Management of Patients

With Upper Respiratory Tract

Disorders
Upper Airway Infections
upper respiratory infections or URIs
most common cause of illness and affect most people
on all occasion
Upper Airway Infections
RHINITIS (HAY FEVER)
• Group of disorders characterized by inflammation and
irritation of the mucous membranes of the nose.
Acute or chronic
Allergic or nonallergic

• Allergic rhinitis: seasonal or perennial

Common indoor and outdoor allergens
Indoor Allergens
• Dust mite feces
• Dog dander
• Cat dander
• Cockroach droppings
• molds
Common indoor and outdoor allergens
Outdoor Allergens
• Tress
• Weeds
• Grasses
• molds
Clinical Manifestations of RHINITIS
• Rhinorrhea
Excessive nasal drainage, runny nose
• Nasal congestion
• Nasal discharge
• Sneezing
• Pruritus of the nose, roof of the mouth, throat, ears
Pharmacologic treatment
Symptom relief
• Antihistamine
• Corticosteroid nasal spray
• Oral decongestants
• Saline nasal spray
Nursing management
AVOID OR REDUCE EXPOSURE TO ALLERGENS
AND IRRITANTS
Upper Airway Infections
VIRAL RHINITIS
AKA Common Cold
“cold” refers to an infectious, acute inflammation of the
mucous membranes of the nasal cavity characterized by:
Nasal congestion
Rhinorrhea
Sneezing
Sore throat
General malaise
Upper Airway Infections
VIRAL RHINITIS
Highly contagious 2 days before the symptoms appear
and during the first part of the symptomatic phase
Clinical Manifestations of VIRAL RHINITIS
• Low-grade fever • General malaise
• Nasal congestion • Headache
• Rhinorrhea • Muscle ache
• Nasal discharge
• Halitosis
• Sneezing
• Teary watery eyes
• Symptoms of viral
rhinitis may last from 1
to 2 weeks
• Cold sore (herpes
simplex virus)
Medical Management
Symptomatic therapy
• Adequate fluid intake
• Rest
• Preventions of chilling
• Use of expectorant PRN
Medical Management
• Salt water gargle
• NSAID
• Antihistamine
• Petroleum jelly
• Alternative medicines
• Steam Inhalation
RHINITIS MEDICAMENTOSA
Rebound rhinitis
Rebound nasal congestion commonly associated with
overuse of the over-the-counter nasal decongestant
Nursing Management
Hand hygiene measures
RHINOSINUSITIS
• Formerly known as sinusitis
• Inflammation of paranasal
sinuses and nasal cavity
Causes of Rhinosinusitis
Vasomotor:
• Idiopathic
• Abuse of nasal decongestants
• Psychological stimulation
• Irritants
Causes of Rhinosinusitis
Mechanical:
• Tumor
• Deviated septum
• Crusting
• Hypertrophied turbinates
• Foreign body
• CSF leak
Causes of Rhinosinusitis
Infections:
• Acute viral infection
• Rare nasal infections
Causes of Rhinosinusitis
Hormonal
• Pregnancy
• Use of oral contraceptives
• Hypothyroidism
Clinical Manifestations
• Purulent nasal discharge accompanied by nasal
congestion
• Facial pain, pressure, or a sense of fullness
• Facial pain-pressure-fullness
• Localized or diffused headache
• Fever
Assessment and Diagnostic Findings
• History and physical examination
• Tenderness to palpation over the inflamed sinus area

*CT SCAN for any sensitive to inflammatory changes

and bone destruction
*sinus fluid aspiration
Complications
• Osteomyelitis
• Mucocele- cyst of the paranasal sinuses
Rare:
• Sinus thrombosis
• Meningitis
• Brain abscess
• Ischemic brain infarction
• Severe orbital cellulitis
Medical management
Bacterial
• Drug of choice: Augmentin

Viral
• nasal saline lavage
• decongestants
Keypoints
• Patients with nasotracheal and nasogastric tubes in
place are at the risk of development of sinus infection.
• Accurate assessment of patients with the tubes are
critical.
ACUTE PHARYNGITIS
• Sudden painful inflammation of the pharynx, the back
portion of the throat that includes the posterior third
of the tongue, soft palate, and tonsils.
• “SORE THROAT”
Pathophysiology
Viral infection(most common cause)
• Adenovirus
• Influenza virus
• Epstein-Barr virus
• Herpes simplex virus
Pathophysiology
Bacterial infection
Group A Beta-hemolytic Streptococcus (GABHS)
Group A strep

Inflammatory response in the pharynx

Clinical Manifestations
• Fiery red pharyngeal membrane and tonsils
• Lymphoid follicles (swollen and flecked with white-
purple exudate)
• Enlarged and tender cervical lymph nodes
• Fever
• Malaise
• Sore throat
Clinical Manifestations
• SCARLATINA-FORM RASH WITH URTICARIA—SCARLET
FEVER
SCARLET FEVER
Diagnostic Exam
• Rapid antigen detection testing-- Throat swab
• Throat culture
Medical management
Bacterial
• Penicillin
• Erythromycin
• Clarithromycin
• Azithromycin
Nutritional Therapy
• Liquid or soft diet
• Cool beverages
• Warm liquids
• Flavoured frozen desserts
Nursing Management
• Symptomatic management
• Initiation of correct administration of antibiotics
Nephritis
Rheumatic fever
• Bed rest
• Preventive measure: not sharing eating utensils etc
• Proper disposal of tissues
• Change toothbrush
CHRONIC PHARYNGITIS
• Persistent inflammation of the pharynx

• Common: work in dusty surrounding, excessive use of

voice, chronic cough, habitual use of alcohol and
tobacco.
CHRONIC PHARYNGITIS
Three types of chronic pharyngitis:
1. Hypertrophic
2. Atrophic
3. Chronic granular– numerous swollen lymph follicles
on the pharyngeal wall.
Clinical Manifestations
• Constant sense of irritation or fullness of the throat
• mucus that collects in the throat and can be expelled
by coughing, and difficulty swallowing.
Medical Management
• Relieving symptoms
• Avoid exposure to irritants
• Nasal sprays
• Antihistamine

*tonsillectomy
Nursing Management
• Avoidance of alcohol, tobacco, second hand smoke,
exposure to cold or environmental and occupational
hazard.
• Wear disposable mask
• Drink plenty of fluids
• Gargle –warm saline
• lozenges
GENERAL NURSING INTERVENTIONS
1. Maintain Patent Airway
• Increase fluid intake to loosen secretions
• Utilize room vaporizers or steam inhalation
• Administer medications to relieve nasal congestion
GENERAL NURSING INTERVENTIONS
2. Promote comfort
• Administer prescribed analgesics
• Administer topical analgesics
• Warm gargles for the relief of sore throat
• Provide oral hygiene
GENERAL NURSING INTERVENTIONS
3. Promote communication
• Instruct patient to refrain from speaking as much as
possible
• Provide writing materials
GENERAL NURSING INTERVENTIONS
4. Administer prescribed antibiotics
• Monitor for possible complications like meningitis,
otitis media, abscess formation
5. Assist in surgical intervention
TONSILITIS and ADENOIDITIS
• Infection and inflammation of the tonsils and
adenoids
• Most common organism- Group A- beta hemolytic
streptococcus (GABHS)
TONSILITIS and ADENOIDITIS
ASSESSMENT FINDINGS
• Sore throat and mouth breathing
• Fever
• Difficulty swallowing
• Enlarged, reddish tonsils
• Foul-smelling breath
TONSILITIS and ADENOIDITIS
Laboratory test
1. CBC
2. throat culture
TONSILITIS and ADENOIDITIS
MEDICAL MANAGEMENT
1. Antibiotics- penicillin
2. Tonsillectomy for chronic cases and abscess
formation
TONSILITIS and ADENOIDITIS
NURSING INTERVENTION for tonsillectomy
1. Pre-operative care
Consent
Routine pre-op surgical care
TONSILITIS and ADENOIDITIS
2. POST-operative care
Position: Most comfortable is PRONE, with head turned
to side
Maintain oral airway, until gag reflex returns
Apply ICE collar to the neck to reduce edema
Advise patient to refrain from talking and coughing
Ice chips are given when there is no bleeding and gag
reflex returns
TONSILITIS and ADENOIDITIS
TONSILITIS and ADENOIDITIS
2. POST-operative care
Notify physician if:
a. Patient swallows frequently
b. vomiting of large amount of bright red or dark blood
c. PR increased, restless and Temp is increased
PERITONSILAR ABSCESS
• AKA quinsy
• Most common suppurative complication of sore
throat
• Adult: 20-40 years old
• Collection of purulent exudate between the tonsillar
capsule and the surrounding tissues
Clinical Manifestations
• Severe sore throat
• Fever
• Trismus (inability to open the mouth)
• Drooling
• Raspy voice
• Odynophagia
• Dysphagia
• otalgia
LARYNGITIS
• Inflammation of the larynx, often occurs as a result of
the voice abuse or exposure to dust, chemicals,
smoke, or other pollutants
• an inflammation of the vocal cords
Pathophysiology
Acute laryngitis:
• results from infection, excessive use of the voice, inhalation
of smoke or fumes, or aspiration of caustic chemicals.
Chronic laryngitis:
results from upper respiratory tract disorders (such as
sinusitis, bronchitis, nasal polyps, or allergy), mouth breathing,
smoking, gastroesophageal reflux, constant exposure to dust
or other irritants, alcohol abuse, or cancer of the larynx
Pathophysiology
• Edema of the vocal cords caused by irritation (from an
infection, lesion, or overuse of the voice or other
cause) impairs the normal mobility of the vocal cords,
causing an abnormal sound.
Clinical Manifestations
• hoarseness (persistent hoarseness in chronic
laryngitis) or aphonia
• changes in the character of the voice
• pain (especially when swallowing or speaking)
• a dry cough, fever, malaise, dyspnea, throat clearing,
restlessness, or laryngeal edema.
Diagnostic exam
• Indirect laryngoscopy
• Videostroboscopy:
shows the movement of the vocal cords.
Treatment
• resting the voice (primary treatment)
• symptomatic care, such as an analgesic and throat
lozenges (for viral infection)
• antibiotic therapy (bacterial infection), usually with
cefuroxime
Treatment
• identification and elimination of underlying cause
(chronic laryngitis)
• possible hospitalization (in severe acute laryngitis)
• possible tracheotomy if laryngeal edema results in
airway obstruction
• drug therapy, which may include antacids, histamine-
2 blockers, antibiotics, and systemic steroids.
Nursing Management
• refrain from talking to avoid straining the vocal cords
and allow vocal cord inflammation to decrease
• place a sign over his bed to remind others of talking
restrictions
*intercom
Nursing Management
• Provide a pad and pencil or a slate for communication.
• Provide an ice collar, a throat irrigant, and cold fluids
for comfort.
EPISTAXIS
• Nosebleed

EPIDEMIOLOGY
• Anterior epistaxis is more common in younger
patients.
• Posterior epistaxis is more common in the elderly
population.
EPISTAXIS
Anterior Epistaxis
• Comprise 90% of nose bleeds.
• Most commonly originates from Kiesselbach’s plexus
(a confluence of arteries on the posterior superior
nasal septum).
EPISTAXIS
ETIOLOGY
• Trauma to the nasal mucosa (usually self-induced)
• Foreign body
• Allergic rhinitis
EPISTAXIS
ETIOLOGY
• Nasal irritants (such as cocaine, decongestants)
• Pregnancy (due to engorgement of blood vessels)
• Infection (sinusitis, rhinitis)
EPISTAXIS
Posterior Epistaxis
• Comprises approximately 10% of epistaxis
• More common in older patients and is thought to be
secondary to atherosclerosis of the arteries supplying
the posterior nasopharynx.
EPISTAXIS
ETIOLOGY
• Hypertension
• Anticoagulation therapy
• Liver disease
• Blood dyscrasias
• Neoplasm
• Atherosclerosis of nasal vessels
EPISTAXIS
CLINICAL FEATURES
• Blood may be seen effluxing from both nares or down
the posterior oropharynx.
• Visualization of the bleeding usually requires use of a
fiber-optic laryngoscope.
• Bleeding is often more severe than with an anterior
bleed.
EPISTAXIS
Treatment:
• Direct pressure on the bleeding site.
• Venous pressure is reduced in the sitting position,
and leaning forward lessens the swallowing of
blood.
• Ice packs
• Cautery with silver nitrate
• Treatment of other possible underlying causes of
bleeding
end