(20) CARE OF PATIENT WITH ALTERATION/PROBLEMS

IN INFECTIOUS AND INFLAMMATORY DISORDERS:

PNEUMONIA
PNEUMONIA:

- An inflammation of the lung

parenchyma caused by various
microorganism, including bacteria,
mycobacteria, fungi, and viruses.
(Pneumonia is a type of pneumonitis
because the infection causes
inflammation).
 TYPE: Primary pneumonia:
- Result from inhalation or
aspiration of a pathogen, such as bacteria
or a virus.
Secondary pneumonia:

- Follow lung damage from noxious

chemical or other insult or may result
from hematogenous spread bacteria.

PNEUMONITIS:
Aspiration pneumonia:
- A general term that describe an
inflammatory process in the lung tissue - Result from inhalation of foreign
that may predispose or place the patient at matter, such as vomitus or food particles,
risk for microbial invasion. (Usually used into the bronchi.
by doctors to refer to noninfectious causes
of lung inflammation).
PATHOPHYSIOLOGY:

- Lower respiratory tract can be exposed

to pathogens by inhalation, aspiration,
vascular dissemination, or direct contract
with contaminated equipment such as
suction catheters.
PNEUMONIA:

- Classified as community-acquired
pneumonia (CAP), hospital-acquired
(nosocomial), pneumonia (HAP).

Pneumonia is classified 3 ways:

 ORIGIN: may be viral, bacterial,

fungal, or protozoal in origin.

 LOCATION: bronchopneumonia
involves distal airways and aveoli;
- lobar pneumonia involves part of a
lobe or an entire lobe.
(21) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
TUBERCULOSIS
TUBERCULOSIS:
- A infectious disease spread by air
bone route. Caused by inhalation of
droplets that contain the tuberculosis
bacteria (Mycobacterium luberculosis).
Infected person can spread small air bone
particles through coughing, sneezing, and
talking.
 Close contact with those infected
increases the chances of transmission.
 Once inhaled, the organism
typically settles into the lung, but
can infect any organ in the body.
 The organism has an outer capsule.
FACTORS THAT INFLUENCE THE
LIKEHOOD OF TRANSMISSION
INCLUDE:
(1) Number of organism expelled into the
air.
(2) Concentration of organism ( small
spaces with limited ventilation would
mean higher concentration ).
(3) Length of time exposure, and
(4) Immune system of the exposed person.
TYPES:
 PRIMARY TB
- occurs when the patient is initially
infected with the mycobacterium.
 SECONDARY TB
- reactivated at a larger stage. Cavitation
of these areas occurs as the organism
travels along the airways.
 LATENT TB
- infection occcurs when a person has a
positive tuberculin skin test but no
symptoms of disease. Chest x-ray may
show granuloma or calcification.
PATHOPHYSIOLOGY:
- After being inhaled in the ling, the
organism causes a localized reaction.
- Macrophages and sensitized
t-lymphocytes attempt to isolate and kill
of the mycobacterium within the lung.
- Damage is also caused to surrounding
ling tissue.
- Caseous granulomas develop along
lymph node channels during the same
time.
- These areas creats a Ghon’s complex
which is a combination of the area
initially infected by the airbone bacillus
called the Ghon’s focus and lymphatic
lesion.
(22) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
EBOLA, MERS-COV, SARS
EBOLA:
- Virus that causes problems with how
your blood clots.
 It is known as a hemorrhagic fever
virus, because clotting problems lead
to internal bleeding, as blood leaks
from small blood vessels in your
body.
 Causes inflammation and tissue
damage.
 Five different species of the virus have
been found.
PATHOPHYSIOLOGY:
- Enters the patient through mucous
membranes, breaks in the skin, or
parenterally and infects many cell types,
including monocytes, macrophages,
dendritic cells, fibroblast, hepatocytes,
adrenal cortical cells, and epithelial cells.
 Ebola virus migrates from the initial
infection site to regional lymph nodes
and subsequently to the liver, spleen,
and adrenal gland.
 HEPATOCELLULAR NECROSIS
occurs and is associated with
dtsregulation of clothing factors
and subsequent coagulopathy.
 ADRENOCORTICAL
NECROSIS can be found and is
associated with hypotension and
impaired steroid synthesis.
 Ebola virus appears to trigger a
release of pro-inflammatory
cytokines with subsequent
vascular leak and impairment of
clotting ultimately resulting in
multi-organ failure and shock.
MIDDLE EAST RESPIRATORY
SYNDROME ( MERS )
- Is viral respiratory illness that is
new to humans. It was first reported in
Saudi Arabia in 2012 and has since
spread to several other countries,
including the United State.
 Origin of the virus are not fully
understood but according to the
analysis of different virus genomes
it is believed that it may have
originated in bats and later
transmitted to camels.
 Human-to-Human transmission is
possible, but only few such as
transmission have been found
among family members living in
the same house.
 Human-to-Human transmission
appears to be more frequent.
(22) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
EBOLA, MERS-COV, SARS
PATHOPHYSIOLOGY:
- Virus induces the release of
proinflammatory cytokines, leading to
serve inflammation and tissue damage,
which may manifest clinically as serve
pneumonia and respiratory failure.
 VASCULAR ENDOTHELIAL CELLS
located in the pulmonary interstitial
may also be infected by MERS-CoV,
and, because MERS-CoV receptor
DDP4 is expressed in different human
cells and tissues, dissemination of the
infection may occur.
 Lymphopenia has been noted in most
patient infected with MARS-CoV, as
was noted in SARS infection.
SEVERE ACUTE RESPIRATORY
SYNDROME ( SARS )
- Identified in 2003. SARS-CoV is
thought to be an animal virus from an
as-yet-uncertain animal reservoir, perhaps
bats, that spread to other animals
(civet cats) and first infected himans in
the Guandong province of southern China
in 2002.
PATHOPHYSIOLOGY:
- Incubates for 2 to 10 days.
 Spread by close person-to-person
contact.
 Coronavirus that causes SARS is
thought to be transmitted by
respiratory droplets produced when
an infected person coughs or
sneezes.
 Droplet spread occurs when droplets
from cough or sneeze of an infected
person are propelled a short distance
(typically up to 3 feet) through the
air and deposited on the mucous
membranes of the mouth, nose, or
eyes of a person who is nerby.
 Can also spread when a person
touches a surface or object
contaminated with infectious
droplets and then touches his
mouth, nose, or eyes.
(24) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
STD, HIV AND AIDS

Antibiotic therapy, nylon underwear,

Sexually Transmitted Diseases (STD): tight clothing, pregnancy, oral
contraceptives).
- Are generally acquired by sexual
contact. Organisms (bacteria, viruses or Infection:
parasites) that cause sexually transmitted
diseases may pass from person to  Trichomonas vaginalis vaginitis
person in blood, semen, or vaginal and (STD)
other bodily
fluids. Cause:

 Trichomonas vaginalis

Clinical Manisfestation:

Infection:  Frothy yellow-white or yellow green

 Candidiasis vaginal discharge

Cause: Pathophysiology:
 Candida albicans, glabrata, or
tropicalis.  Inflammation of vaginal
epithelium, producing burning
Clinical Manifestation: and itching
 Reddish irritation
 White, cheese like discharge clinging Management
to epithelium Diagnostic:

Pathophysiology: - Diagnosis confirmed by

 Inflammation of vaginal epithelium,
producing itching
Management
Diagnostics:
- Diagnosis is made by microscopic
identification of spores and hyphae on a
glass slide prepared from a discharge
specimen mixed with potassium hydroxide.
microscopy Other FDA approved Tests:
OSOM Trichomonas, Rapid Test,
Affirm VP III
Treatment:
- Relieve inflammation, restore
acidity, and reestablish normal
bacterial flora;

Treatment: Medication:
- Review other causative factors (e.g.,
- provide oral metronidazole for
patient and partner.
(24) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
STD, HIV AND AIDS
 Doxycycline (Vibramycin) to eradicate
Infection: chlamydia.

 Cervicitis: Acute and Chronic

Cause:
Infection:
 Chlamydia
 Gonococcus  Herpes Simplex
 Streptococcus
 Many pathogenic bacteria Cause:

Clinical Manifestation:  Herpes Simplex Virus

 Profuse purulent discharge Backache

Urinary frequency and urgency Clinical Manifestation:

Pathophysiology:  Tingling/itching of skin

 Inflammation of vaginal epithelium, Pathophysiology:

producing burning and itching
 Virus must come in contact with
Management mucosal surfaces or abraded skin
Diagnostics: for infection to be initiated.

 Direct immunofluores cence assays Management

(DFA) Diagnostics:
 Enzyme immunoassay (EIA)
 Swab test
Treatment:  Blood test

 Evaluate and treat sexual partners Treatment:

 Avoid sex for seven days after
completion of treatment  Lesions may be bathed in mild
soap and water
Medication:  Sex partners may benefit from
evaluation and counseling
 Eradicate the gonococcal organism, if
present: penicillin (as directed) or Medication:
spectinomycin or tetracycline, if
patient is allergic to penicillin.  Antivirals
Tetracycline,
(24) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
STD, HIV AND AIDS
Human immunodeficiency virus
(HIV):
- is caused by HIV, which is a retrovirus
that causes immunosuppression.
The viral infection causes the person to be
susceptible to infections that would
normally be controlled through immune
responses. The term HIV disease is used
interchangeably with HIV infection. HIV
is managed as a chronic disease, since
people are living longer.
MODE OF TRANSMISSION:
 through contact with infected blood or
blood products during transfusion or
tissue transplantation or by sharing
a contaminated needle.
 through contact with infected body
fluids, such as semen and vaginal
fluids, during unprotected sex.
STAGES:
 Primary infection (Acute/Recent
HIV Infection).
- The period from infection with HIV
to the development of HIV-
specific antibodies is known as primary
infection.
 HIV asymptomatic (CDC
Category A).
- After the viral set point is reached,
HIV-positive people enter into a chronic
stage in which the immune system cannot
eliminate the virus despite its best efforts.
 HIV symptomatic (CDC
Category B).
- Category B consists of
symptomatic conditions in
HIV-infected patients that
are not included in the conditions
listed in category C.
 AIDS (CDC Category C).
- When the CD4+ T-cell level
drops below 200 cells/mm3 of blood,
the person is said to have
AIDS.
PATHOPHYSIOLOGY:
 DNA synthesis. HIV changes in
genetic material from RNA to
DNA through action of reverse
transcriptase, resulting in
double-stranded DNA that carries
instruction for viral replication.
 The mRNA creates chains of new
proteins and enzymes that
contain the components needed in
the construction of new viruses.
COMPLICATIONS:
 Opportunistic infections. Patients
who are immunosuppressed are at
risk for opportunistic infections
such as pneumocystis pneumonia
which can affect 80% of all people
infected with HIV.
 Respiratory failure. Impaired
breathing is a major complication
that increases the patient’s
discomfort and anxiety and may
lead to respiratory and cardiac
failure.
(23) CARE OF PATIENT WITH ALTERATION/PROBLEMS
IN INFECTIOUS AND INFLAMMATORY DISORDERS:
HEPATITIS

HEPATITIS:  HEPATITIS C

- Widespread inflammation of the live INCUBATION:

tissue with liver cell damage due to hepatic
cell degeneration and necrosis;  7-50 Days
proliferation and enlargement of the
kuplfer cell; inflammation of the periportal MODE OF TRANSMISSION:
areas ( may cause interruption of the bile
flow).  Parenteral route: through blood
and blood products, needle,
syringes.
TYPES OF HEPATITIS:

 HEPATITIS A  HEPATITIS D

INCUBATION:
INCUBATION:
 14-56 Days
 15-45 Days
MODE OF TRANSMISSION:
MODE OF TRANSMISSION:
 Blood and body fluids; seen in
 Often occurs in crowed living person who have hepatitis B.
conditions
 Fecal/oral route  HEPATITIS E
 Poor personal hygiene
 Form food, milk, water or sheltfish
INCUBATION:

 HEPATITIS B  150-64 Days

INCUBATION: MODE OF TRANSMISSION:

 50-180 Days  Fecal/oral route; usually

water-borne; seen in travelers
MODE OF TRANSMISSION: returning from underdeveloped
countries.
 Blood and body fluids (saliva, semen,
vaginal secretions)
 Often from contaminated needles
among IV drugs abusers;
intimate/sexual contact.