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UPPER RESPIRATORY INFECTIONS
Adult Health Nursing 7th Ed
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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
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ACUTE RHINITISCLINICAL MANIFESTATIONS
Sinus congestion -increased sinus drainage - postnasal drip - throat irritation - headache - earache Productive cough. Fever. If uncomplicated, it subsides in a week.
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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
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Diagnostic TestsThroat and sputum cultures.
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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.
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NURSING INTERVENTIONS
-Promote comfort. -Encourage fluids. -Apply warm, moist packs to
sinuses.
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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.
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NURSING DIAGNOSIS
Ineffective airway clearance, related to nasal exudate
Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection
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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
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Acute Follicular Tonsilitis
-If it is caused by Group A β-hemolytic Streptococci, sequelae can occur:
-Rheumatic fever -Carditis -Nephritis. -Most common in children.
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CLINICAL MANIFESTATIONS
-sore throat -fever -chills -malaise -enlarged, tender, cervical lymph nodes. -general muscle aching. -Labs -CBC reveals an increased WBC count.
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MUSCLE ACHE, ENLARGED CERVICAL NODE
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ASSESSMENT
SUBJECTIVE: -patient complains of: - severity of the sore throat - ear pain - headache -joint pain
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OBJECTIVE DATA: 1. Visual exam: - throat secretions - enlarged, reddened tonsils.
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DIAGNOSTIC TESTS
1. Throat culture
2. CBC to check the WBC count With bacterial infection, WBC can rise to 10-20,000
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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.
,
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NURSING INTERVENTIONS
-Thorough oral care - promotes comfort - reduces/prevents infection.
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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
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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
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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.
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Nursing Interventions
- assess hydration status. - encourage ice chips, popsicles, and cold
fluids. - avoid citrus fluids -may irritate the throat
- measures to avoid vomiting
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VOMITING
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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
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Patient and Family Teaching
- notify the PCP if there are any complications.
- void ASA or other blood-thinning
medications
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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
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LARYNGITIS
Clinical manifestations/assessment Hoarseness Voice loss Scratchy and irritated throat Persistent cough
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Assessment
Subjective Patient report of:
Progressive hoarseness Productive/non-productive cough Exposure to inhaled irritants
Objective Evaluate patient’s voice quality Sputum characteristics
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DIAGNOSTIC TESTS
Laryngoscopy - edema - drainage of vocal cords and
laryngeal mucosa
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MEDICAL MANAGEMENT Viral—no specific treatment Bacterial—antibiotics Analgesics Antipyretics Antitussives Warm or cool mist vaporizer Limit use of voice
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NURSING DIAGNOSES
Pain, related to pharyngeal irritation
Impaired verbal communication , related to edematous vocal cord
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NURSING INTERVENTIONS
Encourage oral intakeEncourage adequate restUse of vaporizer increase humidity keep
secretions thin and easier to expectorateMedication teachingAvoid exposure to inhaled irritantsPreventive measures
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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
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PHARYNGITIS
Clinical manifestations/assessment Dry cough Tender tonsils Enlarged cervical lymph glands Red, sore throat - scratchy difficulty swallowing Fever
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PHARYNGITIS - Medical Management
Antibiotics Penicillin, Erythromycin Treat severe infections Prevent superimposed infections in people with cardiac history
Analgesics AntipyreticsWarm or cool mist vaporizer
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Nursing Interventions/ Patient Teaching
Offer throat gargles/rinsesAdequate RestAdequate oral fluidsUse of vaporizerMedications: pain meds, antibiotic,
antipyretic
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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
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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
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SINUSITISClinical manifestations
Constant, severe headache Pain and tenderness in involved sinus region
Purulent exudate Malaise Fever
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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
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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
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MEDICAL MANAGEMENTSurgical interventions:
Nasal Windows – - allows better drainage and removal of diseased mucosal tissueAntibioticsAnalgesicsAntihistaminesVasoconstrictor nasal spray (Afrin)
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NURSING INTERVENTIONS/Diagnoses
Warm mist vaporizer Warm, moist packs
Nursing DiagnosesIneffective breathing pattern, related to nasal congestion
Pain, related to sinus congestion