1. LOWER RESPIRATORY
TRACT INFECTIONS
MANALI H SOLANKI
F.Y.M.SC.NURSING
J G COLLEGE OF NURSING

2. TERMINOLOGY:
• BRONCHITIS
• PNEUMONIA
• PULMONARY TUBERCULOSIS
• HAEMOPTISIS
• HAEMATEMESIS

3. INTRODUCTION
• Lower respiratory tract infection
comprises an array of diseases ranging
from bronchitis to pneumonia.
• Non-pneumonic LRTI is described as
lower respiratory tract symptoms in a
patient who has no history of these or any
other chest signs related with infection,
by all of the major respiratory viral
groups.

4. ANATOMY AND PHYSIOLOGY
OF RESPIRATORY SYSTEM

10. BRONCHITIS:

11. DEFINITION:
• Bronchitis is an inflammation
of the bronchial tubes, the
airways that carry air to lungs

12. TYPES:
• There are two types of bronchitis
1.Acute bronchitis
2.Chronic bronchitis

13. Acute bronchitis
• Acute (i.e. recent onset) bronchitis is
an inflammation of the lower
respiratory passages (bronchi).

14. Chronic bronchitis
• Chronic bronchitis is defined
as a cough that occurs every
day with sputum production
that lasts for at least 3
months, two years in a row.

15. CAUSES:
• Viral infection that causes the
inner lining of the bronchial tubes
to become inflamed and undergo
the changes that occur with any
inflammation in the body.

16. • Bacteria can also cause bronchitis (a
few examples include, Mycoplasma,
Pneumococcus, Klebsiella,
Haemophilus).
• Chemical irritants (for example,
tobacco smoke, gastric reflux
solvents) can cause acute bronchitis

17. RISK FACTORS:
• Smokers
• People who are exposed to a lot of
second-hand smoke
• People with weakened immune systems
• The elderly and infants
• People with gastroesophageal reflux
disease (GERD)
• Those who are exposed to irritants at work

18. SIGN AND SYMPTOMS

19. • Coughing
• Production of clear, white, yellow,
grey, or green mucus (sputum)
• Shortness of breath
• Wheezing
• Fatigue
• Fever and chills
• Chest pain or discomfort
• Blocked or runny nose

20. ASSESSMENT AND
DIAGNOSTIC FINDINGS
• Patient history

21. Physical examination

22. Pulmonary function tests

23. Spirometry

25. Peak flow monitoring (PFM)

26. Pulse oximetry

27. X-ray

28. MEDICAL MANAGEMENT:
• Ibuprofen or acetaminophen
• Cough suppressant
E.g. Delsym, Robitussin Cough,
Dextromethorphan
• Steroid medicine

29. • Nasal decongestants: like Naphazoline,
Phenylephrine Oxymetazoline ,
Propylhexedrine, Phenylpropanolamine
• Antiviral medicine
Like amantadine, oseltamivir
• Antibiotics: Antibiotics may be given to
help treat or prevent an infection caused
by bacteria

30. PREVENTION:
• Avoid alcohol
• Avoid irritants in the air
• Drink more liquids
• Get more rest
• Eat healthy foods
• Use a humidifier or vaporizer

31. • Avoiding people who are sick with colds or
the flu
• Getting a yearly flu vaccine
• Getting a pneumonia vaccine (especially
for those over 60 years of age)
• Washing hands regularly
• Avoiding cold, damp locations or areas
with a lot of air pollution
• Wearing a mask around people who are
coughing and sneezing

32. NURSING MANAGEMENT
• Monitor for adverse effects of bronchodilators-
tremulousness, tachycardia, cardiac
arrhythmias, central nervous system stimulation,
hypertension.
• Monitor oxygen saturation at rest and with
activity.
• Eliminate all pulmonary irritants, particularly
cigarette smoke. Smoking cessation usually
reduces pulmonary irritation, sputum production,
and cough. Keep the patient’s room as dust-free
as possible.

33. • Use postural drainage positions to help
clear secretions responsible for airway
obstruction.
• Teach controlled coughing.
• Encourage high level of fluid intake (8 to
10 glasses; 2 to 2.5 L daily) within level of
cardiac reserve.
• Give inhalations of nebulized saline to
humidify bronchial tree and liquefy
sputum. Add moisture (humidifier,
vaporizer) to indoor air.

34. • Avoid dairy products if these increase
sputum production.
• Encourage the patient to assume
comfortable position to decrease
dyspnoea.
• Use pursed lip breathing at intervals and
during periods of dyspnoea to control rate
and depth of respiration and improve
respiratory muscle coordination.
• Discuss and demonstrates relaxation
exercises to reduce stress, tension, and
anxiety.

35. • Encourage frequent small meals if the patient is
dyspnoeic; en a small increase in abdominal
contents may press on diaphragm and impede
breathing.
• Offer liquid nutritional supplements to improve
caloric intake and counteract weight loss.
• Avoid foods producing abdominal discomfort.
• Encourage use of portable oxygen system for
ambulation for patients with hypoxemia and
marked disability.

36. PNEUMONIA

37. DEFINITION
• Pneumonia is an inflammation of the
lungs caused by bacteria, viruses, or
chemical irritants. It is a serious
infection or inflammation in which the
air sacs fill with pus and other liquid.

38. TYPES:
• Bacterial pneumonia

39. Viral pneumonia

40. Mycoplasma pneumonia

41. Aspiration pneumonia

42. Fungal pneumonia

43. Hospital acquired pneumonia

44. Community acquired pneumonia

45. CAUSES:
• Bacterial
• Viral
• Fungal
• Nosocomial and others

46. RISK FACTORS
• Smoke.
• Abuse alcohol.
• Have other medical conditions, such as
chronic obstructive pulmonary disease
(COPD), emphysema, asthma, or
HIV/AIDS.
• Are younger than 1 year of age or older
than 65

47. • Have a weakened or impaired immune system.
• Take medicines for gastroesophageal reflux
disease (GERD).
• Have recently recovered from a cold or influenza
infection.
• Are malnourished.
• Have been recently hospitalized in an intensive
care unit.

48. • Have been exposed to certain
chemicals or pollutants.
• Are Native Alaskan or certain Native
American ethnicity.
• Have any increased risk of breathing
mucus or saliva from the nose or
mouth, liquids, or food from the
stomach into the lungs.

49. SIGN AND SYMPTOMS
• Cough
• Rusty or green mucus (sputum) coughed up from lungs
• Fever
• Fast breathing and shortness of breath
• Shaking chills

50. • Chest pain that usually worsens when
taking a deep breath (pleuritic pain)
• Fast heartbeat
• Fatigue and feeling very weak
• Nausea and vomiting
• Diarrhoea
• Sweating
• Headache
• Muscle pain

51. ASSESSMENT AND DIAGNOSTIC
FINDINGS
• Chest x ray

52. Blood tests

53. Sputum culture

54. Pulse oximetry

55. chest CT scan

56. bronchoscopy

57. Pleural fluid culture

58. Thoracentesis

59. MEDICAL MANAGEMENT
• MACROLIDES
• TETRACYCLINES
• FLUOROQUINOLONES

60. SURGICAL MANAGEMENT
• Thoracotomy

61. Chest Tubes

62. COMPLICATIONS OF PNEUMONIA:
• Abscesses
• Respiratory Failure
• Bacteraemia
• Empyema and Pleural Effusions
• Collapsed Lung

63. NURSING MANAGEMENT
• Maintain a patent airway and adequate
oxygenation.
• Obtain sputum specimens as needed.
• Use suction if the patient can’t produce a
specimen
• Provide a high calorie, high protein diet of
soft foods

64. • To prevent aspiration during
nasogastric tube feedings, check the
position of tube, and administer
feedings slowly.
• To control the spread of infection,
dispose secretions properly.
• Provide a quiet, calm environment,
with frequent rest periods.

65. • Monitor the patient’s ABG levels,
especially if he’s hypoxic.
• Assess the patient’s respiratory status.
Auscultate breath sounds at least every 4
hours.
• Monitor fluid and intake output.
• Evaluate the effectiveness of administered
medications.
• Explain all procedures to the patient and
family

66. PREVENTION
• Good Hygiene and Preventing
Transmission
• Changing Hospital Practices
• Vaccines
• Viral Influenza Vaccines (Flu Shot)
• Pneumococcal Vaccines
• Vitamins

67. PULMONARY TUBERCULOSIS

68. DEFINITION
• Pulmonary tuberculosis is a chronic
infectious inflammation of the lung, as
well as a special pneumonia.

69. CAUSES AND RISK FACTORS
• Alcoholism
• IV drug abuse
• Crowded living conditions
• Homelessness
• Poverty

70. • Immigration from certain countries
• Low body weight
• Certain medical treatments (such as
corticosteroid treatment or organ
transplants)

71. SIGN AND SYMPTOMS
• Cough (usually cough up mucus)
• Coughing up blood
• Excessive sweating, especially at night
• Fatigue
• Fever
• Unintentional weight loss

72. Other symptoms that may occur with
this disease:
• Breathing difficulty
• Chest pain
• Wheezing

73. ASSESSMENT AND DIAGNOSTIC
FINDINGS
• Biopsy of the affected tissue (rare)
• Bronchoscopy
• Chest CT scan
• Chest x-ray
• Interferon-gamma blood test such as the
QFT-Gold test to test for TB infection
• Sputum examination and cultures
• Thoracentesis

74. Tuberculin skin test

75. MEDICAL MANAGEMENT
• 1st line drugs
DRUG DOSE
Isoniazide (INH) 300 mg/day
Rifampicin 600 mg/day
Pyrazinamide 1500 mg/day 25 mg/kg/day
Ethambutol 1200 mg/day 15-25
mg/kg/day
Streptomycin 0.75—1gm/day 25 mg/kg/day

76. 2nd line drugs
Amikacin (AG) 15 mg/kg/day
Aminosalicylic acid 8-12 gm/day
Capreomycin 15 mg/kg/day
Ciprofloxacin 1500 mg/day (divided)
Clofazimine 200 mg/day
Cycloserine 500-1000 mg/day
(divided)
Ethionamide 500-750 mg/day
Levofloxacin 500 mg/day
Rifabutin 300 mg/day

77. Current recommended treatment for
pulmonary TB has three regimens—
• 6 Month Regimen—virtually 100% effective,
more expensive. (usually only used in
pulmonary TB)

78. First 2 months
DRUG DOSE
Isoniazide—300mg 1 tablet daily (300mg)
Rifampicin—300mg 2 tablets daily (600mg)
Pyrazinamide—500mg 3 tablets daily (1500mg)
Ethambutol—400mg 3 tablets daily (1200mg)

79. Next 4 months
DRUG DOSE
Isoniazide—300mg 1 tablet daily (300mg)
Rifampicin—300mg 2 tablets daily (600mg)
Pyridoxine—10mg 1 tablet daily (10mg) for 6
months

80. 9 Months Regimen
• First 2 months
DRUG DOSE
Isoniazide—300mg 1 tablet daily (300mg)
Rifampicin—300mg 2 tablets daily (600mg)
Ethambutol—400mg 3 tablets daily
(1200mg)

81. Next 7 months
DRUG DOSE
Isoniazide—300mg 1 tablet daily (300mg)
Rifampicin—300mg 2 tablets daily
(600mg)
Pyridoxine—10mg 1 tablet daily (10mg)

82. 12 Months Regimen—inexpensive
and reasonably effective.
• Regimen 1—effectiveness is nearly 100%
Injection 1gm (IM)—Twice
Streptomycin Weekly
Tablet Isoniazide 15 mg/kg/day
Tablet Pyridoxine 1 tablet of 10mg daily

83. Regimen 2—very cheap,
effectiveness is 80-90%
Isoniazide 1 tablet daily
(300mg)
Tablet Thiocetazone 1 tablet daily (150mg)
Pyridoxine 1 tablet daily (10mg)

84. Prophylactic Dose
• Isoniazide is indicated for the prophylactic
use of TB, the dose is 300mg/day
(5mg/kg/day) or 900mg twice weekly for 6
months in most cases and 12 months in
case of immuno-compromised patients

85. ADVERSE EFFECT OF DRUGS
Isoniazide Peripheral Neuropathy
Rifampicin Cholestatic jaundice +
renal toxicity + Flu like
syndrome
Pyrazinamide Hepatotoxicity + Hyper-
Uricaemia
Ethambutol Retinobulbar optic neuritis

86. Prevention

87. DIETARY MANAGEMENT

88. NURSING MANAGEMENT
• Ineffective Airway Clearance may be
related to excessive, thickened mucous
secretions, possibly evidenced by
presence of rhonchi, tachypnea, and
ineffective cough.
• Acute pain related to localized
inflammation and persistent cough.

89. • Imbalance nutrition less than body
requirement related to frequent cough,
anorexia and fatigue.
• Risk for infection related to inadequate
primary defences and decreased cilliary
action
• Anxiety related to outcome of diseases as
evidenced by poor concentration on work,
isolation from others, rude behaviour

90. • Activity Intolerance related to
imbalance between O2 supply and
demand, possibly evidenced by
reports of fatigue, dyspnoea, and
abnormal vital sign response to
activity.
• Knowledge deficit regarding the
treatment modalities and prognosis

91. ABSTRACT
• Lower respiratory tract infection and rapid
expansion of an abdominal aortic
aneurysm: a case report

92. SUMMARY:

94. BIBLIOGRAPHY: