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Chapter 24 Coordinating Care for Patients With Infectious Respiratory Disorders
fatigue, myalgias, new-onset anosmia and/or ageusia (loss of smell/taste), and gastrointestinal disorders (e.g., nausea, vomiting, diarrhea). Treatments are mainly sup- portive and directed toward preventing severe illness, hospitalization, and death. Management of patients with mild symptoms not requiring hospitalization is aimed toward reducing symptoms and reinforcement of pub- lic health measures for mitigating viral spread such as quarantine, social distancing, hand washing, and mask- ing. Hospitalization is indicated for patients with severe COVID-19 illness. It is important to be on high alert for impending respiratory failure, which can happen rapidly early in the hospital course. Vaccination is considered the best preventive strategy to curtail the pandemic. Outpa- tient symptom management consists of antipyretics, anal- gesics, and adequate fluid intake and rest to reduce fevers, relieve myalgias, and avoid dehydration. Outpatients with moderate illness and who are at risk for progression to severe illness may receive antiviral medications. The major complication in patients with severe COVID-19 infection is acute respiratory distress syndrome (ARDS). Pneumonia remains among the most frequent conditions for which the death rate has not significantly declined over the past decade. It can be viral or bacterial. Clinical mani- festations include fevers, tachypnea, tachycardia, decreased SpO 2 , fatigue, and a productive cough. Purulent respiratory secretions indicate a primary or secondary bacterial infection. Primary treatment options include bronchodilator therapy to open up inflamed airways and antibiotic therapy. Tuberculosis is an extremely contagious disease that is most prevalent in at-risk populations. Night sweats with bloody or rusty sputum are common manifestations of TB infection. Treatment is long-term antibiotic therapy. Regular monitoring for TB is done through the Mantoux TB skin test. It is required in all healthcare workers. Blood testing using IRGAs for any positive skin test will confirm or rule out the presence of TB infection. Any patient presenting with respiratory symptoms who is suspected of having a contagious respiratory illness should be placed in a private room or should be cohorted with patients with similar symptoms. Patients who pre- sent with unexplained weight loss, fever, and night sweats should be placed in an AFB negative airflow room immedi- ately to prevent transmission within the healthcare facility.
3. Prioritizing Hypotheses: Which hypothesis is most impor- tant and should be managed by the nurse first? 4. Generating Solutions: What interventions are indicated? 5. Taking Actions: What are teaching priorities for this patient? 6. Evaluating Outcomes: What findings demonstrate effective- ness of the interventions?
CHAPTER SUMMARY The human respiratory system has its own innate protective mechanisms to prevent infectious respiratory illness. When these mechanisms become overwhelmed or are impaired, viral, bacterial, and fungal infections occur. The patients at greatest risk for infectious airway disorders are patients who are very young and patients over 65 years of age, most often because of underlying chronic illnesses of the respiratory, cardiovascular, endocrine, and immune systems. Clinical manifestations of infectious airway disorders can cause mild to severe symptoms, can occur suddenly or over a period of days to weeks, and can be highly contagious. Influenza presents with a sudden onset of symptoms that includes fever with respiratory symptoms. Clear respiratory secretions indicate an influenza viral infec- tion. Treatment is symptom based but may include antivirals with severe symptoms. The administration of antiviral medications does not cure a viral infection but does reduce the severity and duration of symptoms so that individuals can return to their daily activities sooner. Vaccination with inactivated virus or bacterium is the best method for preventing the onset of respiratory illness due to influenza. In late December 2019, an outbreak of a novel (new) coronavirus was identified as severe acute respiratory syn- drome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) declared a pandemic in March 2020. Coronaviruses are enveloped RNA viruses belong- ing to a group of known coronaviruses causing respi- ratory illness, ranging from the common cold to acute respiratory failure. COVID-19 can range from asymp- tomatic to life-threatening in severity. Symptoms include fever, cough, rhinorrhea, dyspnea, tachypnea, headache,
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