UPPER RESPIRATORY INFECTIONS

Adult Health Nursing 7th Ed

ACUTE RHINITIS

Coryza, “common cold”

Etiology and pathophysiology

-An inflammatory condition - mucous membranes of the nose and accessory sinuses -Caused by one or more viruses. -signs/symptoms-evident 24-48 hours

after exposure

ACUTE RHINITISCLINICAL MANIFESTATIONS

Sinus congestion -increased sinus drainage - postnasal drip - throat irritation - headache - earache Productive cough. Fever. If uncomplicated, it subsides in a week.

Acute RhinitesSUBJECTIVE: 1. Pt. complaints of symptoms

OBJECTIVE: 1. Color , consistency of nasal

discharge. 2. Visual exam the throat for redness, edema, local irritation.

3. Presence and duration of fever

Diagnostic TestsThroat and sputum cultures.

MEDICAL MANAGEMENT -Accurate diagnosis -prevention of complications. -No specific treatment -Aspirin or Tylenol - analgesia/fever -Cough suppressant - dry, nonproductive cough. -Cough expectorant - productive cough -antibiotic - bacterial infection.

NURSING INTERVENTIONS

-Promote comfort. -Encourage fluids. -Apply warm, moist packs to

sinuses.

PATIENT AND FAMILY TEACHING

-proper hand washing -disposal of tissues -limit exposure to others during

the first 48 hours -check body temp. every 4 hours.

NURSING DIAGNOSIS

Ineffective airway clearance, related to nasal exudate

Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection

ACUTE FOLLICULAR TONSILLITIS

Etiology and pathophysiology -Acute inflammation of the

tonsils.

-Result of an air- or food borne bacterial infection -often Streptococcus

-Can be viral

Acute Follicular Tonsilitis

-If it is caused by Group A β-hemolytic Streptococci, sequelae can occur:

-Rheumatic fever -Carditis -Nephritis. -Most common in children.

CLINICAL MANIFESTATIONS

-sore throat -fever -chills -malaise -enlarged, tender, cervical lymph nodes. -general muscle aching. -Labs -CBC reveals an increased WBC count.

MUSCLE ACHE, ENLARGED CERVICAL NODE

ASSESSMENT

SUBJECTIVE: -patient complains of: - severity of the sore throat - ear pain - headache -joint pain

OBJECTIVE DATA: 1. Visual exam: - throat secretions - enlarged, reddened tonsils.

DIAGNOSTIC TESTS

1. Throat culture

2. CBC to check the WBC count With bacterial infection, WBC can rise to 10-20,000

MEDICAL MANAGEMENT

-Early antibiotics - specific to the bacteria. -Tonsillectomy and adenoidectomy (T&A) - usually done in people who have recurrent attacks -Medications: - antipyretics, analgesics, and antibiotics -Warm, saline mouth gargles.

,

NURSING INTERVENTIONS

-Thorough oral care - promotes comfort - reduces/prevents infection.

NURSING INTERVENTIONS

-Post-operative - observe for: - bleeding. - fever- check V.S.

- provide physical and emotional comfort - postioning - support - pain medication

- apply an ice collar to the neck - comfort and vasoconstriction. Watch for s/sx; elevated temp

Nursing Diagnoses

Pain, related to inflammation/irritation of the pharynx.

Risk for deficient fluid volume, related to inability to maintain usual oral intake because of painful swallowing

Risk for aspiration, related to postoperative bleeding

Nursing Interventions

-Maintain patent airway - keep the pt. lying on his side - prevents aspiration.

-Observe for frequent swallowing - may indicate bleeding - check the back of the throat with a flashlight for blood trickling down.

Nursing Interventions

- assess hydration status. - encourage ice chips, popsicles, and cold

fluids. - avoid citrus fluids -may irritate the throat

- measures to avoid vomiting

VOMITING

Patient and family Teaching

- Complete the prescribed antibiotic

- Tonsillectomy patient - instruct on the dietary precautions. - avoid clearing his throat, vigorous coughing, sneezing, or nose

blowing after surgery for 1-2 weeks. - may cause bleeding

Patient and Family Teaching

- notify the PCP if there are any complications.

- void ASA or other blood-thinning

medications

LARYNGITIS

Etiology/pathophysiology Inflammation of the larynx - due to virus or bacteria May cause severe respiratory distress in children under 5 years old -small larynx of the young child - subject to spasm when irritated or

infected - becomes partially or totally obstructed

LARYNGITIS

Clinical manifestations/assessment Hoarseness Voice loss Scratchy and irritated throat Persistent cough

Assessment

Subjective Patient report of:

Progressive hoarseness Productive/non-productive cough Exposure to inhaled irritants

Objective Evaluate patient’s voice quality Sputum characteristics

DIAGNOSTIC TESTS

Laryngoscopy - edema - drainage of vocal cords and

laryngeal mucosa

MEDICAL MANAGEMENT Viral—no specific treatment Bacterial—antibiotics Analgesics Antipyretics Antitussives Warm or cool mist vaporizer Limit use of voice

NURSING DIAGNOSES

Pain, related to pharyngeal irritation

Impaired verbal communication , related to edematous vocal cord

NURSING INTERVENTIONS

Encourage oral intakeEncourage adequate restUse of vaporizer increase humidity keep

secretions thin and easier to expectorateMedication teachingAvoid exposure to inhaled irritantsPreventive measures

PHARYNGITISEtiology/pathophysiology

Inflammation of the pharynx Chronic or acute Frequently accompanies the common cold

Viral, most common Bacterial – a severe form of pharyngitis – strep throat

PHARYNGITIS

Clinical manifestations/assessment Dry cough Tender tonsils Enlarged cervical lymph glands Red, sore throat - scratchy difficulty swallowing Fever

PHARYNGITIS - Medical Management

Antibiotics Penicillin, Erythromycin Treat severe infections Prevent superimposed infections in people with cardiac history

Analgesics AntipyreticsWarm or cool mist vaporizer

Nursing Interventions/ Patient Teaching

Offer throat gargles/rinsesAdequate RestAdequate oral fluidsUse of vaporizerMedications: pain meds, antibiotic,

antipyretic

NURSING DIAGNOSES

Impaired oral mucous membrane, related to edema

Deficient fluid volume, risk for, related to decreased oral intake as a result of painful swallowing

SINUSITIS

Etiology/pathophysiology Inflammation of the sinuses Usually begins with an upper respiratory infection

Viral or bacterial Chronic or acute

Underlying pathophysiology: Begins with a URI sinus infection

SINUSITISClinical manifestations

Constant, severe headache Pain and tenderness in involved sinus region

Purulent exudate Malaise Fever

SINUSITIS

Assessment:Subjective:Patient report of:

Decrease appetite or nausea Generalized malaise, headache, pain in

the sinus regionObjective

VS – esp. temp Character and amt of drainage

SINUSITIS

DIAGNOSTIC TESTS:Sinus Radiographs – reveals cloudy or fluid filled sinuses

Transillumination – shining a light in the mouth with the lips closed around it. Infected sinuses will look dark and normal sinuses will transilluminate

MEDICAL MANAGEMENTSurgical interventions:

Nasal Windows – - allows better drainage and removal of diseased mucosal tissueAntibioticsAnalgesicsAntihistaminesVasoconstrictor nasal spray (Afrin)

NURSING INTERVENTIONS/Diagnoses

Warm mist vaporizer Warm, moist packs

Nursing DiagnosesIneffective breathing pattern, related to nasal congestion

Pain, related to sinus congestion