Sinusitis

Sinusitis is an inflammation of the nasal sinuses that can be acute or chronic.

Pathophysiology
 First it develops as a result of an upper respiratory tract infection, particularly a viral infection, bacteria, fungus, or an exacerbation of allergic, entered in our nose. This
viral infection makes the tissue inside our nose to swell or inflame. The swelling in our nose will be the cause of blockage in the openings in the sinuses, and once there is a
blockage, this will then cause the fluid to build up in the sinuses.
 And then there will be a transudation of fluid leads to obstruction of sinus cavities, which is an excellent medium for bacterial growth.
 That will have caused by chronic nasal obstruction from discharge and edema of the nasal mucous membrane. Hence, the sinusitis.
 Complication: Chronic Sinusitis, there will be an abnormal growth on the lining of the nose or sinuses, known as nasal polyps.
Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests
Predisposing factors Acute: o Pressure and pain o Promote measures that relieve  Pain and pressure in the o CT Scan to see if the
(Non-modifiable): Develops as a result over the sinus area pain and discomfort. facial area which gets worse infection is spreading
- Age of an upper o Nasal secretion - Administer prescribed or if you have chronic
- Gender respiratory tract when leaning forward.
o Cough due to the antibiotics (erythromycin) sinusitis,
infection, particularly and nasal decongestant  Congested nasal passages o Endoscopy, putting a
constant dripping of
a viral infection, thick discharge (oxymetazoline - OTC). with green or yellow mucus thin tube with a
bacteria, fungus, or backward into the o Instruct the client to inhale steam, secretion that drains down at microscope in your
Precipitating factors an exacerbation of (steam bath, hot shower, facial nose to look at your
nasopharynx the back of your nose and
(modifiable): allergic. sauna) sinuses.
o Chronic headaches into your throat.
- Smoking habit o Increase fluid intake
in the periorbital
- Exposure to  Severe headache.
area and facial pain o Instruct the client to apply hot wet
secondhand most pronounced  Ineffective airway clearance
packs to facial area.
smoke on awakening related to obstruction or the
- Weak immune o Nasal stuffiness presence of thickened
system, or taking o Fatigue
drugs that secretions.
weaken the  Disturbed sleep pattern
immune system. related to obstruction of the
nose.
Rhinitis & Allergic Rhinitis
It is a disorder characterized by inflammation and irritation of the mucous membranes of the nose. Rhinitis often coexists with other respiratory disorders, such as asthma. Rhinitis
may be acute or chronic, and allergic or non-allergic. Allergic rhinitis is an allergic reaction to inhaled airborne allergens characterized by seasonal occurrences. It is the most
common form of respiratory allergy.
Pathophysiology
 Rhinitis may be caused by a variety of factors, including changes in temperature or humidity; odors; infection; age; systemic disease; use of over-the-counter (OTC) and
prescribed nasal decongestants; and the presence of a foreign body. Allergic rhinitis may occur with exposure to allergens such as foods (e.g., peanuts, walnuts, Brazil nuts,
wheat, shellfish, soy, cow’s milk, eggs), medications (e.g., penicillin, sulfa medications, aspirin), and particles in the indoor and outdoor environment (Chart 18-2). The
most common cause of non-allergic rhinitis is the common cold (Peters, 2015).
 Allergic Rhinitis Occurs when IgE antibodies in the nasal mucosa combine or response with inhaled allergens on the mucosal surface. The nasal mucosa reacts by slowing
of ciliary action, and releases a vasoactive substance from mast cells, causes edema formation, and leukocyte infiltration. Tissue edema is a result of vasodilation and
increased capillary permeability.
 Complication: include Chronic Rhinitis, due to an extension of rhinitis. It may also include syphilis or tuberculosis as all of which are characterized by the formation of
inflamed lesions and the destruction of soft tissues.
Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests
Predisposing factors Rhinitis: o Runny nose(mucus) o Antihistamine (S-Claritin,  o Skin
Ineffective breathing pattern related prick test,
(Non-modifiable): Common cold o Clogged nose / Cetirizine) to allergic reaction wherein small amount
- Age Bacterial or viral stuffy o Antibacterial, Antibiotic, of material that can
 Deficient knowledge about allergy
- Gender infection o Sneezing anti-infective (erythromycin, trigger allergies will
- Climate: humidity tetracycline) and the recommended have pricked to the
o Fever (38°c)
o Headache o Antipyretic (Paracetamol, modifications in lifestyle and self- skin and be observed.
Precipitating factors Allergic Rhinitis: Acetaminophen) care practices
(modifiable): Caused by a reaction o Steam inhalation  Ineffective individual coping with o Allergy blood test, a
- Smoking habit of the body’s immune o Nasal Spray test that can measure
- Exposure to system to an chronicity of condition and need for
o Nasal decongestant (otrivine) your immune system’s
secondhand environmental environmental modifications. response to a specific
smoke trigger. This airborne  Ineffective airway clearance related allergen
- Weak immune particles such as dust, to obstruction or the presence of
system or plant pollens.
thickened secretions.
- taking drugs that
 Disturbed sleep pattern related to
weaken the
immune system. obstruction of the nose.
-  Self-concept disturbance related to
the condition.
Tonsillitis
It is an inflammation of the tonsils.
Pathophysiology

 The inflammation of the tonsils occurs when bacteria attack the lymphoid tissue on the tonsils, the most common bacteria is the group A streptococcus.
 This will then proceed to a reaction in the immune system as it will fight with this foreign invader, then to a result where the tonsils will inflame as it’s sign of infection.

Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests

Predisposing factors o Gargle, warm saline o Ineffective breathing pattern o Throat swab to identify
(Non-modifiable): Caused by a viral o Sore throat o Mouthwash related to the inflammatory bacterial infection.
- Age organism; the most o Fever o Antibiotic (strepsil) process in the respiratory tract.
- Gender common is group A o Snoring o Increase fluid intake. o Ineffective airway clearance
- streptococcus o Dysphagia related to mechanical
o Halitosis o TONSILLECTOMY - Removal of tonsil, obstruction of the airway
. secretions and increased
applicable only to a person who
Precipitating factors production of secretions.
(modifiable): experiences tonsilitis more than 6 or
o Risk for aspiration related to
- Exposure to viral more.
impaired swallowing and
agents. bleeding at the operative site.
- Smoking o Acute pain related to
- Oral Sex inflammation of tonsils and the
surgical procedure.
o Deficient fluid volume related
to inadequate oral intake
secondary to painful
swallowing.

Epistaxis
It refers to a severe nosebleed or hemorrhage from the nose.
 Pathophysiology

 Epistaxis may be spontaneous or may result from trauma (that is usually because of nose pricking). It is most commonly originating in the anterior portion of the nasal cavity in adults, and
tends to originate in the posterior portion and be more severe in adults.
 And when it is dry it will lead to a crust formation, with the person trying to remove the crusts (booger) by pricking, rubbing or blowing. Thus it will bleed.
 Systemic causes are less common, such that of hypertension, heatstroke or renal disease.
 Complications: Rhinitis, Maxillary and frontal sinusitis, Hem tympanum, otitis media.

Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests

Predisposing factors o Pt placed in an upright posture, o Alternation in comfort r/t o Inspection with nasal
(Non-modifiable): - Caused by o Bleeding through leaning forward to reduce venous disease condition manifested speculum to determine
- Age dryness leading nares. pressure, and instruct to breath gently by bleeding site of bleeding.
- Gender to crust o Blood in the auditory via mouth to prevent swallowing the o Activity intolerance r/t fatigue, Important to determine
- formation canal if the tympanic blood. lethargy and malaise which side bled first.
- HPN membrane is o Compress the soft outer portion of o Alteration in body
- HEATSTROK perforated. the nares against the septum for 5-10 o Laboratory evaluation to
temperature r/t disease
Precipitating factors E minutes. exclude blood dyscrasia
(modifiable): - DRUG condition manifested by fever
o Avoid nose blowing. (a term for any blood-
- Unhygienic ABUSE o Knowledge deficit r/t disease
o related disease that
- condition affects the cells or
. plasma of blood, or the
bone marrow or lymph
tissues.).

Pharyngitis
Acute pharyngitis is a sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils. It is commonly referred to
as a sore throat. Because of environmental exposure to viral agents and poorly ventilated rooms, the incidence of viral pharyngitis peaks during winter and early spring in regions that have warm
summers and cold winters. Viral pharyngitis spreads easily in the droplets of coughs and sneezes, as well as from unclean hands that have been exposed to the contaminated fluids.
Pathophysiology

 Viral infection causes most cases of acute pharyngitis. Responsible viruses include the adenovirus, influenza virus, Epstein–Barr virus, and herpes simplex virus. Bacterial infection accounts
for the remainder of cases. Streptococcal pharyngitis warrants the use of antibiotic treatment. When GAS causes acute pharyngitis, the condition is known as strep throat. The body responds
by triggering an inflammatory response in the pharynx. This results in pain, fever, vasodilation, edema, and tissue damage, manifested by redness and swelling in the tonsillar pillars, uvula,
and soft palate. A creamy exudate (a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation. ) may be present in the tonsillar pillars.
 Uncomplicated viral infections usually subside promptly, within 3 to 10 days after onset. However, pharyngitis caused by bacteria, such as GAS, is a more severe illness. If left untreated, the
complications can be severe and lifethreatening.
 Complications: include rhinosinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis. In rare cases, the infection may lead to sepsis, pneumonia, meningitis, rheumatic
fever, and glomerulonephritis (Buensalido, 2019a).

Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests

Predisposing factors Acute: Acute: o Promote measures that relieve pain o Ineffective breathing pattern o Culture and sensitivity of
(Non-modifiable): Caused by a viral o Fiery red pharyngeal and discomfort. related to the inflammatory the throat identify
- All Age groups organism; the most membrane and tonsils - Administer prescribed process in the respiratory tract. bacterial infection.
- Gender common is group A o Lymphoid follicles antibiotics (erythromycin), o Ineffective airway clearance o
- Climatic factor: streptococcus are edematous and analgesic ( ), related to mechanical
winter, early flecked with exudate. antitussive (hydrocodone), obstruction of the airway
spring Chronic: o Fever, malaise, and and nasal decongestant secretions and increased
Common in adults who sore throat. (oxymetazoline - OTC). production of secretions.
work or live in dusty o Instruct the client to inhale steam, o Risk for aspiration related to
surroundings, use their Chronic: (steam bath, hot shower, facial impaired swallowing and
Precipitating factors voice to express, suffer o Constant sense of sauna). bleeding at the operative site.
(modifiable): from chronic coughs, irritation or fullness o Instruct client to have liquid or soft o Acute pain related to
- Environmental and habitually use in the throat. diet. Increase Fluid intake. inflammation of tonsils and the
exposure to viral alcohol and tobacco. o Mucus collects in the Discourage spicy foods. surgical procedure.
agents. throat and can be o Encourage the client to gargle with o Deficient fluid volume related
- Poorly ventilated expelled by coughing. warm saline gargles and use throat to inadequate oral intake
rooms o Dysphagia lozenges. secondary to painful
- Smoking o Instruct client to avoid smoking and swallowing.
exposure to smoke or polluted air.

Laryngitis
Inflammation of larynx.
 Pathophysiology
 Due to etiological factor;
 The mucosa of larynx becomes congested and may become oedematous;
 A fibrinous exudate may occur on the surface;
 Signs and symptoms;
 Sometimes infection involves the perichondrium of laryngeal cartilages producing perichondritis.
Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests
Predisposing factors o Voice rest - Ineffective breathing o History taking
(Non-modifiable): Caused by a viral o Inflamed larynx o Steam inhalation pattern related to the o Physical examination
- All Age groups organism in a few o Dysphonia o Fluid intake
inflammatory process in o X-ray on the neck and
- Gender cases, allergic or o Dysphagia o Avoid smoking and cold chest
- History of GERD psychological. o Humidification the respiratory tract. o CBC
o Dyspnea
- Age o Increase intake of fluid - Ineffective airway o Biopsy
o Anorexia
- History of smoking Gastroesophageal o Fever o Voice rehabilitation clearance related to o Laryngoscopy
- History of breathing reflux may be a Drugs: mechanical obstruction o
- triggering event - Antifungal or antibiotics for of the airway secretions
bacterial and fungal infection
and increased
- Short course of steroids like
Precipitating factors dexamethasone may be used to production of
(modifiable): decrease the inflammation and secretions.
- Exposure to irritants shorten the course the course of - Anxiety related to the
such as cigarette symptoms disease experienced by
smoke, acid reflux - H2 blockers such as zantac or
the child.
(reflux/heartburn) Prilosec for a period of 4-6 weeks in
case of GERD -
- Extremely cold
weather - Analgesic such as ibuprofen,
- Excess alcohol acetaminophen
consumption - Cough suppressant
- Having respiratory -
infection such as
cold and flu

Atelectasis
Atelectasis refers to closure or collapse of alveoli and often is described in relation to chest x-ray findings and clinical signs and symptoms. Atelectasis may be acute or chronic and
may cover a broad range of pathophysiologic changes, from microatelectasis (which is not detectable on chest x-ray) to macroatelectasis with loss of segmental, lobar, or overall
lung volume. The most commonly described is acute atelectasis, which occurs most often in the postoperative setting usually following thoracic and upper abdominal procedures
or in people who are immobilized and have a shallow, monotonous breathing pattern. Excess secretions or mucus plugs may also cause obstruction of airflow and result in
atelectasis in an area of the lung. Atelectasis also is observed in patients with a chronic airway obstruction that impedes or blocks the flow of air to an area of the lung (e.g.,
obstructive atelectasis in the patient with lung cancer that is invading or compressing the airways). This type of atelectasis is more insidious and slower in onset.
Pathophysiology
 Atelectasis may be described as either nonobstructive or obstructive. Non-obstructive atelectasis occurs in adults as a result of reduced ventilation. Obstructive atelectasis
results from any blockage that impedes the passage of air to and from the alveoli, reducing alveolar ventilation. Obstructive atelectasis is the most common type and
results from reabsorption of gas (trapped alveolar air is absorbed into the bloodstream); no additional air can enter into the alveoli because of the blockage.
 As a result, the affected portion of the lung becomes airless and the alveoli collapse. Causes of atelectasis include foreign body, tumor or growth in an airway, altered
breathing patterns, retained secretions, pain, alterations in small airway function, prolonged supine positioning, increased abdominal pressure, reduced lung volumes due to
musculoskeletal or neurologic disorders, restrictive defects, and specific surgical procedures (e.g., upper abdominal, thoracic, or open heart surgery).
 Patients are at high risk for atelectasis postoperatively because of several factors. A monotonous, low tidal breathing pattern may cause small airway closure and alveolar
collapse. This can result from the effects of anesthesia or analgesic agents, supine positioning, splinting of the chest wall because of pain, or abdominal distention. Secretion
retention, airway obstruction, and an impaired cough reflex may also occur, or patients may be reluctant to cough because of pain.
 The mechanisms and consequences of acute atelectasis in postoperative patients. Atelectasis resulting from bronchial obstruction by secretions may also occur in patients
with impaired cough mechanisms (e.g., musculoskeletal or neurologic disorders) as well as in those who are debilitated and confined to bed. In addition, atelectasis may
develop because of excessive pressure on the lung tissue (i.e., compressive atelectasis), which restricts normal lung expansion on inspiration.
 Complications: Such pressure can be produced by a pleural effusion (fluid accumulating within the pleural space), a pneumothorax (air in the pleural space), or a
hemothorax (blood in the pleural space). The pleural space is the area between the parietal and the visceral pleurae, and is normally a potential rather than an actual space.
Pressure may also be produced by a pericardial effusion (pericardium distended with fluid), tumor growth within the thorax, or an elevated diaphragm.

Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests

Predisposing factors o Remove secretions by o Ineffective Breathing o Atelectasis is one of the
(Non-modifiable): • Post-operative o Cyanosis coughing or suctioning Pattern related to atelectasis as most commonly encountered
- Age anesthesia, general o Dyspnea o Chest physical therapy evidenced by shortness of abnormalities seen on a
- Gender
 - History of anesthesia. o Anxiety (percussion or postural breath, SpO2 level of 85%, chest x-ray.
COPD, • COPD o Tachycardia drainage) respiratory rate of 27, cough, o Physical examination
Pneumothorax, • Pneumothorax, o Tachypnea o Nebulizer therapy with rapid and shallow breathing, o Pulse Oximetry
pleural pleural effusion, bronchodilator chest pain when breathing, cold o Medical history – history
effusion, hemothorax o Sodium bicarbonate may and clammy skin, and taking is important to
hemothorax restlessness. identify possible causes of
be used to remove
o Impaired Gas Exchange related atelectasis. The presence of
secretions
Precipitating factors to atelectasis as evidenced signs and symptoms and of
o To remove obstruction
(modifiable): by shortness of breath, SpO2 possible trauma will be
bronchoscopy level of 85%, cough, respiratory
- Poorly ventilated asked.
o Thoracentesis rate of 29 bpm, and rapid,
rooms o Physical examination
- Smoking shallow breathing o Ultrasound of the thorax –
o Risk for Ineffective Airway this imaging procedure is
- 2nd hand smoke
Clearance non-invasive and can help
o Risk for Ineffective Airway identify atelectasis from
Clearance other lung problems like
pleural effusion.
o Bronchoscopy – this
procedure involves the
insertion of a tube down the
individual’s throat to see the
possible causes of
obstructive atelectasis like
mucus plug, presence of a
foreign object, and presence
of a tumor

Pleural Effusion
Pleural effusion, a collection of fluid in the pleural space, is rarely a primary disease process; it is usually secondary to other diseases. Normally, the pleural space contains a small
amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction.
Pathophysiology
  May be either transudative or exudative. Transudative effusions occur primarily in non-inflammatory conditions; is an accumulation of low-protein, low cell count fluid.
Exudative effusions occur in an area of inflammation; is an accumulation of high-protein fluid.
 In certain disorders, fluid may accumulate in the pleural space to a point at which it becomes clinically evident. This almost always has pathologic significance. The
effusion can be a relatively clear fluid, or it can be bloody or purulent. An effusion of clear fluid may be a transudate or an exudate. A transudate (filtrate of plasma that
moves across intact capillary walls) occurs when factors influencing the formation and reabsorption of pleural fluid are altered, usually by imbalances in hydrostatic or
oncotic pressures.
 The finding of a transudative effusion generally implies that the pleural membranes are not diseased. A transudative effusion most commonly results from heart failure. An
exudate (extravasation of fluid into tissues or a cavity) usually results from inflammation by bacterial products or tumors involving the pleural surfaces.
 Complication: heart failure, TB, pneumonia, pulmonary infections (particularly viral infections), nephrotic syndrome, connective tissue disease, PE, and neoplastic tumors.
The most common malignancy associated with a pleural effusion is bronchogenic carcinoma.
Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests
Predisposing factors - Treatment is aimed at underlying - Ineffective breathing o Chest X-ray or
(Non-modifiable): o Dyspnea, pleuritic cause (heart disease, infection). pattern related to ultrasound detects
- All Age groups chest pain, cough - Thoracentesis is done to remove collecting of fluid in presence of fluid.
- Gender o Dullness or flatness fluid, collect a specimen and pleural space o Thoracentesis
- History of heart to percussion relieve dyspnea. - biochemical,
problem o Decreased or absent - O2 therapy, mechanical bacterialogic, and
breath sounds ventilation cytologic studies of
- Bronchodilator (DOB) pleural fluid
Precipitating factors - Analgesic (Opioid drugs e.g., indicates cause.
(modifiable): tramadol, morphine)
- IV fluid, Blood transfusion to
enter hypovolemia.

Empyema / Pyothorax
An empyema is an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and a loculated (walled-off) area where infection is located.
Pathophysiology
  Most empyemas occur as complications of bacterial pneumonia or lung abscess. They also result from penetrating chest trauma, hematogenous infection of the pleural
space, nonbacterial infections, and iatrogenic causes (after thoracic surgery or thoracentesis).
 At first the pleural fluid is thin, with a low leukocyte count, but it frequently progresses to a fibro-purulent stage and, finally, to a stage where it encloses the lung within a
thick exudative membrane (loculated empyema).
Hydrothorax
It is an accumulation of water fluid within the pleural space.
Pathophysiology

 It has been suggested that an increased venous pressure in azygos veins might lead to leakage of plasma into the pleural space and the subsequent development of hepatic hydrothorax.
However, it is well known from patients with congestive heart failure, that elevated systemic venous pressures without pulmonary venous hypertension do not give rise to pleural
effusions. In addition, the leakage of pleural fluid due to increased blood flow in azygos veins fails to explain the right-side predomination of hepatic hydrothorax.

Hemothorax
An accumulation of blood within the pleural space.
Pathophysiology
 Bleeding into the hemithorax may arise from diaphragmatic, mediastinal, pulmonary, pleural, chest wall and abdominal injuries. Each hemithorax can hold 40% of a patient's circulating
blood volume. Studies have shown that injury to intercostal vessels (e.g., internal mammary arteries and pulmonary vessels) lead to significant bleeding requiring invasive
management. Early physiologic response of a hemothorax has hemodynamic and respiratory components. The severity of the pathophysiologic response depends on the location of the
injury, the patient's functional reserve, the volume of blood, and the rate of accumulation in the hemithorax. In the early response, acute hypovolemia leads to a decrease in preload, left
ventricular dysfunction and a decrease in cardiac output. Blood in the pleural space affects the functional vital capacity of the lung by creating alveolar hypoventilation, V/Q mismatch, and
anatomic shunting. A large hemothorax can lead to an increase in hydrostatic pressure which exerts pressure in the vena cava and pulmonary parenchyma causing impairment in preload
and increase pulmonary vascular resistance. These mechanisms result in tension hemothorax physiology and cause hemodynamic instability, cardiovascular collapse, and death.

Pneumothorax
Air in the pleural space occurring spontaneously or from trauma. In Pt with chest trauma, it is usually the result of a laceration to the lungs parenchyma, tracheobronchial tree, or
esophagus. The Pt’s clinical status depends on the rate of air leakage and size of wound. As it’s classified into three;
 Simple pneumothorax (Spontaneous) – sudden onset of air in the pleural space with deflation of the affected lungs in the absence of trauma.
  Traumatic Pneumothorax (Open) – sucking wound of chest, it implies an opening in the chest wall large enough to allow air to pass freely in and out of thoracic cavity with
each attempted respiration.
 Tension pneumothorax – buildup of air under pressure in the pleural space resulting in interference with filling of both the heart and lungs.
Pathophysiology
 When there is a large open hole in the chest wall, the Pt will have a “steal” in ventilation of other lung.
 A portion of the tidal volume will move back and forth through the hole in the chest wall, rather than the trachea as it normally does.
 Spontaneous pneumothorax is usually due to rupture of a sub-pleural bleb. This may occur secondary to chronic respiratory disease or idiopathically. May occur in healthy
people, particularly in thin, white males and those with family history of pneumothorax.
 Complications: Acute respiratory failure, and Cardiovascular collapse with tension pneumothorax.
Etiology Assessment findings Treatment NSG Diagnosis Diagnostic Tests
Predisposing factors - Surgical intervention by Pleurodesis - Ineffective breathing o Chest X-ray or
(Non-modifiable): - Due to rupture of o Hyper resonance; or thoracotomy with resection of pattern related to air in ultrasound detects
- All Age groups BLEB. diminished breath apical blebs is advised for Pt with the pleural space. presence of air.
- Gender - Puncture of pleural sounds recurrent spontaneous - Impaired gas exchange o
- History of cavity by foreign o Reduced mobility of pneumothorax. related to atelectasis and
pneumothorax object e.g., wound affected half of - Needle aspiration or chest tube collapse of lung
stab, gunshot thorax drainage may be necessary to
- Due to too much o Tracheal deviation achieve re-expansion of collapsed
Precipitating factors away from affected lung if greater than 50%
air increased of +
(modifiable): side in tension pneumothorax.
atmospheric
pressure. pneumothorax.
o Dyspnea