Disorders of the
Respiratory System
Upper Airway Infections (URTI)
Viral Rhinitis (Common Cold)
The term “common cold” often is used when
referring to an URTI.
The term “cold” refers to an afebrile, infectious, acute
inflammation of the mucous membranes of the nasal
cavity.
Caused by a virus (viral rhinitis).
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Clinical Manifestations
Nasal congestion
Runny nose
Sneezing
Nasal discharge, Nasal itchiness
Tearing watery eyes, “scratchy” or sore throat
General malaise, low-grade fever, chills, and often
headache and muscle aches.
The symptoms last from 1 to 2 weeks.
Management
No specific treatment
Symptomatic therapy
Adequate fluid intake
Encouraging rest
Increasing intake of vitamin C
Using expectorants as needed.
Warm salt-water gargles soothe the throat
NSAIDs
Antihistamines are used to relieve sneezing, rhinorrhea, and
nasal congestion.
Nursing Management
• Patient teaching of self care & prevention of infection & break
chain of infection
• Hand washing remains the most effective measure to
prevent transmission of organisms.
Acute Sinusitis
–The sinuses, mucus-lined
cavities filled with air that
drain normally into the nose.
–Acute sinusitis frequently
develops as a result of an
URTI particularly a viral
infection or an exacerbation
of allergic rhinitis.
Acute Sinusitis
Acute sinusitis is an infection of the paranasal sinuses.
Develops as a result of an URI, and an exacerbation of
allergic rhinitis.
Nasal congestion, caused by inflammation, edema, and
transudation of fluid, leads to obstruction of the sinus
cavities and result for bacterial growth.
Bacterial organisms account for more than 60% of the
cases of AS, namely Streptococcus Pneumoniae and
Haemophilus Influenzae.
Clinical Manifestations Ear pain and fullness
Facial pain or pressure Dental pain
Nasal obstruction
Cough
Fatigue
↓ed sense of smell
Purulent nasal discharge
Sore throat
Fever
Eyelid edema
Headache Facial congestion or
fullness.
Medical management
Antibiotics (Amoxicillin & Ampicillin).
Decongestants may be administered.
Saline irrigation for opening blocked passages,
there by allowing drainage of purulent discharge.
Topical decongestants should be administered with
the patients head back to promote maximal
drainage.
Nursing intervention
The nurse can instruct the patient on methods
to promote drainage such as
Inhaling steam (steam bath, hot shower)
Increasing fluid intake
Applying local heat (hot wet packs)
Complications
Meningitis
Brain abscess
Ischemic Infarction
Osteomyelitis
Chronic Sinusitis
Chronic Sinusitis is an inflammation
of the sinuses that persists for more
than 3 weeks in an adult and 2
weeks in a child.
Pathophysiology
Narrowing or obstruction in the Ostia (openings)
of the sinuses.
Could be because of infection, allergy, or
structural abnormalities
Results in stagnant (non flowing) secretions, an
ideal medium for infection.
The organisms are the same as those implicated in
acute sinusitis.
Clinical Manifestations
Impaired mucociliary clearance and ventilation
Cough
Chronic hoarseness
Chronic headaches in the periorbital area
Facial pain.
Fatigue and nasal stuffiness.
Decrease in smell and taste and a fullness in the
ears.
Diagnostic Findings Complications
CT scan of the sinuses Severe orbital cellulites
MRI Subperiosteal abscess
Nasal Endoscopy Sinus thrombosis
Management Meningitis
Almost the same as for Encephalitis
Acute Sinusitis. Ischemic Infarction.
The course of treatment
may be 3 to 4 weeks
Chronic Sinusitis…
Subperiosteal Abscess
Orbital Cellulites
Surgical Interventions:
• FESS (Functional Endoscopic Sinus Surgery)
• Caldwell Luc Surgery
• Ethmoidectomy
• Sphenoidotomy
Caldwell Luc
Tonsillitis and Adenoiditis
Is the inflammation of tonsils
and adenoids.
Infection of the adenoids
frequently accompanies acute
tonsillitis.
Group A beta-streptococcus is
the most common organism
associated with tonsillitis and
adenoiditis.
Nursing Interventions for Patients
11/4/2 with Respiratory 19
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Disorders
Tonsillitis and Adenoiditis…
Clinical manifestation
• Sore throat
• Fever
• Snoring
• Difficulty in swallowing
• Ear ache
• Draining ears
• Bronchitis
• Foul smelling
• Voice impairment
• Noisy respiration
Tonsillitis and Adenoiditis
Peritonsillar abscess
Is a collection of purulent exudate between the
tonsillar capsule and the surrounding tissues,
including the soft palate.
Develop after an acute tonsillar infection,
progresses to a local cellulitis & abscess
Tonsillitis and Adenoiditis
C/M of Peritonsillar abscess
Odynophagia
Otalgia
Dysphagia
Thickening of the Voice
Drooling & local pain
Swelling of the soft palate
Tonsillitis and Adenoiditis …
Medical management
Antibiotics (usually penicillin)
Abscess must be drained
Abscess may also be incised and drained
Tonsillitis and Adenoiditis …
Surgical Management
Tonsillectomy or Adenoidectomy
Tonsillectomy or Adenoidectomy is indicated only if
Repeated period of illness of tonsillitis
Hypertrophy of the tonsils and adenoids that
could cause obstruction and obstructive sleep
apnea
Repeated attacks of purulent Otitis media
Tonsillitis and Adenoiditis …
Nursing intervention
–Patient Education
–Advise adequate fluid intake
–Frequent use of mouth washes and gargles
using saline solution
Tonsillitis
• Streptococcus- etiologic agent
• Tonsillectomy is recommended when tonsillitis
recurs 5 to 6 times a year. Prevent autoimmune
responses caused by Group A beta hemolytic
streptococcus (GABHS), which include
glomerulonephritis and rheumatic heart disease
• Position after tonsillectomy: lateral/side lying
position. Alternative position is prone with
pillow under the chest- drainage and prevent
aspiration
• Frequent swallowing indicates bleeding
• Ice-cold fluids like popsicle
• Ice cream is not recommended
• Milk increases viscosity of sputum. Triggers clearing of throat
and coughing which may cause bleeding
• Stool is normally dark or black for few days
• ASA is contraindicated postop
Post-Tonsillectomy
• No red or dark colored foods and beverages (chocolate drinks, soda,
tomato juice, grape juice, cranberry juice, prune juice etc)
• No irritating foods and beverages (citrus fruits/fruit juices, pineapple,
spicy foods)
• No hard and scratchy foods (popcorn, pretzels, nuts)
• No milk and milk products (ice cream, Klondike bar, etc)
• No drinking straw
Acute Pharyngitis
Is an inflammation in the throat.
Usually causing symptoms of a sore throat.
Most cases caused by viral infection.
When group A beta-hemolytic streptococcus, the
most common bacterial organism, causes Acute
Pharyngitis (Strep Throat).
Acute Pharyngitis…
Pathophysiology
Infection
Inflammatory response in the pharynx
Pain, fever, vasodilation, edema, and tissue damage
Manifested by redness and swelling in the tonsillar
pillars, uvula, and soft palate
A creamy exudate may be present in the tonsillar
pillars
If left untreated, leads to bacteremia, pneumonia,
meningitis, rheumatic fever, or nephritis
Acute Pharyngitis…
Clinical Manifestation
Affected pharyngeal membrane and tonsils
Lymphoid follicles that are swollen with exudates.
Enlarged and tender cervical lymph nodes
Fever and malaise
Sore throat
Hoarseness cough and rhinitis
Acute Pharyngitis…
Complication Diagnostic Findings
Sinusitis – Rapid screening tests for
Otitis media streptococcal antigens
Pneumonia Streptolysin titers
Peritonsilar abscess – Throat cultures
Mastoiditis – Nasal swabs and blood
cultures
Cervical Adenitis
Rheumatic fever
Nephritis
Acute Pharyngitis…
Medical management
– Viral pharyngitis is treated with supportive
measures.
– Bacterial pharyngitis is treated with Antibiotics.
– Antibiotics are administered for at least 10 days
– Liquid or soft diet is provided during the acute
stage of the disease.
– In sever situations; fluids are administered by
intravenously.
Acute pharyngitis…
Nursing intervention
– Patient education
– Patient should stay in bed during the febrile stage
– Alcohol, tobacco, second-hand smoke, and
exposure to cold are avoided
– Encourage the patient to drink plenty of fluids.
– Gargling with warm saline solutions may relieve
throat discomfort.
– Lozenges will keep the throat moistened
Chronic Pharyngitis
persistent inflammation of the pharynx.
common in adults who work or live in dusty surroundings
use their voice excess
suffer from chronic cough, and
habitually use alcohol and tobacco.
Chronic Pharyngitis ….
Clinical Manifestations
– Constant sense of irritation or fullness in the throat
– Mucus that collects in the throat and can be expelled by
coughing, and
– Difficulty swallowing
Chronic Pharyngitis ….
Management
Is based on relieving symptoms,
Avoiding exposure to irritants, and
Correcting any upper respiratory, pulmonary, or
cardiac condition that might cause chronic cough.
Nasal congestion may be relieved by short-term
use of nasal sprays or medications containing
ephedrine sulfate or phenylephrine hydrochloride.
Chronic Pharyngitis ...
Antihistamine decongestant medications, such as
Drixoral or Dimetapp, is taken orally every 4 to 6
hours.
Aspirin or Acetaminophen is recommended for
its anti inflammatory and analgesic properties.
Encourage the patient to drink plenty of fluids.
Gargling with warm saline solutions may relieve
throat discomfort.
Lozenges will keep the throat moistened.
Chronic
Pharyngitis…
Laryngitis
Is an inflammation of the larynx
Often occurs as a result of voice abuse or exposure
to dust, chemicals, smoke & other pollutants, or as
part of an URTI.
It also may be caused by isolated infection
involving only the vocal cords.
The cause of infection is almost always a virus.
Laryngitis…
• Usually associated with allergic rhinitis
or pharyngitis.
• The onset of infection may be associated
with exposure to sudden temperature
changes, dietary deficiencies,
malnutrition, and an immune
suppressed state.
Laryngitis…
Clinical Manifestations
– Hoarseness
– Aphonia (complete loss of voice)
– Severe cough
– Chronic laryngitis is marked by persistent
hoarseness
– May be a complication of URTI
Laryngitis
…
Medical Management
Resting the voice
Avoiding smoking
Avoiding second-hand smoke
Appropriate antibacterial therapy
Topical corticosteroids, such as Vanceril inhalation
Laryngitis…
Nursing Management
The nurse instructs the patient
To rest the voice
To maintain a well-humidified environment.
Expectorant agents are suggested
Along with a daily fluid intake of 3 L to thin
secretions.