Upper Respiratory Tract

Infection (URTI)
It is the inflammation of the upper respiratory tract caused by
viral or bacterial infection. Upper respiratory tract disorder
are those that involves the nose, paranasal sinuses, pharynx,
larynx.
VIRUSES: rhinovirus. Other viruses include the
influenza virus, adenovirus, enterovirus, and respiratory
syncytial virus.
BACTERIA: streptococcus pneumonae, haemophilus
influenza and Moraxella catarrhalis.
ANATOMY AND
PHYSIOLOGY OF
THE UPPER
RESPIRATORY
TRACT
The upper respiratory tract consists of all
structures involving air passage from the
nostrils to the trachea; these include the
nose, pharynx, and larynx. The upper
respiratory tract is responsible for warming
air inspired by the mouth and nose and
filtering the air of dust, smoke, and pollen.
Filtration is achieved by nasal hairs and
mucus which trap foreign particles.
FEVER
 Upper Respiratory Tract Infection
Non-modifiable Modifiable Risk
Risk Factor Factor
• The flu can be fatal for newborns, the
 elderly, and patients with chronic  • Environment
medical conditions.
Newborn: 0-1 yrs. Old
• Climate
Toddler:2-3 yrs. Old • Droplets
School age:6-12 yrs. Old
Teens:13-19 yrs. Old • Fomites
Adult: 18-45 yrs. Old
Elderly: 65 yrs. Old and above)
• There is no specific gender.
 PATHOPHYSIOLOGY OF URTI

Pathogens gain entry to the respiratory tract by

inhalation of droplets (aerosol) or direct contact then
invade the mucosa, which is affected the Nose,
Paranasal sinuses, Pharynx, and Larynx that can
cause this type of Infections Rhinitis, Viral Rhinitis,
Rhino sinusitis, Pharyngitis, Tonsillitis, and Adenoiditis
and Laryngitis because of the pathogen multiplies in
or the epithelium causing inflammation, and increased
mucus secretion.
Barriers that prevent the organism from attaching to the
mucosa include 1) the hair lining that traps pathogens,
2) the mucus which also traps organisms 3) the angle
between the pharynx and nose which prevents particles
from falling into the airways and 4) ciliated cells in the
lower airways that transport the pathogens back to the
pharynx. The adenoids and tonsils also contain
immunological cells that attack the pathogens.
 CLINICAL MANIFESTATION

SIGNS AND SYMPTOMS

• COUGH
• FEVER • BREATHLESSNESS
• LETHARGY • SWOLLEN LYMPH NODES
• RED EYES • FATIGUE
• SORE THROAT • HOARSE VOICE
• RUNNY NOSE
 NURSING CARE PLAN
Assessment Diagnosis Objectives Planning Interventions Rationale Evaluation
             
Assess for:   Maintain airway   Position head To open or
Related   patency.   appropriately for age maintain open
factors for Ineffective airway Expectorate/clear After (hours/days) and condition. airway in an at-
individual clearance related to secretions readily. of nursing Elevate head of bed, rest or
clients. excessive mucus Verbalize intervention the encourage early compromised
Breath production. understanding of patient will be able ambulation, or individual.
sounds, causes and to demonstrate change client’s To take advantage
presence therapeutic absence/reduction position every 2 of gravity
and management of congestion with hours. decreasing
character of regimen. breath sounding Auscultate breath pressure on the
secretions, Demonstrate clear, noiseless sounds and assess diaphragm and
use of behaviors to respiration, and air movement. enhancing
accessory improve or maintain improved oxygen drainage
muscles for clear airway. exchange. of/ventilation to
breathing. Identify potential different lung
Character of complications and segment.
cough and how to initiate To ascertain
sputum. appropriate current status and
Respiratory preventive or note effects of
rate, pulse corrective actions. treatment in
oximeter or clearing airways.
oxygen
saturation,
vital signs.
 Assessment Diagnosis Objectives Planning Interventions Rationale Evaluation
Assess for:            
Inspect nasal Acute pain related to Report pain is After (hours/days) of Assess for To determine
mucosa for upper airway relieved or nursing intervention the referred pain, as possibility of
increased inflammation. controlled. patient will be able to appropriate. underlying
redness, Follow prescribed demonstrate use of Identify specific conditions or
swelling, pharmacological relaxation skills and signs/symptoms organ dysfunction
exudate, and regimen. diversional activities, as and changes in requiring
nasal polyps Verbalize non- indicated, for individual pain treatment.
Palpate the pharmacological situations. characteristics Patient’s
frontal and methods that requiring medical experiencing
maxillary sinuses provide relief. follow-up. acute pain usually
for tenderness Verbalize sense of has
for inflammation. control of elevated/altered
Inspect tonsils response to acute vital signs.
and pharynx for situation and To modify pain
redness, positive outlook for management
asymmetry, or the future. regimen and
evidence of allows for timely
drainage, intervention for
ulceration or developing
enlargement. complications.
Palpate the
trachea to
determine the
midline position
of the neck and
to detect any
masses or
deformities.
Lymph nodes are
palpated for
enlargement and
tenderness.
 Drug Drug Classification INDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES
 
Diphenhydramine
Brand Name
Antihistamine
 
benadryl
 
Generic Name Therapeutic Classification
Diphenhydramine
Dose
Hypersensitivity reactions (eczema,
PO: ADULTS, ELDERLY: 25–50 mg.
pruritus, rash, cardiac disturbances,
Maximum: 400 mg/day. IM, IV: 10–50
Ethanolamine photosensitivity) may occur. Overdose BASELINE ASSESSMENT If pt is having acute
mg/dose. PO, IV, IM: CHILDREN: 5 mg/
symptoms may vary from CNS allergic reaction, obtain history of recently ingested
kg/day in divided doses. Maximum: 300
depression (sedation, apnea, foods, drugs, environmental exposure, emotional
mg/day
hypotension, cardiovascular collapse, stress.
  death) to severe paradoxical reactions Monitor B/P rate; depth, rhythm, type of respiration;
Frequency (hallucinations, tremors, seizures). quality, rate of pulse. Assess lung sounds for rhonchi,
Contraindications: Acute exacerbation of wheezing, rales.
Children, infants, neonates may
  Pregnancy Category asthma, neonates or premature infants,  
experience paradoxical reactions
ADULTS, ELDERLY: q6–8h.   breastfeeding. Cautions: Narrow-angle INTERVENTION/EVALUATION Monitor B/P, esp. in
(restlessness, insomnia, euphoria,
CHILDREN: q6–8h. Pregnancy/Lactation: Crosses placenta. glaucoma, stenotic peptic ulcer, elderly (increased risk of hypotension). Monitor
nervousness, tremors). Over dosage in
Detected in breast milk (may produce prostatic hypertrophy, pyloroduodenal/ children closely for paradoxical reaction.
  children may result in hallucinations,  
irritability in breastfed infants). Increased risk bladder neck obstruction, asthma,
  COPD, increased IOP, cardiovascular
seizures, death. PATIENT/FAMILY TEACHING
of seizures in neonates, premature infants if  
  used during third trimester of pregnancy. disease, hyperthyroidism •  Tolerance to antihistaminic effect generally does not
Frequent: Drowsiness, dizziness, muscle occur; tolerance to sedative effect may occur. 
May prohibit lactation. Pregnancy Category weakness, hypotension, urinary retention, •  Avoid tasks that require alertness, motor skills until
B. Children: Not recommended in newborns, thickening of bronchial secretions, dry response to drug is established. 
premature infants (increased risk of mouth, nose, throat, lips; in elderly: •  Dry mouth, drowsiness, dizziness may be an
paradoxical reaction, seizures). Elderly: sedation, dizziness, hypotension. expected response to drug.  •  Avoid alcohol.
Route of Administration Increased risk for dizziness, sedation, Occasional: Epigastric distress, flushing,  
confusion, hypotension, hyperexcitability visual/hearing disturbances, paresthesia,
diaphoresis, chills.

Mechanism of Action

PO, IV, IM Competes with histamine for receptor site on

effector cells in GI tract, blood vessels,
respiratory tract.
 Drug
Acetaminophen
Brand Name
Tylenol
Generic Name
Acetaminophen
Dose
IV: ADULTS, ADOLESCENTS WEIGHING
50 KG OR MORE: 1,000 mg or 650 mg.
Maximum single dose: 1,000 mg;
maximum total daily dose: 4,000 mg.
ADULTS, ADOLESCENTS WEIGHING
LESS THAN 50 KG: 15 mg/kg or 12.5
mg/kg. Maximum single dose: 750 mg;
maximum total daily dose: 75 mg/kg/ day
(3,750 mg). CHILDREN 2–12 YRS: 15
mg/kg or 12.5 mg/kg. Maximum: 75
mg/kg/day, not to exceed 3,750 mg/day
Frequency
 
IV: ADULTS, ADOLESCENTS WEIGHING
50 KG OR MORE: q6h or q4h.
ADULTS, ADOLESCENTS WEIGHING
LESS THAN 50 KG: q6h or q4h.
CHILDREN 2–12 YRS: q6h or q4h.
Route of Administration
PO, IV
Drug Classification
Non-narcotic analgesic, antipyretic
Therapeutic Classification
Central analgesic
Pregnancy Category
 
Pregnancy/Lactation: Crosses placenta;
distributed in breast milk. Routinely used in
all stages of pregnancy, appears safe for
short-term use. Pregnancy Category B.
Children/ Elderly: No age-related precautions
noted.
Mechanism of Action
Appears to inhibit prostaglandin synthesis in
the CNS and, to a lesser extent, block pain
impulses through peripheral action. Acts
centrally on hypothalamic heatregulating
center, producing peripheral vasodilation
(heat loss, skin erythema, diaphoresis).
INDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES
BASELINE ASSESSMENT If given for analgesia,
assess onset, type, location, duration of pain. Effect of
medication is reduced if full pain response recurs prior
to next dose. Assess for fever. Assess alcohol usage.
Early Signs of Acetaminophen Toxicity: INTERVENTION/EVALUATION Assess for clinical
Contraindications: Severe hepatic
Anorexia, nausea, diaphoresis, fatigue improvement and relief of pain, fever. Therapeutic
impairment or severe active liver
within first 12–24 hrs. Later Signs of serum level: 10–30 mcg/ml; toxic serum level: greater
disease (Ofirmev).
Toxicity: Vomiting, right upper quadrant than 200 mcg/ml. Do not exceed maximum daily
Cautions: Sensitivity to acetaminophen;
tenderness, elevated hepatic function recommended dose: 4 g/day.
severe renal impairment; alcohol
tests within 48–72 hrs after ingestion. PATIENT/FAMILY TEACHING
dependency, hepatic impairment, or •  Consult physician for use in children younger than 2
Antidote: Acetylcysteine (see Appendix K
active hepatic disease; chronic yrs, oral use longer than 5 days (children) or longer
for dosage).
malnutrition and hypovolemia (Ofirmev); than 10 days (adults), or fever lasting longer than 3
G6PD deficiency (hemolysis may occur). days.
SIDE EFFECTS Rare: Hypersensitivity
Limit dose to less than 4 g/day. • Severe/recurrent pain or high/continuous fever may
reaction
indicate serious illness. 
•  Advise not to take more than 4 g/24-hr period. Many
nonprescription combination products contain
acetaminophen. Avoid alcohol.
 Drug Drug Classification INDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES
 
Amoxicillin
Brand Name
Antibiotic
 
Amoxil and larotid
 
Generic Name Therapeutic Classification

Amoxicillin

Dose
PO: ADULTS, ELDERLY, CHILDREN 12
YRS AND OLDER: 250–500 mg or 500–
BASELINE ASSESSMENT Question for history of
875 mg or 775 mg (Moxatag)
Penicillin allergies, esp. penicillins, cephalosporins, renal
CHILDREN OLDER THAN 3 MOS: 20–100 Antibiotic-associated colitis, other impairment. INTERVENTION/EVALUATION Hold
mg/kg/day CHILDREN 3 MOS AND superinfections (abdominal cramps, medication and promptly report rash, diarrhea (fever,
YOUNGER: 20–30 mg/kg/day NEONATE: severe watery diarrhea, fever) may result abdominal pain, mucus and blood in stool may
20–30 mg/kg/day Contraindications: Hypersensitivity to from altered bacterial balance of GI tract. indicate antibioticassociated colitis). Be alert for
  any penicillin. Severe hypersensitivity reactions, superinfection: fever, vomiting, diarrhea, anal/genital
Cautions: History of allergies (esp. including anaphylaxis, acute interstitial pruritus, black “hairy” tongue, oral mucosal changes
Frequency cephalosporins), infectious nephritis, occur rarely. (ulceration, pain, erythema). Monitor renal/hepatic
mononucleosis, renal impairment, SIDE EFFECTS Frequent: GI function tests. PATIENT/FAMILY TEACHING
  Pregnancy Category asthma. disturbances (mild diarrhea, nausea, •  Continue antibiotic for full length of treatment. 
PO: ADULTS, ELDERLY, CHILDREN 12 vomiting), headache, oral/ vaginal •  Space doses evenly. 
  •  Take with meals if GI upset occurs. 
YRS AND OLDER: q8h, q12h or once candidiasis. Occasional: Generalized
Pregnancy/Lactation: Crosses placenta, •  Thoroughly crush or chew the chewable tablets
daily. CHILDREN OLDER THAN 3 MOS: in rash, urticarial.
appears in cord blood, amniotic fluid. before swallowing. 
divided doses q8–12h. CHILDREN 3 MOS
Distributed in breast milk in low •  Report rash, diarrhea, other new symptoms.
AND YOUNGER: in divided doses q12h.
concentrations. May lead to allergic
NEONATE: in divided doses q12h.
sensitization, diarrhea, candidiasis, skin rash
 
in infant. Pregnancy Category B. Children:
 
Immature renal function in neonate/young
 
infant may delay renal excretion. Elderly:
Age-related renal impairment may require
dosage adjustment.
Route of Administration

Mechanism of Action

PO
Inhibits bacterial cell wall synthesis.
 DISCHARGE PLAN/
HEALTH TEACHING
At least 30 minutes of moderate physical activity
Exercise/Activity: to help the patient to feel better by releasing
nasal congestion.

Treatment: Decongestant, Nasal Spray and Anti-histamine/antibiotics

Health Teaching:  Teach the client/family to identify and avoid
specific factors that exacerbate ineffective
airway clearance, including known allergens
and especially smoking (if relevant) or
exposure to second hand smoke.
 Teach client how to deep breath and cough
effectively.
 PROGNOSIS

A common cold can last up to 14 days, with symptoms

lasting 7 to 11 days on average. Fever, sneezing, and
sore throat usually go away quickly, but cough and
nasal discharge are among the symptoms that last the
longest. The duration of symptoms in young children
may be affected by their attendance at day care. The
duration of viral URIs in one study ranged from 6.6
days for children aged 1-2 years in home care to 8.9
days for children younger than 1 year in day care.
Children in day care were also more likely to have
respiratory symptoms that lasted more than 15
days.Most influenza patients recover within a week, 
though cough, fatigue, and malaise can last up to two w
eeks. The flu can be fatal for newborns, the elderly, and
 patients with chronic  medical
conditions. More than 200,000 people are hospitalized 
each year as a result of flu complications, with 0.36 
deaths per 100,000 patients occurring each year.
Common Laboratory Test for URTI includes:
Complete blood count (CBC) – is a blood
test used to evaluate the overall health and
detect wide range of disorders, including
anemia, leukemia and infections.

Erythrocyte Sedimentation Rate (ESR)- is a

blood test that show if you have an
inflammation in your body. Immune
systems response to injury, infection and
many types of conditions.
Anti-streptolysin (ASO) Titer Test- is a blood
test that checks for a strep infection. When
you come into contact with harmful
bacteria, your body produces antibodies to
defend itself against these bacteria.
Sputum test, also known as a sputum culture-is a
test that your doctor may order when you have a
respiratory tract infection or other lung-related
disorder to determine what is growing in the
lungs.
THANK YOU