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( can these notes/terms be written so its in complete sentences where a group of high school students can understand them) Pneumonia, TB, Flu, & COVID-19 1. Respiratory Infections Respiratory infections range from mild to life-threatening and require early recognition, isolation precautions, and respiratory support. Encourage vaccination against influenza, pneumonia, and COVID-19 to prevent infections. Interventions for clients with respiratory infections include: ⮹ Implement appropriate isolation precautions to prevent disease transmission (TABLE 1). ⮹ Raise the HOB to promote lung expansion. ⮹ Administer supplemental oxygen as needed to treat hypoxemia (pulse oximetry reading <90%). ⮹ Monitor respiratory status frequently, including breath sounds, oxygen saturation, and respiratory effort. 2. Pneumonia Pneumonia: Lung infection causing inflammation and fluid buildup in the alveoli, leading to impaired gas exchange (FIGURE 1). ⮹ Can be acquired in the community (CAP), in a health care setting (HCAP), or as a result of aspiration or mechanical ventilation (VAP). ⮹ Clients with pneumonia are at high risk for dehydration due to fever, tachypnea, and poor oral intake. Assessment findings Productive cough with purulent or rust-colored sputum ⮹ Dyspnea, hypoxia, crackles ⮹ Fever, malaise ⮹ Chest X-ray shows area of density or consolidation. TABLE 1. ISOLATION PRECAUTIONS AT A GLANCE Infection Precautions Pneumonia Varies based on causative organism Tuberculosis (TB) Airborne ⮹ N95 respirator ⮹ Private room with negative pressure airflow and HEPA filter Influenza Droplet ⮹ Surgical mask ⮹ Private room or cohort clients with same infection COVID-19 Airborne + Contact + Eye shield ⮹ N95 respirator ⮹ Gown, gloves, and face shield ⮹ Private room with negative pressure airflow and HEPA filter See INFECTION CONTROL CHEAT SHEET. FIGURE 1. PNEUMONIA © Bootcamp.com 5 2. Pneumonia, Continued Interventions 1. Support oxygenation: ⮹ Encourage incentive spirometer use and deep breathing exercises to prevent atelectasis. ⮹ Administer supplemental oxygen as needed. ⮹ Balance rest and activity. 2. Administer antibiotics and supportive medications: Administer broad-spectrum antibiotics as soon as pneumonia is suspected. ⮹ Final antibiotic selection is based on blood culture results. ⮹ Administer bronchodilators and mucolytics to help clear secretions. ⮹ Administer analgesics and antipyretics to manage symptoms (acetaminophen, ibuprofen). 3. Manage dehydration: Encourage fluid intake of 2-3 L/day to prevent dehydration and help thin secretions for easier expectoration. ⮹ Administer IV fluids as needed. 4. Monitor for complications: ⮹ Respiratory failure:î €pulse oximetry, productive cough, dyspnea ⮹ Sepsis:î ‰WBCs,î ‰lactate level, fever, and altered mental status 5. Provide client education: ⮹ Complete antibiotics as prescribed. ⮹ Eat small, frequent meals to conserve energy. ⮹ Report signs of worsening infection or sepsis. Pneumonia: Administer broad-spectrum antibiotics to treat infection and encourage fluid intake of 2-3 L/day to prevent dehydration and thin secretions. 3. Pulmonary Tuberculosis Pulmonary tuberculosis (TB): Lung infection caused by M. tuberculosis ⮹ Spread via airborne droplets (coughing, sneezing, talking) ⮹ TB primarily infects the lungs but can also affect Respiratory other body parts (kidneys, bone). Risk factors ⮹ Close contact with infected individuals (health care workers) ⮹ Immunosuppression (HIV, organ transplant recipient) ⮹ Crowded living conditions (prisons, shelters) Assessment findings TB infections are either latent or active. ⮹ Latent: Positive TB test but asymptomatic and not contagious ⮹ Can become active TB if the immune system becomes weakened ⮹ Active: Contagious with symptoms such as: ⮹ Persistent cough (>3 weeks) Hemoptysis (coughing up blood) Fever, night sweats ⮹ Unintentional weight loss Tuberculin skin test (TST) ⮹ TST (Mantoux) test is positive in clients with latent or active TB. ⮹ Administer intradermal injection of 0.1 mL of tuberculin PPD into the forearm (ID injection at a 5-15 degree angle) (FIGURE 2). 48-72 hr after injection, measure the diameter of the induration (raised, hardened area), not the diameter of redness. Positive if induration is: ⮹ ≥15 mm in clients with no TB risk factors ⮹ ≥10 mm in clients with high risk for exposure (homeless shelter/prison, recent immigrants) ⮹ ≥5 mm in immunocompromised clients (HIV+, organ transplant) Tuberculin skin test (TST): 48-72 hours after administration, measure only the induration (raised, hardened area), not the redness. The test is positive if induration is ≥5 mm for clients with immuosupression (HIV), ≥10 for clients in high risk living situations (prison, homeless shelter), and ≥15 for clients with no TB risk factors. © Bootcamp.com 52 3. Pulmonary Tuberculosis, Continued FIGURE 2. TUBERCULIN SKIN TEST (TST) Interventions 1. Implement airborne precautions: ⮹ Negative pressure room ⮹ N95 mask for health care workers ⮹ Client wears a surgical mask when leaving the room. 2. Confirm active versus latent TB: ⮹ Positive TB skin test (Mantoux test) ⮹ Sputum culture: Confirms active TB ⮹ Screen close contacts for TB and provide treatment as needed. 3. Promote medication adherence: Medication adherence is a high priority to prevent drug-resistant TB. Anti-tuberculosis (RIPE) therapy with multiple medications (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) is required for 6-12+ months (TABLE 2). ⮹ If medication nonadherence is suspected, directly observed therapy (DOT) may be required, where a health care worker administers medications directly to the client. 4. Educate on transmission: ⮹ Teach client methods toî €transmission (avoid crowded areas, cough or sneeze into tissues and dispose into plastic bag). ⮹ No longer contagious after three consecutive negative sputum cultures TABLE 2. TB RIPE MEDICATIONS AT A GLANCE Risk for hepatotoxicity ⮹ Monitor liver function tests (AST/ALT) before and during RIPE therapy. ⮹ Instruct clients to avoid alcohol. ⮹ Monitor for jaundice and dark urine. ⮹ Medication adherence is critical to prevent drug resistant TB. ⮹ Directly observed therapy (DOT) may be needed for clients with nonadherence. Medication Nursing considerations Rifampin ⮹ Turns sweat and tears red orange: Instruct client to wear glasses instead of contacts to prevent staining. ⮹ î €effectiveness of oral contraceptives: Instruct client to use backup method (condoms). Isoniazid ⮹ Risk for neuropathy from impaired absorption of vitamin B6: Take supplemental vitamin B6 (pyridoxine) daily and notify HCP for numbness and tingling. Pyrazinamide ⮹ Risk for photosensitivity: Instruct client to wear sun protection. Ethambutol ⮹ Risk for optic neuritis: Instruct client to immediately report vision changes and assess visual acuity before and during treatment. Respiratory TB treatment: TB requires multi-drug therapy (RIPE regimen) for months. To reduce risk for hepatotoxicity, monitor liver function tests before and during treatment and instruct clients to avoid alcohol. © Bootcamp.com 53 4. Influenza Influenza: Viral infection of the respiratory tract caused by the influenza virus ⮹ Spreads through droplet transmission (sneezing, coughing, talking) Assessment findings include an abrupt onset of: ⮹ Fever, chills ⮹ Myalgias (muscle aches), fatigue ⮹ Dry cough Interventions 1. Prevent infection: ⮹ Encourage annual flu vaccine. ⮹ Implement droplet precautions to prevent transmission (surgical mask). 2. Manage symptoms: Administer antivirals like oseltamivir (Tamiflu) within 48 hr of symptom onset. ⮹ Provide supportive care (fluids, rest, analgesics, antipyretics). 3. Monitor for complications: ⮹ Assess for respiratory distress (î €pulse oximetry, dyspnea). ⮹ Can cause pneumonia or exacerbate chronic conditions (COPD, asthma) 5. COVID-19 COVID-19: Viral infection caused by the SARS-CoV-2 virus. ⮹ Primarily spread through droplet and airborne transmission Risk factors for severe COVID-19 include: ⮹ Unvaccinated status ⮹ Older age (>65) Interventions 1. Implement infection control precautions: Implement airborne and contact precautions with eye protection (N95, gown, gloves, face shield). ⮹ Avoid giving inhaled medications using a nebulizer, Respiratory which can aerosolize and spread the virus; administer inhaled medications using a metered dose inhaler instead. 2. Support oxygenation: ⮹ Administer noninvasive ventilation (NIV) as needed (CPAP, BiPAP, high-flow nasal cannula). ⮹ Place clients with severe hypoxemia in a prone position toî ‰perfusion to the larger, posterior surface of the lungs (FIGURE 3). ⮹ Notify HCP for hypoxemia that does not improve with oxygen therapy (refractory hypoxemia), which indicates acute respiratory distress syndrome (ARDS). 3. Prevent complications: ⮹ Administer antivirals (remdesivir) and glucocorticoids (dexamethasone) to reduce disease severity. ⮹ Administer antipyretics for fever (acetaminophen). ⮹ Administer anticoagulants as prescribed (enoxaparin) to prevent clots due toî ‰DVT/PE risk. ⮹ Monitor for cytokine storm, a severe inflammatory response (high fever, chills). 4. Vaccination and education: Encourage COVID-19 vaccines and booster shots to reduce risk of transmission, severe disease, and death. ⮹ Reinforce hand hygiene, masking, and social distancing to prevent disease transmission. ⮹ Chronic conditions (diabetes, lung disease, renal failure) ⮹ Obesity ⮹ Pregnancy Assessment findings vary and include: ⮹ Fever, fatigue ⮹ Dry cough, dyspnea ⮹ Loss of taste/smell ⮹ Severe cases: Respiratory failure, ARDS, multi-organ failure Influenza: Influenza requires droplet FIGURE 3. PRONE POSITION

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