PULMONARY TUBERCULOSIS

TB is an infectious disease that primarily affects the lung

parenchyma.

M. tuberculosis – an acid-fast aerobic rod that grows slowly

and is sensitive to heat and ultraviolet light.

TRANSMISSION

TB spreads from person to person by airborne transmission.

• Talking
• Coughing
• Sneezing
• Laughing
• Singing

RISK FACTORS

▪ Close contact with infected person

▪ Immunocompromised status
▪ Substance use disorder CLINICAL MANIFESTATIONS
▪ Person without adequate health care
▪ Preexisting medical conditions/ special treatment ▪ low-grade fever
▪ Travel from countries with high prevalence of TB ▪ cough
cases ▪ night sweats
▪ fatigue
▪ Institutionalization
▪ weight loss
▪ Living in overcrowded, substandard housing
▪ Being a health care worker ▪ nonproductive coughs and expectorated
mucopurulent sputum
PATHOPHYSIOLOGY
DIAGNOSTIC FINDINGS

1. Positive skin test, blood test or sputum culture

2. Complete health history
3. Physical examination
4. Tuberculin skin test
5. Chest x-ray
6. Drug susceptibility test

MEDICAL MANAGEMENT

❑ Isoniazid
❑ Rifampin
❑ Pyrazinamide
❑ Ethambutol

NURSING MANAGEMENT

❑ Promoting Airway Clearance

❑ Promoting Adherence to Treatment Regimen
❑ Promoting Activity and Adequate Nutrition
❑ Preventing Transmission of Tuberculosis
Transmission

RESPIRATORY PANDEMICS

• EBOLA

• MERS-COV

• H1N1

• COVID 19

• A respiratory pandemic is an outbreak of a contagious

disease that primarily spreads through respiratory
transmission. In such a pandemic, a new infectious
agent, often a virus, emerges and rapidly spreads
through the respiratory system, causing widespread
illness and potentially leading to significant public
health and societal impacts.
EBOLA DISEASE ▪ Bleeding/bruising is not universally present

HISTORY OF EBOLA

• The Ebola virus disease (EVD) was first discovered in

1976 during simultaneous outbreaks in Sudan and the
Democratic Republic of Congo (formerly Zaire).

• The virus was named after the Ebola River in Zaire,

where one of the outbreaks occurred. Since its
discovery, Ebola has caused sporadic outbreaks in
Central and West Africa.

• Notable outbreaks include the 1995 outbreak in

Kikwit, Zaire, and the devastating West African
outbreak from 2014 to 2016, which affected Guinea,
Liberia, and Sierra Leone.

• The West African outbreak led to significant

international attention and efforts to develop vaccines
and treatments. While smaller outbreaks have
occurred since, progress has been made in
preparedness and international cooperation

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS

Initial

• high fever

• Muscle aches

• Fatigue

3rd to 4th symptomatic day

• severe diarrhea

• Abdominal pain

Person-to-Person Transmission • vomiting

▪ In infected individuals, the virus can be found in all body

fluids:
MEDICAL MANAGEMENT

• Ventilator and dialysis support

NURSING MANAGEMENT

• Psychological support
• Infection control measures
• Isolation and quarantine
▪ Contact with the body fluids of a person that is sick or has • Monitoring VS
died of Ebola disease • Fluid and electrolyte management
▪ Ebola is not spread through airborne transmission
MIDDLE EAST RESPIRATORY SYNDROME
Signs and symptoms of Ebola disease include :
CORONAVIRUS (MERS-COV)

• is a viral respiratory disease caused by Middle East

respiratory syndrome coronavirus (MERS‐CoV) that
was first identified in Saudi Arabia in 2012.

• MERS-CoV is a zoonotic virus.

• Transmitted by close contact through air or direct

contact but not highly infectious
▪ No sign or symptom is pathognomonic for Ebola disease • Approximately 35% of MERS cases reported to WHO
have died.
▪ Fever is not universally present
 • The Philippines reported to WHO its first laboratory • Avoid consumption of raw or undercooked
confirmed case of MERS-CoV on February 2015 animal products
• Avoid contact with dromedary camels

PATHOPHYSIOLOGY H1N1 (SWINE FLU) VIRUS

Step 1: Viral Invasion • Scientifically known as H1N1
• Is a type of influenza A virus which is more severe
• MERS-CoV enters host cells by binding to a DPP4
kinds of influenza A virus originated from pigs.
receptor expressed in the kidney and other organs,
• A virus that causes respiratory illness in humans. It
and uses proteases of the host to enter lung cells.
gained global attention in 2009 when a pandemic
Furin activates the S protein on the viral envelope,
outbreak occurred.
mediating the membrane fusion and virus entry into
host cells
Spread of H1N1 virus
Step 2: Viral Replication and Infection
• The H1N1 virus is highly contagious and can spread
• Once inside the cell, MERS-CoV MERS-CoV is able
rapidly from person to person through respiratory
to infect and kill not only alveolar epithelial cells but
droplets produced when an infected person talks,
also T cells, monocyte-macrophages, and Dendritic
coughs, or sneezes.
Cells. Only MERS-CoV was able to replicate in the
• The virus can also be spread through contact with
infected immune cells, which consequently resulted in
contaminated surfaces or objects, although this is a
aberrant induction of inflammatory cytokines in
less common mode of transmission.
macrophages and Dendritic Cells.
• Once the virus enters the body, it targets cells in the
Step 3: Direct Impact on the Immune System respiratory tract, particularly in the nose, throat, and
lungs. Then spread to other parts of the body through
• Patients with a more severe case may rapidly develop bloodstream.
pneumonia. They may also experience breathing
failure, kidney damage, high fevers and even death.
The main symptoms of MERS are flu-like and develop CLINIC MANIFESTATION
from 2 to 14 days after exposure.
Symptoms usually start quickly and can include:

• Fever, but not always.

SIGNS AND SYMPTOMS • Aching muscles.
• Chills and sweats.
• Asymptomatic to mild respiratory symptoms to severe • Cough.
acute respiratory disease and death • Sore throat.
• Fever • Runny or stuffy nose.
• Cough • Watery, red eyes.
• Sore throat • Eye pain.
• Muscle/Joint pain • Body aches.
• Shortness of breath • Headache.
• Diarrhea • Tiredness and weakness.
• Nausea • Diarrhea.
• Vomiting • Feeling sick to the stomach, vomiting, but this is more
• Pneumonia common in children than adults.
• For Adult emergency symptoms:
• Trouble breathing or shortness of breath.
CLINICAL MANIFESTATIONS
• Chest pain.
• Leukopenia • Signs of dehydration such as not urinating.
• Lymphopenia • Ongoing dizziness.
• Thrombocytopenia • Seizures.
• Elevated lactate dehydrogenase levels • Worsening of existing medical conditions.
• Severe weakness or muscle pain.

MERS-CoV DIAGNOSIS
Entry of H1N1 virus in the body
• Polymerase Chain Reaction (PCR)
• The H1N1 virus gains entry into the human body
through the respiratory tract, primarily through the
nose and mouth. The virus is able to bind to and infect
MERS-CoV RISK FACTORS the epithelial cells that line the respiratory tract.
• The virus uses two surface glycoproteins,
• Older people
Hemagglutinin (HA) and Neuraminidase (NA), to gain
• People with weakened immune system
entry into the host cells. Hemagglutinin binds to sialic
• People with chronic diseases;
acid receptors on the surface of the host cells, while
• renal disease, cancer, chronic lung disease,
neuraminidase cleaves these receptors to release
hypertension, cardiovascular disease and diabetes
new virions from the infected cells.

MERS-CoV PREVENTIVE MEASURES AND MANAGEMENT

RISK FACTORS
• No vaccine and specific treatments are currently
• Children under age 2 and adult older than 65 years of
available
age
• General precautions:
• Living or working condition ( Facilities/Hospital)
• General hygiene measures such as hand
• Weakened immune system
washing
• Chronic illness
• Avoid contact with sick animals
• Race
 • Pregnancy NURSING MANAGEMENT
• Obesity
• Check vitals and temperature
• Isolate the patient
COMPLICATIONS • Wear mask and gloves
• Encourage patient to cough and sneeze into a tissue
• Worsening of chronic conditions, such as heart • Encourage fluids
disease and asthma. • Provide oxygenation
• Pneumonia. • Administer antiviral medications
• Neurological symptoms, ranging from confusion to • Encourage hand washing
seizures. • Listen to the chest for rales, crackles, wheezing
• Respiratory failure. • Assess for respiratory distress
• Bronchitis. • Use alcohol-based hand gels for hand rinsing
• Muscle tenderness. • Encourage patient to wear a mask
• Bacterial infections.

HEALTH TEACHING AND PROMOTION

PREVENTION
• Educate patient and family about the flu
• The Centers for Disease Control and Prevention • Encourage patient to get vaccinated
(CDC) recommends annual flu vaccination for • Discontinue smoking
everyone age 6 months or older. The H1N1 virus is • Drink ample fluids
included in the seasonal flu vaccine. • Do not mix with crowds until symptoms disappear
• Avoid work or school until symptoms resolve
• The flu vaccine can lower your risk of getting the flu. It
• Wash hands
also can lower the risk of having serious illness from
• Wear a mask
the flu and needing to stay in the hospital.

• Each year’s seasonal flu vaccine protects against the

PATHOPHYSIOLOGY
three or four influenza viruses. These are the viruses
expected to be the most common during that year’s
flu season.

• Flu vaccination is especially important because the flu

and coronavirus disease 2019 (COVID-19) cause
similar symptoms

This measure also help prevent the flu and limit it’s spread

• Wash your hands often. If available, use soap and

water, washing for at least 20 seconds. Or use an
alcohol-based hand sanitizer that has at least 60%
alcohol.

• Cover your coughs and sneezes. Cough or sneeze

into a tissue or your elbow. Then wash your hands.

• Avoid touching your face. Avoid touching your eyes,

nose and mouth.

• Clean and disinfect surfaces. Regularly clean often-

touched surfaces to prevent spread of infection from a
surface with the virus on it to your body.
FIELD DIAGNOSIS
• Avoid contact with the virus. Try to avoid people who
• Clinical Signs
are sick or have symptoms of flu. And if you have
• Postmortem Finding
symptoms, stay home if you can. When flu is
spreading, consider keeping distance between
yourself and others while indoors, especially in areas LABORATORY DIAGNOSIS
with poor air flow. If you’re at high risk of
complications from the flu consider avoiding swine Samples to be collected
barns at seasonal fairs and elsewhere.
• Live( Antemortem)
- Nasal Swab
- Paired Serum
MANAGEMENT AND TREATMENT • Dead ( Post-mortem)
-Lung
• Most people with swine flu (H1N1) who are otherwise
healthy don’t need special drugs or treatments. If you
have swine flu, you should: ANTIGEN / VIRAL DETECTION
• Get plenty of rest.
• Drink fluids. • HA Test
• Eat a light diet. • HI Test
• Stay home. • ELLISA
• Take acetaminophen (Tylenol®) to reduce fever and • Reverse Transcriptase PCR
relieve aches and pains • DNA Sequencing
ANTIBODY DETECTION clinical findings include fever, cough, shortness of
breath, and loss of taste or smell.
• HI Test
- using known SI virus
- Paired Serum Samples
PATHOPHYSIOLOGY

Step 1: Viral invasion

• SARS-CoV-2, the virus that causes COVID-19, enters

cells through the angiotensin-converting enzyme 2
(ACE2) receptor. ACE2 is expressed on a variety of
cells throughout the body, including lung epithelial
cells, heart cells, and kidney cells.

Step 2: Viral replication

• Once inside a cell, SARS-CoV-2 replicates its genetic

material and produces new viral particles. These new
viral particles are then released from the cell and can
infect other cells.

Step 3: Immune response

• The body's immune system responds to the SARS-

CoV-2 infection by producing antibodies and
COVID-19 deploying white blood cells to fight the virus. However,
in some cases, the immune response can be
History of the Disease (Pandemic)
overactive, leading to a cytokine storm. A cytokine
• The COVID-19 pandemic, caused by the novel storm is a condition in which the body releases too
coronavirus SARS-CoV-2, has had a profound impact many inflammatory cytokines, which can damage
on global health, economies, and daily life. tissues and organs.
• The outbreak of COVID-19 was first identified in
Step 4: Lung injury
December 2019 in the city of Wuhan, Hubei province,
China. The first cases were linked to a seafood • SARS-CoV-2 infection can damage the lungs in a
market in Wuhan, where live animals were also sold. number of ways. The virus can directly damage lung
• Wuhan was placed under lockdown to contain the cells, and it can also trigger an inflammatory response
outbreak, and this initial effort was a crucial step in that damages lung tissue. In some cases, the lung
trying to control the spread of the virus. damage can lead to pneumonia, acute respiratory
• On March 11, 2020, the WHO declared COVID-19 a distress syndrome (ARDS), and death.
global pandemic.
• Governments around the world implemented a range Step 5: Multi-organ failure
of measures to curb the spread of the virus. These
• In severe cases of COVID-19, the virus can spread to
measures included lockdowns, travel restrictions,
other organs in the body, including the heart, brain,
social distancing, mask mandates, and quarantine
and kidneys. This can lead to multi-organ failure and
protocols.
death.

ASSESSMENT
SIGNS AND SYMPTOMS

1. Diagnostic Tests: Respiratory Symptoms:

• COVID-19 can be assessed through various • fever

diagnostic tests, including RT-PCR (Reverse • cough
Transcription Polymerase Chain Reaction), antigen • shortness of breath
tests, and antibody tests. • chest pain

2. Clinical Evaluation: Gastrointestinal Symptoms:

• Clinical assessment involves evaluating symptoms, • nausea

exposure history, and physical examination. Common • vomiting
• diarrhea
Neurological Symptoms: PNEUMONITIS - is a more general term that describes an
inflammatory process in the lung tissue that may predispose or
• Loss of taste and smell place the patient at risk for microbial invasion.
• Confusion

Constitutional Symptoms:
CLASSIFICATIONS
• Fatigue
• muscle aches 1. Community-Acquired Pneumonia (CAP)

- occurs in the community or ≤48 hours after hospital

Severe Symptoms:
admission
• Severe pneumonia - can also be institutionalization of patients who do not
• acute respiratory distress syndrome (ARDS) meet the criteria for health care–associated
• organ failure pneumonia (HCAP)

CLINICAL MANIFESTATIONS 2. Health Care Associated Pneumonia (HCAP)

Mild to Moderate Cases: - occurs in a nonhospitalized patient with extensive

health care contact
• Fever - an important distinction of HCAP is that the causative
• Cough pathogens are often MDROs because of prior contact
• Shortness of Breath with a health care environment.
• Fatigue
• Muscle Aches
• Loss of Taste and Smell 3. Hospital-Acquired Pneumonia (HAP)

- occurs ≥48 hours after hospital admission that did not

Severe Cases: appear to be incubating at the time of admission
- Hospitalized patients are also exposed to potential
• Severe Pneumonia bacteria from other sources (respiratory therapy
• Acute Respiratory Distress Syndrome (ARDS) devices, transmission of pathogens by the hands of
• Organ Failure health care personnel)

Long COVID: 4. Ventilator-Associated Pneumonia (VAP)

• persistent fatigue - A type of HAP that develops ≥48 hours after

• cognitive impairments endotracheal tube intubation
• shortness of breath - VAP occurs within 96 hours of the onset of
• chest pain mechanical ventilation is usually due to antibiotic-
• joint pain sensitive bacteria
• gastrointestinal symptoms

5. Pneumonia in the Immunocompromised Host

NURSING MANAGEMENT
- occur with the use of corticosteroids or other
Infection Control: immunosuppressive agents, chemotherapy, nutritional
depletion, and etc.
• Personal Protective Equipment (PPE) - Patients with compromised immune systems
• Hand Hygiene commonly develop pneumonia from organisms of low
• Isolation Precautions virulence
• Environmental Cleaning

Symptom Management: 6. Aspiration Pneumonia

• Respiratory Support - refers to the pulmonary consequences resulting from

• Fever Management Fluid and Nutritional Support entry of endogenous or exogenous substances into
• Pain and Discomfort Management Psychosocial the lower airway
Support - bacteria may be aspirated into the lung, such as
gastric contents, exogenous chemical contents, or
Patient Education: irritating gases.

• Preventative Measure
• Medication Management PATHOPHYSIOLOGY
• Quarantine and Isolation Guidelines

Monitoring and Assessment:

• Vital Signs
• Respiratory Assessment
• Neurological Assessment

PNEUMONIA

-an inflammation of the lung parenchyma caused by various

microorganisms, including bacteria, mycobacteria, fungi, and
viruses.
 6. Bronchoscopy – used when a diagnosis cannot be
made from an expectorated or induced specimen

PREVENTION

PNEUMOCOCCAL VACCINATION - reduces the incidence of

pneumonia, hospitalizations for cardiac conditions, and deaths
in the older adult population
• Pneumococcal Conjugate Vaccine (PCV13)
- protects against 13 types of pneumococcal bacteria
- all adults 65 years of age or older as well as adults
19 years or older with conditions that weaken the immune
system

• Pneumococcal Polysaccharide Vaccine (PPSV23)

- a newer vaccine and protects against 23 types of
pneumococcal bacteria.

A. MEDICAL MANAGEMENT

• antibiotics therapy - for bacterial

pneumonias
• adequate rest and hydration
• manage any complications
• supplemental oxygenation may be
prescribed.
• Inpatients should be switched from
intravenous (IV) to oral therapy
when they are hemodynamically
stable, are improving clinically, are
able to take medications/fluids by
mouth

RISK FACTORS Other Therapeutic Regimen:

• conditions that produce mucus or bronchial Note: Antibiotics are ineffective in viral upper
obstruction respiratory tract infections and pneumonias. Treatment of viral
• smoking pneumonia is primarily supportive.
• depressed cough reflex • Hydration
• prolonged immobility • Antipyretic agents - used to treat headache and fever
• nothing-by-mouth (NPO) status; placement of • Antitussive medications - be used for the associated
nasogastric, orogastric, or endotracheal tube cough
• antibiotic therapy • Warm, moist inhalations - helpful in relieving bronchial
• general anesthesia irritation.
• aging • Antihistamines - provide benefit with reduced
• respiratory therapy with improperly cleaned sneezing and rhinorrhea
equipment

B. NURSING MANAGEMENT
CLINICAL MANIFESTATIONS
• Improving airway patency
Note: Pneumonia varies in its signs and symptoms • Promoting fluid intake
depending on the type, causal organism, and presence of • Promoting rest and conserving energy
underlying disease. • Maintaining nutrition
• Managing potential complications
• sudden onset of chills
• rapidly rising fever (38.5° to 40.5°C
• pleuritic chest pain INFLAMMATORY BOWEL DISEASE
• marked tachypnea
• shortness of breath and the use of accessory muscles -is a group of chronic disorders: Crohn’s Disease and
in respiration Ulcerative Colitis
• predominant symptoms: headache, low-grade fever, -result in inflammation or ulceration (or both) of the bowel
pleuritic pain, myalgia, rash, and pharyngitis. -both have striking similarities but also several differences
• Orthopnea
• productive cough
• central cyanosis (severe cases) RISK FACTORS

-Family history, particularly if a first-degree relative has the

DIAGNOSTIC FINDINGS disease
-Caucasian
1. Health history - particularly of a recent respiratory -Ashkenazi Jewish descent
tract infection -Living in a northern climate
2. Physical examination -Living in an urban area
3. Chest X-ray
4. Blood Culture - bloodstream invasion [bacteremia]
occurs frequently -the cause is still unknown
5. Sputum Sample Three (3) underlying factors
-genetic predisposition
-altered immune response
-altered response to gut microorganism

Both disorders have extra-intestinal manifestations;

systemic symptoms common to both include

-Fever -Arthralgias or joint pain

-Malaise -Episodes of Diaphoresis

CROHN’S DISEASE (REGIONAL ENTERITIS)

- inflammation of the GI tract wall that extends through all

layers (i.e., transmural lesion)

CLINICAL MANIFESTATIONS

- chronic diarrhea
- prominent right lower quadrant abdominal pain unrelieved by
defecation
- crampy pains occur after meals
- weight loss, malnutrition/nutritional deficit, and secondary
anemia
- steatorrhea (i.e., excessive fat in the feces)

DIAGNOSTIC STUDY FINDINGS

- Barium Studies
-Narrowing of colon -Mucosal edema
-Thickening of bowel wall -fistulas

- an immune-related disorder from uncontrolled inflammation - Sigmoidoscopy

(malfunctional gene). - Colonoscopy

COMPLICATIONS

- intestinal obstruction or stricture formation

- perianal disease
- fluid and electrolyte imbalances
- malnutrition from malabsorption
- fistula and abscess formation

THERAPEUTIC MANAGEMENT

- Corticosteroids
- Immunomodulators
- Antibiotics
- Parenteral nutrition
- Partial or complete colectomy, with ileostomy or
anastomosis

ULCERATIVE COLITIS

- a recurrent ulcerative and inflammatory disease of the

mucosal and submucosal layers of the colon and rectum.
- usually starts from rectum and spreads to colon and slowly it
involves intestinal membranes and all layers of intestine
- common in Caucasians and people of Jewish heritage.
 • Barium enema show mucosal irregularities, focal
strictures or fistulas, shortening of colon, and
dilatation of bowel loops
• CT scan, MRI, ultrasound
• Leukocyte scanning
• Stool examination

COMPLICATIONS

• Toxic megacolon
• Perforation
• Bleeding
• Vascular engorgement
• Highly vascular granulation tissue
• Osteoporotic fractures

MEDICAL MANAGEMENT

• Restorative proctocolectomy with ileal pouch anal

anastomosis
• Nutritional therapy: oral fluids, low-residue, high-
protein, high-calorie diet with supplemental vitamin
therapy and iron replacement
• Pharmacologic therapy: Aminosalicylate formulations,
antibiotics, corticosteroids, and immunomodulators

NURSING MANAGEMENT

• Provide ready access to bathroom or bedpan

• Position the patient comfortably
• Monitor daily weights for fluid gains or losses
• Encourage intermittent rest periods
• Emotional support
• Monitor for rectal bleeding
• Relieve rectal pain

CLINICAL MANIFESTATIONS

• Diarrhea
• Lower left quadrant abdominal pain
• Intermittent tenesmus
• Rectal bleeding
- Pallor
- Anemia
- Fatigue
• Anorexia
• Weight loss
• Fever
• Vomiting
• Dehydration
• Cramping
• Feeling of an urgent need to defecate
• Passage of 10 to 20 liquid stools each day
• Hypocalcemia and anemia frequently develop

ASSESSMENT AND DIAGNOSTIC FINDINGS

• Assess for tachycardia, hypotension, tachypnea,

fever, and pallor.
• Examine abdomen for bowel sounds, distention, and
tenderness.
• Stool is positive for blood.
• Low hematocrit and hemoglobin levels
• Elevated WBC count
• Low albumin levels
• Electrolyte imbalance PERITONITIS
• Abdominal x-ray
• Sigmoidoscopy or colonoscopy reveal friable, • Inflammation of the peritoneum, which is the serious
inflamed mucosa with exudate and ulcerations membrane lining the abdominal cavity and covering
the viscera.
 • Usually, it is a result of bacterial infection but may • Hypotensive
occur secondary to a fungal or mycobacterial • Oliguric or anuric
infection.
• The most common bacteria are Escherichia coli and
Klebsiella, Proteus, Pseudomonas, and ASSESSMENT AND DIAGNOSIS FINDINGS
Streptococcus species
• White blood cell count is elevated (> 11,000/mm3)
• Peritonitis can also result from external sources such
• Increased in the bands
as abdominal surgery or trauma
• Consistent with bacterial infection
• Hemoglobin and Hematocrit levels may be low
• Serum electrolytes studies may reveal altered levels
of potassium, sodium, and chloride
• Blood chemistry panels and arterial blood gases may
reveal dehydration and acidosis
• Abdominal X-ray may show free air and fluid as well
as distended bowel loops
• Abdominal ultrasound may reveal abscesses and fluid
collection
• Computed tomography (CT) scan of the abdomen
may show abscess formation
• Ultrasound-guided paracentesis for patient with
• According to Dale (2019), peritonitis can be
ascites
categorized as
• MRI for diagnosis of intra-abdominal abscesses
1. Primary peritonitis- also called spontaneous bacterial
peritonitis (SBP), occurs as a spontaneous bacterial infection MEDICAL MANAGEMENT
of ascitic fluid. This occurs most commonly in adult patient with
liver failure. • Administration of several litres of isotonic
2. Secondary peritonitis- occurs secondary to perforation of solution is prescribed
abdominal organs with spillage that infects the serious • Analgesic medications are prescribed for
peritoneum. pain
• The most common cause include • Antiemetic agents are given as prescribed
• perforated appendix for nausea and vomiting
• perforated peptic ulcer • Intestinal intubation and suction assist
• perforated sigmoid colon • Oxygen therapy by nasal cannula and mask
• volvulus of the colon • Airway intubation and ventilatory assistance
• strangulation of the small intestine occasionally are required
3. Tertiary peritonitis- occurs as a result of a superinfection in • Antibiotic therapy
a patient who is immunocompromised. • Large doses of a broad-spectrum antibiotic
Example: are given IV until the specific organism
causing the infection is identified
• Tuberculosis peritonitis in a patient with AIDS • Hemodynamic support
• Fluid and electrolyte replacement
• Systemic broad-spectrum antibiotics, and
nutritional support
• Ultrasound-guided and CT-guided peritoneal
drainage of abdominal and extraperitoneal
abscesses has allowed
• Surgical treatment is directed towards
excision, resection with or without
anastomosis, repair, and drainage
• Fecal diversion for extensive sepsis
• Antibiotic therapy is continued
postoperatively

NURSING MANAGEMENT
CLINICAL MANIFESTATIONS
• Intensive care is needed for the patient with
• Symptoms depend on the location and extent of the
septic shock
inflammation • Increase fluid and food intake gradually and
• Early clinical manifestations of peritonitis frequently reduces parenteral fluid as prescribed
are the signs and symptoms of the disorder causing
condition (e.g., manifestations of infection)
• At first, pain in diffuse but then becomes constant, APPENDICITIS
localized, and more intense over the site of the
pathologic process -small vermiform appendage about 8 to 10 cm long
• Movement usually aggravate the pain -most common reason for emergency abdominal surgery
• The affected are of the abdomen becomes extremely
tender and distended
• The muscles become rigid
• Rebound tenderness becomes present
• Anorexia
• Nausea
• Vomiting occurs
• Peristalsis is diminished
• Paralytic ileus
• Initial temperature of 37.8• to 38.3•C (100• to 101•F)
• Increased pulse rate
 • The secretion of pancreatic enzymes into the
gastrointestinal tract through the pancreatic duct
represents its exocrine function.
• The secretion of insulin, glucagon, and somatostatin
directly into the bloodstream represents its endocrine
function.

Acute Pancreatitis

-It ranges from a mild, self-limiting disorder to a severe.

Chronic Pancreatitis

-It is an inflammatory disorder characterized by progressive

anatomic and functional destruction of the pancreas.
CLINICAL MANIFESTATION

• Vague periumbilical pain with anorexia PANCREATITIS PATHOPHYSIOLOGY

progress to right lower quadrant
• Nausea 1. TRIGGER
• Local tenderness may be elicited at a) Gallstones enter the common bile duct and
McBurney’s point lodge at the ampulla of Vater, obstructing the
• Rovsing’s sign may be elicited by palpating flow of pancreatic juice or causing a reflux of
the left lower quadrant bile from the common bile duct into the
• Abdominal distention pancreatic duct, thus activating the powerful
• Constipation enzymes within the pancreas.
b) Infection that causes the pancreas to be
inflamed
ASSESSMENT AND DIAGNOSTIC FINDINGS c) Spasm and edema of the ampulla of Vater
d) Blunt abdominal trauma, peptic ulcer
• WBC of adult - >10500/mm3
disease, ischemic vascular disease,
• Neutrophils >75%
hyperlipidemia, hypercalcemia, and the use
• C-reactive protein levels are elevated
of corticosteroids, thiazide diuretics, oral
contraceptives, and other medications
COMPLICATIONS e) Idopathic
f) Alcohol and nicotine consumption
• Gangrene 2. Self-digestion of the pancreas by own proteolytic
• Perforation enzymes
3. Pancreas becomes inflamed
4. release digestive enzymes into the abdomen and
MEDICAL MANAGEMENT bloodstream and irritate the nerves
• Surgery
• Antibiotics ACUTE PANCREATITIS
• Laparotomy and laparoscopy

NURSING MANAGEMENT

• Preventing or treating surgical site infection

• Relieve pain
• Preventing fluid volume deficit
• Reducing anxiety
• Preventing atelectasis
• Maintaining skin integrity
• Attaining optimal nutrition

PANCREATITIS & CHOLECYSTITIS

PANCREATITIS

• The pancreas, located in the upper abdomen, has

endocrine as well as exocrine functions.
 • Calcium stones

ASSESSMENT AND DIAGNOSTIC FINDINGS

• Endoscopic Retrograde Cholangiopancreatography

(ERCP)
• MRI
• CT SCANS
• ULTRASOUND
• GLUCOSE TOLERANCE TEST

ACUTE PANCREATITIS CLINICAL MANIFESTATIONS

• Severe abdominal pain

• Tenderness of the back
• Typically in the midepigastrium MEDICAL MANAGEMENT
• Pain is frequently acute in onset, occurring 24 to 48
• Directed toward relieving symptoms
hours after a very heavy meal or alcohol ingestion.
• Enteral Feedings
• Pain is unrelieved by antacids
• Parenteral Nutrition
• Abdominal distention
• Nasogastric Suction
• poorly defined, palpable abdominal mass
• Histamine-2 (H2) Antagonists (e.g. cimetidine)
• Decreased peristalsis or slow digestion
• Proton Pump Inhibitors (e.g. pantoprazole)
• Vomiting that does not relieve the pain and nausea
• Pain Management
− Administration of Analgesia.
ASSESSMENT AND DIAGNOSTIC FINDINGS − Parenteral Opioids (e.g. morphine, fentanyl,
or hydromorphone)
• History of abdominal pain − Antiemetic Agents
• risk factors • Intensive Care
• physical examination − Correction of fluid and blood loss and low
• Elevated WBC albumin levels
• Hypocalcemia − Hemodynamic Monitoring
• Transient hyperglycemia and glucosuria − Arterial Blood Gas Monitoring
• Elevated serum bilirubin levels − Antibiotic Agents
• Elevated serum amylase and lipase levels within − Intensive Insulin Therapy
24hrs of symptoms onset • Respiratory Care
- Serum amylase usually returns to normal − Aggressive Respiratory Care
within 48 to 72 hours − Close Monitoring of ABG
- Serum lipase levels remain elevated, often • Biliary Drainage
days longer than amylase. − Placement of biliary drains (for external
• Abdominal xray drainage)
• Ultrasound − Stents (indwelling tubes)
• MRI − Surgical Intervention
• CBC − Diagnostic Laparotomy
• paracentesis or peritoneal lavage • Postacute Management
• ERCP − Oral Feedings (low in fat and protein)
− Follow-up (e.g. Ultrasound, X-Ray studies,
or ERCP)
CLINICAL MANIFESTATIONS
− ERCP
• Recurring attacks of severe upper abdominal and • Depends on its probable cause in each patient.
back pain. Pain is often unrelieved by large doses of • Treatment is directed toward preventing and
opioids. Pain is progressive. managing acute attacks, relieving pain and
• Vomiting discomfort, and managing exocrine and endocrine
• Some experience continuous severe pain insufficiency of pancreatitis
• some have dull nagging constant pain • Nonsurgical Management
• Periods of well being between occurrence of pain − Indicated for the patient who refuses
attacks surgery, is a poor surgical risk, or when the
• Weight loss - usually caused by disease and symptoms do not warrant
• decreased dietary intake secondary to anorexia surgical intervention.
• Malabsorption − Endoscopy
• Impaired digestion − Use of Nonopioid Methods (e.g.
• Steatorrhea or stools that are frequent, frothy, and monotherapy)
foul − Antioxidants
 − Yoga and other mindfulness-based therapies • Escherichia coli, Klebsiella species, and
• Surgical Management Streptococcus.
- Pancreaticojejunostomy (also referred to as • Acalculous cholecystitis describes acute gallbladder
Roux-en-Y) inflammation in the absence of obstruction by
- Whipple’s Resection gallstones; impaired contraction
(pancreaticoduodenectomy) • after major surgical procedures, orthopedic
- Distal Pancreatectomy procedures, severe trauma, or burns. Also,
alterations in fluids and electrolytes,
NURSING MANAGEMENT alterations in regional blood flow in the
visceral circulation. Bile stasis (lack of
• Relieving Pain and Discomfort
gallbladder contraction) and increased
• Improving Breathing Pattern
viscosity of the bile are also thought to play a
• Improving Nutritional Status
role.
• Maintaining Skin Integrity
• Monitoring and Managing Potential Complications
• Promoting Home, Community-Based, and Transitional GALLSTONES CAUSED BY:
Care Bilirubin
Cholesterol
CHOLECSYTITIS

• Redness and Swelling (Inflammation) of the

gallbladder
• It occurs due to the presence of gallstones blocking
the bile ducts or an infection in the gallbladder.

ANATOMY AND PHYSIOLOGY

SIGNS AND SYMPTOMS

• Upper Abdominal Pain

• Nausea and Vomiting
• Fever
• Tenderness in the Abdomen
• Weakness and Fatigue
• Abdominal distention (bloating)

CHOLECYSTITIS PATHOPHYSIOLOGY

• Calculous cholecystitis is the cause of more than 90%

of cases of acute cholecystitis
• gallstones, form from the solid constituents
of bile; two major types of gallstones:
pigment and of cholesterol.
• Cholesterol is insoluble in water. Its solubility depends
on bile acids and lecithin (phospholipids). RISK FACTORS
• Bile remaining in the gallbladder initiates a chemical
• Being a female
reaction; autolysis and edema occur; and the blood
• Obesity
vessels in the gallbladder are compressed,
• Older age
compromising its vascular supply.
• Family history
 • Being pregnant cystitis and provide a comprehensive guide to understanding
• Ethnicity (Native or Mexican American this condition, its causes, and possible treatments.

Cystitis is the inflammation of the urinary bladder.

ASSESSMENT AND DIAGNOSTIC FINDINGS
There can be acute or chronic nonbacterial causes of
• Abdominal X-Ray inflammation that can be misdiagnosed as bacterial infections.
• Ultrasonogrophy
• Radionuclide Imaging or Cholescintigraphy
• Oral Cholecystography
• Endoscopic Retrograde
Cholangiopancreatography (ERCP)
• Percutaneous Transhepatic
Cholangiography

MEDICAL MANAGEMENET

• Supportive and dietary management

• rest, IV fluids, nasogastric suction, analgesia,
and antibiotic agents. Low fat liquids diet
hence avoid eggs, cream, pork, fried foods,
cheese, rich dressings, and alcohol
• Ursodeoxycholic acid (UDCA) and chenodeoxycholic
acid (chenodiol or CDCA) – dissolve gallstones SIGNS AND SYMPTOMS
composed of cholesterol ; inhibits its synthesis
A variety of signs and symptoms are associated with cystitis.
• ERCP: Endoscopic Retrograde
Burning. A sensation of burning upon urination is felt.
Cholangio Pancreatography
Frequency. The patient experiences voiding more than every
three (3) hours.
Nocturia. The patient experiences awakening at night to
urinate.
Dysuria. There is difficulty in urinating.
Urethral discharge. The presence of discharge is also possible,
especially in males.

ASSESSMENT/DIAGNOSTIC TESTS:

Results of various tests, such as bacterial colony counts,

cellular studies, and urine cultures, help confirm the diagnosis
of cystitis.
•Microscopic urinalysis. Microscopic urinalysis shows red blood
cells and white blood cells greater than ten/high-power field
suggesting UTI.
•Urine culture. Urine cultures are useful for documenting
cystitis and identifying the specific organism present.
•Cellular studies. A patient with cystitis usually has microscopic
• Cholecystectomy - Remove cause of cholecystitis hematuria and pyuria.
• Choledochostomy- too ill •Leukocyte esterase test. A multiple-test dipstick often includes
• Intracorporeal Lithotripsy– laser; electric sparks testing for WBCs and nitrite testing.
• Extracorporeal shock wave lithotripsy (ESWL) •CT scan. A CT scan may detect pyelonephritis or abscesses.
•Ultrasonography. Ultrasonography is extremely sensitive for
detecting an obstruction, abscesses, tumors, and cysts.

NURSING MANAGEMENET MEDICAL MANAGEMENT

• Relieving pain Pharmacologic Therapy
• Improving Respiratory Status
• Maintaining skin integrity and promoting biliary Appropriate antimicrobials are the treatment of choice for most
drainage initial lower UTIs.
• Improving nutritional status
• Monitoring and managing potential complications Antibiotic Therapy:
• Promoting home, community-based care, and
Few side effects. The ideal medication for treatment is an
transitional care
antibacterial agent that eradicates bacteria with minimal effects
on fecal and vaginal flora.

Cystitis and Urolithiasis The length of treatment. Recent studies suggest that a single
dose of antibiotic or an antibiotic regimen of 3 to 5 days length
Cystitis and Urolithiasis are common conditions in urology. This may be sufficient to render the urine sterile.
presentation will explore the definitions, pathophysiology,
assessment, diagnostic tests, and medical management of Drug of choice. Single-dose antibiotic therapy with amoxicillin
both conditions. or trimethoprim and sulfamethoxazole may be effective in
females with acute noncomplicated UTI.

Urine culture. A urine culture taken 1 to 2 weeks later indicates

CYSTITIS whether or not the infection has been eradicated.

is a common urinary tract infection that affects millions of

people worldwide. In this presentation, we will delve deep into
NURSING INTERVENTION In general, the patient is able to pass stones 0.5 cm in
diameter. Stones larger than 1 cm in diameter usually must be
PATIENT EDUCATION: removed or fragmented (broken up by lithotripsy) so that they
can be removed or passed spontaneously.
• MEDICATION (purpose, side effects)
• FLUID INTAKE (STAY HYDRATED)
• REMEDY (THE USE OF HEATING PAD)
ASSESSMENT & DIAGNOSTIC FINDINGS:

• The diagnosis is confirmed by a noncontrast CT scan.

UROLITHIASIS • Blood chemistries and a 24-hour urine test for
measurement of calcium, uric acid, creatinine,
Urolithiasis, is a common condition that affects millions of
sodium, pH, and total volume may be part of the
people every year. In this presentation, we will explore its
diagnostic workup.
pathophysiology, assessment, diagnostic tests, and medical
• Dietary and medication histories and family history of
management.
renal calculi are obtained to identify factors
Urolithiasis refers to stones in the urinary tract. Urinary stones predisposing the patient to the formation of stones
predominantly occur in the third to fifth decade of life and affect
• When stones are recovered (whether freely passed by
men twice as often as women.
the patient or removed through special procedures),
The prevalence of renal calculi is 10.6% for males and 7.1% for chemical analysis is carried out to determine their
females; however recent studies show that rates are increasing composition.
among women with estimates that the ratio of affected males-
• Stone analysis can provide a clear indication of the
to-females is 1.3 to 1
underlying disorder. For example calcium oxalate or
calcium phosphate stones usually indicate disorders
of oxalate or calcium metabolism, whereas urate
stones suggests a disturbance in uric acid
metabolism.

MEDICAL MANAGEMENT

Opioid analgesic agents are given to prevent shock and

syncope that may result from the excruciating pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in
treating renal calculus pain because they provide specific pain
relief. They also inhibit the synthesis of prostaglandin E,
reducing swelling and facilitating passage of the stone.

Unless the patient is vomiting or has heart failure, or any other

condition requiring fluid restriction, fluids are encouraged. This
increases the hydrostatic pressure behind the stone, assisting
it in its downward passage. A high, around-the-clock fluid
intake reduces the concentration of urinary crystalloids, dilutes
the urine, and ensures a high urine output

Nutritional therapy plays an important role in preventing renal

calculi. Fluid intake is the mainstay of most medical therapy for
renal calculi. Unless fluids are concentrated, patients with renal
calculi should drink eight to ten 8-oz glasses of water daily or
have IV fluids prescribed to keep the urine dilute. A urine
output exceeding 2 L/day is advisable.

If the stone does not pass spontaneously or if complications

occur, common interventions include endoscopic or other
procedures. For example ureteroscopy, extracorporeal shock
SIGNS AND SYMPTOMS stone removal (ESWL), or endourologic (percutaneous) stone
removal may be necessary.
Signs and symptoms of stones in the urinary system depend
on the presence of obstruction, infection, edema

When stones block the flow of urine, obstruction develops, PELVIC INFLAMMATORY DISEASE
producing an increase in hydrostatic pressure and distending
the renal pelvis and proximal ureter Pelvic inflammatory disease (PID) refers to the inflammation of
the female reproductive organs. It is typically an ascending
Infection (pyelonephritis and UTI with chills, fever, and infection, spreading from the lower genital tract.
frequency) can be a contributing factor with struvite stones.

Stones lodged in the ureter (ureteral obstruction) cause acute,

excruciating, colicky wavelike pain that radiates down the thigh The disease affects the:
to the genitalia. Often, the patient has a desire to void, but little Uterus (endometritis)
urine is passed, and it usually contains blood because of the Fallopian tubes (salpingitis)
abrasive action of the stone. Ovaries (Oophoritis)
Pelvic Peritoneum (Peritonitis)
This group of symptoms if called ureteral colic. Colic is Pelvic Vascular System
mediated by prostaglandin E, a substance that increases
ureteral contractility and renal blood flow and that leads to Infection can be categorized as:
increased intraureteral pressure and pain. Acute
Subacute
Recurrent -antimicrobial therapy
Chronic -inability to follow or tolerate an
Localized outpatient oral regimen,
Widespread -severe illness
-tubo-ovarian abscess

CAUSE Pharmacologic Therapy

- Antibiotic therapy is prescribed (usually a
It is most often caused by sexually transmitted disease, such
combination of ceftriaxone, doxycycline, and
as chlamydia and gonorrhea. Most cases of PID are
metronidazole).
polymicrobial. Other causes of PID include:
• Microorganisms that normally live in the vagina, such
as Escherichia coli (E. coli) and Gardnerella vaginalis
NURSING DIAGNOSIS
• Microorganisms that enter the reproductive tract
• Acute pain related to pelvic inflammatory disease
during childbirth, miscarriage, or abortion
• Increased body temperature related to infection
• Microorganisms that enter the reproductive tract
secondary to pelvic inflammatory disease as
during the insertion of an intrauterine device (IUD)
evidenced by a body temperature of 38.5C
• Microorganism that enter the reproductive tract during
• Impaired urinary elimination related to inflammatory
medical procedures, such as endometrial biopsies or
process as evidenced by burning sensation during
hysteroscopies.
urination
Prevalence:
NURSING MNG. & RESPONSIBILITIES
⮚ 4.4% in sexually experienced women of reproductive
• Monitor vital signs
age from 18-44 years.
• Monitor and record characteristics and amount of
⮚ PID was also highest in women reporting a previous vaginal discharge
sexually transmitted infections (STI). • Administer analgesics agents as prescribed for pain
relied (ibuprofen, aspirin, acetominophen)
• Heat compress abdomen
SIGNS AND SYMPTOMS • Carefully handling perineal pads with gloves
• Pain in lower abdomen and pelvis • Teach proper perineal care
• Unusual or heavy vaginal discharge that may have an • Explain why douching is not good
unpleasant odor. • Inform patient about signs and symptoms
• Vaginal bleeding during or after sexual contact • Health teaching to the partner
• Dyspareunia • Inform patient of the need for precautions and
• Fever with chills encourage to take part in the procedure
• Painful, frequent or difficult urination
BENIGN PROSTATIC HYPERPLASIA
RISK FACTORS
• Multiple sexual partner
• History of previous Sexually Transmitted Infection
(STI)
• History of sexual abuse
• Frequent vaginal douching

COMPLICATIONS
• Pelvic or generalized peritonitis
• Abscesses
• Strictures
• Fallopian tube obstruction

DIAGNOSTIC TESTS & FINDINGS:

• Pelvic examination ( intense tenderness may be noted
on palpation of the uterus or movement of the cervix) Benign Prostatic Hyperplasia (BPH) is a non-cancerous
• urine and blood test enlargement of the prostate that may cause problems
• ultrasound associated with urination that can lead to decreased quality of
life.
PATHOPHYSIOLOGY • Typically occurs in men older than 40.
• 50% of men will have BPH once they become 60.
• Affects 90% of men aged 85 above.

CAUSE
The exact cause of benign prostatic hyperplasia (BPH) is
unknown, but it is thought to be caused by a combination of
factors, including:

Changes in hormone levels: BPH may be caused by

MEDICAL MANAGEMENT changes in the levels of testosterone, dihydrotestosterone, and
❑ Women patients are mostly outpatients but estrogen.
monitored carefully
❑ Treatment of sexual partners Genetics: Men with a family history of BPH are more likely to
❑ Temporary abstinence develop the condition themselves.
❑ Indications for hospitalization include:
-surgical emergencies Certain medical conditions: Certain medical conditions, such
-pregnancy as obesity, hypertension, diabetes and obesity, may increase
-no clinical response to outpatient the risk of developing BPH.
oral
Western Diet: high in animal fat, protein and refined DIAGNOSTIC FINDINGS/ LABORATORIES
carbohydrates but low in fiber. • History & examination
1. Abdominal/ GU exam
Unhealthy lifestyle: Reduced activity, smoking and heavy 2. Focused neuro exam
alcohol consumption. Environmental factors: exposure to • Digital rectal exam (DRE)
certain environmental factors, such as pesticides and • Urinalysis
herbicides • Urine culture
• BUN
• Prostate- specific antigen (PSA)
STAGES OF BPH

PATHOPHYSIOLOGY
• Prostatic enlargement depends on the potent
androgen dihydrotestoosterone ( DHT). In the
prostate gland, type II 5- alpha-reductase metabolizes
circulating testosterone into DHT, which works locally,
not systematically. DHT binds to androgen receptors
in the cell nuclei, potentially resulting in BPH.

CLINICAL MANIFESTATIONS
Common Symptoms
• Frequent urination
• Nocturia (peeing more often at night)
• Hesitancy in starting urination
• Decreased and intermittent force of stream
• Not being able to fully empty the bladder
• Dribbling (urine dribbles out after urination)

Less Common Symptoms

• Urinary Tract Infection (UTI)
• Not being able to pee
• Hematuria (blood in the urine)
Chronic urinary retention and large residual volumes can
lead to azotemia (accumulation of nitrogenous waste
products) and kidney failure.

MEDICAL MANAGEMENT
RISK FACTORS • Insertion of Catheters
• Males ages >50 - Ordinary Catheters or Metal Catheters
• Trauma • Cystostomy
• Male hormones • “watchful Awaiting”
• Smoking
• Heavy alcohol assumption PHARMACOLOGIC THERAPY
• Hypertension • Alpha adrenergic blockers
• Heart Disease - Alfuzosin, terazosin, doxazosin and tamsulosin
• Diabetes • 5-alpha-reductase inhibitors
- finasteride and dutasteride
COMPLICATIONS NOTE: The use of alternative and complementary
• Acute urinary retention phytotherapeutic agents and dietary supplements (e.g.
• Hematuria Serenoa repens and Pygeum africanum) are not
• Urinary tract infection recommended by the medical community.
• Bladder damage
• Bladder stones
• Kidney damage NURSING DIAGNOSIS
• Urinary Retention related to obstruction in the bladder
ASSESSMENT or urethra
International Prostate Symptom Score (IPSS) assess severity • Acute pain related to bladder distention
of the symptoms. A score of 0 to 7 indicates mild symptoms, 8
to 19 indicates moderate symptoms and 20 to 35 indicates NURSING MANAGEMENT :
severe symptoms. • Manage urinary retention
• Promoting optimal fluid balance
• Provide acute pain relief and pain management
• Reducing anxiety and provide emotional support

SURGICAL MANAGEMENT :
• Open prostatectomy
• Transurethral resection of the prostate (TURP)
• Transurethral needle ablation (TUNA)