DISEASES ACQUIRED

THROUGH THE
RESPIRATORY SYSTEM
.. Caused by Bacteria

chronic , subacute or acute disease

that most commonly affects the
respiratory system, usually the
lungs, but may involve parts of other
system such as the lymphatics,
oseous urogenital, nervous and
gastrointestinal.
Synonym: consumption; phthisis

Infectious agent
Mycobacterium

tuberculosis- an
organism that multiplies slowly and
are characterized as acid- fast
aerobic organism, which ca be killed
by heat, sunshine, drying and
ultraviolet light.
Sputum of the person with TB is the
most common source of the
organism.

Incubation period
From

2 to 10 weeks
ETIOLOGY:
Poverty/ overcrowded homes
Energy/ protein undernutrition
Deficiencies in Vit A, D an d C
Debilitation to intercurrent infections
prevalent among the poor decrease
resistance against infection
Children below 5 years old.
Cigarette smoking

Mode of transmission
An

airborne infection transmitted by

droplet nuclei (coughing, sneezing,
or singing)
Two ways an organism gain access
to the body:
Inhalation
ingestion

PATHOGENESIS OF
TUBERCULOSIS.

Risk Factors for

Activation of TB
With

initial infection
Close contact
(+) PPD test
Lowered resistance due to
alcoholism, medication therapy or
other underlying disease condition
Elderly

Clinical Manifestations
PRIMARY INFECTION
Change of behavior
Easy fatigability
Alertness to apathy
Irritability
Fleeting infection

or GIT
Crepitant rales

of the respiratory

POSTPRIMARY/PROGRESSIVE
PRIMARY
Visibly

ill
Cough that gradually becomes
distressing
Abnormal physical signs
Abnormal breath sounds
Hemoptysis (rare case)

CHRONIC PULMONARY
TB
SYSTEMIC SIGNS & SYMPTOMS
General malaise, anorexia, easy
fatigability, apathy, irritability,
indigestion, flu-like symptoms
Physical signs
Fever
Night sweat
Loss of weight

PULMONARY SIGNS
Cough
Fine crepitant rales
Hemoptysis and chest pain
Pleural pain--- pleurisy with effusion
dyspnea

Extrapulmonary TB
Mycobacterium

can infect any organ

in the body (pleurae, lymph nodes,
genito- urinary, bones, joint,
peritoneum and CNS)
E.g. potts disease- TB of the bone

METHODS OF PHYSICAL
EXAMINATION
Inspection
Palpation
Auscultation

DIAGNOSIS OF THE
DISEASE
History
Physical examination
Diagnostic examination
Roentgenography (X-RAY)
Bronchoscopy & bronchography
Bacteriology Ziehl Neelsen Method
Histopathology
Hematology

TUBERCULIN TEST

1. MANTOUX TEST
A

tuberculin test consists of

intradermal injection of a purified
protein derivative
Formed wheel measures 5 to 7 mm
in diameter
The test should read 48-72 hours
later
Result:
10 mm or more- (+)
5-9 mm- cross reaction

2. PATCH/ VON PROQUET

TEST
A

skin test identifying allergens,

especially those causing contact
dermatitis
24 to 48 hours
Positive reaction- the skin under the
suspected patch is red or swollen
and the control area is not red or
swollen

3. HEAF MULTIPLE PUNCTURE/

SREENING TEST
Introduces

tuberculin into the skin

either by puncture with a device
coated with dried tuberculin or
puncturing through a film of liquid
tuberculin
48-72 hours

COMPLICATIONS
Bronchial

and tracheal ulcerations

Tuberculous laryngitis
Pleurisy- inflammation of the pleura
Dry pleurisy
Wet pleurisy

Spontaneous

and accidental pneumothorax

Bronchiectasis
Intestinal tuberculosis
Miliary dessimination- dissemination of tiny sized
lesions

TREATMENT
Isoniazid

(INH)

Rifampicin

(RMP)

Ethambutol

(EMB)

Pyrazinamide

(PZA)

Streptomycin

( STM)

NURSING CARE
Isolation
TB

Education Program for the patient

Promote Comfort
Promote Skin care
Oral hygiene
Elimination
proper Diet
Psychological care
follow medications therapy
Monitor temperature
Weight monitoring

MENINGOCOCCA
L INFECTIONS

1. ACUTE
MENINCOCOCCEMIA
Usually

starts as nasopharyngitis
followed by sudden onset of high
fever, with chills, nausea, vomiting,
malaise and headache
Petechial, parpuric, ecchymotic
hemorrhages scattered all over the
entire body surface
WATERHOUSE FRIEDRICHSEN
SYNDROME- is the rapid
development of the petechia to

2. MENINGOCOCCAL
MENINGITIS
May

be ushered by a short
predromal period but often is sudden
in onset and appears to coincide with
the first symptoms of infection

Sudden

onset of high fever,

convulsions, nausea, vomiting and
intense headache

Delirium,

stupor and coma in more

 petechia;l

or purpuric rashes
Signs of increased ICP
Bulging fontanel in infant
Positive Macewen sign-helps to

diagnose hydrocephalus and brain

abscess
Choked disc- swelling of the optic nerve

Meningeal irritation.
Stiff

neck ( nuchal rigidity)

Opistothonus

Kernigs

sign

Brudzinskis

sign

MEDICATION
Rifampicin
Mynocycline
Meningococcal

polysaccharide

vaccine
Penicillin
chloramphenicol

Nursing Intervention
Patient

safety
Management of underlying
symptoms
Shock precaution- gradual decrease
in temperature is imperative

3. Bacterial Meningitides
Is

an inflammation of the meninges

or covering of the brain
An acute infectious disease caused
by a specific organism which invades
the blood stream and is carried
thereby to the meninges where it
sets up a purulent inflammation

Causative agents..
Neisseria

meningitidis
Haemophilus influenza
Streptococcus pneumoniae

Incubation period
Variable

the extreme limits being set

at from 1- 10 days. Majority of cases,
it is from 3- 6 days

Mode of transmission
By

respiratory droplets via passage

through the nasopharyngeal mucosa

Period of
Communicability
24

hours after the start of effective

antibiotic therapy

PATHOPHYSIOLGY
Direct contact or
droplet infection

Colonization of
nasopharynx

Bacteremia

Direct
involvement of
blood vessels

Septic thrombolic
emboli

MENINGES

Clinical manifestation
Fever
Rapid

pulse;respiratory arrythmias
Hyperesthesia of the skin- increase
sensitivity to stimuli

Soreness

of the skin and muscles

Convulsion/ seizure
Symptoms and signs of increased
intracranial pressure
Signs of meningeal irritation
Signs of pyramidal tract involvement

 Sign

of vasomotor instability (tache

cerebrale)- a congested streak produced
by drawing the nail across the skin

Cranial

nerve palsies-

a form of palsy
involving one or more of the cranial nerves.

Petechiae
Focal

cerebral signs
Encephalitis manifestations
(drowsiness-lethargy- coma
Sudden confusion

DIAGNOSTIC
PROCEDURES
1. Lumbar puncture- insertion of a
needle into the lumbar subarachnoid
space and withdrawal of CSF for
diagnostic therapeutic purpose

2. gram- staining of CSF

3. Blood examinations
4. Smears from petechiae
5. Capsular swelling test
6. Flourescent antibody testing
7. Countercurrent
immunoelectrophoresis
8. Culture test
9. Urine culture
10. Sensitivity to antibiotics

Complications
Subdural

effusion or empyema
Hydrocephalus
Dry tap-Not being able to collect a sample of the
fluid

Persistent

vomiting
Deafness and total blindness in one or
both eyes
Ocular conditions
Deaf- mutism
Otitis media and mastoiditis

 Pyogenic

arhritis
Endocarditis, pericarditis and myocarditis
Bronchitis and pneumonia
Cystitis
Ventriculitis- inflammation of the brain
ventricles.

Motor

loss
Personality changes
Convulsions
Shock in meningococcal meningitis

TREATMENT
Ampicillin
Choramphenicol
Combination of penicillin,

chloramphenicol and sulfonamide

Penicillin in massive doses (drug of
choice for meningococcemia)
Reduction of intracranial pressure
ABG determinations
Supportive fluid replacement

 Intravenous

drug therapy
Andrenocorticosteriods endotoxic
shock
Anti- convulsant drug

Nursing interventions
Prevent

the occurrence of further

complications
Maintain normal amount of fluid and
electrolyte balance
Prevent the spread of the disease
Prevent stress provoking factor
Maintain personal hygiene and
cleanliness
Maintain proper elimination of waste
product of metabolism

 Nutritional

intake
Monitoring procedures
Encourage liberal fluid intake
Be on constant alert for
complications

DIPTHERIA

 An

acute bacterial disease that can

infect the body in two areas; the
throat (respiratory diptheria) and the
skin (skin or cutaneous diptheria)

Etiologic Agent
Corynebacterium

Loffler Bacillus)

diptheria (Klebs-

Incubation period
After

being exposed to the

bacterium, it usually takes two to six
days for the symptoms to develop.

Period of
Communicability
It

varies. It is more than two to four

weeks in untreated patients or one
to two days in treated patients

Source of infection
Infection

in some from discharges of

the nose, pharynx, eyes or lesions on
other parts of the body of infected
persons.

Mode of Transmission
Transmitted

through contact with a

patient or a carrier or with articles
soiled with discharges of infected
person.

Predisposing Factors
An

operation in an area of the nose

and throat
Economic status
Lack of proper nutrition
overcrowding

Types of Diptheria
1. Nasal - with foul smelling
serosanguinous secretions from the
nose.

2. Tonsilar
The

lesion are confined to the tonsils

only but tend to spread over the
pillars, into the soft palate and uvula.

3. Nasopharyngeal
Cervical

lymph nodes are swollen

Neck tissues are edematous that
result in the appearance of bulls
neck
Has a marked degree of anorexia
Breath is usually fetid

4. Laryngeal
Commonly

found in children (2-5

years old)
Most sever and fatal
Respiration is increased because
less air is brought to the lungs due to
the narrowing of the air passages
With moderate hoarseness, the voice
is diminished until it is finally absent

5. Wound or cutaneous
Diptheria
Affects

the mucous membrane and

any break in the skin

CLINICAL
MANIFESTATIONS
Feeling

of fatigue, malaise, slight sore

throat and fever
Cervical adenitis
Rapid pulse rate
Swollen neck with edema extending on
the chest
Respiratory diptheria: breathing
difficulty, husky voice, increased heart
rate, stridor,nasal secretions, swelling of
the palate, low grade fever

Complications
Myocarditis
Polyneuritis
Airway obstruction
Cervical adenitis
Bronchopneumonia

Diagnostic Test
Swab

from nose and throat or other

suspected lesions
Virulence test
Schick test
Moloney test

Treatment modalities
Penicillin
Antitoxin
Erthromycin
Supportive therapy

Nursing Management
Bedrest.
Diet-

soft food- small frequent

feedings
Encourage fruit juices rich in vitamin
C
Ice collar must be applied on the
neck
Nose and throat must be taken cared
of

BACTERIAL
PNEUMONIA

 Refers

to the consolidation or
solidification of the air sacs with the
inflammatory exudate.

Etiologic agents
Streptococcus

pneumoniae
Staphylococcus aureus
Hemophilus influenzae
Klebsiela pneumoniae

Incubation period
1-3

days with sudden onset of

shaking chills, rapidly raising fever
and stabbing chest pain aggravated
by coughing and respiration

Mode of transmission
Droplet

infection
Indirect contact

4 STAGES OF THE
DISEASE
Stage

of
Stage of
Stage of
Stage of

lung engorgement
red hepatization
gray hepatization
resolution

Clinical manifestation
Sudden

onset of shaking chills

Rapidly rising fever
Stabbing chest pain
Paroxysmal or choking cough
Pain in the abdomen
Herpes appears on lips
Sputum
Convulsions and vomiting in children

 Body

malaise
Tachypnea
Rapid and bounding pulse
Flushed cheeks, bright eyes,
cyanosis
Painful cough
Labored respiration
Diaphoresis
Delirium in the acute stage of the
disease

diagnosis
physical examination
Sputum typing
Blood or serologic examinations
Neufeld- Quelling test- test for
capsular swelling

Complications
Pleurisy
Empyema or pleural effusion
Pericarditis and endocarditis with

effusion
pneumococcal meningitis
Otitis media
Hypestathic edema and hyperemia
Rare complications- arthritis, abscess
of the lungs, gangrene of the lungs,
embolus of the artery and atelactasis

Treatment
Absolute

bed rest
Adequate salt, fluid and vitamin intake
Oxygen administration
Relief of abdominal ditention, cardiac
arrhythmias and pleuritic pain
Control of pulmonary edema
Expectorants and bronchodilators
Antibiotics
Cooling enemas and potassium
permanganate irrigations

Nursing Intervention
Keep

patient warm
Do back rubbing
Do bronchial tapping
Bedrest
Elevate head and shoulders
Cushion bone prominences with pillows
Hygiene care
Increase fluid intake
High calorie diet
Monitor I and O

PERTUSSIS
(Whooping
Cough)

 An

infectious disease characterized

by repeated attacks of spasmodic
coughing which consists of series of
explosive expirations, typically
ending in a long- drawn forced
inspiration which produces a crowing
sound, the whoop, and usually
followed by vomiting

Causative agent
Bordetella

pertussis- a non motile

gram negative bacillus that is easily
destroyed by light, heat and drying

Incubation period

Seven

to
fourteen
days

Period of
communicability
Starts

from 7 days after exposure to

3 weeks after typical paroysms

Mode of transmission
Direct

contact
Droplet infection
Indirect contact

Stages of Pertussis
Catarrhal stage- most
communicable stage; lasts for 1 to
2 weeks
2. Paroxysmal stage- lasts for 4 to 6
weeks
3. Convalescent stage
1.

Clinical manifestations
Catarrhal

stage

Mucoid rhinoria
Sneezing
Lacrimation and dry bronchial cough
Irritating, hacking, nocturnal and

becoming severe cough

 Paroxysmal

stage

Cough becomes spasmodic and

recurrent with excessive explosive

outbursts
Choking on mucus that causes vomiting
Nosebleeding, increased venous
pressure, periorbital edema, conjunctival
hemorrhage and hemorrhage of the
anterior chamber of the eye
Face becomes cyanotic; tongue
protrudes; distended veins on face and

 Profuse

sweating, involuntary
urination, lethargy and exhaustion
Convulsion- intra cranial hemorrhage

 Convalescent

stage

Gradual decrease in paroxysms of

coughing both in frequency and severity

Vomiting ceases

Complications
Interstitial

pneumonia
Atelactasis
Convulsions
Umbilical hernia
Otitis media
Bronchopneumonia
Severe malnutrition and starvation

Diagnostic procedures
Nasopharyngeal
Sputum
CBC

culture

swabs

TREATMENT
Supportive

therapy

Fluid and electrolyte replacement

Adequate nutrition
Oxygen therapy

Antibiotic

therapy
Hyperimmune convalescent serum
or gamma globulin are found
effective

NURSING MANAGEMENT
Isolation

and medical asepsis should

be carried out
Suctioning equipment should be
ready at all times
Sunshine and fresh air are important
Promote rest
Warm baths
Monitor intake and output

Thank you