Infectious Disorders Of The Adults Module 3 PDF

 Course Content 1. Infectious and Inflammatory Disorders 2. Urinary System A. Infectious Disorders of Adults a. Cystitis ▪ Pneumonia b. Urolithiasis (Stones) ▪...

 Course Content 1. Infectious and Inflammatory Disorders 2. Urinary System A. Infectious Disorders of Adults a. Cystitis ▪ Pneumonia b. Urolithiasis (Stones) ▪ Tuberculosis 3. Reproductive System ▪ Ebola a. Pelvic Inflammatory Disease ▪ MERS CoV b. Benign Hypostatic Hypertrophy ▪ H1N1 4. Skin ▪ Covid 19 a. System Lupus Erythematosus ▪ Hepatitis 2. Immunologic Disorders ▪ Guillain- Barre Syndrome A. Multiple Sclerosis ▪ Sexually Transmitted Disease (STD’s) B. Type 1 DM B. Inflammatory Disorders (All body systems) C. Ulcerative Colitis 1. Gastro-intestinal System D. Acute Glomerulonephritis a. Inflammatory Bowel Disease, E. Allergy (Hypersensitivity) b. Crohn’s and Ulcerative Colitis F. Lupus Erythematous c. Appendicitis, Peritonitis G. Rheumatoid Arthritis d. Pancreatitis 3. Transplant Rejection e. Cholecystitis INFECTIOUS DISORDERS OF THE ADULTS PNEUMONIA  PNEUMONIA a is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses Pneumonia can be classified into four types: ✓community-acquired pneumonia (CAP), ✓health care–associated pneumonia (HCAP), ✓Hospital acquired pneumonia (HAP), and ✓Ventilator Assisted Pneumonia (VAP)  PNEUMONIA (PATHOPHYSIOLOGY) resident macrophages serve to protect the lung from foreign pathogens inflammatory reaction triggered by these very macrophages is what is responsible for the histopathological and clinical findings seen in pneumonia. macrophages engulf these pathogens and trigger signal molecules or cytokines that recruit inflammatory cells like neutrophils to the site of infection causes inflammation of the lung parenchyma and makes the lining capillaries "leaky," which leads to exudative congestion and underlines the pathogenesis of pneumonia. PNEUMONIA (COMMUNITY ACQUIRED) CAUSATIVE AGENT CAP - occurs either in the community setting or within the first 48 hours after hospitalization or institutionalization PNEUMONIA (COMMUNITY ACQUIRED) S. pneumoniae (pneumococcus) is the most common cause of CAP in people younger than 60 years without comorbidity and in those 60 years and older with comorbidity a gram-positive organism that resides naturally in the upper respiratory tract, colonizes the upper respiratory tract and can cause disseminated invasive infections,  PNEUMONIA (COMMUNITY ACQUIRED) H. influenzae causes a type of CAP that frequently affects older adults and those with comorbid illnesses (e.g., chronic obstructive pulmonary disease [COPD], alcoholism, and diabetes). Mycoplasma pneumonia is caused by M. pneumoniae; spread by infected respiratory droplets through person-to-person contact. The inflammatory infiltrate is primarily interstitial rather than alveolar. It spreads throughout the entire respiratory tract, Viruses are the most common cause of pneumonia in infants and children PNEUMONIA (HEALTH CARE ASSOCIATED) An important distinction of HCAP is that the causative pathogens are often MDR (Multiple drug resistant) HCAP is often difficult to treat, Initial antibiotic treatment of HCAP is often different from that for CAP due to the possibility of MDR bacteria  PNEUMONIA (HOSPITAL ACQUIRED) HAP develops 48 hours or more after admission and does not appear to be incubating at the time of admission. Certain factors may predispose patients to HAP because of impaired host defenses (e.g., severe acute or chronic illness), a variety of comorbid conditions, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, hypotension, and metabolic disorders. PNEUMONIA (HOSPITAL ACQUIRED) common organisms responsible for HAP include the Enterobacter species, Escherichia coli, H. influenzae, Klebsiella species, Proteus, Serratia marcescens, Pseudomonas aeruginosa, methicillin-sensitive or methicillin-resistant Staphylococcus aureus (MRSA), and S. pneumoniae. PNEUMONIA (VENTILATOR ASSOCIATED) the patient has been endotracheally intubated and has received mechanical ventilatory support for at least 48 hours. is a complication in as many as 28% of patient who require mechanical ventilation PNEUMONIA (IMMUNOCOMPROMISED HOST) includes Pneumocystis pneumonia (PCP), fungal pneumonias, and Mycobacterium tuberculosis. The organism that causes PCP is now known as Pneumocystis jiroveci instead of Pneumocystis carinii occurs with the use of corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, the use of broadspectrum antimicrobial agents, acquired immune deficiency syndrome ASPIRATION PNEUMONIA Aspiration pneumonia refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway common form of aspiration pneumonia is bacterial infection from aspiration of bacteria that normally reside in the upper airways  ASPIRATION PNEUMONIA Substances other than bacteria may be aspirated into the lung, such as gastric contents, exogenous chemical contents, or irritating gases. This type of aspiration or ingestion may impair the lung defenses, cause inflammatory changes, and lead to bacterial growth and a resulting pneumonia.  PNEUMONIA (CLINICAL MANIFESTATIONS) The patient with streptococcal (pneumococcal) pneumonia usually has a sudden onset of chills, rapidly rising fever (38.5° 1657 to 40.5°C pleuritic chest pain tachypnea (25 to 45 breaths/min) , shortness of breath and the use of accessory muscles in respiration Some patients exhibit an upper respiratory tract infection (nasal congestion, sore throat)  PNEUMONIA (CLINICAL MANIFESTATIONS) Predominant symptoms may be headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis. After a few days, mucoid or mucopurulent sputum is expectorated In severe pneumonia - the cheeks are flushed and the lips and nail beds demonstrate central cyanosis orthopnea (shortness of breath when reclining or in the supine position), →preferring to be propped up or sitting in bed leaning forward (orthopneic position) in an effort to achieve adequate gas exchange without coughing or breathing deeply. Appetite is poor, and the patient is diaphoretic and tires easily. Sputum is often purulent  PNEUMONIA (ASSESSMENT AND DIAGNOSTIC FINDINGS) HEALTH HISTORY SPUTUM EXAMINATION PHYSICAL EXAMINATION, CHEST X-RAY, BLOOD CULTURE PNEUMONIA (PREVENTIVE MEASURES) PNEUMONIA (MEDICAL MANAGEMENT) PNEUMONIA (MEDICAL MANAGEMENT) PNEUMONIA (MEDICAL MANAGEMENT)  PNEUMONIA (PHARMACOLOGIC THERAPY) appropriate antibiotic as determined by the results of a culture and sensitivity With known multidrug resistance, a three-drug combination therapy may be used; this drug regimen may include an antipseudomonal cephalosporin or ceftazidime (Fortaz) or antipseudomonal carbapenem or piperacillin/tazobactam (Zosyn) plus antipseudomonal fluoroquinolone or aminoglycoside plus linezolid (Zyvox) or vancomycin (Vancocin)  PNEUMONIA (PHARMACOLOGIC THERAPY) Treatment of viral pneumonia is primarily supportive Hydration is a necessary part of therapy Antipyretics may be used to treat headache and fever; antitussive medications may be used for the associated cough. Warm, moist inhalations are helpful in relieving bronchial irritation. Antihistamines may provide benefit with reduced sneezing and rhinorrhea. Nasal decongestants may also be used to treat symptoms and improve sleep; If hypoxemia develops, oxygen is given  PNEUMONIA (PHARMACOLOGIC THERAPY) hydration (2 to 3 L/day) Humidification may be used to loosen secretions and improve ventilation. Chest physiotherapy (percussion and postural drainage) position to promote rest and breathing (e.g., semiFowler’s position) avoid overexertion and to engage in only moderate activity during the initial phases of treatmen INFECTIOUS DISORDERS OF THE ADULTS TUBERCULOSIS PULMONARY TUBERCULOSIS is an infectious disease that primarily affects the lung parenchyma also may be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes. infectious agent, M. tuberculosis PULMONARY TUBERCULOSIS TRANSMISSION ✓airborne transmission ✓An infected person releases droplet nuclei (usually particles 1 to 5 mcm in diameter) through talking, coughing, sneezing, laughing, or singing RISK FACTORS. ✓Close contact with someone who has active TB ✓Living in overcrowded, substandard housing. ✓Any person without adequate health care ✓Immunocompromised status PULMONARY TUBERCULOSIS (PATHOPHYSIOLOGY) begins when a susceptible person inhales mycobacteria and becomes infected, body’s immune system responds by initiating an inflammatory reaction. Phagocytes (neutrophils and macrophages) engulf many of the bacteria, and TB-specific lymphocytes lyse (destroy) the bacilli and normal tissue reaction results in the accumulation of exudate in the alveoli PULMONARY TUBERCULOSIS (PATHOPHYSIOLOGY) Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. then transformed to a fibrous tissue mass, the central portion of which is called a Ghon tubercle/ GHON FOCUS becomes necrotic, forming a cheesy mass. This mass may become calcified and form a collagenous scar. the bacteria become dormant, and there is no further progression of active disease PULMONARY TUBERCULOSIS (PATHOPHYSIOLOGY) After initial exposure and infection, active disease may develop because of a compromised or inadequate immune system response Active disease also may occur with reinfection and activation of dormant bacteria. Ghon tubercle ulcerates, releasing the cheesy material into the bronchi. The bacteria then become airborne, resulting in the further spread of the disease. PULMONARY TUBERCULOSIS (CLINICAL MANIFESTATIONS) a low-grade fever, cough, night sweats, fatigue, and weight loss cough may be nonproductive, or mucopurulent sputum Hemoptysis also may occur PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) Tuberculin Skin Test Mantoux method is used to determine whether a person has been infected with the TB bacillus and is used widely in screening for latent M. tuberculosis infection screening tool for TB infection among children Tubercle bacillus extract (tuberculin), purified protein derivative (PPD), is injected into the intradermal layer of the inner aspect of the forearm The test result is read 48 to 72 hours after injection. reaction occurs when both induration and erythema (redness) are present. PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) Tuberculin Skin Test 0 to 4 mm is considered not significant 5 mm or greater may be significant in people who are considered to be at risk. It is defined as positive in patients who are HIV positive 10 mm or greater is usually considered significant in people who have normal or mildly impaired immunity significant reaction indicates past exposure to M. tuberculosis or vaccination with bacille Calmette-Guérin (BCG) vaccine significant (positive) reaction does not necessarily mean that active disease is present in the body; all significant reactors are candidates for active TB.  PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) SPUTUM CULTURE ✓Direct sputum smear microscopy (DSSM) is fundamental to the detection of infectious cases and is recommended for case finding among adults and children who can expectorate ✓CXR is used to complement bacteriologic testing in making a diagnosis. However, it has low specificity and does not differentiate drug-susceptible from drug-resistant disease ✓TB culture and drug susceptibility test (DST) using solid (Ogawa or Lowenstein Jensen) or liquid media (MGIT) is a routine diagnostic test for drug-resistant TB cases under the NTP National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf  PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) TB CLASSIFICATION National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf  PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) TB CLASSIFICATION National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf  PULMONARY TUBERCULOSIS (Assessment and Diagnostic Findings) TB CLASSIFICATION National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf PULMONARY TUBERCULOSIS (MEDICAL MANAGEMENT) MEDICAL MANAGEMENT PULMONARY TUBERCULOSIS (MEDICAL MANAGEMENT) MEDICAL MANAGEMENT  PULMONARY TUBERCULOSIS (MEDICAL MANAGEMENT) TB MANAGEMENT PER CATEGORY National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf  PULMONARY TUBERCULOSIS (MEDICAL MANAGEMENT) TB MANAGEMENT PER CATEGORY National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf  PULMONARY TUBERCULOSIS (MEDICAL MANAGEMENT) TB MANAGEMENT PER CATEGORY National Tuberculosis Program _ Manual Of Procedures _5th_Edition.pdf PULMONARY TUBERCULOSIS NURSING MANAGEMENT Increasing the fluid intake promotes systemic hydration and serves as an effective expectorant. Adherence to the prescribed treatment regimen is key in treating the disease and controlling the spread of infection take the medication either on an empty stomach or at least 1 hour before meals, because food interferes with medication absorption small, frequent meals may be required PULMONARY TUBERCULOSIS NURSING MANAGEMENT a progressive activity schedule that focuses on increasing activity tolerance and muscle strength important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene. INFECTIOUS DISORDERS OF THE ADULTS EBOLA EBOLA fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest. EBOLA first human outbreak of Ebola virus disease occurred in 1976 occurred in a village near the Ebola River, from which the disease takes its name. In 2014, the virus broke through this usual pattern and rampaged through the West African countries Liberia, Guinea, and Sierra Leone, with secondary cases in other countries in Africa, Europe, and the United States EBOLA Ebola is spread through direct contact with blood or body fluids (urine, vomit, feces, saliva, sweat, semen, and breast milk) from the person who is ill from the virus and possibly from contact with semen of a man who has recovered from Ebola. occasionally be spread by handling infected bats or infected wild animals that are sometimes hunted for food EBOLA EBOLA  EBOLA Nursing Management Supportive care patient should be isolated in a private room, away from other patients health care workers should wear complete PPE washing hands, avoiding touching the body fluids of people who have, or may have, Ebola Ervebo vaccine has been shown to be effective in protecting people from the species Zaire ebolavirus INFECTIOUS DISORDERS OF THE ADULTS MERS-COV Middle East respiratory syndrome coronavirus MERS COV MERS-COV MERS-CoV is a Middle East respiratory zoonotic virus, syndrome which means that is coronavirus transmitted between animals and people infected through direct or indirect contact with infected dromedary camels,  MERS COV Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by Middle East respiratory syndrome coronavirus (MERS‐CoV) that was first identified in Saudi Arabia in 2012. Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe acute respiratory syndrome (SARS) and Coronavirus disease-2019 (COVID-19). WORLD HEALTH ORGANIZATION https://www.who.int/  MERS COV The clinical spectrum of MERS- CoV infection ranges from no symptoms (asymptomatic) or mild respiratory symptoms to severe acute respiratory disease and death. fever, cough and shortness of breath. Pneumonia is a common finding, but MERS patients may not always develop this condition WORLD HEALTH ORGANIZATION https://www.who.int/  MERS COV MEDICAL MANAGEMENT No vaccine or specific treatment are currently available, however several MERS-CoV specific vaccines and treatments are in clinical development. treatment of MERS patients is supportive and based on the patient’s clinical condition. avoid contact with dromedary camels, drinking raw camel milk or camel urine, or eating meat that has not been properly cooked. WORLD HEALTH ORGANIZATION https://www.who.int/ INFECTIOUS DISORDERS OF THE ADULTS H1N1  H1N1 (SWINE FLU) Swine influenza is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of influenza in pigs. Swine flu viruses do not normally infect humans. However, sporadic human infections with influenza viruses have occurred. When this happens, these viruses are called "variant viruses.“ The 2009 H1N1 influenza A virus was first detected in people in the United States in April 2009. CENTER FOR DISEASE CONTROL https://www.cdc.gov/swine-flu/about/index.html  H1N1 (SWINE FLU) CENTER FOR DISEASE CONTROL https://www.cdc.gov/swine-flu/about/index.html  H1N1 (SWINE FLU) fever lethargy (tiredness) lack of appetite coughing runny nose sore throat eye irritation nausea vomiting CENTER FOR DISEASE CONTROL https://www.cdc.gov/swine-flu/about/index.html  H1N1 (SWINE FLU) MANAGEMENT ✓There are four different antiviral drugs that are recommended for use in the United States for the treatment of flu: oseltamivir, peramivir, zanamivir, and baloxavir. ✓CDC recommends that people who have contact with pigs get a seasonal flu vaccine every year to help prevent being infected with seasonal and variant influenza viruses ✓Safe handling and preparation of pork People at increased risk for severe influenza complications should avoid exposure to pigs.. CENTER FOR DISEASE CONTROL https://www.cdc.gov/swine-flu/about/index.html  H1N1 (SWINE FLU) MANAGEMENT Don't eat, drink or put anything in your mouth in areas with pigs. Wash your hands with soap and running water before and after exposure to pigs outside or inside a swine barn. If soap and water are not available, use an alcohol-based hand rub. To further reduce the risk of infection, avoid or minimize contact with pigs in the pig barn CENTER FOR DISEASE CONTROL https://www.cdc.gov/swine-flu/about/index.html INFECTIOUS DISORDERS OF THE ADULTS COVID 19  COVID 19 Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV- 2 virus. WORLD HEALTH ORGANIZATION https://www.who.int/health-topics/coronavirus#tab=tab_1  COVID 19 WORLD HEALTH ORGANIZATION https://www.who.int/health-topics/coronavirus#tab=tab_1  COVID 19 SIGNS AND SYMPTOMS Less common symptoms are: Less common symptoms are: The most common tight chest or chest pain muscle aches and heavy arms symptoms are: or legs shortness of breath fever severe fatigue or tiredness hoarse voice runny or blocked nose, or numbness or tingling chills sneezing appetite loss, nausea, sore throat headache vomiting, abdominal pain or sore eyes diarrhoea dizziness loss or change of sense of new and persistent cough taste or smell difficulty sleeping. WORLD HEALTH ORGANIZATION https://www.who.int/health-topics/coronavirus#tab=tab_1  COVID 19 People who have pre-existing health problems are at higher risk when they have COVID-19 People with severe disease and those needing hospital treatment should receive treatment as soon as possible. The consequences of severe COVID-19 include death, respiratory failure, sepsis, thromboembolism (blood clots), and multiorgan failure, including injury of the heart, liver or kidneys. WORLD HEALTH ORGANIZATION https://www.who.int/health-topics/coronavirus#tab=tab_1  COVID 19 (PREVENTION) VACCINATION Guideline Clinical management of COVID-19 patients- WORLD HEALTH ORGANIZATION  COVID 19 (MANAGEMENT) ANTIVIRAL MEDICATIONS ISOLATION confirmed moderate COVID-19 (pneumonia) be isolated to contain virus transmission symptomatic treatment such as antipyretics for fever and pain, adequate nutrition and appropriate rehydration. supplemental oxygen therapy – severe cases awake prone positioning of severely ill patients hospitalized with COVID- 19 Guideline Clinical management of COVID-19 patients- WORLD HEALTH ORGANIZATION  COVID 19 (MANAGEMENT) cautious fluid management in patients with COVID-19 without tissue hypoperfusion mild ARDS, non-invasive ventilation – continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) may be used. SEVERE ARDS endotracheal intubation; mechanical ventilation using lower tidal volumes Guideline Clinical management of COVID-19 patients- WORLD HEALTH ORGANIZATION