1A: Infection
,Pneumonia
Clinical Manifestations
● Respiratory Distress: Dyspnea (shortness of breath), tachypnea (rapid breathing), nasal flaring,
and use of accessory muscles to breathe.
● Sputum & Cough: Persistent cough producing thick, purulent, yellow-tinged, blood-tinged, or
classic rust-colored sputum.
● Chest Pain: Sharp, pleuritic chest discomfort that worsens significantly on deep inspiration or
coughing.
● Older Adult Presentation (High-Yield): Confusion, disorientation, or altered mental status
resulting from hypoxia is the primary hallmark sign in older adults. They often present without a
high fever or classic respiratory symptoms.
● Auscultation & Percussion:
○ Adventitious breath sounds: Moist inspiratory crackles and coarse wheezes across
affected lung fields.
○ Dullness on chest percussion over consolidated (fluid-filled) lung tissue.
● Systemic Signs: Fever, chills, flushed face, active diaphoresis (sweating), anxiety, fatigue,
weakness, and loss of appetite. Oxygen saturation (SpO2) drops below the normal reference range
of 95% to 100%.
Client Teaching & Health Promotion
● Vaccinations: Heavily emphasize getting the pneumococcal vaccine and annual influenza
vaccine, especially for adults over 65, young children, and immunocompromised individuals.
● Medication Adherence: Stress the critical importance of completing the entire prescribed course
of antibiotics, even after symptoms resolve, to prevent secondary infection or drug resistance.
● How to Take Meds:
○ Take penicillins, cephalosporins, and glucocorticosteroids with food. (Note: Some
specific penicillins must be taken 1 hour before or 2 hours after meals).
○ Do not stop glucocorticosteroids abruptly; report black, tarry stools immediately.
○ Suck on hard candies to moisten dry mouth caused by Atrovent (Ipratropium). Watch for
tremors or a racing heart with Albuterol.
● Infection Control & Recovery: Practice strict hand hygiene and proper cough etiquette (cough
into tissues and dispose of them in plastic bags). Rest as needed, avoid crowded areas, and
completely discontinue tobacco use.
Tuberculosis
Clinical Manifestations
● The Classic Triad Pattern:
1. Low-grade fevers that spike specifically in the afternoon.
2. Drenching night sweats.
3. Unexplained weight loss and anorexia (wasting).
● Respiratory Symptoms: A persistent, hacking cough lasting longer than 3 weeks, chest pain,
dyspnea, and hemoptysis (coughing up purulent or blood-streaked sputum).
● General State: Fatigue, lethargy, weakness, and pale/sweaty appearance.
, ● Older Adult Variations: Often present with atypical findings, including altered mentation,
unusual behavior, unexplained weight loss, and anorexia.
Nursing Interventions & Management of Care
● Airborne Isolation Priorities:
○ Place hospitalized clients immediately in a negative-airflow isolation room (AIIR).
○ Healthcare workers must wear a fit-tested N95 HEPA filter mask or PAPR at all times
when in the room.
○ Minimize patient transport. If the patient must leave the room, have the patient wear a
standard surgical mask and use the shortest, least busy route.
● Sputum Collection Protocol: Obtain three consecutive early-morning sputum samples for
Acid-Fast Bacilli (AFB) smear and culture inside a negative airflow room while wearing full
respiratory PPE.
● Supportive Airway & Diet: Administer heated and humidified oxygen therapy as prescribed.
Provide a high-calorie diet rich in protein, iron, and vitamins C and B6 to reverse wasting.
● Infection Containment Teaching: Teach the client to cough/sneeze into tissues and personally
dispose of them into provided plastic sacks. Maintain strict hand hygiene.
● Home Management & Public Health:
○ Airborne precautions are not needed at home because family members have already been
exposed, but all exposed family members must be tested. Avoid outside visitors.
○ Collaborate with local/county health departments to set up Directly Observed Therapy
(DOT), where a clinician physically watches the patient swallow every dose to guarantee
adherence.
○ Inform the client that monthly sputum samples are required until 2 consecutive monthly
cultures come back negative.
● Monitoring Complications (Miliary TB): Instruct the family to seek emergency care for signs
of bloodborne spread: severe headaches, neck stiffness (nuchal rigidity), swollen neck veins, and
sudden drowsiness.
, 1B: Acid-Base Balance and
Oxygenation
,Pneumonia
Clinical Manifestations
● Respiratory Distress: Dyspnea (shortness of breath), tachypnea (rapid breathing), nasal flaring,
and use of accessory muscles to breathe.
● Sputum & Cough: Persistent cough producing thick, purulent, yellow-tinged, blood-tinged, or
classic rust-colored sputum.
● Chest Pain: Sharp, pleuritic chest discomfort that worsens significantly on deep inspiration or
coughing.
● Older Adult Presentation (High-Yield): Confusion, disorientation, or altered mental status
resulting from hypoxia is the primary hallmark sign in older adults. They often present without a
high fever or classic respiratory symptoms.
● Auscultation & Percussion:
○ Adventitious breath sounds: Moist inspiratory crackles and coarse wheezes across
affected lung fields.
○ Dullness on chest percussion over consolidated (fluid-filled) lung tissue.
● Systemic Signs: Fever, chills, flushed face, active diaphoresis (sweating), anxiety, fatigue,
weakness, and loss of appetite. Oxygen saturation (SpO2) drops below the normal reference range
of 95% to 100%.
Client Teaching & Health Promotion
● Vaccinations: Heavily emphasize getting the pneumococcal vaccine and annual influenza
vaccine, especially for adults over 65, young children, and immunocompromised individuals.
● Medication Adherence: Stress the critical importance of completing the entire prescribed course
of antibiotics, even after symptoms resolve, to prevent secondary infection or drug resistance.
● How to Take Meds:
○ Take penicillins, cephalosporins, and glucocorticosteroids with food. (Note: Some
specific penicillins must be taken 1 hour before or 2 hours after meals).
○ Do not stop glucocorticosteroids abruptly; report black, tarry stools immediately.
○ Suck on hard candies to moisten dry mouth caused by Atrovent (Ipratropium). Watch for
tremors or a racing heart with Albuterol.
● Infection Control & Recovery: Practice strict hand hygiene and proper cough etiquette (cough
into tissues and dispose of them in plastic bags). Rest as needed, avoid crowded areas, and
completely discontinue tobacco use.
Tuberculosis
Clinical Manifestations
● The Classic Triad Pattern:
1. Low-grade fevers that spike specifically in the afternoon.
2. Drenching night sweats.
3. Unexplained weight loss and anorexia (wasting).
● Respiratory Symptoms: A persistent, hacking cough lasting longer than 3 weeks, chest pain,
dyspnea, and hemoptysis (coughing up purulent or blood-streaked sputum).
● General State: Fatigue, lethargy, weakness, and pale/sweaty appearance.
, ● Older Adult Variations: Often present with atypical findings, including altered mentation,
unusual behavior, unexplained weight loss, and anorexia.
Nursing Interventions & Management of Care
● Airborne Isolation Priorities:
○ Place hospitalized clients immediately in a negative-airflow isolation room (AIIR).
○ Healthcare workers must wear a fit-tested N95 HEPA filter mask or PAPR at all times
when in the room.
○ Minimize patient transport. If the patient must leave the room, have the patient wear a
standard surgical mask and use the shortest, least busy route.
● Sputum Collection Protocol: Obtain three consecutive early-morning sputum samples for
Acid-Fast Bacilli (AFB) smear and culture inside a negative airflow room while wearing full
respiratory PPE.
● Supportive Airway & Diet: Administer heated and humidified oxygen therapy as prescribed.
Provide a high-calorie diet rich in protein, iron, and vitamins C and B6 to reverse wasting.
● Infection Containment Teaching: Teach the client to cough/sneeze into tissues and personally
dispose of them into provided plastic sacks. Maintain strict hand hygiene.
● Home Management & Public Health:
○ Airborne precautions are not needed at home because family members have already been
exposed, but all exposed family members must be tested. Avoid outside visitors.
○ Collaborate with local/county health departments to set up Directly Observed Therapy
(DOT), where a clinician physically watches the patient swallow every dose to guarantee
adherence.
○ Inform the client that monthly sputum samples are required until 2 consecutive monthly
cultures come back negative.
● Monitoring Complications (Miliary TB): Instruct the family to seek emergency care for signs
of bloodborne spread: severe headaches, neck stiffness (nuchal rigidity), swollen neck veins, and
sudden drowsiness.
, 1B: Acid-Base Balance and
Oxygenation
