Transcript Lower airway slides 119

RESPIRATORY AIRWAY
DISORDERS
DISORDERS OF THE UPPER AIRWAY

EPISTAXIS: (also called nosebleed)
1. The pathophysiology is congestion of the
nasal membranes, leading to capillary
rupture. This condition is frequently caused
by injury. This condition happens more in
men than in women.
2. Can be either a primary or a secondary
disorder.
EPISTAXIS, cont.
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PRIMARY:
1. hereditary hemorrhagic telangiectasia
2. sclerotic vessels
SECONDARY:
1. nasal tumor
2. nasal fracture
3. trauma
4. cocaine use
5. hypertension
6. inhaled steroids
CLINICAL MANIFESTATIONS
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The presence of bright red blood from one or
both nostrils
With severe bleeding, an adult can lose as
much as one liter of blood per hour. This is
rare.
NOSEBLEED
ASSESSMENT
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SUBJECTIVE:
1. Interview the pt.
2. Ask questions relevant to the duration
and severity of the bleeding.
3. Ask the precipitating factors.
ASSESSMENT, cont.
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OBJECTIVE:
1. Assess the bleeding; is it from one nostril
or from both.
2. The nurse must determine if the bleeding
is from the anterior or the posterior portion of
the nasal passageway.
3. The nurse checks the vital signs: BP,P,R
and T. She also checks for signs of
hypovolemic shock.
DIAGNOSTIC TESTS
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1. Draw H + H, PT, INR, PTT. These lab.
tests determine the amount of blood loss,
and identify clotting abnormalities.
2. A rhinoscopy may be performed to locate
the bleeding site. This procedure involves
the insertion of a lighted speculum into the
nasal cavity.
RHINOSCOPY
RHINOSCOPY
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Multiple foreign bodies;
sprigs from an
evergreen tree.
MEDICAL MANAGEMENT
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1. Nasal packing (cotton) that is saturated
with 1:1000 epinephrine for vasoconstriction.
2. Cautery can be either electrical (the
bleeding vessel is burned), or chemical in
which a silver nitrate stick is applied to the
site of bleeding.
3. Posterior packing may be needed. The
use of balloon tamponade may be needed.
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3. cont: Balloon tamponade is
accomplished by inserting a Foley catheter
(or something similar) into the nose and
inflating the balloon after it is placed
posteriorly. Then traction is applied to the
catheter to compress the area.
4. Antibiotics may be prescribed to minimize
the risk of infection.
Sengstaken-Blakemore tube
NURSING INTERVENTIONS
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1. Keep the pt. quiet.
2. Place in a sitting position, leaning forward,
or, reclining with the head and shoulders
elevated.
3. Apply direct pressure for 10-15 minutes.
4. Apply ice compresses to the nose; have
the pt. suck on ice.
NURSING INTERVENTIONS, cont.
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5. Monitor for s/s of bleeding.
6. Apply a gauze pad into the nostril; gently
apply pressure if bleeding continues.
NURSING DIAGNOSES
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1. Ineffective tissue perfusion, cerebral
and/or cardiopulmonary, related to blood loss
2. Risk for aspiration, related to bleeding
PATIENT AND FAMILY TEACHING
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1. Do not pick, scratch or irritate the nose.
2. Do not blow the nose vigorously.
3. Avoid dryness of the nose,
4. Do not insert any foreign objects in the nose.
5. Encourage the use of nasal or saline lubricants.
6. May use a vaporizer.
7. THE PROGNOSIS IS GOOD WITH
TREATMENT.
VAPORIZERS
Deviated septum and nasal polyps
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Etiology/pathophysiology:
1. Deviated septum is either congenital or
from trauma.
2. The septum deviates from the midline,
causing obstruction (usually partial) of the
nasal passageway.
3. Polyps are tissue growths on the nasal
tissues. These are usually caused by
allergies or sinus inflammation.
NASAL POLYPS
CLINICAL MANIFESTATIONS
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1. Stertorous respirations: These sound like
snores. The breathing can be dyspneic,
cause an effort, have postnasal drip, be
strenuous.
NASAL POLYPS
ASSESSMENMT
SUBJECTIVE:
1. Ask if there were any previous
injuries or infections.
2. Check for allergies and sinus congestion.
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OBJECTIVE:
1. Identify the condition and its location.
2. Monitor the rate and rhythm, and character of
respirations.
DIAGNSOTIC TESTS
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1. Visual exam.
2. Sinus radiographic tests.
SINUS CT SCAN
MEDICAL MANAGEMENT
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1. Surgical correction. A nasoseptoplasty may need to be done
to reconstruct, align, or straighten the nasal septum. (for a
deviated septum).
2. Nasal polypectomy.
3. Medications include:
a. Corticosteroids to decrease or make polyps disappear.
b. Antihistamines for allergies, and to decrease congestion.
c. Antibiotics may be used to prevent infection.
d. Analgesics for pain (often for a HA).
NURSING INTERVENTIONS
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1. Maintain a patent airway.
2. Prevent infection.
3. Monitor for bleeding and pain.
DIAGNOSES:
1.
Ineffective airway clearance, related to nasal
exudate
2.
2. Risk for injury, related trauma to bleeding with
vigorous nose blowing
PATIENT AND FAMILY TEACHING
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1. Avoid vigorous nose
blowing, coughing, or
holding your breath while
bearing down. (for at least 2
days post-op)
2. Notify PCP if bleeding or
infection occurs.
3. Use nasal sprays and
drops sparingly.
4. Facial edema and
ecchymosis may appear.
NASAL SPRAYS
HAY FEVER
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Also called antigen-antibody allergic rhinitis
and allergic conjunctivitis.
These conditions occur in the nasal
membranes, nasopharynx, and conjunctiva
form inhaled or contact allergens.
HAY FEVER
HAY FEVER
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Etiology/pathophysiology
1. Occur as the result of an antigen-antibody
reaction.
2. Ciliary action slows, mucous increases,
leukocytes infiltrate.
3. Capillaries dilate, become more
permeable, tissue edema then results.
ALLERGENS
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COMMON
ALLERGENS:
1. weed pollens
2. trees, grass
3. molds, mites
4. fungi, animal dander
CLINICAL MANIFESTATIONS
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1. Photophobia, edema, blurring of vision,
pruritis, excessive tearing.
2. Inability to breathe through the nose,
excessive nasal secretions.
3. Otitis media may occur if the eustachian
tubes are occluded.
NASAL CONGESTION
ASSESSMENT
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1.
2.
3.
4.
5.
6.
7.
8.
Severe sneezing
Congestion
Pruritis
Lacrimation (watery eyes)
Cough
Nosebleed
Headache
Nasal drip
HAY FEVER, cont.
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If the s/s are not treated, the chronic
sufferers can develop secondary infections.
DIAGNOSTIC TESTS
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Physical exam, visualization of the eyes, ears
nose.
A search for the allergens. This is done by
skin testing or by a serum
radioallergosorbent test (RAST)
SKIN TESTING FOR ALLERGENS
MEDICAL MANAGEMENT
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1. Relieve the s/s.
2. Prevent infection.
3. Alleviate other complaints (fatigue, severe
HA, malaise).
4. Antihistamines.
5. Decongestants.
6. Alomide is recommended for allergic
conjunctivitis.
MEDICAL MANAGEMENT, cont.
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7. Topical or nasal corticosteroids.
8. Analgesics.
9. Hot packs over the facial sinuses. (for HA
relief)
PATIENT AND FAMILY TEACHING
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Teach the pt. to avoid the allergens that
cause this condition.
Teach the pt. to self-manage through
symptom control.
Teach about the meds.
OBSTRUCTIVE APNEA
OBSTRUCTIVE SLEEP APNEA
ETIOLOGY AND PATHOPHYSIOLOGY
1. Complete or partial upper airway
obstruction during sleep, causing apnea and
hypopnea.
2. Apnea: the cessation of spontaneous
respirations
3. Hypopnea: abnormally shallow and slow
respirations.
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4. The tongue and the soft palate fall backward, and
partially or completely obstruct the pharynx.
5. This may last 15-90 sec.
6. During this time, the pt. experiences hypoxemia
(decreased PaO2) and hypercapnia (increased
PaCO2).
7. These changes stimulate the pt. to awaken and
take a breath.
8. Apnea and arousal cycles occur as many times
as 200-400 times during a 6-8 hour sleep period.
CLINICAL MANIFESTETIONS
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1.
2.
3.
4.
5.
6.
7.
8.
Frequent awakening at night.
Insomnia.
Excessive daytime sleepiness.
Witnessed apneic episodes.
Loud snoring.
Morning headaches.
personality changes, irritability.
Systemic HTN, stroke, cardiac dysrhythmias.
Symptoms of sleep apnea
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9. Chronic sleep loss can lead to inability to
concentrate, impaired memory, failure to
accomplish tasks, and interpersonal
difficulties.
10. Driving accidents are more common.
11. It is more difficult to maintain employment
and a family life.
12. The male may experience impotence.
13. Severe depression is not uncommon.
Sleep apnea symptoms
RISK FACTORS
1.
2.
3.
4.
5.
6.
Male gender.
Older age.
Obesity.
Nasal allergies, polyps, septal deviation.
Receding chin.
Phayngeal structural abnormalities.
Appropriate referral should be made if these
problems or risk factors are identified.
DIAGNOSTIC TESTS
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This dx. Is made during sleep with the use of
polysomnography.
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The pt.’s chest , abdominal movement, oral airflow,
nasal airflow. SpO2, ocular movement, and heart
rate and rhythm are monitored and time in each
sleep stage is determined.
A dx. of sleep apnea requires documentation of
multiple episodes of apnea or hypopnea.
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POLYSOMNOGRAPHY
MEDICAL MANAGEMENT
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1. Avoid sedatives.
2. Avoid alcoholic beverages 3-4 hours
before sleep.
3. Enter a weight loss program if needed.
4. Symptoms resolve in half of the pts with
sleep apnea who use an oral appliance
during sleep to prevent airflow obstruction.
5. Support groups can be helpful.
nCPAP
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6. Nasal continuous positive pressure
(nCPAP) can be used for pts. who have
severe sx. The blower maintains positive
pressure from 5-15 cm. of H2O in the airway
during both inspiration and expiration to
prevent airway collapse.
7. BiPAP is also used for those pts. who
cannot exhale against a high pressure.
nCPAP devices
BiPAP face mask with the machine
Other treatments
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If the previously mentioned measures fail, then
surgery is the next step.
The 2 most common procedures are:
1. uvulopalatoplasty, pharyngoplasty.
2. genioglossal advancement and hyoid myotomy.
#1 Involves the excision of the uvula, tonsillar pillars,
and posterior soft palate. This removes the
obstructing tissue. (called a UPPP)
UPPP (removal of the uvula, tonsillar
pillars, and the posterior soft palate)
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The # 2 surgery involves advancing the
attachment of the muscular part of tae
tongue on the mandible. (called GAHM)
When GAHM is done, UPPP is also done.
A still newer procedure is laser-assisted
uvulopalatpplasty. This is used to treat sleep
apnea.
MANDIBLE ADVANCEMENT
UPPER AIRWAY OBSTRUCTION
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Etiology/Pathophysiology
1. Precipitated by a recent respiratory event, such as
trauma to the airway or to the surrounding tissues.
2. Common items that obstruct are:
dentures
aspiration of vomitus or secretions
the tongue ( the most common in an unconscious
person)
UNCONSCIOUS PERSON
CLINICAL MANIFESTATIONS
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1. Stertorous respirations. (snoring)
2. Altered respiratory rate and character.
3. Apneic periods.
ASSESSMENT
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SUBJECTIVE:
Very limited because the pt. has a difficult time with breathing,
and therefore, also with speaking.
OBJECTIVE:
1. Assess for signs of hypoxia (disorientation, fatigue, anxiety,
etc.)
2 . Cyanosis of the skin, esp. the lips and nail beds.
3. Snoring, wheezing, or stridorous respirations.
4. With increased hypoxia, the result is bradycardia and
shallow, slow respirations.
CYANOSIS, BRADYCARDIA
DIAGNOSTIC TESTS
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This is a medical emergency. No diagnostic
tests are needed. Prompt assessment is of
utmost importance!!!!!!
MEDICAL MANAGEMENT
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1. Emergency tracheostomy.
2. An artificial airway may need to be
inserted to maintain patency.
TRACHEOSTOMY
NURSING INTERVENTIONS
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1. Open the airway and restore patency.
2. The Heimlich maneuver may be needed
to remove a foreign body.
3. Reposition the head and neck by using
the head-tilt/chin/lift technique.
NURSING DIAGNOSES
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1. Ineffective airway clearance, related to
obstruction in airway.
2. Risk for aspiration, related to partial
airway obstruction.
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1. You walk in the pt.’s room, find him with the
universal choking sign. What do you do?
1. Can you talk? Are you
choking?
2. If he shakes his head,
indicating “no”, then
perform the Heimlich
maneuver
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1.
2.
3.
4.
5.
6.
7.
8.
You walk into your pt.’s room to
perform the morning
assessment. You observe
vomitus all over his face and
chest. He is somnolent. What
do you do?
Monitor his respiratory rate, rhythm, and effort.
Turn him onto his side. Suction out the secretions from his mouth.
Wash all the vomitus from his face, chest.
Check his V.S. ,including pulse oximetry. Apply O2 by nasal cannula.
Auscultate the lungs.
Ask the pt. if he is still feeling nauseated. Administer med., if indicated.
Elevate the head of the bed and turn onto his side.
Assess the pt. as to why he experienced the nausea, and consequent
vomiting.
PATIENT AND FAMILY TEACHING
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1. Teach PREVENTION!!!!!!
2. Teach the Heimlich maneuver.
3. Teach the reasons for all treatments and
procedures.
4. Maybe a CPR class should be
recommended.
Disorders of the Upper Airway
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Cancer of the larynx
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Etiology/pathophysiology
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Squamous cell carcinoma (is increasing in frequency,
and also increasing among women)
Heavy smoking and alcohol use (cigarettes, cigars,
pipes, chewing tobacco, smokeless tobacco)
Chronic laryngitis
Vocal abuse
Family history
CANCER OF THE LARYNX
Cancer of the larynx limited to the vocal
cords is very slow-growing. There is a
decreased supply of lymph tissue and fluid
there.
Elsewhere in the larynx, there is an
abundance of lymph tissue, so cancer in
these areas spreads rapidly.
CLINICAL MANIFESTATIONS
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1. Progressive or persistent hoarseness. If
hoarseness persists for longer then 2 weeks,
medical treatment should be sought. The following
symptoms may indicate metastases to other areas.
(#2-#6)
2. Pain in the larynx, radiating to the ear.
3. Difficulty swallowing.
4. A feeling of a lump in the throat.
5. Enlarged cervical lymph glands.
6. Hemoptysis.
ASSESSMENT
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SUBJECTIVE:
Assess the onset and duration of sx.
OBJECTIVE:
Exam the sputum for blood (usually this is
blood from the respiratory tract).
DIAGNOSTIC TESTS
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1. Visual exam with direct laryngoscopy.
2. CT scan or MRI may be performed to
detect local and regional spread.
3. Take a health hx.
4. A biopsy and a microscopic study of the
lesion will be definitive.
LARYNGOSCOPY
MEDICAL MANAGEMENT
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1. Treatment is determined by the extent of the
tumor.
2. Radiation or surgery is often performed.
3. If the tumor is limited to the cord without limitation
of cord movement, then radiation therapy is the best
treatment.
4. Surgery is used when extension of the tumor
becomes affixed to one of the cords, or extends
upward or downward from the larynx.
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5. Total or partial laryngectomy.
6. Radical neck dissection. This is done to
remove the cervical lymph nodes and the entire
larynx. These pts. Have a high risk of
metastases to the neck.
LARYNGECTOMY
NURSING INTERVENTIONS
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1. Proper suctioning techniques.
2. Assess skin integrity around the tracheal
opening. Be alert for s/s of infection.
3. Monitor I + O. Assist with tube feedings.
(usually temporary)
4. Daily weights. Assess hydration status.
5. Perform a thorough psychosocial
assessment.
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6. Order a speech consult.
7. Encourage communication through writing,
gestures, facial expressions.
8. Invite a member from a support group to
come and visit the pt. Or recommend that the pt.
join a support group. (Lost Chord Club, New
Voice Club)
NURSING DIAGNOSES
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1. Impaired airway clearance, related to
secretions or obstruction
2. Impaired communication (verbal), related
to removal of larynx
1. Provide the pt. with implements for
communication (paper, pencil,
Magic Slate, electronic voice
device,
2. Keep the call light at hand at all
times.
3. Ask the pt. questions that only
require a “yes” or “no” answer.
4. Order a speech consult.
5. Refer to local support groups.
RESPIRATORY INFECTIONS
1.
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ACUTE RHINITIS (or coryza, also known as the
common cold)
ETIOLOGY and PATHOPHYSIOLOGY
An inflammatory condition of the mucous
membranes of the nose and sinuses.
Caused by one or more viruses.
It may become complicated by a bacterial
infection.
Sinus congestion causes an increase in sinus
drainage, post-nasal drip, throat irritation, HA, and
earache.
CLINICAL MANIFESTATIONS
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1. Increased amount of thin, serous nasal
exudate.
2. Productive cough.
3. Sore throat and fever.
4. If uncomplicated, it subsides in a week.
ASSESSMENT
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SUBJECTIVE:
1. The pt.’s complaints of sore throat,
dyspnea, and congestion.
OBJECTIVE:
1. Note the color and consistency of the
nasal discharge.
2. Visually exam the throat. Observe
redness, edema, local irritation.
Diagnostic Tests
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Throat and sputum cultures.
MEDICAL MANAGEMENT
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1. Accurate dx and prevention of
complications.
2. No specific tx. For the common cold.
3. ASA and/or Tylenol may be used for
analgesia or reduction of fever.
4. Cough suppressant for a dry,
nonproductive cough.
5. An expectorant for a productive cough.
6. An antibiotic for a bacterial infection.
NURSING INTERVENTIONS
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1. Promote comfort.
2. Encourage fluids.
3. Apply warm, moist packs to sinuses.
PATIENT AND FAMILY TEACHING
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1. Teach proper hand washing and disposal
of disposal of tissues that were used for
nasal discharge.
2. Limit exposure to others during the first 48
hours.
3. Check body temp. every 4 hours.
NURSING DIAGNOSIS
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Health-seeking behaviors: illness prevention,
related to preventing exacerbation or spread
of infection.
1. Health maintenance
behaviors. (proper
hand washing,
disposal of used
Kleenexes, etc.
2. Adequate fluids and
nutrition.
ACUTE FOLLICULAR TONSILLITIS

ETIOLOGY and PATHOPHYSIOLOGY
1.This can be an acute inflammation of the tonsils.
2. It is the result of an air- or food borne bacterial
infection. (often Streptococcus)
3. It can be viral also, but this is less the case.
4. If it is caused by Group A B-hemolytic
Streptococci, sequelae can occur. These can be:
rheumatic fever, carditis and nephritis. It is most
common in children.
CLINICAL MANIFESTATIONS
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1. Sore throat, fever, chills, malaise.
2. Enlarge, tender, cervical lymph nodes.
3. General muscle aching.
4. Lab. Test reveals an increased WBC
count.
MUSCLE ACHE, ENLARGED
CERVICAL NODE
ASSESSMENT
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SUBJECTIVE:
1. Monitor the severity of the sore throat
2, Ask if the pain is referred to the ears.
3. Is a HA or joint pain present?
JOINT PAIN
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OBJECTIVE DATA:
1. Visual exam that shows throat secretions
and enlarge, reddened tonsils.
DIAGNOSTIC TESTS
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1. Throat culture
2. CBC to check the WBC count.
MEDICAL MANAGEMENT
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1. Early antibiotic meds. Specific to the
bacteria.
2. A tonsillectomy and adenoidectomy (T+A)
is performed. (usually done in people who
have recurrent attacks).
3. Meds. used for tonsillitis are: antipyretics,
analgesics, and antibiotics.
4. Warm, saline mouth gargles.
NURSING INTERVENTIONS
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1. Thorough oral care that will promote comfort and
reduce/prevent infection.
2. If the pt. if a post-op. pt., observe for frequent swallowing.
(this may indicate excessive bleeding).
3. Post-op care: IV fluids until the nausea subsides, then the
pt. may begin drinking ice cold fluids slowly.
4. Advance the diet to soft liquids, then to a regular diet.
5. Apply an ice collar to the neck for comfort and
vasoconstriction.
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6. Check V.S.
7. Provide physical and emotional comfort.
NURSING DIAGNOSES
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1. Pain, related to inflammation/irritation of
1. Assess the degree of pain and the need for
the pharynx. analgesics.
2. Offer warm, saline gargles, ice chips, and/or
ice collar.
3. Document.

2. Risk for deficient fluid volume, related to
inability to maintain usual oral intake
because of painful swallowing.
WHAT ARE THE NURSING
INTERVENTIONS?

INTERVENTIONS:
1. Assess hydration status. (skin turgor,
mucous membranes, urine output).
2. Encourage ice chips, popsicles, and more
oral intake of cold fluids. Avoid citrus fluids
because these may irritate the throat. (ice
cream, sherbet, puddings, yogurt, etc)
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3. Risk for aspiration, related to
postoperative bleeding.
WHAT ARE THE NURSING
INTERVENTIONS?

NURSING INTERVENTIONS
1. Maintain patent airway; keep the pt. lying on his
side as much as possible to prevent aspiration. (if
there is vomitus, check the color. Dark brown may
indicate swallowed blood.)
2. Observe for frequent swallowing. This may
indicate bleeding. Check the back of the throat with
a flashlight for blood trickling down.
VOMITING
PATIENT AND FAMILY TEACHING
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1. The pt. must complete the entire course of the
prescribed antibiotic.
2. For the T+A pt. , instruct on the dietary
precautions.
3. Teach the post-op pt. to avoid clearing his throat,
vigorous coughing, sneezing, or nose blowing after
surgery for 1-2 weeks. These actions may cause
bleeding.
4. Know how to notify the PCP if there are any
complications.
5. Avoid ASA or other blood-thinning meds.
Respiratory Infections
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Laryngitis
–
Etiology/pathophysiology
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–
Inflammation of the larynx due to virus or bacteria
May cause severe respiratory distress in children under
5 years old
Clinical manifestations/assessment
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Hoarseness
Voice loss
Scratchy and irritated throat
Persistent cough
Respiratory Infections
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Laryngitis (continued)
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Medical management/nursing interventions
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Viral—no specific treatment
Bacterial—antibiotics
Analgesics
Antipyretics
Antitussives
Warm or cool mist vaporizer
Limit use of voice
Respiratory Infections
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Pharyngitis
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Etiology/pathophysiology
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Inflammation of the pharynx
Chronic or acute
Frequently accompanies the common cold
Viral, most common
Bacterial
Respiratory Infections
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Pharyngitis (continued)
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Clinical manifestations/assessment
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Dry cough
Tender tonsils
Enlarged cervical lymph glands
Red, sore throat
Fever
Medical management/nursing interventions
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Antibiotics; analgesics; antipyretics
Warm or cool mist vaporizer
Respiratory Infections
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Sinusitis
–
Etiology/pathophysiology
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Inflammation of the sinuses
Usually begins with an upper respiratory infection; viral
or bacterial
Clinical manifestations/assessment
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Constant, severe headache
Pain and tenderness in involved sinus region
Purulent exudate
Malaise
Fever
Respiratory Infections
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Sinusitis (continued)
–
Medical management/nursing interventions
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Antibiotics
Analgesics
Antihistamines
Vasoconstrictor nasal spray (Afrin)
Warm mist vaporizer
Warm, moist packs
Nasal windows
Disorders of the Lower Airway
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Acute bronchitis
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Etiology/pathophysiology
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Inflammation of the trachea and bronchial tree
Usually secondary to upper respiratory infection
Exposure to inhaled irritants
Clinical manifestations/assessment
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Productive cough; wheezes
Dyspnea; chest pain
Low-grade fever
Malaise; headache
Disorders of the Lower Airway
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Acute bronchitis (continued)
–
Medical management/nursing interventions
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Cough suppressants
Antitussives
Antipyretics
Bronchodilators
Antibiotics
Vaporizer
Encourage fluids
Disorders of the Lower Airway
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Legionnaires’ disease
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Etiology/pathophysiology
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Legionella pneumophila
Thrives in water reservoirs
Causes life-threatening pneumonia
Leads to respiratory failure, renal failure, bacteremic
shock, and ultimately death
Disorders of the Lower Airway
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Legionnaires’ disease (continued)
–
Clinical manifestations/assessment
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Elevated temperature
Headache
Nonproductive cough
Difficult and rapid respirations
Crackles or wheezes
Tachycardia
Signs of shock
Hematuria
Disorders of the Lower Airway
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Legionnaires’ disease (continued)
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Medical management/nursing interventions
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Oxygen
Mechanical ventilation, if necessary
IV therapy
Antibiotics
Antipyretics
Vasopressors
Disorders of the Lower Airway
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Anthrax
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Etiology/pathophysiology
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Clinical manifestations/assessment
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Bacillus anthracis
Spread by direct contact with bacteria or spores
Three types: cutaneous, GI, inhalational
Cold or flu-like symptoms
Hemorrhage, tissue necrosis, and lymphedema
Medical management
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Antibiotics
SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
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This is a serious acute respiratory infection
caused by a coronavirus.
It’s spread by close contact with people, via
droplets of air.
It may also be spread by touching objects
that are contaminated with the virus.
CLINICAL MANIFESTATIONS
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Fever > 104 degrees (38 degrees C).
HA, feeling of discomfort all over, muscle
aches.
After 2-7 days, some people may develop a
cough, SOB, or hypoxia.
About 20% of pts. with SARS require
intubation and mechanical ventilation.
SARS
DIAGNOSTIC TESTS
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Chest x-ray: It may be normal in the early
stage. In some pts., the chest x-ray may
later reveal interstitial infiltrates that progress
to patchy appearances.
A SARS dx. can later be made from detection
of serum antibodies or positive tissue
cultures.
LUNG INFILTRATES
LUNG INFILTRATES
LAB. AND DIAGNOSTIC TESTS, cont.
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Blood specimen for lab. tests.
Nasopharyngeal swab, oropharyngeal swab, and
nasopharyngeal aspirate will be obtained.
Bronchoalveolar lavage may be used to obtain
secretions from the lower respiratory tract.
Reverse transcription polymerase chain reaction
tests may be done on serum, stool, and nasal
secretions.
NASOPHARYNGEAL SWAB
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Initially, the pt.’s WBC count will be normal or
low.
In about 50% of cases, the platelet count will
be 50,000-150,000/mm.3.
Early in the respiratory phase, the creatine
phosphokinase levels (CPK) may be as high
as 3000 units/L. (normal 5-200 units/L)
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More criteria that can be used to dx. SARS
include travel within the last 10 days of sx.
onset to an area with current community
transmission of SARS. (China, Hong Kong,
Taiwan, Toronto, etc.)
Close contact within 10 days of sx. onset with
a person suspected of having SARS.
MEDICAL MANAGEMENT
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The disease is serious so treatment needs to
be started ASAP.
The treatment is based on the signs and sx.,
and before the cause is confirmed.
People who are suspected of having SARS
should be placed in respiratory isolation,
including use of an appropriate disposable
particulate respirator mask.
PARTICULATE RESPIRATOR MASK

There is no definitive treatment, but antiviral
agents (ribavirin), antibiotics, and
corticosteroids may be used.