Cough and Cold - Assessment Flashcards

1
Q

Cough and Cold

Nonspecific term used to describe a spectrum of acute infections that may involve the nose,
sinuses, pharynx, larynx and trachea

What are possible causes (3)?

A

virus,
bacteria,
or fungi

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2
Q

Cough and Cold

Most viral infections are self‐limited, resolve spontaneously and are managed symptomatically

What are possible Complications (3)?

A

Influenza,
respiratory syncytial virus,
COVID

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3
Q

Cough and Cold

Viral Rhinitis (Common Cold) is the most common infectious disease caused by more than 200 different viruses,
list the common ones:
A

◦ Rhinovirus is the most common (30‐50%) → more
common in the spring and fall

◦ Coronavirus (10‐20%) → more common during mid‐
winter and early spring

◦ Also RSV, adenovirus, parainfluenza, enterovirus

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4
Q

Cough and Cold

Viral Rhinitis (Common Cold)

Estimated __% of time lost from work and __% of absences from school are due to the common cold

A

40%

30%

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5
Q

Cough and Cold

Viral Rhinitis (Common Cold)

Transmission: (3)

A

◦ Hand contact with secretions that contain the virus

◦ Small‐particle aerosols in the air

◦ Direct inhalation of large‐particle aerosols from an
infected person

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6
Q

Cough and Cold

Viral Rhinitis (Common Cold)

Generally ____‐limiting

A

self‐limiting

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7
Q

Cough and Cold

Viral Rhinitis (Common Cold)

Can predispose to ___ complications and exacerbate ___

A

bacterial

asthma

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8
Q

Cough and Cold

Viral Rhinitis Pathophysiology

Is Viral Rhinitis Pathophysiology completely understood?

A

No

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9
Q

Cough and Cold

Viral Rhinitis Pathophysiology

Contact between virus and nasal mucosa likely important for initiation of infection,
then –>

A

Virus attaches to cell → replicates and kills the cell → cell bursts and releases new viruses → body releases inflammatory mediators (bradykinins and interleukins)

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10
Q

Cough and Cold

Viral Rhinitis Pathophysiology

The inflammatory reaction prevents the spread of the virus but causes symptoms like –> (2)

A

• Increase in vascular permeability, glandular secretion,
and vasodilation

• Cholinergic stimulation = increased mucous gland
secretion and sneezing

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11
Q

Cough and Cold

Viral Rhinitis Pathophysiology

Viral replication peaks in __ hrs, shedding can continue up to _ weeks

A

48 hrs

3 weeks

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12
Q

Cough and Cold

Viral Rhinitis – Signs and Symptoms

• Symptoms peak in ___ days and generally resolve around day _ but can last up to _ weeks

• Sore throat – generally resolves in a few days (usually
occurs __ )

• Nasal Congestion & Rhinorrhea (usually occurs ___ )
- Discharge is clear and watery at the beginning and
can become purulent

What are the other signs and symptoms? (5)

A

2‐4 days 7, 3

1 st

2 nd

  1. Sneezing (during the first few days)
  2. Cough (can last 1‐2 weeks, dry at the beginning and
    can become productive)
  3. Headache
  4. Chills, malaise
  5. Fever (infrequent in adults but common in children)
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13
Q

Cough and Cold

Differential Diagnosis of the Common Cold

Slide 10 - table

A

Look at slide 10 table

Pharyngitis: inflamm of the pharynx and get sore throat (ppl assume strep throat)
No nasal discharfe or congestion
- Fever may be present
- Cough is usally absent and headache not often
- 3 days

Rhinosinusitis

- Often viral, but very painful when it's bacterial and pain spreads through jawline
- Discharges purenlent, fever persistent
- Antibiotics needed
- No sore throat, post nasal drip that can cause cough
- Congestion, aches and pains in facial area, tenderness and tooth pain
Allergic rhibitis
	- Fever is absent
	- Like a common cold
	- Congestion, sore throat with post nasal drip
Flu
	- Severe aches and pains
	- Fever that is high
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14
Q

Cough and Cold

Cough and Cold Assessment

Always inquire about past history, which 2 types of past histories to ask?

A

Past medical history

Past social history

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15
Q

Cough and Cold

Cough and Cold Assessment

Examples of past medical history to ask:

A

allergies
personal or family history of asthma or atopy
any recent respiratory infections
any immunosuppressive conditions or medications
cancer
medication history
sick contacts

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16
Q

Cough and Cold

Cough and Cold Assessment

Examples of past social history to ask:

A

smoking history and habits
marijuana use
environmental/occupation exposures
travel history (? TB exposure)

17
Q

Cough and Cold

Cough and Cold Assessment

Symptoms of TB:

A

Cough that lasts more than 3 weeks
Loss of appetite
Fever/Chills
Night sweats

18
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Symptoms

A
Fever,
chest pain,
sore throat,
rhinitis,
nasal congestion,
acid/bitter taste in mouth,
headache,
swollen glands,
shortness of breath,
sneezing,
cough,
malaise
19
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Characteristics

A

Quality of cough (dry, wet, hacking),
sputum presence,
colour of sputum,
frequency

20
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - History

A

Change in frequency (i.e. worsening over time?)

21
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Onset

A

When did the cough start, duration (acute, subacute, or chronic)

22
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Location

A

Limited to upper respiratory tract or more systemic symptoms?

23
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Aggravating Factors

A

Worse at night? With exercise?
Cold weather?
After eating?
Other triggers of cough?

24
Q

Cough and Cold

Cough and Cold Assessment

SCHOLAR - Relieving Factors

A

Tried anything to alleviate symptoms? (eg. Lozenges, syrups)

25
Q

Cough and Cold

What are the general risk factors for upper respiratory infection? (4)

A
  • Daycare
  • Psychological stress
  • Sleep disorders
  • Increased severity of infection
26
Q

Cough and Cold

What are the general risk factors that may increase upper severity of upper respiratory infection? (4)

A
  • Underlying chronic diseases
  • Congenital immunodeficiency disorders
  • Malnutrition
  • Cigarette smoking
27
Q

Cough and Cold

What are the Complications & Hospitalization
Risk for Influenza? (6)

A
  • Adults and children with chronic medical conditions
  • Nursing home resident or chronic care facility
  • Persons > 65
  • Healthy children <5 years of age
  • Pregnant women
  • Indigenous persons
28
Q

Cough and Cold

Red Flags

A
  • Hemoptysis
  • Severe paroxysms of cough with post‐tussive emesis
    and/or inspiratory whooping sound
  • Chest pain
  • Weight loss
  • Wheezing and/or SOB
  • Dyspnea with lower extremity edema
  • Fever & purulent sputum production
  • Confusion/change in mental status
  • Cough lasting > 3 weeks
  • Severe dehydration
  • Severe pain in neck, throat
29
Q

Cough and Cold

Differential Diagnosis in Children

What are the characteristics of Croup?

A
  • Barking, seal‐like cough, usually nonproductive
  • Gradually worsening inspiratory stridor
  • Dyspnea
  • Fever
  • Hoarseness
  • Symptoms often worse at night
  • Prodrome (2–5 days) consisting of mild fever,
  • rhinorrhea, malaise, sore throat and cough
30
Q

Cough and Cold

Differential Diagnosis in Children

What are the characteristics of Otitis Media?

A
  • Fever, especially one beginning several days
    after the start of a cold
  • Earache or child tugging at or fingering ear
  • Irritability and/or lethargy
  • Purulent drainage from ear
31
Q

Cough and Cold

What are the Goals of Therapy?

A

• Alleviate symptoms
• Diagnose and treat underlying causes of cough if
possible
• Eradicate viral infection and shorten duration of viral
infection
• Lessen interference with activities of daily living
• Prevent complications and adverse effects from
medications
• Prevent person‐to‐person transmission

32
Q

Cough and Cold

Non-pharm

A
  • Maintain usual fluid intake
  • Humidifiers (evidence lacking)

Prevention (usual stuff), mask, sneezing and cough etiquette

33
Q

Cough and Cold

Clinical pearls - READ

A
  • no cure, symptom management only
  • antibiotics have no role in common cold
  • lack of evidence for non-Rx pdts
  • Dextromethorphan, Codeine and First Generation
    Antihistamines cause drowsiness
  • Combination products are more convenient and
    produce better compliance, however, increases
    the potential for adverse effects from multiple
    ingredients
  • Petrolatum can be applied to nares for comfort (but be
    cautious)
  • Acetaminophen and NSAIDs - 1st line
34
Q

Cough and Cold

Combogesic - first acetaminophen/ibuprofen combo product to hit OTC shelves

A
  • Each tablet has acetaminophen 325 mg plus
    ibuprofen 97.5 mg, with directions to take 1 or 2
    every 6 hours
  • cost about double the amount of combining the separate generics