LOWER

RESPIRATORY
INFECTION
TREACHEOBRONCITIS
PNUEMONIA
PTB
LUNGS ABSCESS
TREACHEOBRONCITIS - Inflammation of the trachea
and
bronchi

Etiology/ Causes:
- Viruses
- Bacteria
- Miscellaneous (asthma, COPD, allergies, cystic
fibrosis, ciliary dyskinesia, tracheostomy)
RISK FACTORS
Close contact with someone who has a cold or acute bronchitis
Failure to get age-appropriate immunizations (shots)
Exposure to tobacco smoke, fumes, dust and air pollution
ACUTE TRACHEOBRONCHITIS An inflammation of
the mucus membrane of the trachea and bronchial tree
Clinical Manifestation
Dry irritating cough
Sternal soreness from coughing
Fever, stress, night sweating
Headache & general malaise
As the infection progress the patient develop (shortness of breath
noisy breath & purulent sputum
Another sign of symptoms
COUGH
SPUTUM
HEMOPTYSIS
FEVER
DIFFICULTY BREATHING
STRIDOR, WHEEZE, RHONCHI
CHEST PAIN AND CHEST TIGHTNESS
SORE THROAT (FROM PERSISTENT COUGHING)
SHORTNESS OF BREATH
MUSCLE PAIN
UNEXPLAINED LOSS WEIGHT
PATHOPYSILOGY
DIAGNOSTIC:

SPUTUM C&S
CHEST X-RAY
BREATH SOUNDS
SONOROUS WHEEZES
STRIDOR
Non productive cough, fever, malaise; (later blood-
streak
sputum, coughing attacks)
Inspiratory crackles
TREATMENT:
BED REST
COOL VAPOR & COOL THERAPY
STEAM
MOIST HEAT TO CHEST
INCREASE FLUID INTAKE
EXPECTORANT
ANTIPYRETICS; HUMIDIFIERS
ANTITUSSIVES; BROAD SPECTRUM
IF BACTERIAL;
ANTIBIOTIC Depend on symptoms and culture
NURSING RESPONSIBLITIES
Teaching
Eat a healthy and balanced diet
Wash hands frequently
Exercise regularly
Encourage fluid intake
Cough exercise to remove secretions
Reduce occupational exposures to lungs irritants
Avoid others who may have symptoms of upper respiratory
infection
Complete antibiotics (if prescribed)
Prevent over exertion
 Tracheo-bronchitis
ACUTE
INFLAMMATION OF THE
BRONCHIAL MUCOUS
MEMBRANES OF
TRACHEAOBRONCHITIS
CAUSES:
most common cause of
acute bronchitis is a lower
respiratory viral infection.
CHRONIC
Prolonged inflammation of bronchi;
low grade fever; hypertrophied mucous
glands in bronchi
CAUSES:
Is caused by repeated
inflammation of the lung tissue.
A cough that often brings up
mucus. It can also cause
shortness of breath, wheezing,
a low fever, and chest
tightness.
Risk Factors chronic/acute

inhaling cigarette smoke,

including secondhand smoke
having low resistance to
illnesses, which occurs in
older adults, the very young, Risk factors for acute bronchitis are the same as those for getting viral and
bacterial infections and two include;
and those who have 1) being in close contact with people that are coughing, sneezing and

otherwise weakened immune 2)

touching items that infected persons recently handled.

People that are exposed to air pollution, tobacco smoke, and to

systems chemicals that are aerosolized are at higher risk for acute bronchitis.

having gastric reflux

being frequently exposed to
irritants, including dust or
chemical fumes
Pathophysiology Acute Bronchitis
Colonization of Bacteria to the bronchi
Inflammation of the Bronchi
As inflammation progresses there is increased blood flow to
the bronchi
Causing an increase in pulmonary secretions (so goblet cell
produce mucus)
 PNEUMONIA
PNEUMONIA An inflammation of the lungs caused by an infection.
(An acute respiratory illness associated with recently develop
pulmonary shadowing which is either segmental or affecting
more then one lobe).

ETIOLOGY/CAUSES:
Infective: VIRUSES
BACTERIAL
FUNGAL
Non -Infective
TOXINS
CHEMICAL
The infection causes deterioration of lung resulting fluid accumulation
and breathing difficulties.
Aspiration; another common causes for developing of pneumonia is
aspiration of inhaled materials (saliva, nasal, secretion, food) in the
air ways.
> It happen when the material causes inflammatory response
in
the lungs
MORPHOLOGIC TYPES:
LOBAR
BRONCHO
INTERSTITIAL- is a group of lung disorders in which the lung tissues become
inflamed and then damaged.

DURATION:
ACUTE
CHRONIC

CLINICAL:
PRIMARY/SECONDARY NURSING HOME ACQUIRED PNEUMONIA
TYPICAL/ATYPICAL COMMUNITY/HOSPITAL ACQUIRED
BRONCHOPNEUMONIA (PATCHY)
EXTREMES OF AGE
SECONDARY RISK FACTOR
STEPTOCOCCUS,STREPTOCOCCUS, PNEUMONIA & H. INFLUENZA
PATCHY CONSOLIDATION
USUALLY BILATERAL
MORE IN LOWER LOBE

LOBAR PNEUMONIA
MIDDLE AGE (20-50) * DIFFUSE
PRIMARY IN HEALTHY ADULT * USUALLY UNLATERAL
MALES COMMON
95% PNEUMOCOCCUS(KLEBS.
ENTIRE LOBE CONSOLIDATION
Community Acquired (Typical)
Community Acquired (typical)

Hospital-acquired pneumonia(HAP) ornosocomial

pneumoniarefers to any pneumoniacontracted by a patient in
ahospitalat least 4872 hours after being admitted. It is thus
distinguished from community-acquired pneumonia. It is usually
caused by a bacterial infection, rather than a virus.
NURSING HOME- ACQUIRED PNEUMONIA (NHAP) is
defined as pneumonia occurring in a resident of a long-term care
facility or nursing home. NHAP is one of the most common infectious
diseases in long-term care facilities.
CHRONIC PNEUMONIAis an illness that lasts at
least 6 weeks and is caused by a microorganism. The
chest radiograph usually shows diffuse or focal
shadows. The incidence of
eitherchronicorrecurrentchest infections is
unknown.
ACUTE PNEUMONIA leads to certain
complications such as endocarditis, pleuritis and
pericarditis. In pleuritis, fluid accumulates between
inner chest wall and pleura layers, that causes
cough, shortness of breath and chest pain. In
pericarditis, pericardium tissues surrounding the
heart becomes inflamed.
 RISK FACTORS
Smoke. Cigarette smoking is the strongest risk factor for pneumonia
in healthy young people + alcohol
65 years of age
Condition that weakens your immune system
COPD chronic obstructive pulmonary disease
Human immunodeficiency syndrome (HIV)
Acquired immunodeficiency syndrome (AIDS)
Heart disease
Emphysema
Diabetes
Construction workers, Hospital workers, Major surgery/Serous
injury
MOST COMMON SYMPTOMS OF PNEUMONIA
Chills, Wheezing & Fatigue
Cough)
Fever,
Shortness of breath
Other symptoms include:
Chest pain that gets worse when you breathe deeply or cough
Confusion
Headache
Loss of appetite, low energy, and fatigue & low or high WBC count
Muscle aches and joint stiffness
Sweating and clammy skin
Crackles (auscultation)
Dullness (percussion)
LESS COMMON SYMPTOMES:
Lung secretions
Dehydration
Behavior changes
Diarrhea
Ear pain
Eye pain or soreness
Neck lump
Rash
Sore throat
 DIAGNOSTICS
People with suspected pneumonia should have a complete medical evaluation. It may be hard
for your health care provider to tell whether you have pneumonia or bronchitis, so you may
need achest x-ray. Depending on how severe the illness is, other tests may be done,
including:
Arterial blood test
Complete blood count(CBC)
Blood cultures
Blood tests to identify the specific bacteria
Bronchoscopy(rarely needed)
CT scan of the chest
Open lung biopsy(only done in very serious illnesses when the diagnosis cannot be made from
other sources)
Sputum culture
Urine test to check forLegionellabacteria
Urine tests or a throat swab may also be done.
Lab
PHARMACOLOGY/TREATMENT
Control your fever with aspirin, nonsteroidal anti-inflammatory drugs
(NSAIDs, such as ibuprofen or naproxen), or acetaminophen.
DO NOT take cough medicines without first talking to your doctor.
Drink plenty of fluids to help loosen secretions and bring up phlegm.
Get a lot of rest.
Antibiotics are used to treat pneumonia, such as amoxicillin, clarithromycin,
erythromycin, penicillin, etc. are used for treating bacterial pneumonia.
If your condition is severe, you will likely be admitted to a hospital.
Antibiotics are used for 2 weeks or more
Maintain oxygenation
Maintain airway clearance
Monitor temperature
 Nursing Responsibilities
Hand hygiene
Yearly flu immunization
Elevate head of bed, change position
Auscultation lung fields, noting areas of decreased or absent
airflow adventitious breath sounds: crackles, wheezing
Assess the rate and depth of respiration and chest movement
Teach and assist the patient with proper deep breathing exercise
Assist and monitor effect nebulizer treatment.
Monitor serial chest X-ray, ABG, pulse oximetry readings
Assess skin turgor/color of skin, mucous membranes, nail beds,
moisture
Monitor heart rate and rhythm
 Monitor body temperature, as indicated.
Assess mental status
Assess anxiety level and encourage verbalization of feeling and
concern
Investigate reports of nausea and vomiting
Monitor intake and output and character of urine
Provide comfort of measure: back rubs, quite music, massage.
Encourage use relaxation and breathing exercise
Assess the pain characteristics
Limit visitors as indicated
Instruct the patient concerning the disposition of secretion
Monitor vital sign
Administer analgesics and antitussives as indicted
Pulmonary tuberculosis (PT) is a contagious bacterial infection that involves the lungs. It may spread to other organs.

ETIOLOGY/ Causes:
* Pulmonary tuberculosis (TB) is caused by the
bacteriumMycobacterium tuberculosis (M. tuberculosis) Tubercle
bacilli
* Bacteria is easily spread from an infected person to someone
else. You can get TB by breathing in air droplets from a cough or
sneeze of an infected person.
* The infection may stay inactive (dormant) for years. In some
people, it becomes active again (reactivates).
 *Most people who develop symptoms of a TB infection
first became infected in the past.

The following people are at high risk of active TB or reactivation of

TB:
Elderly
Infants
People with weakened immune systems, for example due toHIV/AIDS,chemotherapy,
diabetes, or medicines that weaken the immune system
Your risk of catching TB increases if you:
Are around people who have TB
Live in crowded or unclean living conditions
Have poor nutrition
The following factors can increase the rate of TB infection in a population:
Increase in HIV infections
RISK FACTORS
Close contact with some one who have active TB
Immunocompromised status (elderly cancer, HIV
infection)
Drug abuse and alcoholism, Smoking Cigarettes
People lacking adequate health care
Pre existing medical conditions (DM, chronic renal failure)
Institutional (long term facilities)
Immigrant from other countries (with higher incidence of
TB)
Living in substandard conditions
Occupation(health care workers)
CLINICAL MANIFESTATION
ANOREXIA
LOW GRADE FEVER
NIGHT SWEATS
FATIQUE
WEIGHT LOSS
DYSPNEA
NON RESOLVING BRONCHOPNEUMONIA
CHEST TIGHTNESS
NON PRODUCTIVE COUGH
CHEST PAIN
MUCOPRULENT SPUTUM WITH HEMOPTPYSIS
Hemoptysis- may also occur
 Increase in number of homeless people (poor environment and
nutrition)
Drug-resistant strains of TB
SIGNS AND SYMPTOMS:
The primary stage of TB does not cause symptoms. When symptoms of
pulmonary TB occur, they can include:
Breathing difficulty
Chest pain
Cough (usually with mucus)
Coughing up blood
Excessive sweating, especially at night
Fatigue
Fever
Weight loss & pallor
Wheezing
Inflammation
DIAGNOSTICS:
The health care provider will perform a physical exam. This may show:
Clubbing of the fingers or toes (in people with advanced disease)
Swollen or tender lymph nodes in the neck or other areas, swollen spleen and liver
Fluid around a lung (pleural effusion)
Unusual breath sounds (crackles)
Tests that may be ordered include:
Bronchoscopy
Chest CT scan
Chest x-ray
Interferon-gamma release blood test, such as the QFT-Gold test to test for TB infection
(active or infection in the past)
Sputum examination andcultures
Thoracentesis
Tuberculin skin test(also called a PPD test)
Biopsyof the affected tissue (done rarely)
TUBERCULIN SKIN TEST
0.1 ML purified protein derivative(PPD) IS INJECTED INTO FOREARM
After 48-72 hrs. check for induration at the site
If induration is equal to and more than 10MM- POSITIVE

MEDICAL MANAGEMENT:
o Pulmonary TB is treated primarily with anti tuberculosis agent for 6 to
12 months
o PHARMACOLOGICAL MANAGEMENT/
FIRST LINE ANTITUBERCULAR MEDICATION
Streptomycin 15mg/kg
Isoniazid 5mg/kg(300mg)max
CONT:
Rifampin 10mg/kg
Pyrazinamide 15-30mg/kg
Ethambutol 15-25mg/kg daily for 8weeks continuing until 7
months
SECOND LINE MEDICATION
Capreomycin 12-15mg/kg
Ethionamide 15mg/kg
Paraaminosalycilate sodium 200-300mg/kg
Cycloserine 15mg/kg
Vitmine B
CONT: TREATMENT
You may need to take many different pills at different times of
the day for 6 months or longer.
When people do not take their TB medicines like they are
supposed to, the infection can become much more difficult to
treat..
If a person is not taking all the medicines as directed, a provider
may need to watch the person take the prescribed medicines.
You may need to stay at home or be admitted to a hospital for 2
to 4 weeks to avoid spreading the disease to others until you are
no longer contagious.
Your provider is required by law to report your TB illness to the
local health department.
Support Groups
- You can ease the stress of illness by joining
asupport group.

Possible Complications:
Pulmonary TB can cause permanent lung damage if not treated early.
Medicines used to treat TB may cause side effects, including:
Changes in vision
Orange- or brown-colored tears and urine
Rash or liver inflammation
A vision test may be done before treatment so your doctor can monitor
any changes in the health of your eyes.
COMPLICATIONS
BONE SPINAL PAIN AND JOINT DESTRUCTION MAY
RESULT FROM TB
BRAIN ( MENINGITIS )
LIVER OR KIDNEY
HEART (CARDIAC TAMPONADE)
PLURAL EFFUSION & ATELECTASIS
TB PNEUMONIA
LUNG ABSCESS
DIFFICULT BREATHING
PATHOPHYSIOLOGY
Infection of lungs caused by Mycobacterium tuberculosis,
an acid fast bacterium > causes tubercles, fibrosis and
calcification within the lungs.
Tubercle bacillus may be communicated to others by
means of drop formation(inhalation), ingestion, or inoculation
Predisposing factors include debilitating disease such as
alcoholism, cardiovascular disease, HIV infection, diabetes
mellitus, and cirrhosis, as well as poor nutrition and crowded
living conditions
The emerging of multi-drug-resistant tuberculosis has
complicated management of the disease.
 Chronic progressive, and reinfection phase is most frequently
encountered in adults an involves progression or reactivation
of primary lesions after months or years of latency.
Swallowing infected sputum may lead to
laryngeal, oropharyngeal and intestinal
tuberculosis
NURSING RESPONSIBILITIES:
Medication
Encourage rest avoidance of exertion
Monitor breath sounds
Respiratory rate
Sputum
Dyspnea
Provide supplemental oxygen as ordered
Encourage increased fluid intake
instruct about best position to facilitate drainage
Be aware that TB is transmitted by respiratory droplets
Isolation of patient
CONT:
Use High efficiency particulate masks for high risk
Instruct about risk of drug resistance if drug regimen is not
continuously followed
Carefully monitor vital signs and observe for temperature
change
Monitor weight of the patient
Provide small frequent meals
Administered vitamin supplements as ordered
Teaching educate patient to control the spread of infection by covering
mouth and nose while coughing and sneezing
_ Explain the importance that a chest X-ray is taken 4 to 6
weeks after recovery to evaluate lungs for clearing & detect
CONT:
Give ventilated room for rest
Give comfort position
Maintaining nutrition
Provide fluid with electrolyte
Enriched drinks or shake may be helpful
Encourage chair rest after fever subsides
Encourage breathing exercise
Advice smoking and alcohol to stop.
PREVENTION
ISOLATION
VENTILATE THE ROOM
COVER THE MOUTH
WEAR MASK
FINISH ENTIRE COURSE OF MEDICATION
GET VACINATIONS
WASH HAND
LUNGS ABSCESS is a type of liquefactive necrosis
of the lung tissue and formation of cavities (more than 2
cm) containing necrotic debris or fluid caused by microbial
infection. This pus-filled cavity is often caused by
aspiration, which may occur during altered consciousness.
LUNG ABSCESS
Acute lung abscess
is usually
circumscribed with not Chronic lung abscess is
so well-defined usually irregular star-like
surrounding to lung shape with well-defined
parenchyma, fulfilled surrounding to lung
with thick necrotic parenchyma, fulfilled with
detritus grayish line or thick
detritus
Division of lung abscesses:
According to the duration:
Acute (less than 6 weeks);
Chronic (more than 6 weeks);
Etiology:
Primary (aspiration of oropharyngeal secretions, necrotizing pneumonia,
immunodeficiency);
Secondary (bronchial obstructions, haematogenic dissemination, direct
spreading from mediastinal infection, from subphrenium, coexisting lung
diseases);
Way of spreading:
Brochogenic (aspiration of oropharyngeal secretions, bronchial obstruction
by tumor, foreign body, enlarged lymph nodes, congenital malformation);
Haematogenic (abdominal sepsis, infective endocarditis, septic
thromboembolisms).
DIAGNOSTIC
History taking ( previous respiratory infection, trauma)
Physical examination
Chest X-ray
Direct bronchoscopic (visualization possible of tumor or foreign
body
Sputum C&S
CT SCAN, BIOPSY, MRI
CBC
Immunological test (which detects microbial antigens in serum,
sputum and urine)
Thoracentesis (to obtain a specimen of pleural fluid for
examination
Management (surgical)
Surgical is rare but pulmonary resection (lobectomy) is
performed.
some indication
massive hemoptysis
no response medical management
localized malignant
persistent abscess cavity
CLINICAL MANIFESTATION
DULL CHEST PAIN
DYSPNEA, SHORTNESS OF BREATH
WEAKNESS, LETHARGY
ANOREXIA AND WEIGHT LOSS
FINGER CLUBBING
SIGNS AND SYMPTOMS
Early signs and symptoms of lung abscess cannot be
differentiate from pneumonia and include:
Fever with shivering
Cough
Night sweats
Dyspnea
Weight loss and fatigue
Chest pain and sometimes anemia.
At the beginning cough is non-productive, but when
communication with bronchus appears, the productive cough
(vomique) is the typical sign

TREATMENT (NON-PHARMACOLOGICAL/PHARMACOLOGICAL)
DIET HIGH IN PROTEIN AND CALORIESIS NECESSARY BECAUSE
CHRONIC infections associated with a catabolic state
Fluid and electrolyte
Medication
(The treatment of lung abscess is guided by the available
microbiology with consideration of the underlying or associated
conditions. No treatment recommendation has been issued by
major societies specifically for lung abscess).
NURSING RESPONSIBILITES
Position semi-fowler
Toxic symptoms should rest in bed, a temperature over 39 *C should be
physical cooling.
Diet and nutrition should be increased in patient given high-protein, high
vitamins, high calorie, easily digestive food, to enhance the body resistance,
chronic abscess with weight loss, anemia, and other nutritional supplement
in patients with performance is more important.
Sputum coaching effective in patient with cough, Sputum expectorant to
promote.
Postural drainage area under the lesion position to take effective mucus
drainage.
Rehydration encourage patients to increased fluid intake, not only
conductive to cooling and detoxifying, while promoting the bodys hydration,
so easy to expectorant purulent sputum.
Pain in patient with chest pain may be local fixed, reduced respiratory rate
may also reduce pain such as relaxation.
CONT:

HEALTH EDUCATION:
Explain to the patients with lung abscess and enhance oral
routes of infection, upper respiratory tract and skin hygiene
importance
Must be recognized so that patients do not adhere to completion
of treatment or delayed treatment will lead to consequences of
chronic lung abscess
Explain the positive treatment of skin abscess, boil, or purulent
pulmonary lesion way, do not squeeze carbuncles, boils, to
prevent the occurrence of blood-borne lung abscess.
To patient to prevent the common cold, avoid the significance of
various causes of infection and timely treatment to prevent
exacerbations