UPPER RESPIRATORY TRACT INFECTIONS
ANATOMIC AND PHYSIOLOGIC OVERVIEW
 The respiratory system is composed of the upper and
lower respiratory tracts.
 Together, the two tracts are responsible for ventilation
(movement of air in and out of the airways).
 The upper respiratory tract, known as the upper airway,
warms and filters inspired air so that the lower
respiratory tract (the lungs) can accomplish gas exchange
or diffusion.
 Gas exchange involves delivering oxygen to the tissues
through the bloodstream and expelling waste gases, such
as carbon dioxide, during expiration. The respiratory
system depends on the cardiovascular system for
perfusion, or blood flow through the pulmonary system
 Upper airway structures consist of the nose; paranasal
sinuses; pharynx, tonsils, and adenoids; larynx; and
trachea.
PARASANAL SINUSES
FUNCTION OF THE RESPIRATORY SYSTEM
OXYGEN TRANSPORT
 Oxygen is supplied to, and carbon dioxide is removed
from, cells by way of the circulating blood through the thin
walls of the capillaries.
 Oxygen diffuses from the capillary through the capillary
wall to the interstitial fluid. At this point, it diffuses through
the membrane of tissue cells, where it is used by
mitochondria for cellular respiration.
 The movement of carbon dioxide occurs by diffusion in the
opposite direction—from cell to blood.
RESPIRATION
 Gas exchange between atmospheric air and the blood and
between the blood and cells of the body
 Movement of air in and out of the airways continually
replenishes the oxygen and removes the carbon dioxide
from the airways and the lungs.
 This whole process of gas exchange between the
atmospheric air and the blood and between the blood and
cells of the body is called respiration.
VENTILATION
 movement of air in and out of the airways
 When the capacity of the chest is increased, air enters
through the trachea (inspiration) and moves into the
bronchi, bronchioles, and alveoli, and inflates the lungs.
 When the chest wall and the diaphragm return to their
previous positions (expiration), the lungs recoil and force
the air out through the bronchi and the trachea.
 The inspiratory phase of respiration normally requires
energy; the expiratory phase is normally passive, requiring
very little energy.
 Physical factors that govern airflow in and out of the lungs
are collectively referred to as the mechanics of ventilation
and include air pressure variances, resistance to airflow,
and lung compliance.
o Air Pressure Variances: Air flows from a region of
higher pressure to a region of lower pressure.
o Airway Resistance: Resistance is determined by the
radius, or size of the airway through which the air is
flowing, as well as by lung volumes and airflow
velocity
o Compliance: Compliance is the elasticity and
expandability of the lungs and thoracic structures.
o Lung Volumes and Capacities: Lung volumes are
categorized as tidal volume, inspiratory reserve
volume, expiratory reserve volume, and residual
volume. Lung capacity is evaluated in terms of vital
capacity, inspiratory capacity, functional residual
capacity, and total lung capacity
.
PULMONARY DIFFUSION & PERFUSSION
 Pulmonary diffusion: exchange of gas molecules (oxygen
and carbon dioxide) from areas of high concentration to
areas of low concentration
 Pulmonary perfusion: blood flow through the pulmonary
vasculature.
GAS EXCHANGE
 Gas exchange is the process by which oxygen and carbon
dioxide move between the bloodstream and the lungs.
CARBON DIOXIDE TRANSPORT
 At the same time that oxygen diffuses from the blood into
the tissues, carbon dioxide diffuses from tissue cells to
blood and is transported to the lungs for excretion.
NEUROLOGIC CONTROL OF VENTILATION
 Resting respiration is the result of cyclic excitation of the
respiratory muscles by the phrenic nerve. The rhythm of
breathing is controlled by respiratory centers in the brain.
The inspiratory and expiratory centers in the medulla
oblongata and pons control the rate and depth of
ventilation to meet the body’s metabolic demands
UPPER AIRWAY INFECTIONS
 Upper respiratory tract disorders are those that involve the
nose, paranasal sinuses, pharynx, larynx, trachea, or
bronchi. Many of these conditions are relatively minor, and
their effects are limited to mild and temporary discomfort
and inconvenience for the patient.
 A URI is often defined as an infection of the mucous
membranes of the nose, sinuses, pharynx, upper trachea,
or larynx
A.Y. 2022-2023 | BSN 2-B 1
 URIs affect the nasal cavity; ethmoidal air cells; and o The nurse instructs the patient with allergic rhinitis to
frontal, maxillary, and sphenoid sinuses; as well as the avoid or reduce exposure to allergens and irritants,
pharynx, larynx, and upper portion of the trachea. such as dusts, molds, animals, fumes, odors,
RHINITIS powders, sprays, and tobacco smoke
 is a group of disorders characterized by inflammation and
irritation of the mucous membranes of the nose. VIRAL RHINITIS (COMMON COLD)
 may be acute or chronic, and allergic or nonallergic  the most frequent viral infection in the general population
 Allergic rhinitis is further classified as seasonal or  The term common cold often is used when referring to a
perennial rhinitis and is commonly associated with URI that is self-limited and caused by a virus
exposure to airborne particles such as dust, dander, or  cold refers to an infectious, acute inflammation of the
plant pollens in people who are allergic to these mucous membranes of the nasal cavity characterized by
substances. nasal congestion, rhinorrhea, sneezing, sore throat, and
PATHOPHYSIOLOGY general malaise.
 Rhinitis may be caused by a variety of factors, including:  The term is also used when the causative virus is
o changes in temperature or humidity; influenza (the flu)
o odors;  Colds are highly contagious because virus is shed for
o infection; about 2 days before the symptoms appear and during the
first part of the symptomatic phase.
o age;
 Rhinoviruses are the most likely causative organisms.
o systemic disease;
 Despite popular belief, cold temperatures and exposure to
o use of over-the-counter (OTC) and prescribed nasal
cold rainy weather do not increase the incidence or
decongestants severity of the common cold.
o the presence of a foreign body.
 Allergic rhinitis may occur with exposure to allergens such
as:
o foods (e.g., peanuts, soy, cow’s milk, eggs),
o medications (e.g., penicillin, aspirin), and
o particles in the indoor and outdoor environment
 The most common cause of nonallergic rhinitis is the
common cold
CLINICAL MANIFESTATIONS
 Rhinorrhea (excessive nasal drainage, runny nose);
 Nasal congestion; nasal discharge (purulent with bacterial
rhinitis);
 Sneezing;
 Pruritus (itching) of the nose, roof of the mouth, throat,
eyes, and ears.
 Headache may occur, particularly if rhinosinusitis is also
present
MEDICAL MANAGEMENT
 The management of rhinitis depends on the cause, which
may be identified through the history and physical
examination. The nurse asks the patient about recent
symptoms as well as possible exposure to allergens in the
home, environment, or workplace. If viral rhinitis is the
cause, medications may be prescribed to relieve the
symptoms. In allergic rhinitis, allergy tests may be
performed to identify possible allergens. If symptoms
suggest a bacterial infection, an antimicrobial agent is
used.
 Pharmacologic Therapy
o Antihistamines and nasal sprays may be useful.
Antihistamines remain the most common treatment
and are given for sneezing, pruritus, and rhinorrhea
o Brompheniramine/pseudoephedrine is an example of
combination antihistamine/decongestant medications
o Oral decongestant agents may be used for nasal
obstruction. The use of saline nasal spray can act as
a mild decongestant and can liquefy mucus to prevent
crusting
 Nursing Management

A.Y. 2022-2023 | BSN 2-B 2