Severe and additional acute respiratory disorders

Severe acute disorders of the respiratory system

Pertussis

Pertussis (also called whooping cough) is a contagious disease that is caused by Bordetella pertussis. Pertussis is spread by coughing or sneezing and develops within 5 to 10 days after exposure. Initially, the person may experience nasal drainage, a low-grade fever, and a mild, occasional cough. Later signs include a rapid coughing followed by a high-pitched “whoop” sound and vomiting. The person may be exhausted after the coughing fit. According to the CDC, infected people are most contagious up to about 2 weeks after the cough begins.

The provider will complete a history and physical examination. A nasopharyngeal specimen is obtained for a culture. A polymerase chain reaction (PCR) test can be done. Pertussis is treated with antibiotics. The person is encouraged to stay home, rest, and use a humidifier. Good hand washing helps to eliminate transmission. The DTaP and Tdap vaccines are used to help prevent pertussis.

Pneumonia

Pneumonia is an infection of the lungs. It may affect one or both lungs. The alveoli fill with fluid or pus. Young children, adults over 65 years of age, people who smoke, and those with chronic illnesses are at more risk for pneumonia. The severity of pneumonia can range from mild to life threatening. In the United States, about 1 million people have pneumonia yearly, and about 50,000 people die from the disease. Adults are at the most risk. Globally, it is the leading infectious disease killer of children under age 5.

Pneumonia can be caused by bacteria, viruses, and fungi (Table 41.2). If a person has viral pneumonia, there is also a risk of getting bacterial pneumonia. Various chemicals can also cause pneumonia. Aspirating fluid or a foreign material into the lungs can also cause pneumonia. Signs and symptoms of pneumonia vary based on the severity and type of pneumonia. Typically, pneumonia causes high fever, chills, productive cough, shortness of breath, and chest pain with coughing or breathing. A person may also experience decreased appetite and fatigue. Confusion may occur in older adults.

Providers will listen to a patient’s lungs for abnormal sounds. Chest x-rays, a CBC, a sputum culture, and pulse oximetry are typical diagnostic procedures used to check for pneumonia. Treatment for pneumonia is based on the type of pneumonia a person has. Antibiotics are used for bacterial pneumonia, and antiviral medications are used for viral pneumonia. Patients are encouraged to drink plenty of fluids and get rest. OTC antipyretics and analgesics (e.g., ibuprofen and acetaminophen) may be recommended.

Pulmonary embolism

Pulmonary embolism (PE) is a condition in which one of the pulmonary arteries is blocked. PE is a medical emergency and can be life threatening. Due to the blockage, blood flow may be interrupted to that section of the lung. This can lead to pulmonary hypertension. Oxygen can be limited to other body organs.

Often, PE is a complication of deep vein thrombosis (DVT). Blood clots form in the veins, usually in the legs. Some of the clots break off and travel through the bloodstream. Eventually, the clot blocks a pulmonary artery.

Risk factors for PE include the following:

• Current or past DVT
• Being bedridden, having surgery; breaking a bone
• Pregnancy
• Chronic illness (stroke, hypertension, chronic heart disease, obesity)
• Smoking
• Use of birth control pills or hormone therapy pills

Pulmonary embolism can cause problems breathing, unexplained shortness of breath, and rapid breathing. A patient may experience chest pain, coughing or coughing up blood, arrhythmias, lightheadedness, and fainting.

Besides a medical history and physical examination, the provider may order the following diagnostic procedures:

• Ultrasound: to detect DVT in the legs
• CT scan with contrast to detect PE or DVT
• Lung ventilation/perfusion scan (VQ scan)
• Pulmonary angiography
• Chest x-ray and chest MRI scan
• Echocardiography and electrocardiogram (ECG)

The goals of treatment include preventing more clots or larger clots from forming. Treatment includes the following:

• Anticoagulants: “Blood thinners” (e.g., warfarin [Coumadin] and heparin) to prevent clots from forming.
• Thrombolytics: Medications that break up the clot. These are used in emergencies. Thrombolytics can be delivered by a catheter to the site of the clot.
• Compression stockings: To help prevent blood from pooling and clotting in the legs.

Pulmonary tuberculosis

Pulmonary tuberculosis (TB) is caused by bacteria that can affect the lungs. There are two TB-related conditions: latent TB infection and TB disease. Tuberculosis is caused by Mycobacterium tuberculosis, which is spread through the air. The following individuals are at risk for TB:

• Anyone who has lived in a country where TB is prevalent
• Anyone in frequent close contact with someone with TB disease
• Those working in healthcare, a homeless shelter, or a prison
• Those living in a nursing home, prison, or homeless shelter
• People who have latent TB infection and a weakened immune system because TB can become active under these conditions

There are differences regarding the spread and the signs/symptoms of the two TB-related conditions:

• With latent TB infection, a person cannot spread TB bacteria to others, and there are no signs or symptoms.
• With TB disease, a person can spread the disease by coughing, sneezing, singing, or talking. TB disease can cause a bad cough that lasts 3 or more weeks, pain in the chest, blood in the sputum, weakness, no appetite, weight loss, chills, fever, and night sweats.

Initially, the person is tested with either a Mantoux tuberculin skin test (TST) (also known as a purified protein derivative [PPD] test) or a TB blood test (e.g., QuantiFERON-TB Gold Plus [QFT-Plus], T-SPOT.TB). If the test is positive, then the person will have additional testing (e.g., chest x-ray and sputum smear/culture) to determine if it is latent TB infection or TB disease. With latent TB infection, the chest x-ray is normal, and the sputum smear/culture is negative. With TB disease, the chest x-ray is abnormal, and the sputum smear/culture is positive. Treatments include the following:

• For latent TB infections, isoniazid or rifapentine may be prescribed. The goal is to prevent TB disease; a weakened immune system can increase the risk of TB disease.
• For TB disease, isoniazid, rifampin, ethambutol, or pyrazinamide may be prescribed. With treatment, TB disease symptoms tend to diminish within 2 to 3 weeks, but medication treatment may last for 6 to 9 months.