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    Respiratory 4 Spring 07

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    api-3697326
    The document discusses the flu and tuberculosis. It provides details on how the flu is highly contagious and can be spread before and after symptoms appear. It then gives statistics on flu hospitalizations and deaths in the United States. The document also discusses treatment and prevention of the flu, including antiviral medications and vaccines. It then covers tuberculosis, explaining how it is caused by the Mycobacterium tuberculosis bacteria and how the disease progresses from a primary infection to potentially active TB.

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    Respiratory 4 Spring 07

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    83 views26 pages
    The document discusses the flu and tuberculosis. It provides details on how the flu is highly contagious and can be spread before and after symptoms appear. It then gives statistics on flu hospitalizations and deaths in the United States. The document also discusses treatment and prevention of the flu, including antiviral medications and vaccines. It then covers tuberculosis, explaining how it is caused by the Mycobacterium tuberculosis bacteria and how the disease progresses from a primary infection to potentially active TB.

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    The document discusses the flu and tuberculosis. It provides details on how the flu is highly contagious and can be spread before and after symptoms appear. It then gives statistics on flu hospitalizations and deaths in the United States. The document also discusses treatment and prevention of the flu, including antiviral medications and vaccines. It then covers tuberculosis, explaining how it is caused by the Mycobacterium tuberculosis bacteria and how the disease progresses from a primary infection to potentially active TB.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    83 views26 pages

    Respiratory 4 Spring 07

    Uploaded by

    api-3697326
    The document discusses the flu and tuberculosis. It provides details on how the flu is highly contagious and can be spread before and after symptoms appear. It then gives statistics on flu hospitalizations and deaths in the United States. The document also discusses treatment and prevention of the flu, including antiviral medications and vaccines. It then covers tuberculosis, explaining how it is caused by the Mycobacterium tuberculosis bacteria and how the disease progresses from a primary infection to potentially active TB.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    The Flu … and TB

    Mary J. Aigner RN,


    MSN, FNPC
    The flu … why care?
    ✏ Highly contagious
    ✏ May be infectious and able to spread
    ✏ Before symptoms start (Adults 1 day, Kids 5d)
    ✏ Up to 5(A)/10(K) days after symptoms appear
    ✏ Severely immunocompromised can shed virus for weeks or
    months

    ✏ Primarily
    person-to-person via large droplets (> 5ųm
    diameter)
    ✏ From cough, sneeze
    How many affected?
    ✏ 1979-80 through 2000-01
    ✏ # flu related hospitalizations
    ✏ Range:54,000 to 430,000
    ✏ Average: 226,000 per year
    ✏ 63% hospitalized > or = 65 years

    ✏ Deaths
    ✏ 36K deaths/year average (1990-1999)
    ✏ Usufrom pneumonia or cardiac exascerbations or
    chronic diseases
    ✏ Most > or = 65 years (90% of deaths from px or flu)
    More data (from CDC)
    ✏ InU.S. - # deaths related to flu has
    increased
    ✏ WHY?
    ✏ Deaths uncommon in children
    ✏ With or without high-risk conditions
    ✏ During1990’s: average 0.4/100,000 (< 5yrs)
    ✏ Same time, adults averaged 98.3/100K (>=65)
    Initial Symptoms (p 633)
    ✏ Severe HA
    ✏ Muscle aches
    ✏ Fever
    ✏ Chills
    ✏ Fatigue
    ✏ Weakness
    ✏ anorexia
    More manifestations
    ✏ Sore throat
    ✏ Cough
    ✏ Rhinorrhea
    ✏ (watery discharge)

    ✏ Fatigue x 1-2 weeks


    after acute episode
    resolved
    Treatment ✏ Antiviral meds (633)
    ✏ Need script
    ✏ Symptomatic ✏ Older drugs
    ✏ Amantadine
    ✏ Fever - Tylenol
    ✏ Pain - Tylenol
    (Symmetrel)
    ✏ Rimantadine (Flumadine)
    ✏ Lots of fluids
    ✏ Rest and More rest ✏ Newer drugs
    ✏ Zanamivir (Relenza)
    ✏ Cough syrup
    ✏ Oral inhalant
    ✏ Saline gargles ✏ Oseltamivir (Tamiflu)
    ✏ Or throat spray ✏ Both can be used as
    ✏ Antihistamines prevention or treatment
    ✏ For rhinorrhea (within 24-48 hours)
    Prevention of Flu
    ✏ Flu vaccine
    ✏ Changed yearly based on most likely viral
    strains to appear during season
    ✏ When is the typical flu season?
    ✏ Given IM, 0.5 ml. - usu in arm
    ✏ Or nasal spray
    ✏ (jury still out on effectiveness w/adults)
    ✏ Recommended for > 50 yrs, chronic illness,
    immunocompromised, live in institutions, health
    care workers
    *variant of
    A/New
    Caledonia
    Used 2006-7
    2007-08 Flu Vaccine
    Per recommendations of WHO
    For Northern Hemisphere,
    contains:
    ✏ A/Solomon Islands*
    ✏ 3/2006-like
    ✏ H1N1
    ✏ A/Wisconsin
    ✏ 67/2005-like
    ✏ H3N2
    ✏ B/Malaysia
    ✏ 2506/2004-like
    ✏
    What do the letters & numbers
    mean?
    ✏ The “H” stands for hemagglutinin
    ✏ 500 molecules of h. make one virion
    ✏ It determines extent of infection in host
    ✏ There are 16 subtypes labeled with “H”
    ✏ The “N” stands for neuraminidase
    ✏ Nine different “N” subtypes
    ✏ So… the number stands for the
    specific subtype
    Like it or not…here’s more
    ✏ Most known strains are now extinct
    ✏ Sometimes, variants are named for
    species virus adapted to, or endemic in
    ✏ Bird flu (or Avian flu)
    ✏ Human flu
    ✏ Swine flu
    ✏ Horse flu (Tell about
    ✏ Dog flu ravens)
    Still More
    ✏ Influenza A virus ✏ Influenza B virus
    ✏ Family called ✏ No sub-categories
    Orthomyxoviridae ✏ Slower antigenic
    ✏ RNA virus drift than A virus
    ✏H and N are 2 of 11 ✏ (mutates slower)
    proteins in virus
    ✏ All A subtypes ✏ So what might this
    affect birds (hosted mean for humans?
    by birds)
    ✏ Some in mammals
    CDC: Guidelines for Prevention &
    Control of Flu in Acute-Care Facilities
    ✏ Vaccination
    ✏ All health-care personnel & high-risk
    ✏ Infection Control measures
    ✏ Surveillance
    ✏ Education
    ✏ Flu testing
    ✏ Respiratory hygiene/cough etiquette
    ✏ Standard precautions
    ✏ Droplet precautions
    ✏ Antiviral prophylaxis
    ✏ Restrictions for Ill visitors or personnel
    Let’s check out the
    Let’s take a
    break!
    TB pathophys
    ✏ Caused by Mycobacterium tuberculosis
    ✏ Most common infection worldwide
    ✏ Transmitted via aerosolization
    ✏ Cough, laugh, sneez, whistle, sing
    ✏ More infected with bacillus but don’t
    develop active TB
    So what happens?
    ✏ Bacillus multiples in bronchi/alveoli
    ✏ Exudative response occurs
    ✏ Causes pneumonitis
    ✏ Body develops immunity
    ✏ Further growth usually controlled
    ✏ Lesions resolve - little or no bacillus left
    ✏ BUT - small % develop active TB
    ✏ 5-15%
    Active TB - pg 640
    ✏ Greatest risk:
    ✏ People who are HIV (-) 2
    yrs after infection

    ✏ OK class - does that


    make sense to anyone?
    Immunity & Infection
    ✏ Cell mediated immunity develops
    ✏ 2-10 weeks after infection
    ✏ + PPD test (conversion)
    ✏ Primary infection small
    ✏ Will not show on CXR
    ✏ 1) granulomatous inflammation (p 640),
    2) caseation necrosis (if shows on CXR,
    called a Ghon tubercle or primary lesion)
    And then …
    ✏ Areas of caseation undergo
    ✏ Resorption,
    ✏ Degeneration
    ✏ Fibrosis
    ✏ Necrotic areas may calcify or liquefy
    ✏ If liquid – material empties into bronchus –
    causes cavity (cavitation)
    ✏ During all of this, bacilli are growing and
    spreading through lymph into more of lungs
    It can also …
    ✏ Lesions may progess during inflammation
    stage
    ✏ Bacilli multiply rapidly
    ✏ Extends through the pleura
    ✏ Causes pleural or pericardial effusion
    ✏ Miliary or hematogenous TB
    ✏ Spreads throughout body as organisms enter
    bloodstream
    ✏ Brain, mininges, liver, kidney, bone marrow
    Initially
    ✏ Infection most often in
    ✏ Middle or lower lobes
    ✏ Local lymph nodes infected, enlarged

    ✏ Then – period of asymptoms


    ✏ Years or decades before symptoms again
    ✏ Person is NOT infectious (although infected)
    until symptoms reoccur
    Secondary TB
    ✏ Reactivation of disease
    ✏ In previously infected person
    ✏ More likely when host defenses lowered
    ✏ Eg. older, HIV
    ✏ Usu in upper lobes
    ✏ Called Simon’s foci

    ✏ See page 631, T34-8 for classifications


    Risk of Transmission
    ✏ Reduced after
    infected person
    ✏ has been on meds
    for 2-3 weeks
    ✏ Clinically better
    ✏ Bacilli in sputum
    reduced
    FEARLESS

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