Upper respiratory tract infection

Natasha J. AbdullaBSN3-B

Upper respiratory tract infections (URI or URTI)

are the illnesses caused by an acuteinfection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx. This commonly includes: tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and thecommon cold.

Infections of the upper airway.

Aphonia - impaired ability to use one’s voice due to disease or injury to the larynx

Apnea – cessation of breathing. Dysphagia – difficulties in swallowing. Epistaxis – hemorrhage from the nose due to rupture of tiny,

distended vessels in the mucous membrane of any area in the nose. Laryngitis- inflammation of the larynx; may be caused by voice

abuse, exposure to irritants or infectious organisms. Laryngectomy – removal of all or part of the larynx and surrounding

structures. Nuchal rigidity – stiffness of the neck or inability to bend the neck. Pharyngitis – inflammation of the throat, usually viral or bacterial in

origin. Rhinitis- inflammation of the mucous membranes of the nose; may

be infectious, allergic or inflammatory in origin. Rhinorrhea – drainage of a large amount of fluid from the nose. Sinusitis – inflammation of sinuses; may be acute or chronic may be

viral, bacterial, or fungal in origin. Tonsillitis – inflammation of the tonsils, usually due to an acute

infection. Xerostomia – dryness of the mouth from a variety of causes.

Common URI terms are defined as follows:

Rhinitis - Inflammation of the nasal mucosa Rhinosinusitis or sinusitis - Inflammation of the nares and

paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid

Nasopharyngitis (rhinopharyngitis or the common cold) - Inflammation of the nares, pharynx,hypopharynx, uvula, and tonsils

Pharyngitis - Inflammation of the pharynx, hypopharynx, uvula, and tonsils

Epiglottitis (supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area

Laryngitis - Inflammation of the larynx Laryngotracheitis - Inflammation of the larynx, trachea, and

subglottic area Tracheitis - Inflammation of the trachea and subglottic area

Common Cold/ Viral Rhinitis

also cold coryza is inflammation in the nasal mucous membranes.

The release of histamine and other substances causes vasodilatation and edema, which result in symptoms.

It may occur as a reaction to allergens (hay fever) such as pollen, dust, molds, or some foods, or it may be caused by viral or bacterial infection.

Viral rhinitis is another name for a common cold.

Signs and Symptoms

Nasal congestion Localized itching Sneezing rhinorrhea Nasal discharge Scratchy or sore throat Viral or Bacterial rhinitis may also be

accompanied by fever and malaise.

Diagnostic Test

If allergic rhinitis is suspected, skin testing may be done t determine the offending allergens.

Blood test for IgE antibodies may be also be done to determine if allergies are the cause.

Medical Management

Provide adequate fluid intake. Encourage rest. Prevent chilling. Use expectorants as needed. Warm salt, and non-t water gargle soothe the sore

throat. Aspirin and ibuprofen, relieve the aches, pains, and

fever in adults. Antihistamines to relieve sneezing, rhinorrhea, and

nasal congestion. Topical nasal decongestant agents must be used

with caution.

Therapeutic Intervention/ Nursing Care

Treatment is symptomatic Teach patient that rest and fluids are most

effective. Acetaminophen can be used for generalized

discomfort. Antihistamines may help control symptoms by

inhibiting the histamine response. Decongestants cause vasoconstriction which

reduces the swelling and congestion. Severe allergies may be treated with

desensitization (allergy shots)

Influenza or Flu

Commonly referred as flu, an acute, highly contagious respiratory tract infection

Usually occurs seasonally in epidemics. Easily transmitted via droplets from

coughs and sneezes of infected individuals, or it may be transmitted by physical contact with a person or object that harbors the virus. The incubation period from time of exposure to onset of symptoms is 1 to 3 days.

Signs and Symptoms

Respiratory manifestations: Sinusitis Dyspnea Sore throat Nasal stuffiness Nasal discharges Dry cough

Abrupt onset of chills, myalgia (muscle pain) , sore throat, cough, general malaise lasting up to several weeks.

Etiology

1.) Influenza results from one of three types of myxovpirus influenzae: type a, type b or type c.

2.) The elderly are at particular risk for and even death from influenza because of preexisting chronic disease and compromised immune function.

Recommended priority of influenza vaccination

Persons age > years with comorbid ( the presence of one or more disorders (or diseases)  conditions.

Residents of long term care facilities Persons age 2 to 64 years with comorbid

conditions Children aged 6 to 23 months Pregnant women Health care personnel who provide direct patient

care Household contacts and out-of-home caregivers of

children aged < 6months

Complications

The most common complicated is PNEUMONIA. Which may be caused the same virus as the flue or by a secondary bacterial infection.

This should be considered if the patient experiences:

Persistent fever Shortness of breath If the lungs develop crackles and

whizzes

Diagnostic Test

Viral cultures of throat or nasal swabbing can be down to identify influenza, but results may takes to 5-10 days.

Rapid tests can identify the presence of virus in less than 30 minutes. Cultures may also be done to rule out the bacterial infection.

Once influenza has been identified in a geographical area, lab test will be less often and tat based on symptopms.

Therapeutic Intervention

Treatment is symptomatic. Acetaminophen is given for fever, headache

and myalgia. Aspirin is avoided in children because it increases the risk for Reye’s syndrome (children given aspirin when they have influenza and varicella (chicken pox) can develop a severe liver and brain disease called reye’s syndrome.

Rest and fluids are essential. Antibiotics are used only if a secondary

bacterial infection is present.

Nursing Care

Assess lung sounds and signs for every 4 hours, and monitor for dehydration.

Encourage rest and fluids ( if not contraindicated), and provide comfort measures.

Educate patients about avoiding aspirin to treat influenza symptoms to prevent Reye’s syndrome.

Acute Sinusitis Inflammation of the sinuses It frequently develops as a result of an

upper respiratory infection, such as an unresolved viral or bacterial infection, or an exacerbation of allergic rhinitis.

Nasal congestion, caused by inflammation, edema, and transudation of fluid leads to an obstruction of the sinus cavities.

Clinical Manifestations

1.) Paina. Frontal headache - frontal sinusitisb. In and around eyes – ethmoidal sinusitis.c. Lateral and nose upper teeth – maxillary sinusitis.d. Occipital headache – spinoidal sinusitis.2.) Nasal congestion/discharges may or may not be

present.3.) Mild fever4.) Acute suppurative infection – if frontal sinusitis is

involved this can be a serious problem because it may rupture posteriorly and lead to brain abscess.

5.) Nasal mucosa may be red and edematous.

Complications• Meningitis• Brain abscess• Ischemic infarction

Medical Management

a.) non surgical drainage of the sinusb.) instill vasoconstictor.c.) antihistamines.

Chronic Sinusitis

A suppurative, inflammation of the sinuses with chronic irreversible changes in the mucosa and sinus bony area.

Is an inflammation of the sinuses that perishes more than 3 weeks in an adult and 2 weeks in a child.

Clinical Manifestations

Impaired mucociliary clearance and ventilation.

Cough Chronic hoarseness. Chronic headaches. Facial pain. Fatigue and nasal stuffiness Decrease in smell and taste and

fullness of ears for some.

Medical Management

Antihistamine, analgesic, antibiotic Repair of stuctural deformities Draining of sihmoinuses – CALDWELL

LUC procedure, functional endoscopic, sinus surgery, external sphenoethmoidalectomy.

Curative Measures

Encourage bed rest with head of bed elevated to promote drainage of secretions.

Apply warm, moist compression at least 4X a day or stream inhalation or nebulisation.

Monitor vital signs, esp. the temperature. Watch for, and report increase in

headaches, blurred vision, chills or vomiting.

Give analgesic, antihistamine as ordered Administer antibiotics as ordered.

Streptococcal Sore Throat or Acute Follicular Pharyngitis

Acute pharyngitis is an inflammation or infection in the throat, usually causing symptoms of a sore throat.

Signs and Symptoms

Fiery eyed pharyngeal membrane and tonsils.

Lymphoid follicles that are swollen and flecked with white purple exudate

Enlarged and tender cervical lymph nodes. Annoying tickling cough. Fever, malaise and sore throat may be

present. Throat pain may prevent swallowing or

difficulty of breathing.

Goal of treatment

Elimination of infection, lowers fever and avoid complications.

Early intervention with chemotherapeutic agent to prevent acute rheumatic fever and glumerulonephritis.

Penicillin for the first 24 hours If throat culture is positive, continue

penicillin for 10 days.

Nursing Interventions

Maintain bed rest during the acute phase.

Provide throat irrigation such as warm saline gargle.

Give analgesics as ordered, assess and document effectiveness.

Administer antibiotics as ordered.

Chronic Pharyngitis

Is a persistent inflammation of the pharynx.

Common in adults who work or live in dusty surroundings, use their voice to excess, suffer from chronic cough, or habitually use alcohol or tobacco.

3 types of chronic pharyngitis

Hypertrophic: characterized by general thickening and congestion of the pharyngeal mucous membrane.

Atrophic: probably a late state of the (type (the membrane is thin, whitish, glistening, and at times wrinkled.)

Chronic granular (“clergyman or sore throat”) characterized by swollen lymph follicles on the pharyngeal wall.

Clinical Manifestations

Constant sense of irritation of fullness in the throat.

Mucus collects in throat and can be expelled by coughing.

Difficulty in swallowing. A sore throat that is worse with

swallowing in the absence of pharyngitis suggests the possibility of throiditis and patients with this symptoms are referred for evaluation for possible thyroiditis.

Medical Management

Avoiding exposure to irritants Correcting any upper respiratory, pulmonary,

or cardiac condition that may be responsible for chronic cough.

Nasal congestion may be relieved by short-term use of nasal sprays.

Dimetapp or drixoral- (anhistamine decongest medications) for patients with history of allergy

Acetaminophen recommended for it’s anti-inflammatory and analgesic properties.

Nursing Management

To prevent infections from spreading, instruct patient to avoid contact with others until the fever subsides.

Avoid alcohol, tobacco, second-hand smoke and exposure to cold or to environmental or occupational pollutants.

Minimize exposure to pollutants by wearing a disposable facemask.

Encourage the patient to drink plenty of fluids. Gargling with warm saline solution may relieve

throat discomfort Lozenges will keep the throat moistened.

Tonsillitis and Adenoiditis

Tonsils are composed of lymphatic tissue and are situated at each side of the oropharynx. The faucionsillitis is less common al or palatine fauces and tongue, respectively. They frequently serve as the site of acute infection (tonsillitis).

Acute tonsillitis can be confused with pharyngitis. Chronic tonsillitis is less common and may be mistaken for other disorder such as allergy, asthma and sinuses

Adenoids or pharyngeal tonsil of lymphatic tissue near the center of the posterior wall of the nasopharynx. Infection of the adenoids frequently accompanies acute tonsillitis.

Group A beta-hemolytic streptococcus (GABS) is the most common organism associated with tonsillitis and adenoiditis.

Often thought of as an childhood disorder, tonsillitis can also occur in adults.

Clinical Manifestations

Symptoms of tonsillitis includes: › Sore throat› Fever› Snoring› Difficulty in swallowing.

Enlarged adenoids may cause mouth breathing, ear ache, draining ears, frequent head colds, bronchitis, foul smelling breath, voice impairment, and noisy respiration.

Assessment and diagnostic findings

A thorough physical examination is performed and a careful history is obtained to rule out related or systemic conditions.

The tonsillar site is cultured to determine the presence of bacterial infection.

In adenoiditis, if recurrent episodes of suppurative otitis media in result in hearing loss, the patient should be given a comprehensive audiometric exam.

Medical Management

Increase fluid intake. Analgesics. Salt water gargles Rest Bacterial infections are treated with penicillin

as first line-therapy. Viral infections are not effectively treated by

antibiotic therapy. Tonsillectomy or adenoidectomy is indicated if

the patient has had repeated episodes of tonsillitis despite antibiotic therapy.

Nursing Management

Continuous observation is required in the immediate postoperative and recovery periods because of the significant risk of hemorrhage.

Most comfortable position is prone with head turned to side to allow drain from the mouth and pharynx. (position post operative)

The nurse must not remove the oral airway until the patient’s gag reflex and swallowing reflexes have returned.

Apply ice collar to the neck and a basin and tissues are provided for the expectoration of the blood and mucus.

Pain is effectively controlled by analgesics.

Laryngitis

An inflammation of the larynx. Often occurs as a result of voice abuse of exposure to dust, chemicals, smoked, other pollutants, or as part of an upper respiratory tract infection.

May be also caused by isolated infection involving only the vocal chords.

The cause of infection is almost always a virus. Bacterial invasion may be secondary.

Common in winter and is easily transmitted.

Clinical Manifestations

Hoarseness Aphonia ( complete loss of voice) Severe cough.

Medical Management

Resting the voice Avoid smoking, resting and inhaling

cool steam of aerosol. Eliminating any other respiratory

disorder. Avoid second-hand smoke.

Nursing Management

Instruct patient to rest the voice. Maintain a well-humidified

environment. Expectorant agents are suggest if there

are laryngeal secretions present during acute episodes.

Daily fluid intake of 3 Liters