Upper Respiratory Infections Flashcards
group of disorders characterized by inflammation and irritation of the nasal mucous membranes. •acute or chronic •nonallergic or allergic (AR)
Rhinitis
Rhinitis during pollen seasons
Seasonal Rhinitis
Rhinitis throughout the year
Perennial Rhinitis
- changes in temperature
- odors
- infection
- age
- systemic disease
- use of OTC/prescribed nasal decongestants
- presence of foreign body
Rhinitis Etiology
- pruritus of the nose
- rhinorrhea (large amount of fluid drain from the nose)
- sneezing
- teary eyes
Symptoms of Rhinitis
- nuts
- shellfish
- eggs
- milk
- penicillin
- aspirin
- drugs with potential allergic reaction
Allergens for Rhinitis
Symptomatic treatment
Rhinitis Medical Management
- antihistamines (most common)
- corticosteroid nasal spray
- saline nasal spray (mild decongestant)
- oral decongestants (for nasal obstruction)
- antimicrobial agents (bacteria)
Rhinitis Pharmacologic therapy
- avoid/reduce exposure to allergens/irritants
- medication health teachings
- hand hygiene technique
- emphasize the importance of flu vaccination
- keep head upright and spray quickly (spray away from the nasal septum)
- close one nostril while spraying and wait for at least a minute to spray the other
- blow and keep the nose clean before putting on any medication
Education
- Most frequent viral infection and most common cause of non-allergic rhinitis.
- Self limiting
Viral rhinitis (common cold)
- nasal congestion
- rhinorrhea
- sneezing
- sore throat
- general malaise
- nasal discharge
- rhinorrhea
- watery eyes
- chills
- sore throat
- halitosis
Viral Rhinitis Manifestation
adequate fluid intake and rest
Viral rhinitis self care
- antihistamines
- expectorants
Symptomatic therapy
Rebound rhinitis
- overuse of topical nasal decongestants (ND)
- ND should not be used for more than 3-5 days in a row
Rhinitis Medicamentosa
- feeling congested shortly after using a nasal spray
- strong urge to use the spray/drops more number of times than recommended
- feeling that the ND doesn’t work well enough despite using it several x in a day
Rhinitis Medicamentosa
Clinical Presentation
- turbinate hyperplasia
- chronic sinusitis
- septal perforation
Rhinitis Medicamentosa Complications
Permanent swelling of the nasal tissues
Turbinate Hyperplasia
Hole in the nasal septum (divides the nose)
Septal Perforation
- hand hygiene
- cough etiquette
Rhinitis Medicamentosa
Educate about Self-care
- stop nasal spray
- oral steroids
- intranasal steroid spray
- oral antihistamine
- surgery (turbine reduction/ septal perforation repair)
Rhinitis Medicamentosa Management
- formerly called sinusitis
- inflammation of the paranasal sinuses and nasal cavities
- bacterial or viral
Rhinosinusitis
Acute (<4 weels)
- Subacute (4-12 weeks)
- Chronic (>12 weeks)
Rhinosinusitis classification
- Acute bacterial rhinosinusitis (ABRS)
- Acute viral rhinosinusitis (AVRS)
Acute Rhinosinusitis classification
- Purulent nasal drainage
- Facial pain-pressure fullness
- Colored/cloudy nasal discharge congestion
- Blockage or stuffiness
- Localized/Diffused headache
- High fever (39C)
- Symptoms occur 10 DAYS OR MORE after initial UR symptoms
ABRS Manifestations
- Purulent nasal drainage
- Colored/cloudy nasal discharge congestion
- Blockage or stuffiness
- Localized/Diffused headache
- Symptoms occur FEWER THAN 10 DAYS POST ONSET of UR symptoms
- DOES NOT worsen
AVRS Manifestations
- History and PA
- CT scan for complications
- Flexible endoscopic culture techniques
- Swabbing of sinuses
- Transillumination
Rhinosinusitis Assessment and Dx Findings
To shrink the nasal mucosa, relieve pain, and treat infections
Rhinosinusitis Medical Management Goal
- Intranasal lavage (Viral)
- Decongestants (common antiviral medication) and antihistamines (Viral)
- Intranasal corticosteroids (Viral/Bacterial)
- 5-7 days course of antibiotics (Bacterial)
Rhinosinusitis Medical Management
Educate about self care
- air humidification
- warm compress to relieve pain
- avoid swimming (dirty water and chlorine), diving, air travel (pressure affects sinuses), and tobacco
- health teaching on the use of medications
- watch out for complications
Rhinosinusitis Nursing Management
- Accompanied by nasal polyps
- Lasts 12 weeks or longer with 2 or more of the following symptoms
- mucopurulent drainage
- nasal obstruction
- facial pain-pressure fullness
- hyposmia (decreased sense of smell)
Chronic Rhinosinusitis
diagnosed when 4 or more episodes of ABRS occur/year
Recurrent Acute Rhinosinusitis
- History and Physical Assessment
- Imaging Studies:
- X-ray
- Sinoscopy
- Ultrasound
- CT scanning
- MRI
Chronic Rhinosinusitis Assessment and Diagnostics
golden standard in determining the presence of sinusitis
CT Scan
- OTC nasal sprays
- analgesics
- decongestants
- antibiotics
- corticosteroids nasal spray
Chronic Rhinosinusitis Medical Management
Functional Endoscopic Sinus Surgery (FESS)
- minimally invasive technique used to restore sinus ventilation and normal function
- computer guided surgery
- Chronic rhinosinusitis does NOT improve during surgery for more than 3 months.
Chronic Rhinosinusitis Surgical Management
- blow nose gently and use tissue to remove nasal drainage
- increase fluid intake
- apply local heat
- elevate head of the bed
- health teachings on medications
Chronic Rhinosinusitis Nursing Management
sudden and painful inflammation of the pharynx, including the
- posterior third of the tongue
- soft palate
- tonsils
Pharyngitis
- Acute
- Chronic
Pharyngitis Classifications
- spreads easily through droplets of coughs,s neezes, and unclean hands
Acute Pharyngitis
Viral infection
Most common cause of Acute Pharyngitis
- adenovirus
- influenza virus
- herpes simplex virus
- Epstein-Barr virus
Viruses that cause acute pharyngitis
Group A Streptococcus (GAS) which then coins the term for the infection, Streptococcal Pharyngitis (Strep Throat)
Bacteria that causes Acute Pharyngitis
- Fiery-red pharyngeal membrane and tonsils enlarged
- Tender cervical lymph nodes
- No cough
- Fever
- Malaise
- Sore throat (appears 1-5 days after exposure)
*Uncomplicated viral infection subsides 3-10 days onset
Acute Pharyngitis Symptoms
- determine the cause (bacterial/viral)
- GAS: Initiate antibiotics
- Rapid Streptococcal Antigen Test (RSAT)
- Throat Culture (most dependable)
Acute Pharyngitis Diagnostic Findings
Viral: supportive measures
Nutrition
- liquid/soft diet
- cool beverages, warm liquids, flavored frozen food
Bacterial: antimicrobial agents
- Penicillin (drug of choice)
- Analgesics
- Cephalosporins or Macrolides if allergic to Penicillin
Acute Pharyngitis Medical Management
- Symptomatic management
- Bed rest
- Saline gargle (throat irrigation)
- ice collar
- Not sharing eating utensils
- Replace old toothbrush
Acute Pharyngitis Nursing Management
Persistent inflammation of the pharynx
Chronic Pharyngitis
General thickening and congestion of the pharyngeal mucous membrane
Hypertrophic
Late stage of type 1 (Membrane is thin, whitish, glistening, and at times wrinkled)
Atrophic
Numerous swollen lymph follicles on the pharyngeal wall
Chronic Granular
- Constant sense of irritation/fullness in the throat
- Intermittent post nasal drip
- Sore throat
Chronic Pharyngitis Manifestations
- relieve the symptoms
- Avoid exposure to irritants
Chronic Pharyngitis Medical Management
Tonsillectomy
Chronic Pharyngitis Surgical Management
- Nasal sprays
- Antihistamine decongestant
Chronic Pharyngitis Pharmacologic Therapy
Avoid
- tobacco
- second hand smoke
- exposure to cold, environmental/occupational pollutants
- Minimize exposure to pollutants (use disposable masks)
- High fluid intake
- Gargling warm saline solution
- Lozenges
Chronic Pharyngitis Nursing Management
Inflammation of the tonsils (two oval-shaped pads of tissue at the back of the throat)
Tonsilitis
Confused with pharyngitis
Acute Tonsilitis
Less common and may be mistaken for disorders like allergy, asthma, and rhinosinusitis.
Chronic Tonsilitis
- Inflammation of the adenoids (near the eustachian tube) caused by infection.
- Frequently accompanied by acute tonsilitis
Adenoiditis
Group A Betahemolytic Streptoccocus (GABHS)
Common bacteria that causes adenoiditis
Epstein-Barr virus
Common virus that causes adenoiditis
- Sore throat
- Fever
- Snoring
- Difficulty swallowing
- Frequent swallowing (bleeding may be present)
- Nasal obstruction
- Hard to swallow and smell
Tonsilitis Clinical Manifestations
- Mouth breathing (foul smelling)
- Earache
- Draining ears
- Frequent colds
- Bronchitis
- Voice impairment
- Noisy respiration
Adenoiditis Clinical Manifestations
- Thorough Physical Examination and history
- Specimen culture
- Audiometric assessment 9for recurring otitis media)
Tonsilitis and Adenoiditis Assessment and Diagnostic Findings
- High fluid intake
- Analgesics
- Salt water garfles
- Rest
Supportive Measures
- Penicillin (1st line)
- Cephalosporins
Antibiotics for bacterial infection
- Tonsillectomy
- Adenoidectomy
Surgical management
Immediate Postoperative Care
- Continuous monitoring
- Prone position. head turned sideways
- Maintain oral airaway until gag reflex returns
- Apply ice collar
- Antibiotics to relieve pain
Tonsilitis and Adenoiditis Nursing Management
- Understanding signs and symptoms of hemorrhage (it is noraml to have 8-10 days bleeding)
- Health teaching about pain medications
- Full course antibiotics as prescribed
- Warm saline solution
- Soft diet
- Maintain good hydration
- Avoid milk products (promotes thich mucus production (hard to remove))
- Vomiting within 24 hours
- Avoid heavy lifting for 10 days
Tonsilitis and Adenoiditis Self-care Education
- Understanding signs and symptoms of hemorrhage (it is noraml to have 8-10 days bleeding)
- Health teaching about pain medications
- Full course antibiotics as prescribed
- Warm saline solution
- Soft diet
- Maintain good hydration
- Avoid milk products (promotes thich mucus production (hard to remove))
- Vomiting within 24 hours
- Avoid heavy lifting for 10 days
Tonsilitis and Adenoiditis Self-care Education
- Also called quinsy
- A bacterial infection which is a complication of untreated strep throat or tonsilitis
- Most common suppurative (pus formation) complication of sore throat
- Collection of purulent exudate between the tonsillar capsule and the surrounding tissues
Peritonsilar Abscess
- Severe sore throat
- fever
- Trismus (inability to open the mouth due to the inflammed muscles lying laterally at the tonsils)
- Drooling
- Odynophagia (painful swallowing)
- Dysphagia (difficulty swallowing)
- Otalgia (ear pain)
Peritonsilar Abscess Manifestations
- Abscess aspiration
- Intraoral ultrasound
- Transcutaneous cervical ultrasound
Peritonsilar Abscess Diagnostic Tests
- Antimicrobial agents
- Corticosteroid therapy
- Penicillin (prescribed early)
Peritonsilar Abscess Management
- Tonsillectomy (Poor candidates of needle aspiration)
- Needle aspiration (Decompresses abscess and perform best sitting down)
- Incision and drainage of abscess
Peritonsilar Abscess Surgical Management
- Preoperative nursing care
- Maintain hydration status (cool and room temp)
- Monitor the patient
- Provide adequate nutrition
- Sitting upright
- gentle gargling post op 1-2 hours interval for 24-36 hours
Peritonsilar Abscess Nursing Management
- Inflammation of the larynx and often associated with pharyngitis and rhinitis
- Result of: voice abuse. exposure to pollutants, and as part of URI
- Caused by a virus same as cold and pharyngitis
Laryngitis
- Hoarseness _ Aphonia (loss of voice) - Severe cough - Dysarthria (Difficulty speaking) - Sore throat (worsens at night) - URI - Shortness of breath - Painful swallowing - Painful speaking
Laryngitis Manifestations
- Rest voice
- Avoid irritants
- Rest
- Inhaling cool steam
- Antibiotics
Laryngitis Medical Management
- Resting of voice
- Maintain a well-humidified environment
- Adequate fluid intake
- Health teachings on prescribed medications
- Follow up care
Laryngitis Nursing Management
