressure medications blood pressure or
pulmonary edema - Fluid overload: maintain a
- Pulmonary embolism diuretics, healthy level by
- Viral infections restriction of fluid getting regular
- Exposure to certain exercise;
toxins  02 administration maintaining a
- Smoke inhalation healthy weight;
R: to correct hypoxemia
Near drowning eating a diet rich
in fresh fruits,
Nursing management:
vegetables and
 Assisting with 02
low-fat dairy
administration 
products; and
 Administer limiting salt and
medication: alcohol.
morphine,
 Watch your
vasodilators,
blood
inotropic medication
cholesterol. Chole
sterol is one of
several types of
fats essential to
good health. But
too much
cholesterol can be
too much of a
good thing.
Higher than
normal
cholesterol levels
can cause fatty
deposits to form
in your arteries,
impeding blood
flow and
increasing your
risk of vascular
disease.
But lifestyle
changes can often
keep your
cholesterol levels
low. Lifestyle
changes may
include limiting
fats (especially
saturated fats);
eating more fiber,
fish, and fresh
fruits and
vegetables;
exercising
regularly;
stopping smoking;
and drinking in
moderation.
 Don't smoke. If
you smoke and
can't quit on your
own, talk to your
doctor about
strategies or
programs to help
you break a
smoking habit.
Smoking can
increase your risk
of cardiovascular
disease. Also
avoid secondhand
smoke.
 Eat a heart-
healthy diet. Eat
a healthy diet
that's low in salt,
sugars and solid
fats and rich in
fruits, vegetables
and whole grains.
 Limit salt. It's
especially
important to use
less salt (sodium)
if you have heart
 disease or high
blood pressure. In
some people with
severely damaged
left ventricular
function, excess
salt may be
enough to trigger
congestive heart
failure.
If you're having a
hard time cutting
back on salt, it
may help to talk
to a dietitian. He
or she can help
point out low-
sodium foods as
well as offer tips
for making a low-
salt diet
interesting and
good tasting.

 Exercise
regularly. Exercis
e is vital for a
healthy heart.
Regular aerobic
exercise, about 30
 minutes a day,
helps you control
blood pressure
and cholesterol
levels and
maintain a
healthy weight. If
you're not used to
exercise, start out
slowly and build
up gradually. Be
sure to get your
doctor's OK
before starting an
exercise program.
 Maintain a
healthy
weight. Being
even slightly
overweight
increases your
risk of
cardiovascular
disease. On the
other hand, even
losing small
amounts of
weight can lower
your blood
 pressure and
cholesterol and
reduce your risk
of diabetes.
 Manage
stress. To reduce
your risk of heart
problems, try to
reduce your stress
levels. Find
healthy ways to
minimize or deal
with stressful
events in your
life.

Acute - Obstruction People who: Medical Management:  refraining from

respiratory - Injury smoking
failure - Drug or alcohol  perform a physical cigarettes,
 smoke tobacco
abuse exam which can
products
- Chemical inhalation  ask you questions damage the
- Stroke  drink alcohol lungs
about your family
- Infection excessively
or personal health  seeing a doctor
 have a family history history at early signs of
of respiratory disease a bacterial
 check your body’s
or conditions infection, such
oxygen and carbon
 sustain an injury to the dioxide levels level as a fever,
spine, brain, or chest with a pulse cough, and high
mucus
  have a compromised oximetry device production
immune system and an  taking all
arterial blood gas
 have chronic (long- medications a
test
term) respiratory doctor
problems, such  order a chest X- prescribes to
as cancer of the lungs, ray to look for keep the heart
chronic obstructive abnormalities in and lungs
pulmonary disease your lungs healthy
(COPD), or asthma  if necessary,
using assistive
devices to
maintain
oxygen levels,
such as
continuous
positive airway
pressure masks,
which a person
can wear at
home
 engaging in
appropriate
levels of
physical activity
to enhance lung
function

Acute  Sepsis People who have a history of Nursing management:  Quit smoking. If
respiratory chronic alcoholism are at  Identify and treat you smoke, seek
distress higher risk of developing cause of the ARDS. help to quit, and
 Fluid overload 
syndrome ARDS. They're also more likely avoid
 Administer oxygen
 Shock  to die of ARDS. secondhand
as prescribed.  smoke
 Neurological injuries  whenever
 Position client in
high Fowler’s possible.
 Burns
position.  Get
 DIC 
 Restrict fluid intake vaccinated. The
 Drug ingestion  as prescribed.  yearly flu
(influenza) shot,
 Inhalation of toxic  Provide respiratory as well as the
substances treatments as pneumonia
prescribed.  vaccine every
five years, can
 Administer
reduce your risk
diuretics,
of lung
anticoagulants, or
infections.
corticosteroids as
prescribed. 

 Prepare the client

for intubation and
mech vent using
PEEP

Pulmonary Due to blood clot or  prolonged bed rest Medical Management:

 Leg exercises - 
Embolism thrombus or inactivity, including - Goal: dissolve the
long trip in a car or in a existing emboli and to avoid venous
plane. prevent new one stasis 
 using oral contraceptives  Early
 02 administration 
 (birth control pills)
 Anticoagulant ambulation 
 surgery.
 pregnancy – before, therapy: Coumadin
 Use of anti
during and after delivery.  Thrombolytic embolic
 cancer. Therapy: stockings 
 stroke. Streptokinase
 heart attack.
heart surgery Nursing Management:
 Minimize the risk of
pulmonary
embolism 

 Preventing
thrombus formation 

 Assessing potential
for pulmonary
embolism 
 Monitor
Thrombolytic
therapy: bed rest
and monitor VS 
 Managing Pain 

 Managing Oxygen
therapy: monitor for
signs of hypoxemia
and 02 sat

 Relieving anxiety