Infectious Disorders of Adults Pneumonia and Tuberculosis

INFECTIOUS DISORDERS OF ADULTS PNEUMONIA AND  shortness of breath that happens while doing TUBERCULOSIS normal activities, or even while resting PNUEMONIA...

INFECTIOUS DISORDERS OF ADULTS PNEUMONIA AND  shortness of breath that happens while doing TUBERCULOSIS normal activities, or even while resting PNUEMONIA  chest pain that’s worse when you breath or cough  feeling tired or fatigue - it is an infection that affects one or both lungs  loss of appetite - It causes the air sacs, or alveoli, of the lungs to fill  nausea or vomiting up with fluid or pus.  headaches Categorized according to how it is acquired: Risk Factors  infants from birth to 2 years old 1. Community-Acquired Pneumonia (CAP) –  people ages 65 and older pneumonia acquired outside of a healthcare  people with weakened immune systems due to: facility *pregnancy 2. Hospital-acquired pneumonia (HAP) - This type of *HIV bacterial pneumonia is acquired during a hospital *the use of certain medications, such as stay. It can be more serious than other types, as steroids or certain cancer drugs the bacteria involved may be more resistant to  people who’ve been regularly exposed to lung antibiotics. irritants, 3. Ventilator Associated Pneumonia (VAP) –  such as air pollution and toxic fumes, especially on pneumonia acquired 48 hours after endotracheal the job intubation  people with certain chronic medical conditions, 4. Aspiration pneumonia - Inhaling bacteria into the such as: lungs from food, drink, or saliva can cause *asthma aspiration pneumonia. *cystic fibrosis 5. Walking pneumonia - milder case; affected *diabetes people may not even know they have pneumonia. *COPD symptoms may feel more like a mild respiratory *heart failure infection than pneumonia. However, walking *sickle cell disease pneumonia may require a longer recovery period *liver disease *kidney disease. ETIOLOGY:  people who’ve been recently or are currently 1. Community-Acquired Pneumonia hospitalized, particularly if they were or are on a - Bacterial causes - Streptococcus pneumoniae, ventilator Staphylococcus aureus, Mycoplasma pneumoniae,  people who’ve had a brain disorder, which can and gram-negative enteric bacilli. affect the ability to swallow or cough, such as: - Viral causes - influenza virus followed by *stroke respiratory syncytial virus parainfluenza virus, and *head injury adenoviruses *dementia - Fungal causes - Histoplasma, Blastomyces, and *Parkinson’s disease Coccidioides.  people who live in a crowded living environment, 2. Hospital-Acquired Pneumonia and such as a prison or nursing home Ventilator-Associated Pneumonia  people who smoke, which makes it more difficult - Gram-negative bacilli like Escherichia coli, for the body to get rid of mucus in the airways Pseudomonas Aerugenosa, Acinetobacter, and  people who use drugs or drink heavy amounts of Enterobacter among others alcohol, which weakens the immune system and - Gram-positive cocci like Staphylococcus aureus; increases the odds of inhaling saliva or vomit into both Methicillin-sensitive and resistant, although the lungs due to sedation the latter is more prevalent - Other viruses and fungi that are more prevalent in immune compromised and severely ill patients - candida species 3. Walking pneumonia - bacteria Mycoplasma pneumoniae Signs and Symptoms:  coughing that may produce phlegm (mucus)  fever  sweating or chills Diagnosis: 2. Antiviral Therapy - Viral Pneumonia: - MEDICAL HISTORY *If the pneumonia is caused by a virus, antiviral  Exposure to sick people at home, work or medications may be prescribed: school or in a hospitals  Influenza Virus: Antiviral drugs like  Flu or pneumonia vaccinations oseltamivir (Tamiflu) or zanamivir are  Medicines you take used to treat influenza-related  Past and current medical conditions & pneumonia, especially if started within whether any have gotten worse recently 48 hours of symptom onset.  Recent travel  COVID-19: Treatment may include  Exposure to birds and others animals antiviral medications like remdesivir,  Smoking along with supportive care and other - DIAGNOSIS therapies depending on disease  Chest x-ray severity.  Blood test 3. Antifungal Therapy  Pulse oximetry - Fungal Pneumonia:  Sputum test  In cases where pneumonia is caused by  ABG a fungal infection (e.g., Pneumocystis  Bronchoscopy jirovecii in immune compromised - PHYSICAL EXAM patients or endemic fungi like  Temperature Histoplasma) antifungal medications  Lung sound such as fluconazole, itraconazole, or  VS amphotericin B are used.  Other symptoms 4. Supportive Care MANAGEMENT AND TREATMENT - Oxygen Therapy:  For patients with hypoxemia (low 1. Antibiotic Therapy blood oxygen levels), supplemental - Bacterial Pneumonia: oxygen maybe provided via nasal First-Line Antibiotics: Empiric antibiotic therapy is cannula, face mask, or more advanced typically started based on the most likely causative modalities like high-flow nasal cannula organisms and the patient’s clinical condition. or mechanical ventilation in severe Commonly used antibiotics include: cases.  Amoxicillin or Amoxicillin-Clavulanate: Often used - Hydration for community-acquired pneumonia (CAP).  Intravenous fluids may be administered  Macrolides (e.g., Azithromycin or Clarithromycin): to maintain hydration, especially in Effective against atypical pathogens like patients who are unable to take in Mycoplasma pneumoniae, Chlamydia fluids orally due to severe illness. pneumoniae, and Legionella. - Fever and Pain Management:  Doxycycline: Another option for treating CAP,  >Antipyretics (e.g., acetaminophen) are especially when a macrolide or beta-lactam used to reduce fever, and analgesics antibiotic is not suitable. (e.g. ibuprofen) can help relieve chest  Fluoroquinolones (e.g., Levofloxacin, pain associated with pleuritic Moxifloxacin): Reserved for patients with inflammation. comorbidities or in cases of suspected drug- 5. Hospitalization resistant pathogens. - Criteria for Hospitalization: - Hospital-Acquired Pneumonia (HAP): Treatment may  Patients with severe pneumonia, those include broader-spectrum antibiotics like piperacillin- who are elderly, have significant tazobactam, cephalosporins (e.g., cefepime), comorbidities, or have inadequate carbapenems, or vancomycin, depending on the home care may require hospitalization suspected or confirmed pathogens. for closer monitoring and intensive - Aspiration Pneumonia: Often treated with antibiotics treatment. that cover anaerobic bacteria, such as clindamycin,  ICU Admission: Severe cases, especially ampicillin-sulbactam, or metronidazole combined those with respiratory failure, septic with a broader-spectrum agent. shock, or multi-organ dysfunction, may require intensive care unit (ICU) admission.  6. Mechanical Ventilation Nursing Care Planning & Goals At the end of the 8 hours - For Respiratory Failure: shift, the patient will be able to:  In cases where pneumonia leads to acute respiratory failure, mechanical ventilation  Improve airway patency. may be necessary to support breathing and  Rest to conserve energy. ensure adequate oxygenation.  Maintenance of proper fluid volume. 7. Adjunctive Therapies  Maintenance of adequate nutrition. - Corticosteroids:  Understanding of treatment protocol and  In certain cases, particularly with severe or preventive measures. refractory pneumonia, corticosteroids like  Absence of complications. prednisone or methylprednisolone may be used to reduce inflammation, though their Nursing Priorities: use is controversial and should be carefully 1. Maintain/improve respiratory function considered. 2. Prevent complications. - Bronchodilators: 3. Support recuperative process.  For patients with underlying COPD or 4. Provide information about disea process, asthma, bronchodilators like albuterol may prognosis, and treatment. be used to open up the airways and ease breathing. Nursing Interventions To improve airway patency: 8. Prevention - Vaccination:  Removal of secretions. Secretions should be  Pneumococcal Vaccine: Recommended for removed because retained secretions interfere with older adults, young children, and gas exchange and may slow recovery. individuals with chronic illnesses to prevent  Adequate hydration of 2 to 3 liters per day thins and pneumococcal pneumonia. loosens pulmonary secretions.  Influenza Vaccine: Helps prevent viral  Humidification may loosen secretions and improve pneumonia caused by the flu virus, which ventilation. can lead to secondary bacterial pneumonia.  Coughing exercises. An effective, directed cough can - Smoking Cessation: also improve airway patency.  Quitting smoking is crucial as smoking  Chest physiotherapy. Chest physiotherapy is damages the lungs and increases the risk of important because it loosens and mobilizes pneumonia. secretions. Nursing Intervention: To promote rest and conserve Complication of Pneumonia energy: 1. Encourage avoidance of overexertion and possible  Respiratory failure, which requires a breathing exacerbation of symptoms. machine or ventilator 2. Semi-Fowler’s position. The patient should assume a  Empyema or lung abscesses. These are infrequent, comfortable position to promote rest and breathing but serious, complications of pneumonia. They and should change positions frequently to enhance occur when pockets of pus form inside or around secretion clearance and pulmonary ventilation and the lung. These may sometimes need to be perfusion. drained with surgery.  Sepsis, a condition in which there is uncontrolled Nursing Intervention: To promote fluid intake: Fluid intake. swelling (inflammation) in the body, which may 1. Increase in fluid intake to at least 2L per day to lead to organ failure replace insensible fluid losses.  Acute respiratory distress syndrome (ARDS), a Nursing Intervention: To maintain nutrition: severe form of respiratory failure 1. Fluids with electrolytes. This may help provide fluid, calories, and electrolytes. Primary Nursing Diagnosis: 2. Nutrition-enriched beverages. Nutritionally - Ineffective airway clearance related to enhanced drinks and shakes can also help restore increased production of secretions and proper nutrition. increased viscosity as evidenced by productive Nursing Intervention: To promote patient’s knowledge: cough 1. Instruct patient and family about the cause of pneumonia, management of symptoms, signs, and symptoms, and the need for follow-up. 2. Instruct patient about the factors that may have contributed to the development of the disease. Evaluation: 3. Which pt is at higher risk for developing Expected patient outcomes include the following: pneumonia? 1. Demonstrates improved airway patency. a. Any hospitalized pt between 19 - 64 y.o. 2. Rests and conserves energy by limiting activities and b. 36 y.o. trauma pt on mechanical ventilator remaining in bed while symptomatic and then slowly c. disabled 51 y.o. with abdominal pain, d/c increasing activities. home 3. Maintains adequate hydration. d. Any pt who has not received the pneumonia 4. Consumes adequate dietary intake. vaccine 5. States explanation for management strategies. Answer: B 6. Complies with management strategies. 4. Which conditions does the nurse recognize as a 7. Exhibits no complications. risk for developing aspiration pneumonia? 8. Complies with treatment protocol and prevention Select All That Apply strategies. a. continuous tube feed b. bronchoscopy procedure Documentation Guidelines: c. MRI Documentation of data must be accurate and up-to-date to d. decreased LOC avoid unnecessary legal situations that might occur. e. Stroke  Document breath sounds, presence and character of f. chest tube secretions, use of accessory muscles for breathing. 5. The nurse is caring for a client with pneumonia  Document character of cough and sputum. who is having difficulty clearing the airway  Document respiratory rate, pulse oximetry/O2 because of viscous, copious lung secretions. saturation, and vital signs. Which interventions should the nurse use to aid  Document plan of care and who is involved in in airway clearance? (Select all that apply.) planning. a. Monitor arterial blood gas (ABG) results  Document client’s response to interventions, b. Assess sputum for color and consistency teaching, and actions performed. c. Provide a dehumidifier  Document if there is use of respiratory devices or d. Encourage fluids airway adjuncts. e. Place in high Fowler position  Document response to medications administered. 6. The nurse caring for a client with pneumonia  Document modifications to plan of care. administers a variety of classifications of QUESTIONS: pharmacologic therapies in collaboration with 1. A nurse is caring for an 89-year-old client admitted the healthcare team. Which medications may with pneumonia. He has an IV of normal saline be appropriate for a client with pneumonia? running at 100 mL/hr and antibiotics that were (Select all that apply.) initiated in the emergency department 3 hours ago. a. Broad spectrum antibiotics He has oxygen at 2 liters/nasal cannula. What b. Oxygen therapies assessment finding by the nurse indicates that c. Liquefying agents goals for a priority diagnosis have been met for this d. Laxatives client? e. Bronchodilators a. The client is alert and oriented to person, place, and time. 7. The nurse understands that there are several b. Blood pressure is within normal limits and ways that pneumonia is classified. Which type client's baseline. of pneumonia does the nurse suspect in a client c. Skin behind the ears demonstrates no redness or who is not a resident of a long-term care facility irritation. and is diagnosed within 48 hours of admission d. Urine output has been >30 mL/hr per Foley to the hospital? catheter a. Hospital-acquired pneumonia 2. An older adult resident in a long-term-care facility b. Healthcare-associated pneumonia becomes confused and agitated, telling the nurse, c. Community-acquired pneumonia "Get out of here! You're going to kill me!" Which d. Ventilator-associated pneumonia action will the nurse take first? a. Check the resident's oxygen saturation. b. Do a complete neurologic assessment. c. Give the prescribed PRN lorazepam (Ativan). d. Notify the resident's primary care provider.  TUBERCULOSIS Difference between the latent tuberculosis infection and the active TB disease GLOBAL TB REPORT (according to WHO) o 1.6 million people died from TB in 2021 including 187 000 people with HIV. TB remains one of the world’s top infectious killers. o An estimated 10.6 million people fell ill with TB worldwide in 2021 Mode of Transmission  transmitted mainly by inhalation of infectious droplets produced by people with pulmonary or laryngeal TB during coughing, laughing, shouting or sneezing TUBERCULOSIS  Invasion may occur through mucous membranes or - An acute or chronic infection caused by damaged skin. Mycobacterium tuberculosis, which is  Extrapulmonary TB - not communicable characterized by pulmonary infiltrates, formation  renal TB - urine is infectious of granulomas with caseation, fibrosis, and  Bovine TB - results from ingestion of unpasteurised cavitation milk and dairy products - Tuberculosis is an infectious disease that primarily  Aerosol transmission - among abattoir workers. affects the lung parenchyma. - It also may be transmitted to other parts of the Period of communicability body, including the meninges, kidneys, bones, and  patient is infectious as long as viable bacilli are being lymph nodes. discharged from the sputum - The primary infectious agent, M. tuberculosis, is  There is greatest risk of transmitting infection an acid-fast aerobic rod that grows slowly and is before an active case is diagnosed. sensitive to heat and ultraviolet light  After starting proper treatment, the risk of Causative spreading the illness greatly decreases within two  Mycobacterium tuberculosis (human TB) and M. weeks. bovis (cattle TB) – common Who are at risk?  M. africanum and M. canetti - rare type in Africa  Recent immigrants and refugees from countries with  Several animal pathogens have been reported to a high incidence of TB, including Vietnam, India, cause zoonotic TB in humans: M. caprae (cattle), China, African nations, and the Philippines  Those in close contact with a case of active TB M. microti (rodents) and M. pinnipedii (seals). Incubation Period  immunosuppressed patients, including those with HIV infection, the elderly and diabetics; and infants  Behr et al. (2018) found that the majority of TB aged less than 5 years cases occur within two years of M.tb exposure.  drug- and alcohol-dependent people  After the initial infection, active disease may  people living in substandard, overcrowded develop soon (primary progressive disease). In conditions or those who are homeless most cases, the infection is asymptomatic, with lesions healing and leaving calcified scars. These Pathophysiology scars may contain viable bacteria (latent TB) and reactivate later when the person's immune system is suppressed by other illnesses, medication or old age. Signs and Symptoms: 4. Chest x-ray: - small, patchy infiltrations; advanced 3 stages: TB may include cavitation, scar tissue/fibrotic areas. 1. Primary TB infection 5. CT or MRI scan: Determines degree of lung damage - immune system cells find and capture the germs and may confirm a difficult diagnosis. - Immune system may completely destroy the 6. Bronchoscopy: Shows inflammation and altered lung germs. tissue - some captured germs may still survive and 7. Histologic or tissue cultures (including gastric multiply washings; urine and cerebrospinal fluid [CSF]; skin - Most people don't have symptoms biopsy): - Some people may get flu-like symptoms, such 8. Needle biopsy of lung tissue: Positive for as: granulomas of TB; presence of giant cells indicating  Low fever, Tiredness, Cough necrosis. 2. Latent TB infection 9. Electrolytes: May be abnormal depending on the - Immune system cells build a wall around lung location and severity of infection tissue with TB germs. 10. ABGs: May be abnormal depending on location, - Germs can't do any more harm if the immune severity, and residual damage to the lungs. system keeps them under control. 11. Pulmonary function studies: Decreased vital - But the germs survive, it only requires 3 capacity, increased dead space components:  Oxygen, Nutrients, Adequate ph Complications: 3. Active TB infection PNUEMOTHORAX - when tuberculosis is not treated - the immune system can't control an infection properly - Germs cause disease throughout the lungs or RESPIRATORY FAILURE- most common other parts of the body. PNUEMONIA – most fatal complication - Active TB disease may happen right after primary infection. Preventions: - usually happens after months or years of latent To prevent transmission of TB, the ff. should be TB infection. implemented: - Symptoms of active TB disease in the lungs 1. Identifications and treatment, Early identifications & usually begin gradually and worsen over a few treatment of persons with active TB weeks 2. Prevention of the spread of infectious droplet nuclei * Stay home * Isolate at home * Ventilate the room * Wear face mask * Vaccinations * BCG (bacille Calmette-Guérin) vaccine - named after Dr Albert Calmette and Dr Camille Guerin - developed the vaccine from a germ called Mycobacterium bovis - BCG is given after birth or any time after birth Diagnosis: 3. Surveillance. Maintain surveillance for TB infection 1. Sputum culture: Positive for Mycobacterium among health care workers by routine, periodic tuberculosis in the stage of the disease tuberculin skin testing 2. Ziehl-Neelsen n (acid-fast stain applied to a smear 4. Control of case of body fluid): Positive for acid-fast bacilli (AFB). - potent anti-TB drugs 3. Skin tests (purified protein derivative [PPD] or Old tuberculin [OT] administered by intradermal injection [Mantoux]) - A positive reaction (area of induration 10 mm or greater, occurring 48–72 hr after interdermal injection of the antigen) indicates past infection and the presence of antibodies but is not necessarily indicative of active disease   Pyrazinamide. Pyrazinamide is a bactericidal agent which increases the uric acid in the blood and has common side effects of hyperuricemia, hepatotoxicity, skin rash, arthralgias, and GI distress.  Ethambutol (Myambutol). Ethambutol is a bacteriostatic agent that should be used with caution with renal disease, and has common side effects of optic neuritis and skin rash. NURSING MANAGEMENT OF TUBERCULOSIS Medical Management:  involves supporting patients who have been Pulmonary tuberculosis is treated primarily with anti- diagnosed with TB, ensuring adherence to tuberculosis agents for 6 to 12 months. treatment, and educating patients and their  First line treatment. First-line agents for the families about the disease treatment of tuberculosis are isoniazid (INH), rifampin (RIF), ethambutol (EMB), and Nursing Assessment pyrazinamide 1. Medical history - past TB infections or treatments,  Active TB. For most adults with active TB, the and their exposure to TB. recommended dosing includes the administration of 2. Physical examination - assess respiratory status all four drugs daily for 2 months, followed by 4 3..possible Diagnostic tests months of INH and RIF. 4..Risk assessment - risk factors for TB  Latent TB. Latent TB is usually treated daily for 9 5. Psychosocial assessment - patient’s psychosocial status, including their mental health, support months (once-weekly isoniazid plus rifapentine for system, and ability to adhere to treatment. 3 months, daily rifampin for 4 months, daily 6. Infection control assessment isoniazid plus rifampin for 3–4 months, and daily NURSING DIAGNOSIS isoniazid for 6–9 months)  Ineffective Airway Clearance related to bloody  Treatment guidelines. Recommended treatment secretions as evidenced by blood-tinged guidelines for newly diagnosed cases of pulmonary sputum TB have two parts: an initial treatment phase and a Nursing Care Planning & Goals continuation phase.  At the end of the 12 hours shift, patient is  Initial phase. The initial phase consists of a multiple- expected to: medication regimen of INH, rifampin, pyrazinamide, - The major goals for the patient include and ethambutol and lasts for 8 weeks - Promote airway clearance.  Continuation phase. The continuation phase of - Adhere to treatment regimen. treatment include INH and rifampin or INH and - Promote activity and adequate nutrition. rifapentine, and lasts for an additional 4 or 7 - Prevent spread of tuberculosis infection months. Nursing Interventions:  Prophylactic isoniazid. Prophylactic INH treatment  Promoting airway clearance. involves taking daily doses for 6 to 12 months.  Adherence to the treatment regimen.  DOT. Directly observed therapy may be selected,  Promoting activity and adequate nutrition. wherein an assigned caregiver directly observes the  Preventing spreading of tuberculosis infection. administration of the drug.  Acid-fast bacillus isolation. PHARMACOLOGIC THERAPY  Disposal. of contaminated sputum The first line anti-tuberculosis medications include:  Monitor adverse effects  Isoniazid (INH). INH is a bactericidal agent that is Evaluation used as prophylaxis for neuritis, and has side effects Expected patient outcomes include: of peripheral neuritis, hepatic enzyme elevation,  Promoted airway clearance. hepatitis, and hypersensitivity.  Adhered to treatment regimen.  Rifampin (Rifadin). Rifampin is a bactericidal agent  Promoted activity and adequate nutrition. that turns the urine and other body secretions into  Prevented spread of tuberculosis infection. orange or red, and has common side effects of hepatitis, febrile reaction, purpura, nausea, and vomiting. Questions: EBOLA VIRUS DISEASE 1. Tuberculosis is an infectious disease transmitted by: Mycobacterium tuberculosis EBOLA VIRUS DISEASE (EVD) 2. What is the reservoir for Mycobacterium According to Centers for Disease Control and Prevention (CDC) tuberculosis?  rare but severe disease with high case-fatality a. infected cattle rates. b. infected rodents  Previously known as Ebola Hemorrhagic Fever, this c. infected human disease is caused by a virus that circulates d. infected seals throughout the body, leading to problems with the 3. TRUE OR FALSE: Secondary tuberculosis is a flare- clotting system and internal bleeding as blood up of dormant bacteria, and is usually a leaks from small blood vessels. consequence of impaired immune function.  If untreated, the fatality rate can reach 90%. Even if treated, people have to accept the fact that the Answer: True fatality rate is as high as 60% 4. People may likely get infected with TB with  caused by four ebolaviruses within the genus exposure to the following places, except: Ebolavirus a. Prison b. Homeless shelters HISTORY OF EBOLA VIRUS DISEASE c. Nursing homes  first cases of Ebola were reported simultaneously d. Uncongested place in 1976 in Yambuku, near the Ebola River in Zaire (now the Democratic Republic of the Congo) and in 5. What specimen is used for acid fast staining of Nzara, Sudan acid fast bacilli? Sputum  Ebola outbreaks have occurred in humans and 6. TB infection with no ACTIVE disease is called as? animals due to eruptions, lab contamination, and Latent TB infection accidents the following countries: 7. Give an example of a trigger that can reactivate .The Democratic Republic of the Congo (DRC) LTBI? HIV, AIDS, SEPSIS & etc.  Sudan (South Sudan) 8. The nurse suspects that a client is at risk for  Senegal  United Kingdom tuberculosis. Which risk factor should the nurse  United States (U.S.) assess in this client? (Select all that apply.)  Philippines a. Sharing clothes with an infected individual  Italy b. Living in a poorly ventilated environment  Spain c. Using injection drugs  Gabon d. Being an immigrant to the United States  Ivory Coast e. Having a compromised immune system  South Africa  Russia 9. The infection control nurse is teaching the staff at  Uganda a long-term care facility after a recent outbreak of  Guinea tuberculosis. Which element of infection control  Liberia should the nurse include in the teaching? (Select  Sierra Leone all that apply.)  The 2014 Ebola outbreak was the largest in a. Implementation of universal screening history, causing over 11,000 deaths in West Africa b. Use of airborne precautions (Guinea, Liveria and Sierra Leone) CAUSATIVE ORGANISM c. Treatment of clients with suspected or 4 ebolaviruses that cause illness in people, with their confirmed disease associated viral species and disease name: d. Administration of the bacille Calmette-Guérin  Ebola virus (species Zaire ebolavirus) causes (BCG) vaccine to residents Ebola virus disease e. Identification of infected individuals  Sudan virus (species Sudan ebolavirus) causes Sudan virus disease  Taï Forest virus (species Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus) causes Taï Forest virus disease Bundibugyo virus (species  Bundibugyo ebolavirus) causes Bundibugyo virus disease 2 ebolaviruses that are not known to cause disease in people:  Reston virus (species Reston ebolavirus) is known to cause illness in nonhuman primates and pigs, but not in people  Bombali virus (species Bombali ebolavirus) was recently identified in bats, but it is unknown if it causes illness in either animals or people SIGNS AND SYMPTOMS: The illness typically progresses from dry to wet symptoms. Also, characterized by the following signs and symptoms: 1. Early Stage  abdominal pain  anorexia  arthralgia  asthenia (extreme)  back pain MODE OF TRANSMISSION  diarrhea DIRECT CONTACT OF THE FOLLOWING:  fatigue  Blood of a person infected with the virus  fever (>37.5⁰C)  Body fluids, such as breast milk, stool, saliva,  headache semen, sweat, urine, or vomit, of a person infected  myalgia with the virus  sore throat  Objects (such as clothes, bedding, needles, and  Vomiting medical equipment) contaminated with body fluids 2. Mid Stage from a person who is sick with or has diedfrom  capillary leak Ebola disease.  confusion  Infected fruit bats or nonhuman primates (such as  difficulty breathing/respiratory distress apes and monkeys).  headache INCUBATION PERIOD  low blood pressure  Ebolavirus symptoms can appear 2-21 days after  nausea and vomiting contact, averaging 8-10 days.  rash (maculopapular)  3. Late Stage Neurological System:  delirium  aggression  hemorrhage (external/internal)  confusion  hiccups  hiccups  multi-organ failure  metabolic encephalopathy  shock (hypovolemic and septic)  neurotropism  seizures Ocular System:  conjunctival infection  uveitis PATHOPHYSIOLOGY PATHOGENESIS OF EBOLA VIRUS DISEASE SYSTEMIC INVOLVEMENT The Ebola virus has the ability to affect most systems throughout the body including, but certainly not limited to: Cardiovascular System:  coagulopathy (increased fibrin-degradation products, reduced clotting factor, and thrombocytopenia)  sepsis  tachycardia Endocrine System:  adrenal failure (impairs secretion of hormones, resulting in hypotension, hypovolemia, and renal TESTS AND DIAGNOSIS sodium loss)  Early Ebola symptoms such as fever, headache, and  pancreatitis weakness are similar to other diseases like malaria Gastrointestinal System: and typhoid fever.  GI hemorrhage (lower and upper)  To diagnose Ebola, an individual must display  hematemesis symptoms and have confirmed exposure to the  melena virus within 21 days Hepatic System:  Ebolaviruses can be detected in the blood within  hepatitis three days of symptom onset.  hepatocellular lesions  Basic blood tests. - Infection's early stage:  hepatocellular necrosis thrombocytopenia, leukopenia, lymphopenia;  Hepatomegaly followed by neutrophilia, elevated  liver damage aminotransferase levels, and normal/slightly raised Immune System: bilirubin.  lymphadenopathy  If someone has Ebola symptoms and has been in  systemic inflammatory response contact, isolate them and notify public health Renal System: professionals immediately.  acute kidney injury  Public health authorities will conduct a public  renal dysfunction health investigation, including identifying and monitoring all potentially exposed contact TESTS AND DIAGNOSIS:: According to the WHO, Ebola samples pose a high biohazard risk. Maximum biological containment should be used throughout the investigation. EV infections can be diagnosed definitively in a laboratory through several types of tests, including: - Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing. - IgM ELISA - Polymerase chain reaction (PCR). - Virus isolation NURSING MANAGEMENT: - Two tests approved by the FDA, which can CDC RECOMMENDATIONS FOR MANAGING PATIENTS detect Ebola in blood or urine samples in 1  Be alert for EVD in patients with fever of 38.6 hour, can be performed on-site in hospitals degrees Celsius (101.5 degrees Fahrenheit); with the proper lab equipment from the tests’ symptoms such as severe headache, muscle manufacturer, BioFire Defense. pain, vomiting, diarrhea, abdominal pain, or - IgM and IgG antibodies are used to diagnose unexplained hemorrhage the disease in later stages or after recovery.  risk factors within the past 3 weeks (travel MEDICAL MANAGEMENT: history to affected countries, exposure to The main goal of treatment is to manage the individual with EVD, or direct handling of bats, symptoms: rodents, or primates from disease-endemic  Fluids and electrolytes. Providing fluids and countries electrolytes (body salts) through infusion into the EVD patients should be isolated in a private room with vein (intravenously). standard, contact, and droplet precautions in place. The > Getting fluids to prevent dehydration CDC has specific recommendations related to infection >Regulating and replacing salts and other prevention and control, including the use of the following chemicals in the body personal protective equipment (PPE):  Oxygen therapy. Offering oxygen therapy to  Double gloves maintain oxygen status.  Waterproof boot covers that go to at least mid-calf  blood transfusions or waterproof leg covers  Prescribing medications. Using medication to  Single use fluid resistant or imperable gown that support blood pressure, reduce vomiting and extends to at least mid-calf or coverall without diarrhea and to manage fever and pain intergraded hood  Treating other infections  Respirators, including either N95 respirators or  patient with EVD may need intensive care unit powered air purifying respirator (PAPR) (ICU) services.  Single-use, full-face shield that is disposable PREVENTION & CONTROL:  Surgical hoods to ensure complete coverage of the  Ebola Zaire vaccine (Ervebo) head and neck Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea  Visitors should be restricted. Exceptions may be considered on an individual basis, and then visitors should be trained and a logbook kept of all who enter the room STANDARD PRECAUTION:  SP protect healthcare staff and patients from infection transmission via Direct or Indirect contact  Ring Vaccination Strategy - This technique modes. The assumption is made that all vaccinates confirmed patients' contacts and blood/body fluids are potentially infectious and persons in close contact with those connections. PPE measures should be taken by staff during This way, everyone who has been or could have healthcare to avoid exposure to bare skin or been exposed to a patient receives the vaccination, mucous membranes forming a 'ring' of protection that can limit disease  also includes Respiratory hygiene, cough etiquette spread and the addition of physical (social) distancing measures  NURSING INTERVENTIONS 1. Prevention of bleeding  Instruct the patient to use a soft-bristled toothbrush and nonabrasive toothpaste, limit straining with bowel movements, forceful nose blowing, coughing, or sneezing, and be careful when using sharp objects like scissors and knives; CONTACT PRECAUTIONS:  administer blood products as prescribed  Contact Precautions are intended to prevent 2. Restore normal fluid and electrolyte balance transmission of infectious agents, including  Administer electrolyte replacements as epidemiologically important microorganisms, prescribed; which are spread by direct or indirect contact with  monitor intake and output; note the patient or the patient’s environment decreased urinary output and positive fluid DROPLET PRECAUTIONS: balance on 24-hour calculations;  Droplet Precautions are intended to prevent  administer oral fluids with caution. transmission of pathogens spread through close  emphasize the relevance of maintaining respiratory or mucous membrane contact with proper nutrition and hydration respiratory secretion 3. Prevent Shock NURSING ASSESSMENT  Monitor daily weight for sudden decreases, 1. History - 2 types of exposure history are especially in the presence of decreasing urine recognized: output or active fluid loss; >Primary - A history of exposure to tropical African  monitor the patient closely for cardiovascular forests is more common in patients with primary overload, signs of difficulty of breathing, Ebola exposure than a history of working in the pulmonary edema, jugular vein distention, and same region's cities. laboratory results >Secondary - refers to human-to-human or 4. Relieve pain primate-tohuman exposures; in each major  Provide rest periods to promote relief, outbreak, medical personnel or family members sleep, and relaxation; who cared for patients or those who prepared  determine the appropriate pain relief deceased patients for burial were at very high risk. method 2. Physical exam  get rid of additional stressors or sources of > depend on the stage of disease at the time of discomfort whenever possible; presentation > Patients may present with fever, pharyngitis, and  provide analgesics as ordered, evaluating severe constitutional signs and symptoms early in the effectiveness and inspecting for any signs and symptoms of adverse effects the disease; a maculopapular rash, more easily seen on white skin than on dark skin, may appear around on 5th day of infection and is particularly visible on the trunk NURSING DIAGNOSIS:  Electrolyte imbalance related to decreased oral intake, loose bowel movement and vomiting  Pain related to musculoskeletal aches and abdominal pain  Bleeding related to impaired clotting factors  Shock related to progressive multi-organ failure Evaluation: Nursing Care Planning and Goals Goals are met for a patient with ebola virus as  Prevention of bleeding. evidenced by:  Restoration of normal fluid and electrolyte  Prevented progression of bleeding. balance. Prevention of shock.  Restored normal fluid and electrolyte balance.  Relief from pain.  Prevented occurrence of shock  Restoration of normal body fluid volume  Relief from pain. Restored normal body fluid volume. Documentation Guidelines SARS and MERS to COVID-19 Documentation in a patient with Ebola virus includes:  Individual findings include factors affecting, About the Disease interactions, nature of social exchanges, and specifics of individual behavior. SARS-COV  Cultural and religious beliefs, and expectations.  a viral respiratory disease caused by Severe acute  Plan of care. respiratory syndrome coronavirus  Teaching plan. MERS-COV  Responses to interventions, teaching, and actions  a viral respiratory infection caused by the Middle performed. East respiratory syndrome coronavirus (MERS CoV)  Attainment or progress toward the desired that causes severe lung infection. outcome. SARS-COV-2 QUESTIONS:  Severe acute respiratory syndrome coronavirus 2 1. Ebola is an emergent virus in W. Africa. What is their (COVID 19) origin? a. Humans  virus has been named “2019-nCoV” and later b. Primates renamed as “SARS-CoV-2.” c. Fruit bats Are associated with severe lower respiratory tract d. Pigs infection, with a high ability to develop acute respiratory 2. How can the spread of this virus be restricted? distress syndrome with extra pulmonary manifestation a. New antivirals (Al-Salihi & Khalaf, 2021) b. New humanised monoclonal antibodies c. Hygiene and social distancing d. New vaccines 3. What is the biggest risk factor for infection with Ebola? a. Working in a category IV laboratory b. Attending a funeral of a victim outside c. Nursing a patient at home d. Attending football matches or large gatherings 4. Stated below are several ways to protect yourself and prevent the spread of Ebola disease. Which one is not correct? a. Avoid contact with blood and body fluids (such as urine, feces, saliva, sweat, vomit, breast milk, amniotic fluid, semen, and vaginal fluids) of people who are sick. b. avoid contacts only with living animals such as bats and primates c. don’t come near in contact with dead bodies d. Avoid contact with semen from a man who has recovered from Ebola disease, until testing shows that the virus is gone from his semen 5. Which of these can pass along the Ebola virus? Select all that apply a. Dandruff b. nails c. tears d. sweat Animal Origins of Human Coronaviruses e. Saliva 6. TRUE OR FALSE: You can catch Ebola from sitting near someone on a plane ANSWER: FALSE 7. TRUE OR FALSE: Ebola is NOT contagious UNTIL someone has symptoms ANSWER:TRUE 8. Death from Ebola is caused by HEMORHAGIC & ORGAN FAILURE 9. Incubation period of EVD? 2 TO 21 DAYS 10. Reservoir of the virus. FRUIT BATS 11. Previous name of ebola virus disease? EBOLA HEMORRHAGIC FEVER ACE2 regulate the renin–angiotensin system (RAS)32 MERS-CoV uses the DPP4 (dipeptidyl peptidase-4) receptor which influences blood pressure and fluid/electrolyte to enter cells, rather than the ACE2 receptor used by SARS- balance, and enhance inflammation and vascular CoV-1 and SARS-CoV-2. This receptor is found in the lungs, permeability in the airways. kidneys, liver, and intestines.  Coronaviruses (CoVs) refer to a family of enveloped, positive-sense, single-stranded, and PATHOPHISIOLOGY highly diverse RNA viruses  ACE2 receptors are distributed in many parts of the body, particularly in the lungs, heart, intestines, blood vessels, and kidneys explains why COVID-19 can have such widespread and diverse effects on human body. WHO ARE AT RISK?  older people  persons with weakened immune systems  those with comorbidities or chronic diseases such as renal disease, cancer, chronic lung disease, and diabetes.  close contact with the infected individuals like BETWEEN SARS 1 AND SARS 2 family and co-workers  The two viruses have very similar proteins on their  Healthcare Personnel Not Using Recommended exterior and use the same proteins, or receptors, on Infection-Control Precautions our cell surfaces to enter the cell. These receptors  MERS: People with Exposure to Camels are found in a lot of different cell types. SIGNS AND SYMPTOMS  SARS-CoV-1 was more aggressive and lethal than SARS-COV SARS-CoV-2. However, SARS-CoV-2 spreads faster, o Fever sometimes with hidden symptoms, allowing each o Chills and shaking infected person to infect several others. o Dry cough  Everyone had severe symptoms in two to three days. o Shortness of breath  With SARS-CoV-2, it takes about two weeks for o Myalgia symptoms to appear, and many people don’t have o Diarrhea any symptoms at all. o Nausea TREATMENT o Vomiting o coryza SARS-COV  Medication – o Sore throat o hypoxia - Antibiotics: Given until bacterial pneumonia is o mortality is higher compared to SARS-COV 2 ruled out or if bacterial pneumonia is present in addition to SARS. o infected people most likely to spread the illness to - Steroids: It may help reduce swelling in the lungs others when they have symptoms antipyretics  Therapy - Oxygen therapy: To improve breathing and maintain blood oxygen levels. -  - isolation preferably in negative-pressure rooms, MERS-C0V - complete barrier nursing precautions taken for  standard, contact, and airborne precautions any necessary contact with patients  hand hygiene - support, including mechanical ventilation  respiratory hygiene MERS-COV  Avoid touching your eyes, nose, and mouth with  Symptomatic and supportive management which unwashed hands. depends on the severity of the disease  Avoid personal contact, such as kissing, or sharing  hydration cups or eating utensils, with sick people.  antipyretic  Clean and disinfect frequently touched surfaces  analgesics and objects, such as doorknobs.  respiratory support like oxygen therapy and  Avoid contact with camels mechanical ventilator  Do not drink raw camel milk or raw camel urine  antibiotics for bacterial infection  Do not eat undercooked meat, particularly camel  management also focuses on reducing the risk of meat complications, such as secondary infections, and renal and respiratory failure SARS-CoV 2 SARS-COV2  Getting vaccinated  supportive  Social distancing and avoiding crowded areas  ventilators to assist breathing and maintain good  Wear a properly fitted mask when physical oxygen levels distancing is not possible and in poorly ventilated  broad-spectrum antibiotics to cover secondary settings. bacterial infection  Hand hygiene  antipyretics  Respiratory hygiene and proper disposal of  conservation fluid management, contaminated tissue  vaccine  If you develop symptoms or test positive for  quarantine COVID-19, self-isolate until you recover.  social isolation DIAGNOSIS SARS-CoV  Blood test: leukopenia, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels  X-ray: Chest X-ray shows patchy infiltrates - substance denser than air, such as pus, blood, or protein  Antibody test: To test for specific antibodies against the SARS virus.  Reverse transcriptase polymerase chain reaction PREVENTION (according to CDC) (RT-PCR) test: Detects the genetic material of the SARS-CoV SARS virus. Is positive within the first ten days of  standard and airborne precaution fever.  Wash hands frequently and thoroughly with soap. MERS-CoV  Disinfect surfaces that could be potentially  Complete blood count (CBC): leukopenia contaminated. lymphocytophenia  Wear gloves before coming into contact with  X-ray: bilateral patchy infiltrates consistent with infected persons. viral pneumonitis and acute respiratory distress  Wear a surgical mask when dealing with infected syndrome (ARDS). Lower lobes tend to be more people. involved. CT scans show interstitial infiltrates.  Wash personal belongings of the person with SARS.  RT-PCR  Avoiding travel to affected areas SARS-CoV 2  Wearing masks and gloves  Polymerase Chain Reaction (PCR) tests - the “gold  Keeping people with symptoms home standard” for COVID-19 tests; more reliable  Social distancing at least 6 feet  Antigen tests - produce results in 15-30 minutes;  avoid contact with affected individual less likely to detect the virus than PCR tests, especially when symptoms are not present.   Antibody tests should never be used to diagnose a Evaluation current infection with the virus that causes COVID- Nursing goals are met as evidenced by: 19. ; can be used for public health surveillance or 1. Patient was able to prevent the spread of infection. to test for conditions associated with COVID-19. 2. Patient was able to learn more about the disease  x-ray: hazy gray areas - something is partially filling and its management. the lungs like fluid, pus, or cells filling the air space 3. Patient was able to improve body temperature Diagnosis includes asking if there is exposure in the levels. preceding two weeks and/or is asked about contact with 4. Patient was able to restore breathing pattern back someone who has traveled to those places and has to normal. symptoms of fever, cough, or dyspnea. 5. Patient was able to reduce anxiety. Nursing Management QUESTIONS Nursing care for a patient with SARS-COV, MERS-CoV and 1. Which of the following is the FIRST priority in COVID-19 preventing infections when providing care for a client? Nursing Assessment A. Handwashing Careful assessment is essential in the evaluation and B. Wearing gloves management of patients who may have SARS-CoV, MERS- C. Using a barrier between client’s furniture and CoV and COVID-19 which includes: nurse’s bag 1. History D. Wearing gowns and goggles  travel history -for MERS: history of residence or 2. The nurse assessed the client and noted shortness travel in the Arabian Peninsula of breath and recent trip to China. The client is  exposure history strongly suspected of having Middle East 2. Physical exam Respiratory Syndrome (MERS-CoV). Which of  presence of flu-like symptoms these prescribed actions will the nurse take first?  shortness of breath A. Place the client on airborne and contact precautions Nurse Care Planning and Goals B. Introduce normal saline at 75 mL/hr C. Give methylprednisolone (SOLU-Medrol) 1 g Establishing nursing care plan goals can help improve intravenously (IV) patient outcomes and decrease the transmission of the D. Take blood, urine, sputum cultures virus. 3. A 10-year-old client contracted Middle East  Prevent the spread of infection. Respiratory Syndrome (MERS-CoV) when traveling  Learn more about the disease and its management. abroad with her parents. The nurse knows she  Improve body temperature levels. must put on personal protective equipment to  Restore breathing pattern back to normal. protect herself while providing care. Based on the  Reduce anxiety mode of MERS-CoV transmission, which personal protective should the nurse wear? NURSING INTERVENTIONS A. Gloves 1. Monitor vital signs B. Gown and gloves 2. Monitor O2 saturation C. Gown, gloves, and mask 3. Frequent positioning D. Gown, gloves, mask, and eye goggles or eye 4. Manage fever shield - adjusting room temperature 4. You are preparing to leave the room after - eliminating excess clothing and covers performing oral suctioning on a client who is on - IV fluids as allowed contact and airborne precautions. In which order - antipyretic medications as prescribed will you perform the following actions? - oxygen therapy 1. Take off the gown. 5. Maintain respiratory isolation 2. Remove N95 respirator. 6.. Enforce strict hand hygiene 3. Perform hand hygiene. 7. Reduce anxiety 4. Take off goggles. 8. 7 Provide information 5. Remove gloves A. 5, 4, 1, 2, 3 B. 4, 5, 2, 1, 3 C. 1, 2, 4, 5, 3 D. 2, 4, 2, 1, 3 5. The school nurse is asked which action will take to have the most impact on the incidence of infectious diseases in school. The correct response is: A. Grant written information about infection control to all parents B. Ensure that students are immunized according to national guidelines C. Make soap and water easily accessible in the classrooms D. Educate students on how to cover their mouths when coughing 6. Severe Acute Respiratory Syndrome (SARS) started in ____________ and was transmitted from _______ to humans. A. China, civet cat B. China, pangolin C. Saudi Arabia, camels D. Asia; seafood 7. TRUE or FALSE: A person with COVID-19 can transmit the virus even though they are asymptomatic. TRUE 8. What preventive measures the nurse can teach the members of the community on how to prevent acquiring COVID-19? Select all that apply: A. Handwashing B. Wearing a facemask when going around others C. Covering mouth and nose when sneezing and coughing D. Avoiding others who are sick E. Staying home when sick F. Social distancing at a distance of 2 feet G. Avoid eating to-go foods 8. When a virus is transmitted from an animal to a human this is termed as? A. mammalian event B. zoonotic spillover event C. interspecies transmission event D. intraspecies spillover event