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