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In Partial Fulfillment of the Requirements for the Subject

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUIDS &
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC)
NCM 112, RLE

UPPER RESPIRATORY DISEASES

Submitted by:
GROUP D (Sub A)
Licop, Jamie Jazelle R.
Mendoza, Kathleen Mae F.
Pascua, Charlotte Grey Q.
Saturnino, Mary Joy
Valenzuela, Ashwell Keezsa O.
Submitted to:
Ma’am Lourdes L. Cabal, MAN, RN
Instructor

Year & Section:

BSN 3-1

Date Submitted:
September 3, 2024
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I. COMMON COLDS

Definition and other names

The common cold, also known as upper respiratory tract infection (URI), is an acute,
self-limited viral infection of the upper airway that also may involve the lower respiratory tract.
The characteristic symptom complex consisting of rhinorrhea, nasal congestion, and sore or
scratchy throat is familiar to all adults.

Signs and Symptoms

• Stuffy, runny nose

• Scratchy, tickly throat

• Sneezing

• Watering eyes

• Low-grade fever

• Sore throat

• Mild hacking cough

• Achy muscles and bones

• Headache

• Mild fatigue

• Chills

• Watery discharge from nose that thickens and turns yellow or green

Etiology/Causes (Precipitating & Aggravating factors)

Precipitating Factors:

1. Seasonal Changes: Colds are more common in fall and winter, partly because people
spend more time indoors in close quarters, which facilitates virus transmission.

2. Exposure to Infected Individuals: Being in close contact with someone who has a cold
increases the risk of infection.
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3. Weakened Immune System: Stress, fatigue, or underlying health conditions can weaken
the immune system, making one more susceptible to infections.

4. Temperature Extremes: Sudden changes in temperature or exposure to cold weather can

stress the body and may contribute to susceptibility, though this is more indirect.

5. Travel: Being in crowded places, such as airplanes or public transport, increases the
likelihood of exposure to cold viruses.

Aggravating Factors:

1. Dry Air: During colder months or in air-conditioned environments, dry air can irritate
the respiratory tract and exacerbate symptoms.

2. Smoking and Exposure to Smoke: Smoking or being around secondhand smoke can
irritate the respiratory tract and make cold symptoms worse.

3. Allergies: Allergic reactions can exacerbate cold symptoms by causing additional

nasal congestion or irritation.

4. Poor Nutrition and Lack of Sleep: A lack of proper nutrition and insufficient rest can
impair immune function, making it harder for the body to fight off infections.

5. Pre-existing Respiratory Conditions: Conditions like asthma or chronic bronchitis

can be aggravated by a cold, making symptoms more severe or prolonged.

Pathophysiology
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Diagnostics (x-ray, laboratory values, etc.)

1. Clinical Evaluation:
History and Symptoms: A detailed patient history is taken to understand the onset, duration,
and nature of symptoms. Typical symptoms include:
• Runny or stuffy nose
• Sneezing
• Sore throat
• Cough
• Mild headache
• Low-grade fever (more common in children)
Physical Examination: The physician examines the patient for:
• Nasal congestion and discharge (color and consistency)
• Throat redness or swelling
• Lungs for any abnormal sounds (wheezing or crackles, which could indicate other
conditions)
• Presence of swollen lymph nodes

2. Diagnostic Tests:

While the diagnosis of the common cold is usually clinical and does not require specific tests,
some tests may be performed to rule out other conditions or to confirm the presence of a viral
infection if needed:

Viral Testing:

• Polymerase Chain Reaction (PCR) Tests: Detect specific viral RNA or DNA. PCR tests
can identify rhinoviruses and other respiratory viruses but are generally used in research
settings or for severe cases.
• Rapid Antigen Tests: Available for certain respiratory viruses like influenza and RSV.
These tests can be used in clinical settings to differentiate between viral infections but
are less commonly used for the common cold.

Nasal Swabs or Aspirates: In some cases, especially if the diagnosis is uncertain or if there are
complications, a sample of nasal secretions may be collected and analyzed for the presence of
viruses.

3. Differential Diagnosis:
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To accurately diagnose a common cold and differentiate it from other conditions, healthcare
providers may consider:

• Flu (Influenza): Symptoms are usually more severe, with higher fever, body aches, and
pronounced fatigue.
• COVID-19: Requires differentiation due to overlapping symptoms but may include fever,
loss of taste or smell, and more severe respiratory symptoms. Testing for SARS-CoV-2
(the virus causing COVID-19) may be necessary.
• Sinusitis: Often presents with facial pain or pressure, prolonged nasal symptoms, and
possibly a more purulent nasal discharge.
• Strep Throat: Characterized by severe sore throat, high fever, and absence of cough. A
throat swab or rapid strep test may be used for diagnosis.
• Allergic Rhinitis: Can present with similar symptoms like a runny nose and sneezing but
usually lacks systemic symptoms like fever.

Medical Management (Surgical and Non surgical)

The medical management of the common cold is primarily focused on alleviating

symptoms, as there is no cure for the condition. Treatment is generally supportive and
non-surgical. Here’s a breakdown of the non-surgical management and the rare scenarios where
surgical intervention might be considered for complications:

Non-Surgical Management:

● Rest - Getting enough rest and sleep can help you recover faster.
● Hydration - Drinking plenty of fluids, such as water, juice, broth, or warm lemon water,
can help you feel better.
● Herbal medicines - echinacea, zinc nasal spray
● Antiviral medications : amantadine, rimatadine - reduce the severity of the symptoms
and reduce the duration of the common cold
● Guaifenesin - expectorant, promote removal of secretions
● Antihistamines - to relieve sneezing, rhinorrhea and nasal congestion.
● Steam - Inhaling steam from a bowl of hot water or shower can help. You can also try a
traditional steam inhalation by sitting over a pan of boiling water with a towel over your
head.
● Saline - Using saline nasal spray or drops can help. You can also gargle with warm salt
water.
● Throat soothers - Honey, throat lozenges, or cough drops can help soothe a sore throat.
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● Pain relievers - Paracetamol or ibuprofen can help reduce a fever and ease aches and
pains. However, you should follow the instructions carefully and not take more than the
recommended dose.
● Temperature and humidity - Keep your room warm but not too hot, and use a
humidifier or cool mist vaporizer to maintain comfortable humidity levels.
● Environment - Disinfect your environment with phenol-alcohol-based compounds and
wash your hands.

You should be careful when giving cold and cough medicines to children and teens, as
some medicines contain ingredients that are not recommended for them. You should also avoid
cough and cold medications that contain opioids, such as codeine or hydrocodone, in children
aged 18 years or younger.

Surgical Management:

Surgical intervention is not typically required for the common cold itself but may be considered
if complications arise:

Complications Requiring Surgical Intervention:

● Chronic Sinusitis: If a common cold progresses to chronic sinusitis and does not
respond to medical management, surgery may be considered to improve sinus
drainage and address structural issues.
● Recurrent Ear Infections: In cases where the common cold leads to recurrent or
chronic otitis media (ear infections), surgical options like tympanostomy (ear tube
insertion) might be considered.
● Tonsillectomy or Adenoidectomy: For individuals with recurrent upper
respiratory infections or complications like obstructive sleep apnea related to
enlarged tonsils or adenoids, surgical removal may be an option.

Management of Severe Complications:

● Abscess Formation: In rare cases, complications such as peritonsillar abscess or

deep neck infections may require surgical drainage and antibiotic treatment.

Nursing Management (Independent, dependent, and educative)

Nursing management for the common cold encompasses independent actions, dependent
actions (those requiring a healthcare provider's order), and educative measures to support patient
care and recovery. Here’s a detailed breakdown:
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Independent Nursing Management:

Assessment:

● Symptom Monitoring: Regularly assess and document the patient’s symptoms,

including the severity of nasal congestion, cough, sore throat, and any other
associated symptoms.
● Vital Signs: Monitor temperature, especially if the patient has a fever. Keep track
of respiratory rate and oxygen saturation if there are any concerns about
respiratory distress.
● Hydration Status: Assess for signs of dehydration (e.g., dry mucous membranes,
decreased urine output) and ensure the patient is drinking adequate fluids.

Comfort Measures:

● Symptom Relief: Administer over-the-counter medications (with proper

authorization) like saline nasal sprays or lozenges to alleviate symptoms.
● Comfort Measures: Encourage the use of humidifiers or steam inhalation to
relieve nasal congestion and sore throat.
● Rest and Positioning: Advise the patient to rest and use proper positioning (e.g.,
elevating the head of the bed) to ease nasal congestion.

Hygiene and Infection Control:

● Hand Hygiene: Reinforce the importance of frequent hand washing to prevent

the spread of infection.
● Isolation Precautions: If in a healthcare setting, implement standard precautions
to minimize transmission to other patients.

Dependent Nursing Management:

Medication Administration:

● Prescription Medications: Administer any prescribed medications according to

the healthcare provider's orders, including antibiotics if a bacterial complication is
suspected (though antibiotics are not used for viral colds).
● Medication Monitoring: Monitor for side effects or adverse reactions to
prescribed medications and report any concerns to the healthcare provider.

Laboratory and Diagnostic Tests:

● Testing: Coordinate with the healthcare provider for any diagnostic tests that may
be ordered, such as viral testing or imaging if complications are suspected.
● Specimen Collection: Assist with or perform specimen collection for diagnostic
tests as directed.
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● Specialist Referrals: Facilitate referrals to specialists (e.g., otolaryngologists) if
there are complications requiring further evaluation or treatment.

Educative Nursing Management:

Patient Education:

● Symptom Management: Educate the patient and their family about managing
cold symptoms with over-the-counter medications and home remedies. Explain
proper usage and dosage.
● Hydration and Nutrition: Advise on the importance of staying hydrated and
maintaining a balanced diet to support recovery.
● Rest: Emphasize the importance of rest in the recovery process and advise on
strategies to ensure adequate sleep.

Preventive Measures:

● Hand Hygiene: Educate about the importance of regular hand washing and
avoiding touching the face to prevent the spread of the virus.
● Avoiding Spread: Teach the patient to use tissues when sneezing or coughing and
to dispose of tissues properly. Encourage them to cover their mouth and nose and
to avoid close contact with others.

When to Seek Medical Attention:

● Warning Signs: Instruct the patient to seek medical care if they experience
worsening symptoms, high fever, difficulty breathing, or if symptoms persist
beyond the typical duration.
● Complications: Educate about potential complications of a cold, such as sinusitis
or ear infections, and when to seek help if symptoms suggest these conditions.

II. PHARYNGITIS
Definition and Other Names

- Pharyngitis, the medical term for sore throat, refers to the inflammation of the mucous
membranes lining the oropharynx. This inflammation can manifest as a scratchy, burning,
or painful sensation in the throat, often making swallowing or talking uncomfortable.

Types of Pharyngitis

1. Acute pharyngitis: This term signifies a sore throat lasting for a short duration,
typically 3 to 10 days.
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2. Chronic pharyngitis: This refers to a sore throat persisting for more than 10
days, often recurring after initial improvement.

Etiology/Causes/Predisposing & Precipitating Factors

Etiology/Causes:

1. Viral Infections: The most common cause, including viruses like rhinovirus,
adenovirus, and influenza.
2. Bacterial Infections: Streptococcus pyogenes (Group A strep) is a major
bacterial cause.

Predisposing Factors:

1. Weakened Immune System: Individuals with compromised immunity are more

susceptible.
2. Allergies: Allergic reactions can lead to inflammation.
3. Exposure to Irritants: Smoking or exposure to pollutants.

Precipitating Factors:

1. Seasonal Changes: Cold weather can increase susceptibility.

2. Close Contact: Being in crowded places can facilitate the spread of infections.

Signs and Symptoms

● Scratchy, burning, or painful sensation in the throat, often making swallowing or

talking uncomfortable.
● Swollen and painful lymph nodes in the neck, often a sign of infection.
● White or yellow patches on the tonsils, a common sign of bacterial pharyngitis,
particularly strep throat.
● Redness and swelling of the throat, a common finding in pharyngitis.
● Ear pain: Pain radiating from the throat to the ear, often associated with
pharyngitis.
● Fever: A common symptom of pharyngitis, especially when caused by bacterial
infections.
● Headache: A frequent symptom associated with pharyngitis, particularly when
caused by viral infections.

Complications
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● Strep throat: A bacterial infection caused by Group A Streptococcus, strep throat can
lead to complications like rheumatic fever if left untreated. Rheumatic fever is a serious
condition that can damage the heart, joints, and brain.
● Tonsillitis: Inflammation of the tonsils can occur due to viral or bacterial infections. If
tonsillitis becomes chronic or recurrent, it might require surgical removal of the tonsils.
● Peritonsillar abscess: A pus-filled pocket that forms near the tonsils. This can cause
severe pain and difficulty swallowing, requiring surgical drainage.
● Sepsis: In rare cases, untreated pharyngitis can lead to sepsis, a life-threatening condition
where bacteria enter the bloodstream.
● Post-streptococcal glomerulonephritis: A kidney inflammation that can occur after a
strep throat infection.

Prevention

● Wash your hands frequently: Use soap and water for at least 20 seconds, especially
after using the restroom, before eating, and after blowing your nose.
● Avoid touching your face: Germs can easily spread from your hands to your eyes, nose,
and mouth.
● Cover your mouth and nose when coughing or sneezing: Use a tissue or cough into
your elbow to prevent spreading germs.
● Stay away from sick people: Limit contact with individuals who are exhibiting
symptoms of a cold or flu.
● Get vaccinated: Stay up-to-date on vaccinations for the flu and other respiratory
illnesses.
● Avoid sharing food and drinks: This can help prevent the spread of germs.
● Clean shared surfaces: Regularly disinfect phones, keyboards, remote controls, and
other frequently touched objects.
● Avoid smoking and secondhand smoke: Smoking weakens the immune system and
increases the risk of infections.

Pathophysiology
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Diagnostics: Laboratory Tests

Clinical Assessment:

● History: A detailed medical history, including symptoms, duration, and potential

exposure to infectious agents, helps guide the diagnosis.
● Physical Examination: A thorough physical examination, including inspection of
the throat, tonsils, and lymph nodes, can reveal signs of pharyngitis.
● Centor Score: This clinical prediction rule, which is especially relevant for
adults, assesses the risk of GABHS infection based on four criteria: tonsillar
exudates, tender anterior cervical lymphadenopathy, a history of fever, and the
lack of a cough.

Laboratory Tests:

● Rapid antigen detection tests (RADT): A positive RADT usually indicates

GABHS infection and warrants treatment.
● Throat cultures: To diagnose GABHS, throat cultures involve swabbing the
pharynx and growing the sample on blood agar. However, their sensitivity can
vary depending on factors like bacterial burden and culture technique.
● Viral Culture: To identify specific viruses, such as rhinovirus, influenza, or
adenovirus, that may be causing pharyngitis. Viral cultures are often less
frequently ordered than bacterial cultures, as treatment for viral pharyngitis is
typically supportive.
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● Computed tomography (CT) scan: May be helpful in identifying a peritonsillar
abscess.

Medical Management

Viral Pharyngitis:

● Symptomatic relief: Over-the-counter (OTC) medications like acetaminophen

(Tylenol) or ibuprofen (Advil) can help manage fever and pain.
● Hydration: Drinking plenty of fluids helps soothe the throat and prevent
dehydration.
● Rest: Allowing the body to rest can aid in recovery.
● Humidifier: Using a humidifier can add moisture to the air, which can help
soothe a dry throat.
● Saltwater gargles: Gargling with warm salt water can help reduce inflammation
and irritation.

Bacterial Pharyngitis (Strep Throat):

● Antibiotics: Antibiotics are necessary for treating strep throat, caused by group
A beta-hemolytic streptococci (GABHS). They minimize the length of symptoms,
prevent complications including rheumatic fever, and reduce the chance of
spreading the infection.
● Penicillin V: The preferred antibiotic, given orally for 10 days.
● Amoxicillin: An acceptable alternative, also given orally for 10 days.
● Symptomatic relief: OTC medications like acetaminophen or ibuprofen can help
manage fever and pain.
● Hydration: Drinking plenty of fluids helps soothe the throat and prevent
dehydration.
● Rest: Allowing the body to rest can aid in recovery.

Surgical Management

● Peritonsillar abscess: Drainage of the abscess is required.

● Tonsillectomy: This procedure is considered for recurrent tonsillitis or other
complications related to the tonsils.

Nursing Management (Independent, Dependent, Collaborative, Educative)

Independent Nursing Interventions:

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● Assessment: Thorough assessment of the patient's symptoms, including pain
level, fever, and difficulty swallowing.
● Monitoring vital signs: Regular monitoring of vital signs, including
temperature, pulse, and blood pressure, to detect any potential complications.
● Comfort measures: Providing comfort measures like cool compresses, gargling
with salt water, and sucking on lozenges can help alleviate pain and discomfort.
● Hydration: Encouraging fluid intake to prevent dehydration, especially in
patients with fever.
● Rest: Promoting rest and sleep can aid in recovery and reduce the risk of
complications.

Dependent Nursing Interventions:

● Administering medications: Nurses administer prescribed medications,

including antibiotics, pain relievers, and antihistamines.

Collaborative Nursing Interventions:

● Communicating with the physician: Collaborate with physicians to ensure

appropriate diagnosis, treatment, and follow-up care.
● Consulting with other healthcare professionals: Consult with other healthcare
professionals, such as speech therapists or dieticians, to address specific needs of
patients with pharyngitis.

Educative Nursing Interventions:

● Teaching about infection control: Educate patients about measures to prevent

the spread of infection, such as hand hygiene and covering coughs and sneezes.
● Explaining medication regimens: Provide clear instructions about medication
dosages, timing, and potential side effects.
● Promoting healthy lifestyle choices: Encourage patients to adopt healthy habits,
such as regular exercise, a balanced diet, and adequate sleep, to enhance their
overall health and reduce the risk of future infections.

Home Care Guidelines

● Hydration: Drinking plenty of fluids helps soothe the throat and prevent
dehydration.
● Rest: Allowing the body to rest can aid in recovery.
● Humidifier: Using a humidifier can add moisture to the air, which can help
soothe a dry throat.
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● Saltwater gargles: Gargling with warm salt water can help reduce inflammation
and irritation.

III. LARYNGITIS

Definition
● Laryngitis is the inflammation of the vocal cords which can alter the way the vocal cords
come together and vibrate, causing voice changes. It can be accompanied by constant
throat pain or pain with talking or swallowing.

Classification
● Simple Laryngitis - usually associated with the common cold or similar infections. The
mucous membrane lining the larynx is the site of prime infection; it becomes swollen and
filled with blood, secretes a thick mucous substance, and contains many inflammatory
cells.
● Chronic Laryngitis - produced by excessive smoking, alcoholism, or overuse of the
vocal cords. The mucous membrane becomes dry and covered with polyps, small lumps
of tissue that project from the surface. The wall of the larynx may thicken and become
inflamed.
● Diphtheritic laryngitis - caused by the spread of diphtheria from the region of the upper
throat down to the larynx. It may cause a membrane of white blood cells, fibrin (blood
clotting protein), and diseased skin cells to attach to and infiltrate the surface mucous
membrane. When looser portions of this false membrane become dislodged from part of
the larynx, they may consolidate at the vocal cords and cause an obstruction there.
● Tuberculosis laryngitis - a secondary infection spread from the initial site in the lungs.
Tubercular nodule-like growths are formed in the larynx tissue. The bacteria die after
infecting the tissue, leaving ulcers on the surface. There may be eventual destruction of
the epiglottis and laryngeal cartilage.
● Syphilitic laryngitis - one of the many complications of syphilis. In the second stage of
syphilis, sores or mucous patches can form; as the disease advances to the third stage,
there is tissue destruction followed by healing and scar formation. The scars can distort
the larynx, shorten the vocal cords, and produce a permanent hoarseness of the voice.

Types of Laryngitis
1. Acute Laryngitis - the most common cause of it is viral infection, such as an upper
respiratory infection. It goes away once the condition that’s causing it improves.

Conditions that can cause laryngitis include:

● Colds
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● Flu
● Bronchitis

2. Chronic Laryngitis - when laryngitis lasts longer than 3 weeks, it's considered chronic.
Most often, it happens due to exposure to something that irritates the larynx for a longer
period.

Pathophysiology

Etiology
1. Viral infection. Most common cause is rhinovirus, others by parainfluenza virus,
respiratory syncytial virus, and adenovirus.
2. Bacterial infection. Such as diphtheria but this is rare.

Predisposing Factors
● Allergies
● Irritants such as gastroesophageal reflux
● Sinus disease
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● Autoimmune disorders such as granulomatosis with polyangiitis(Wegener’s disease) or
pemphigoid/pemphigus
● Chronic dry cough

Precipitating factors
● Smoking or vaping
● Overuse or misuse of the voice, such as singing or cheering
● Drinking too much alcohol
● Poor vocal hygiene
● Throat irritation caused by inhaled medications, such as asthma inhalers
● Sore or dry throat and frequent throat clearing
● An injury, such as a hit to the throat
● Inhalation of chemical fumes

Complications
Difficulty of breathing is an uncommon complication of laryngitis. It only occurs if there
is a lot of inflammation and swelling in the voice box(larynx), which causes the windpipe
(trachea) to narrow. This is rare in adults but sometimes happens in young children with smaller,
narrower windpipes.

Prevention
● Don’t smoke or vape. Also, stay away from secondhand smoke.
● Don’t clear your throat. Ahem, doing so creates abnormal vibrations that trigger
irritation and swelling of the vocal cords.
● Wash hands often and properly. Especially if you’ve been around someone who is sick.
● Avoid overusing alcohol.
● Stay up to date with flu shots and any other vaccines your doctor recommends.
● Avoid close contact with people who have colds, flu, or other respiratory infections.
● Use pillows or elevate the bed and raise your head while you sleep. This helps protect
against acid reflux.
● Avoid cheering or singing at high volumes for long periods.

Signs and Symptoms

Symptoms of laryngitis can begin suddenly and usually get worse over a period of 2 to 3
days.

Common symptoms (Pathognomonic signs) of laryngitis include;

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● A sore throat or raw throat
● A tickling feeling in your throat
● A low-grade fever
● Hoarseness
● Trouble speaking or loss of voice
● A dry cough
● A constant urge to clear your throat
● Swollen glands

It is also often linked to another illness. For example, a cold, flu, throat infection or
tonsillitis. Below are the following symptoms;
● Headache
● Swollen glands
● Runny nose
● Pain when swallowing
● Feeling tired and ache

Diagnosis/Laboratory Tests
● History collection, physical examination
● X-ray of neck or chest
● Throat culture. To confirm what type of infection causes laryngitis.
● CBC (complete blood count)
● Laryngoscopy. It can be through indirect or direct flexible laryngoscopy. This is
recommended for symptoms persisting > 3 weeks.
● Biopsy. It is a procedure to take a sample of tissue for examination under a microscope.

Medical Management
Acute laryngitis often gets better on its own within a week or so. Self-care measures,
such as voice rest, drinking fluids and steam inhalations, also can help improve symptoms.

Chronic laryngitis treatments are aimed at treating the underlying causes, such as
heartburn, smoking or excessive use of alcohol.

Medications used in some cases include:

● Antibiotics. In almost all cases of laryngitis, an antibiotic won't do any good because the
cause is usually viral. But if it's a bacterial infection, the doctor may recommend an
antibiotic.
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● Corticosteroids. Sometimes, corticosteroids can help reduce vocal cord inflammation.
However, this treatment is used only when there's an urgent need to treat laryngitis —
such as in some cases when a toddler has laryngitis associated with croup.
● Cough suppressants
● Analgesic. Such as Acetaminophen and ibuprofen.
● H2 blocker. It’s only used in case of gastroesophageal reflux.

Surgical Management
● Micro - laryngoscope dissection - It is a procedure that is used to view the vocal folds
with a microscope. If there are any growths or vocal cord lesions, the doctor may remove
them with small instruments or a laser.
● Laser - assisted dissection. The use of lasers in surgery has offered a time- and
cost-efficient alternative to cold surgical techniques, and has been employed in the
treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory
papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid
degeneration (Reinke’s edema).

Nursing Management (Independent, Dependent, Collaborative, Educative)

Independent Nursing Interventions

● Assessment. Do a thorough history taking and perform a comprehensive head and
neck examination, focusing on the throat, tonsils, and larynx.
● Monitoring vital signs. It includes temperature, heart rate, respiratory rate, and
blood pressure, to identify any signs of infection or distress.
● Instruct the patient to let their voice rest. Explain the importance of reducing
vocal strain to promote healing.
● Hydration. Encourage increased fluid intake to keep the throat moist and to help
thin mucus secretions. Offer warm, non-caffeinated, and soothing beverages such
as herbal teas and honey-lemon water.
● Humidification. Provide a humidifier or instruct the patient to use a steam
inhalation method to keep the air moist and alleviate throat dryness.
● Comfort measures. Provide patients with comfort measures like warm
compresses, throat gargles, and throat lozenges to relieve discomfort and reduce
inflammation.
● Encourage Rest. Advise the patient to get adequate rest and sleep to promote
healing and conserve energy for recovery.
● Monitor for complications. Continuously assess the patient’s airway for signs of
respiratory distress, especially if there is severe laryngeal edema. Promptly report
any concerning symptoms to the healthcare provider.
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● Provide Emotional Support. Offer emotional support to address the patient’s
frustration or anxiety related to voice changes and communication difficulties.
Encourage open communication and active listening.

Dependent Nursing Interventions

● Pain management. Administer over-the-counter pain relievers or prescribed
medications as directed by the healthcare provider to alleviate throat pain and
discomfort.

Collaborative Nursing Interventions

● Consult with other healthcare professionals: Such as speech therapists or
dieticians, to address specific needs of patients with laryngitis.

Educative Nursing Interventions

● Educate the patient about laryngitis, its causes, and strategies for symptom
management. Emphasize the importance of completing any prescribed
medications and following up with their healthcare provider.
● Educate the patient about avoiding irritants; such as smoking, alcohol,
caffeine, and environmental pollutants, which can worsen laryngitis.
● Emphasize proper hand hygiene and respiratory etiquette; to prevent the
spread of infections, especially if laryngitis is caused by a viral infection.

Home Care Guidelines

Acute cases of laryngitis generally go away on their own after a week or two. Here are some
self-care tips;

● Drink lots of fluids to stay hydrated.

● Rest your voice by speaking as little and as quietly as possible.
● Avoid whispering because it may put more strain on your voice than speaking.
● Avoid irritants like caffeine or tobacco smoke.
● Avoid decongestant medications because they can dry out or lead to irritation in your
throat.
● Consider using a personal humidifier to make inhaling and swallowing easier.
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● Suck on throat lozenges or gargle warm salt water to soothe a sore and irritated throat.

IV. SINUSITIS
Definition: An inflammation of the paranasal sinuses and nasal cavity. Rhinosinusitis is
recommended as a term, since sinusitis is almost always accompanied by inflammation of the
nasal mucosa.

Etiology:
Acute Rhinosinusitis & Acute Viral Rhinosinusitis:
Nasal congestion, caused by inflammation, edema, and fluid transfer from URI, can block
sinus cavities. Other conditions and activities can also impede normal sinus secretion, including
abnormal nose structures, enlarged adenoid, diving, and foreign object pressure.

Pathogens: may include Streptococcus pneumoniae, Haemophilus influenzae, and less

commonly Staphylococcus aureus, and Moraxella catarrhalis. They serve as bacterial reservoirs
that can cause systemic illness when released into the circulation.

Chronic Rhinosinusitis & Recurrent Acute Sinusitis:

Mechanical obstruction in the ostia of the frontal, maxillary, and anterior ethmoid sinuses
is the usual cause. Since it prevents the adequate drainage of nasal passages, resulting in
accumulation of secretions and an ideal medium for bacterial growth.

Recurrent acute sinusitis (CRS) can be caused by allergies, obstructions, structural

anomalies, ciliary dyskinesia, neoplastic disorders, tobacco use, environmental pollution, and
anaerobic or aerobic bacteria.

Patients with chronic recurrent sinusitis (CRS) should be evaluated for

immunodeficiency, as it can lead to chronic invasive fungal sinusitis, fungus ball/mycetoma, and
allergic fungal sinusitis.

Types of Sinusitis:
1. Acute Rhinosinusitis & Acute Viral Rhinosinusitis
- Is classified as acute bacterial rhinosinusitis (ABRS) or acute viral rhinosinusitis (AVRS)
- Usually caused by viral URI or cold, such as unresolved viral/bacterial infection, or an
exacerbation of allergic rhinitis.

Clinical Manifestations:
ABRS: Purulent nasal damage accompanied by nasal obstruction/combination of facial pain,
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may also include cloudy/colored nasal discharge congestion, blockage, stuffiness, or localized
headache. May present high fever 39℃ or higher.
AVRS: Similar to ABRS however does not present high fever, also tends to have an absence of
facial pain, pressure, or fullness. Symptoms occur for fewer than 10 days.

Assessment:
- History and physical examination should be performed.
- Head, neck, nose, ears, teeth, sinuses, pharynx, and chest are examined.
- Tenderness may occur upon palpation over the infected sinus area.
Diagnostics:
- To confirm the diagnosis of maxillary and frontal rhinosinusitis and identify the
pathogen, sinus aspirates may be obtained. A flexible endoscopic culture technique and
swabbing of the sinuses can be used.

Medical Management:
ABRS:
- 14-day course of antibiotics should be prescribed, common antibiotics prescribed are
amoxicillin or amoxicillin-clavulanic acid.
- If a patient is allergic to penicillin, doxycycline or quinolones, alternatives such as
levofloxacin/moxifloxacin can be prescribed.
- Intranasal saline lavage can help with the relief of symptoms, reduce inflammation, and
clear passages of stagnant mucus.
- Decongestant or antihistamine are also recommended for treating ABRS.
AVRS:
- Nasal saline lavage and decongestant (guaifenesin/pseudoephedrine). This helps increase
patency of the ostiomeatal unit and improve drainage of the sinuses.
- Topical decongestants should not be used for longer than 3-4 days.
- Oral decongestants must be used cautiously in patients with hypertension.
- If an allergic component is suspected, OTC antihistamines diphenhydramine and
cetirizine, prescribed antihistamines such as fexofenadine are recommended.

Nursing Management:
- Start decongestants (e.g., pseudoephedrine) at the first sign of rhinosinusitis to promote
drainage and reduce the risk of bacterial infection.
- Use humidification at home to improve sinus drainage.
- Apply warm compresses to relieve pressure.
- Avoid swimming, diving, and air travel during acute infection.
- Patients should stop smoking or using any form of tobacco immediately.
- Educate on the correct use of nasal sprays through demonstration and return demonstration.
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- Be aware of side effects like nasal irritation, burning, bad taste, throat drainage, and epistaxis.
- Consult with a primary provider or pharmacist before using OTC medications, especially for
patients with hypertension, as some cold medications can worsen symptoms.
- Follow the recommended antibiotic regimen closely to maintain a consistent blood level for
effective infection treatment.
- Recognize early signs of a sinus infection and practice preventive measures like healthy habits
and avoiding contact with individuals with URIs.
- Be aware that fever, severe headache, and nuchal rigidity are potential signs of meningitis.

2. Chronic Rhinosinusitis & Recurrent Acute Sinusitis

- An infection or swelling in the sinuses that occurs more than 12 weeks or more.
- Chronic Rhinosinusitis (CRS) is accompanied by nasal polyps.
- Recurrent Acute Sinusitis is characterized by four or more acute episodes of ABRS per
year with no signs or symptoms of rhinosinusitis between the episodes.

Clinical Manifestations:
- Impaired Mucociliary Clearance & Ventilation
- Cough
- Fatigue
- Chronic Hoarseness
- Chronic Headaches in the periorbital area & periorbital edema
- Nasal Discharge
- Facial Pain-Pressure-Fullness
- Hyposmia (decreased sense of smell)
- Fungal Sinusitis: nasal stuffiness, nasal discharge, facial pain, vision loss, headache, and
cranial nerve palsies (especially with sphenoid sinus fungal ball)

Assessment:
- Focus on onset, duration, quantity, and quality of nasal discharge and cough.
- Assess presence, relief, and aggravation of pain.
- Evaluate allergies and history of comorbid conditions (e.g., asthma, tobacco use, and use
of ENDS).
- Obtain history of fever, fatigue, previous episodes, treatments, and response to therapies.
Physical Assessment
- Examine the external nose for anatomic abnormalities (e.g., crooked nose suggesting
septal deviation).
- Assess nasal mucous membranes for erythema, pallor, atrophy, edema, crusting,
discharge, polyps, erosions, and septal perforations or deviations.
- Use appropriate lighting for better visualization of the nasal cavity.
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- Check for tooth infection by tapping teeth with a tongue blade.
Oropharynx & Eye Examination
- Inspect posterior oropharynx for purulent or mucoid discharge indicating CRS infection.
- Examine eyes for conjunctival erythema, tearing, photophobia, and lid edema.
Sinus Examination
- Palpate frontal and maxillary sinuses and inquire about tenderness.
- Inspect pharynx for erythema and discharge, and palpate for cervical node adenopathy.

Diagnostics:
- Use x-ray for initial assessment of paranasal sinus disorders.
- CT scan can detect mucosal abnormalities, sinus ostial obstruction, anatomic variants,
polyposis, and neoplastic disease.
- Nasal endoscopy allows visualization of posterior nasal cavity, nasopharynx, and sinus
drainage pathways, identifying septal deviation and polyps.
- MRI and other imaging techniques may be used to detect osseous destruction, extra sinus
disease extension, and malignancy.

Medical Management:
CRS:
- Encourage adequate hydration.
- Recommend OTC nasal saline sprays.
- Use antispasmodic agents like acetaminophen or NSAIDs.
- Use decongestants such as oxymetazoline and pseudoephedrine.
- Advise sleeping with the head of the bed elevated.
- Avoid exposure to cigarette smoke, fumes, caffeine, and alcohol.
- Prescribed antibiotics may include amoxicillin–clavulanic acid,
erythromycin–sulfisoxazole, second- or third-generation cephalosporins (e.g.,
cefuroxime, cefixime), or newer fluoroquinolones (e.g., moxifloxacin).
- Treatment duration is typically 2 to 4 weeks, but may extend up to 12 months in some
cases.
- Corticosteroid nasal sprays (e.g., fluticasone, beclomethasone) for patients with allergic
rhinitis or nasal polyps.
- Mast cell stabilizers (e.g., cromolyn) for allergic rhinitis.
- Leukotriene inhibitors (e.g., montelukast, zafirlukast) for patients with concomitant
asthma.

Acute Recurrent Sinusitis:

- Encourage hydration and recommend OTC nasal saline sprays.
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- Use antispasmodic agents (acetaminophen, NSAIDs) and decongestants (oxymetazoline,
pseudoephedrine).
- Elevate the head during sleep and avoid smoke, fumes, caffeine, and alcohol.
- Similar antibiotics as CRS (amoxicillin–clavulanic acid, erythromycin–sulfisoxazole,
cephalosporins, fluoroquinolones).
- Typically requires a shorter course of antibiotics (2 to 4 weeks) compared to CRS.
- Corticosteroid nasal sprays may be used if allergic rhinitis or nasal polyps are present.
- Mast cell stabilizers and leukotriene inhibitors can be added based on specific patient
needs.

Nursing Management:
- Instruct patients to blow their nose gently to avoid worsening symptoms, using tissues to
remove nasal drainage.
- Increase fluid intake.
- Apply local heat (e.g., hot wet packs).
- Elevate the head of the bed.
- Emphasize the importance of following the prescribed medication regimen.
- Provide education on early signs of a sinus infection and review preventive measures.
- Instruct on signs and symptoms that require follow-up.
- Provide instructions verbally and in writing.
- Use alternative formats (e.g., large font, patient’s language) if needed.
- Encourage patients to follow up with their primary provider if symptoms persist.

V. EPIGLOTTITIS
Definition: Epiglottitis refers to inflammation of your epiglottis — a flap of tissue at the base of
your tongue that prevents food from going down your windpipe. The most common cause is a
bacterial infection.

Classification/Types
1. Infectious epiglottitis
Infectious epiglottitis is a soft tissue swelling of epiglottis, and the surrounding structures
example; plica aryepiglottica, arytenoids, sinus piriformis and vestibular folds usually
caused by bacteria and occasionally viruses.
2. Noninfectious epiglottitis
This includes all other factors resulting in the development of epiglottitis aside
pathogenic organism. These include trauma from foreign objects inhalation and chemical
burns
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Pathophysiology

Etiology
● Bacterial epiglottitis
Prior to the introduction of Haemophilus influenza type b vaccine, H. influenza was the
most common culprit of epiglottitis. In recent literature, group A [beta]-hemolytic
Streptococci is more commonly observed to be the cause. The disease used to be mostly
found in the pediatric age group of 3 to 5 years. However, recent trends favor adults as
most commonly affected individuals. Other pathogens such as escherichia coli, kingella
kingae may be encountered in immunocompromised hosts. Other common bacterial
causes of epiglottitis include: Staphylococcus aureus and Streptococcus pneumoniae.
● Viral epiglottitis
This mostly happens in immunocompromised people commonly resulting in necrotizing
epiglottitis usually involving infection with CMV or EBV. Affected patients are usually
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neutropenic and lymphopenic at presentation. CMV and EBV modulate the host's
immune defense facilitating immune evasion and thereby predisposing the patient to
superimposed infections. The causative organism of necrotizing epiglottitis is unclear.
● Fungal epiglottitis
Fungi are a rare cause of epiglottitis. Notable among them are aspergillus spp and candida
albicans.

Risk Factors
Some factors increase the risk of getting epiglottitis, including:
● Having a weakened immune system- An immune system weakened by illness or
medicines can be more likely to get bacterial infections that may cause epiglottitis.
● Not being fully vaccinated- Skipping vaccinations or not getting them on time can leave a
child open to Haemophilus influenzae type b (Hib) and increase the risk of epiglottitis.

Complications
Epiglottitis can cause many complications, including:
● Breathing failure- The epiglottis is a small, movable "lid" just above the larynx that
prevents food and drink from entering the windpipe. Swelling of the epiglottis can
completely block the airway.
● This can lead to breathing or respiratory failure- In this life-threatening condition, the
level of oxygen in the blood drops very low.
● Spreading infection- Sometimes the bacteria that cause epiglottitis cause infections in
other parts of the body. Infections can include pneumonia, meningitis or a bloodstream
infection.

Prevention
● Hib vaccine
Getting the Haemophilus influenzae type b (Hib) vaccine prevents epiglottitis caused by
Hib. In the United States, children usually receive the vaccine in three or four doses:
1. At 2 months.
2. At 4 months.
3. At 6 months if the child is getting the four-dose vaccine.
4. At 12 to 15 months.
Because children older than 5 and adults are less likely to develop Hib infection, they're
not usually given the vaccine. But the Centers for Disease Control and Prevention
recommends the vaccine for older children and adults whose immune systems are weak
because of:
a. Sickle cell disease.
b. HIV/AIDS.
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c. Spleen removal.
d. Chemotherapy.
e. Medicine to prevent rejection of organ or bone marrow transplants.

Predisposing Factors
The most common predisposing factor of epiglottitis in children was the infection with
Haemophilus influenzae type b (Hib) bacteria while for adults it includes diabetes mellitus,
ethanol abuse, hyposplenia, autoimmune diseases, immunosuppression, and other causes of
impaired defenses of mucosa or against encapsulated organisms.

Signs and Symptoms

Epiglottitis symptoms usually appear suddenly and get worse quickly. Sometimes, in older
children and adults, it may take a few days for symptoms to fully develop. The most common
epiglottitis symptoms include:
● Severe sore throat
● Difficulty and pain when swallowing (a main symptom in older children and adults)
● Difficulty breathing (a main symptom in children)
● Abnormal or high-pitched breathing noises (a main symptom in children)
● Hoarseness or muffled voice
● Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
● Irritability and restlessness
● Drooling (a main symptom in older children and adults)

Healthcare providers also sometimes refer to the most common epiglottitis symptoms as “the
four Ds”:
1. Dysphagia: Difficulty swallowing.
2. Dysphonia: Hoarseness or an abnormal voice.
3. Drooling: When saliva flows out of your mouth involuntarily.
4. Distress: Difficulty breathing or lack of oxygen.

One of the signs of epiglottitis include being in a “Tripod position”, which is the sitting up on
hands, with the tongue out and the head forward.
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Diagnostics
How is epiglottitis diagnosed?
Your healthcare provider will perform a physical examination and ask about your symptoms.
They may also request certain tests that can help diagnose epiglottitis.
These tests may include:
● Laryngoscopy: During this test, your healthcare provider uses a small camera at the end
of a flexible tube to examine your throat.
● Culture tests: Your provider takes a swab of your throat to test for bacteria or viruses.
● Blood tests: Your provider may perform a variety of blood tests to count your white blood
cells or see if there are any bacteria or viruses in your blood.
● Imaging tests: An X-ray or CT (computed tomography) scan can help determine the level
of swelling and to see if there’s an unwanted object in your airway.

Management
Medical
1. Urgent hospitalization
2. Restoration of airways to full capacity- Your healthcare provider will place an oxygen
mask over your mouth and nose so your lungs can start getting air. If your air passages
are already blocked, they’ll place a tube down your throat to deliver oxygen into your
lungs.
3. Urgent tracheostomy- In severe cases, a person may need a tracheostomy (where your
healthcare provider makes a small incision in your windpipe). Tracheal tube can be
removed within 24 hours
4. Once your lungs are getting oxygen, your provider may insert a breathing tube through
your nose and into your windpipe to make breathing more natural.
5. Your medical team will give you plenty of fluids through an intravenous (IV) drip (a
needle inserted into a vein).

Pharmacological
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● Antimicrobial therapy is preferably based upon results from blood and epiglottic cultures
when possible. Empiric combination antibiotic therapy with a third-generation
cephalosporin and an antistaphylococcal agent is usually recommended.
● Ceftriaxone is the antibiotic of choice (DOC) for epiglottitis. This agent is a
third-generation cephalosporin with broad-spectrum activity against gram-negative
organisms, lower efficacy against gram-positive organisms, and higher efficacy against
resistant organisms.
● Vancomycin is the antistaphylococcal agent of choice in patients with epiglottitis
complicated by sepsis, those with concomitant meningitis, or those from areas with an
increased prevalence of clindamycin-resistant methicillin-resistant S aureus. Patients with
a penicillin allergy should be treated with vancomycin and a quinolone antibiotic agent.
● Antibiotics should be altered as culture sensitivities are identified by the lab and adjusted
to ensure completion of a 10-day course.
● Routine vaccination for HiB is not recommended in adults. However, older children or
adults at an elevated risk of contracting an HiB infection includes those with a history of
functional or anatomic asplenia, immunodeficiency, immunosuppression from cancer
chemotherapy, infection with HIV, and receipt of a hematopoietic stem cell transplant.
For high-risk patients who are also previously unvaccinated, the administration of at least
1 pediatric dose of an HiB conjugate vaccine should be considered.

Nursing (Independent, Dependent, Educative)

Independent
● Assess the following:
a. Respiratory assessment. Assess the patient’s breathing, any history of injury to the
throat, breathing through the mouth, stridor, and hypoxia.
b. Cardiovascular assessment. Assess the patient’s pulse; assess for tachycardia and
a thready pulse.
c. Gastrointestinal assessment. Assess if there is an inability to swallow.
● Anxiety control- The nurse, along with the support of the family, should display actions
to eliminate or reduce feelings of apprehension and tension from an unidentifiable source.
● Hydration- Regulate IV fluid accordingly
Dependent
● Medications- Administer antibiotics as prescribed
Educative
● Learning facilitation- The nurse should promote the ability to process and comprehend
information and encourage the improvement of the ability and willingness of the patient
to receive information.
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● Health education- The nurse should educate the patient about epiglottitis, including its
causes, types, signs and symptoms, and the strategies to manage the symptoms of
epiglottitis.
● Emphasizing the importance of medication- Inform the patient that he or she should take
the full treatment of antibiotics to kill the disease-causing bacteria. If the patient doesn't
take an antibiotic as prescribed, he may need to start treatment again later. If he stops
taking it, it can also promote the spread of antibiotic-resistant properties among harmful
bacteria.
● The nurse should ensure that the patient, as well as the family, should be able to
understand the given health education about the condition/disease process and its
treatment.

Home Care Guidelines

- Be sure to make and go to all appointments, and call your doctor or nurse advice line
(811 in most provinces and territories) if you are having problems. It's also a good idea to
know your test results and keep a list of the medicines you take.
- Take your antibiotics as directed. Do not stop taking them just because you feel better.
You need to take the full course of antibiotics.
- Call 911 or the emergency hotline anytime you think you may need emergency care. For
example, call if:
You have severe trouble breathing or swallowing.
- Call your doctor or nurse advice line now or seek immediate medical care if you have
worsening symptoms of infection, such as:
● Increased pain, swelling, warmth, or redness.
● Pus draining from the area.
● A fever.
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VI. TONSILLITIS

Definition and Other Names

- Tonsillitis is a common condition, particularly in children, that involves inflammation of

the tonsils. These are two oval-shaped pads of tissue located at the back of the throat,
one on each side.

Classification and Types

Tonsillitis can be classified based on its duration and underlying cause:

● Acute tonsillitis: Characterized by a sudden onset of symptoms, typically

resolving within a few days to a week.
● Chronic tonsillitis: Involves recurrent episodes of tonsillitis over a prolonged
period.

Based on the causative agent, tonsillitis can be categorized as:

● Viral tonsillitis: The most common type, caused by viruses such as adenovirus,
rhinovirus, Epstein-Barr virus (EBV), and influenza virus.
● Bacterial tonsillitis: Often caused by Group A beta-hemolytic Streptococcus
(GAS), also known as Streptococcus pyogenes, which can lead to strep throat.

Further types of tonsillitis based on the appearance of the tonsils include:

● Acute follicular tonsillitis: Characterized by small, white or yellow spots

(follicles) on the tonsils.
● Acute lacunar tonsillitis: Presents with larger, white or yellow patches
(exudates) in the crypts of the tonsils.
● Acute membranous tonsillitis: Involves a thick, gray membrane covering the
tonsils, often associated with diphtheria.

Etiology, Causes, and Predisposing/Precipitating Factors

Viral causes:

● Adenoviruses: Commonly associated with the common cold and respiratory infections.
● Rhinoviruses: The most frequent cause of the common cold.
● Epstein-Barr virus (EBV): Known for causing mononucleosis (mono) or glandular
fever.
● Influenza virus: The cause of the flu.
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Bacterial causes:

● Group A beta-hemolytic Streptococcus (GAS): The most common bacterial cause of

tonsillitis, leading to strep throat.

Predisposing factors:

● Age: Tonsillitis is most common in children between the ages of 5 and 15.
● Crowded living conditions: Increased exposure to germs.
● Weakened immune system: Conditions such as HIV/AIDS or autoimmune disorders
can increase susceptibility to infections.
● Smoking: Can irritate the throat and impair immune function.
● Exposure to allergens: Can trigger inflammation in the throat.

Precipitating factors:

● Exposure to infected individuals: Direct contact with someone who has tonsillitis or a
respiratory infection.
● Cold weather: Dry air can irritate the throat and make it more susceptible to infection.
● Poor oral hygiene: Can increase the number of bacteria in the mouth, making it easier
for infections to develop.

Risk Factors

● Young age: Children are more susceptible to tonsillitis due to their developing immune
systems.
● Exposure to crowded environments: Schools, daycare centers, and other places with
close contact increase the risk of infection.
● Weakened immune system: Conditions that compromise the immune system, such as
HIV/AIDS, autoimmune disorders, or certain medications, make individuals more
vulnerable to infections.
● Smoking: Irritates the throat and weakens the immune system, increasing the risk of
tonsillitis.
● Allergies: Can trigger inflammation in the throat, making it more susceptible to
infection.

Complications

● Peritonsillar abscess (quinsy): A collection of pus that forms near the tonsil, causing
severe pain, difficulty swallowing, and muffled speech.
● Recurrent tonsillitis: Frequent episodes of tonsillitis, often requiring tonsillectomy.
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● Sleep apnea: Obstruction of the airway during sleep, caused by enlarged tonsils, leading
to snoring, pauses in breathing, and daytime sleepiness.
● Ear infections: Inflammation of the middle ear, often associated with tonsillitis,
particularly in children.
● Rheumatic fever: A rare but serious complication of untreated GAS pharyngitis,
involving inflammation of the heart, joints, skin, and nervous system.
● Post-streptococcal glomerulonephritis: Inflammation of the kidneys, occurring 1-6
weeks after a GAS infection.

Prevention

● Good hand hygiene: Wash hands frequently with soap and water, especially before
eating and after being in public places.
● Avoid close contact with sick individuals: Stay away from people who have respiratory
infections.
● Cover your mouth and nose when coughing or sneezing: Use a tissue or the inside of
your elbow to prevent spreading germs.
● Maintain a healthy lifestyle: Get enough sleep, eat a balanced diet, and exercise
regularly to boost your immune system.
● Avoid smoking: Smoking irritates the throat and weakens the immune system.
● Practice good oral hygiene: Brush your teeth twice a day and floss regularly to reduce
bacteria in the mouth.

Signs and Symptoms

Common symptoms:

● Sore throat: The most common symptom, often described as a scratchy, painful feeling.
● Difficulty swallowing (dysphagia): Painful swallowing can make eating and
drinking uncomfortable.
● Swollen tonsils: The tonsils become enlarged and red.
● Tender lymph nodes in the neck: Swollen lymph nodes can be felt as lumps on the
sides of the neck.
● Fever: A common sign of infection, particularly with bacterial tonsillitis.
● Headache: Can accompany the sore throat and fever.
● Malaise: A general feeling of fatigue and discomfort.
● Bad breath: Can occur due to the inflammation and bacterial growth.

Symptoms more suggestive of bacterial tonsillitis:

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● White or yellow patches (exudates) on the tonsils: These are often seen with GAS
pharyngitis.
● Red spots (petechiae) on the roof of the mouth (palate): A characteristic sign of GAS
pharyngitis.
● Swollen and tender lymph nodes in the neck (anterior cervical adenitis): A common
feature of GAS pharyngitis.
● Scarlatiniform rash: A fine, red rash that feels like sandpaper, associated with scarlet
fever, a complication of GAS infection.

Pathophysiology

Diagnostics/Laboratory Tests

● Rapid antigen detection test (RADT): This point-of-care test can detect GAS antigens
in throat swabs. It is highly specific but may not be as sensitive as a throat culture.
● Throat culture: The gold standard for diagnosing GAS pharyngitis, involving culturing
a throat swab in a lab to identify the bacteria.
● Nucleic acid amplification test (NAAT): Can detect the DNA or RNA of various
bacteria, including Neisseria gonorrhoeae and Chlamydia trachomatis, which can cause
pharyngitis.

Medical Management (Surgical and Non surgical)

Non-Surgical Management

Viral Tonsillitis: Viral tonsillitis usually resolves on its own within 5-7 days. Treatment focuses
on symptom relief:

● Rest: Encourage plenty of rest to allow the body to fight the infection.
● Hydration: Drink plenty of fluids to prevent dehydration and soothe the throat. Warm
liquids like broth, tea, or water with honey can be particularly comforting.
● Pain relief: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or
acetaminophen (Tylenol) can help manage pain and fever. Avoid aspirin in children and
teenagers due to the risk of Reye's syndrome.
● Gargling: Saltwater gargles (1/2 teaspoon salt in 8 ounces of warm water) can help
soothe the throat, but should be avoided in young children.
● Humidifier: Using a cool-air humidifier can help alleviate dry air, which can irritate the
throat.
● Lozenges: Children older than 4 years can suck on lozenges to relieve throat pain.
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● Avoid irritants: Keep the home free from cigarette smoke and other irritants that can
worsen throat irritation.

Bacterial Tonsillitis (Strep Throat): Bacterial tonsillitis requires antibiotic treatment to prevent
complications like rheumatic fever and kidney inflammation.

● Antibiotics: Penicillin is the most common antibiotic prescribed for GAS pharyngitis,
typically for 10 days. Alternative antibiotics are available for those with penicillin
allergies.

Surgical Management

● Tonsillectomy: Surgical removal of the tonsils (tonsillectomy) may be considered in

cases of:
○ Recurrent tonsillitis: Frequent episodes of tonsillitis, defined as at least seven
episodes in the preceding year, at least five episodes a year in the past two years,
or at least three episodes a year in the past three years.
○ Chronic tonsillitis: Persistent tonsillitis that doesn't respond to antibiotic
treatment.
○ Complications: Tonsillitis causing obstructive sleep apnea, breathing difficulties,
swallowing problems, or abscesses that don't improve with antibiotics.

Nursing Management (Independent, Dependent, Collaborative, and Educative)

Dependent Nursing Interventions

● Administering medications: Administer prescribed antibiotics or pain relievers as

ordered by the physician.
● Monitoring vital signs: Regularly assess temperature, pulse, respiration, and blood
pressure to monitor the patient's condition and detect any complications.
● Assessing pain: Use pain scales to assess the level of pain and document the
effectiveness of pain management interventions.
● Observing for signs of airway obstruction: Monitor for signs of airway obstruction,
such as stridor, retractions, or difficulty breathing. If necessary, notify the physician
immediately.

Independent Nursing Interventions

● Providing comfort measures: Encourage rest, hydration, and use of comfort measures
like warm gargles or lozenges.
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● Teaching about infection control: Educate the patient and family about hand hygiene,
covering coughs and sneezes, and avoiding close contact with others to prevent the
spread of infection.
● Promoting adequate nutrition: Encourage the patient to consume soft, easily
swallowed foods to prevent dehydration and maintain nutritional status.
● Monitoring for complications: Observe for signs of complications, such as peritonsillar
abscess, rheumatic fever, or kidney inflammation. Report any concerns to the physician
immediately.

Collaborative Nursing Interventions

● Collaborating with the physician: Work closely with the physician to develop and
implement a comprehensive care plan.
● Consulting with other healthcare professionals: Consult with specialists such as
otolaryngologists (ENT doctors) or infectious disease specialists as needed.
● Educating the patient and family: Provide clear and concise information about the
condition, treatment options, and potential complications. Answer questions and address
concerns.

Educative Nursing Interventions

● Teaching about tonsillitis: Explain the causes, symptoms, and treatment options for
tonsillitis.
● Emphasizing the importance of completing the antibiotic course: Stress the
importance of taking the full course of antibiotics as prescribed, even if symptoms
improve, to prevent complications.
● Providing instructions for home care: Educate the patient and family about home care
guidelines, such as rest, hydration, pain management, and infection control measures.
● Discussing the need for follow-up: Explain the importance of follow-up appointments
to monitor progress and ensure the infection has resolved.

Home Care Guidelines

● Rest: Encourage the patient to get plenty of rest to allow the body to fight the infection.
● Hydration: Drink plenty of fluids to prevent dehydration and soothe the throat. Warm
liquids like broth, tea, or water with honey can be particularly comforting.
● Pain relief: Use over-the-counter pain relievers like ibuprofen (Advil, Motrin) or
acetaminophen (Tylenol) as directed by the physician. Avoid aspirin in children and
teenagers.
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● Gargling: Saltwater gargles (1/2 teaspoon salt in 8 ounces of warm water) can help
soothe the throat, but should be avoided in young children.
● Humidifier: Using a cool-air humidifier can help alleviate dry air, which can irritate the
throat.
● Lozenges: Children older than 4 years can suck on lozenges to relieve throat pain.
● Avoid irritants: Keep the home free from cigarette smoke and other irritants that can
worsen throat irritation.
● Soft foods: Encourage the patient to eat soft, easily swallowed foods to prevent
dehydration and maintain nutritional status.
● Infection control: Practice good hand hygiene, cover coughs and sneezes, and avoid
close contact with others to prevent the spread of infection.

VII. INFLUENZA

DEFINITION

- Contagious respiratory illness caused by influenza viruses that infect the nose, throat, and
sometimes the lungs.
- Mild to severe illness, may lead to death
- Prevent flu is by getting a flu vaccine each year.

CLASSIFICATION AND TYPES

Influenza viruses are classified into several categories based on their structure and the nature of
their genetic material. Here’s a breakdown of the primary classifications:

1. Types:
○ Influenza A: This type is responsible for seasonal flu epidemics and pandemics.
Influenza A viruses are further classified into subtypes based on the two surface
proteins:
■ Hemagglutinin (H): There are 18 known subtypes (H1 to H18).
■ Neuraminidase (N): There are 11 known subtypes (N1 to N11).
■ For example, H1N1 and H3N2 are specific subtypes of Influenza A.
○ Influenza B: This type primarily causes seasonal epidemics but is not typically
associated with pandemics. Influenza B viruses are not divided into subtypes but
are classified into two lineages: B/Yamagata and B/Victoria.
○ Influenza C: This type causes mild respiratory illness and is not associated with
seasonal epidemics. It is less common and less well-studied than types A and B.
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○ Influenza D: This type primarily affects cattle and has not been known to infect
humans. It was identified relatively recently and is still under research.
2. Strains:
○ Within each type and subtype, there are various strains of influenza viruses.
Strains can differ in their antigenic properties, which can affect how well the
immune system recognizes and responds to them.
3. Seasonal vs. Pandemic:
○ Seasonal Influenza: This refers to the flu strains that circulate and cause illness
annually, often varying slightly from year to year due to antigenic drift, which
involves minor changes in the virus’s surface proteins.
○ Pandemic Influenza: This occurs when a new or significantly different strain of
influenza virus emerges, causing widespread illness globally. Pandemic strains
can result from antigenic shift, a major change in the influenza virus that leads to
the creation of a new subtype that the population has little to no immunity against.

PATHOPHYSIOLOGY
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RISK FACTORS

The risk factors for influenza can vary based on demographic, health, and environmental
conditions. Individuals with certain characteristics or situations are more likely to experience
severe illness or complications from the flu. Here are the main risk factors:

1. Age

● Young Children: Infants and young children, especially those under 5 years old, are at
higher risk due to their developing immune systems.
● Elderly Adults: Individuals aged 65 and older often have weakened immune systems and
are more likely to experience severe complications.

2. Chronic Health Conditions

● Chronic Respiratory Diseases: People with conditions like asthma, chronic obstructive
pulmonary disease (COPD), or other chronic lung diseases are at higher risk.
● Cardiovascular Diseases: Individuals with heart disease or other cardiovascular
conditions are more susceptible to severe outcomes.
● Diabetes: People with diabetes, whether type 1 or type 2, are at increased risk of
complications.
● Kidney Diseases: Those with chronic kidney disease may face a higher risk of severe flu.

3. Immune System Issues

● Immunocompromised Individuals: People with weakened immune systems due to

conditions like HIV/AIDS or those undergoing treatments such as chemotherapy are at
increased risk.
● Autoimmune Disorders: Individuals with autoimmune diseases (e.g., lupus, rheumatoid
arthritis) may be more susceptible.

4. Pregnancy

● Pregnant Women: Pregnant women, especially in the second and third trimesters, are at
increased risk of severe influenza and complications.

5. Living Conditions

● Institutional Settings: Residents of nursing homes, long-term care facilities, and other
group settings are at higher risk due to close living quarters and frequent interactions.
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● Crowded Environments: People who live or work in crowded settings (e.g., schools,
daycare centers) are more exposed to the virus.

6. Socioeconomic Factors

● Limited Access to Healthcare: Individuals with limited access to medical care may not
receive timely vaccinations or treatments, increasing their risk of severe illness.
● Low Socioeconomic Status: Economic hardship can be associated with higher rates of
flu and its complications, partly due to factors like poorer access to healthcare and living
conditions.

7. Lifestyle Factors

● Smoking: Smokers, whether active or passive, have compromised lung function and are
at increased risk of severe influenza complications.
● Poor Nutrition: Inadequate nutrition can weaken the immune system and increase
susceptibility to illness.

8. Seasonal Factors

● Flu Season: Influenza is more common during certain times of the year, typically fall and
winter in temperate regions, which can increase risk during these periods.

9. Previous Flu Exposure

● Lack of Immunization: Individuals who have not been vaccinated against influenza or
who have not received the annual flu vaccine are at higher risk of contracting the virus.

COMPLICATIONS

● Bacterial Pneumonia
● Ear infections
● Sinus Infections
● Worsening of chronic medical condition

PREVENTION

Preventing influenza involves a combination of strategies to reduce the risk of infection and
transmission. Here are the primary methods for preventing the flu:
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1. Vaccination

● Annual Flu Vaccine: The most effective way to prevent influenza is to get the annual flu
vaccine. The vaccine is updated each year to match circulating strains and provides
protection against the most common strains of the virus.
● Special Populations: Certain groups, such as young children, elderly adults, pregnant
women, and individuals with chronic health conditions, should be especially encouraged
to get vaccinated.

2. Good Hygiene Practices

● Hand Washing: Wash hands frequently with soap and water for at least 20 seconds,
especially after being in public places, touching surfaces, or after coughing and sneezing.
● Hand Sanitizer: Use hand sanitizer with at least 60% alcohol if soap and water are not
available.

3. Respiratory Etiquette

● Cover Coughs and Sneezes: Use a tissue or your elbow to cover your mouth and nose
when coughing or sneezing. Dispose of tissues immediately and wash your hands.
● Face Masks: Wearing a mask can help reduce the spread of the flu virus, especially in
crowded or high-risk settings.

4. Avoid Close Contact

● Stay Away from Sick People: Avoid close contact with individuals who are sick with the
flu or other respiratory illnesses.
● Stay Home When Sick: If you are sick with the flu, stay home to avoid spreading the
virus to others. This is particularly important during the first few days of illness when the
virus is most contagious.

5. Environmental Hygiene

● Disinfect Surfaces: Regularly clean and disinfect frequently-touched surfaces, such as

doorknobs, light switches, and phones, especially during flu season.
● Ventilation: Ensure good ventilation in indoor spaces to help reduce the concentration of
airborne virus particles.

6. Healthy Lifestyle Choices

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● Healthy Diet: Maintain a balanced diet rich in fruits, vegetables, and whole grains to
support a healthy immune system.
● Regular Exercise: Engage in regular physical activity to help boost overall health and
immune function.
● Adequate Sleep: Ensure you get sufficient sleep to help your body stay healthy and
resilient against infections.

7. Antiviral Medications

● Prompt Treatment: If prescribed by a healthcare provider, antiviral medications can be

used to treat influenza and may reduce the severity and duration of the illness if started
within 48 hours of symptom onset.

8. Public Health Measures

● Community Vaccination Programs: Support and participate in community vaccination

efforts to increase herd immunity and reduce the spread of influenza.
● Education and Awareness: Stay informed about influenza prevention strategies and
educate others about effective practices to reduce transmission.

PREDISPOSING FACTORS

Predisposing factors for influenza refer to conditions or circumstances that increase an

individual's likelihood of contracting the flu or experiencing severe outcomes from it. These
factors can be related to health status, lifestyle, and environmental conditions. Here’s a detailed
overview:

1. Health Conditions

● Chronic Respiratory Diseases: Conditions such as asthma, chronic obstructive

pulmonary disease (COPD), and other chronic lung diseases can make individuals more
susceptible to severe flu complications.
● Cardiovascular Diseases: Heart conditions, including heart disease and high blood
pressure, can increase the risk of severe influenza.
● Diabetes: People with diabetes are at higher risk for flu complications due to potential
impacts on immune function and overall health.
● Kidney Diseases: Chronic kidney disease or kidney failure can heighten the risk of
severe illness from the flu.
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● Immunocompromised States: Individuals with weakened immune systems, whether due
to conditions like HIV/AIDS or immunosuppressive treatments, are at increased risk.
● Autoimmune Disorders: Conditions such as lupus or rheumatoid arthritis can also
increase susceptibility to severe influenza.

2. Age

● Young Children: Infants and toddlers have developing immune systems and are more
vulnerable to the flu and its complications.
● Elderly Adults: Older adults, particularly those over 65, often have weakened immune
systems and are at greater risk for severe flu outcomes.

3. Pregnancy

● Pregnant Women: Pregnant women, especially in the second and third trimesters, have
altered immune responses and are at increased risk of severe influenza and complications.

4. Living Conditions

● Institutional Settings: People living in or working in institutions such as nursing homes,

long-term care facilities, or other group living environments are at higher risk due to
close contact with others.
● Crowded Environments: High-density settings, such as schools, daycare centers, or
public transportation, increase exposure to influenza viruses.

5. Socioeconomic Factors

● Limited Access to Healthcare: Individuals with poor access to healthcare may not
receive timely vaccination or treatment, increasing their risk.
● Low Socioeconomic Status: Economic hardship can lead to increased risk due to factors
such as limited access to medical care and living conditions that may facilitate the spread
of the virus.

6. Lifestyle Factors

● Smoking: Smokers have compromised lung function and a higher susceptibility to

respiratory infections, including the flu.
● Poor Nutrition: Inadequate nutrition can weaken the immune system, making
individuals more susceptible to infections.
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7. Immune System Status

● Recent Surgery or Illness: Recent major surgery or illness can temporarily weaken the
immune system, increasing susceptibility to influenza.
● Medication: Certain medications, such as corticosteroids or other immunosuppressive
drugs, can impair the immune system and increase the risk of severe flu.

8. Previous Flu Exposure

● Lack of Vaccination: Individuals who have not been vaccinated against the flu or who
have not received the annual flu vaccine are at higher risk of contracting and suffering
from influenza.

COMPLICATIONS PREVENTION

Preventing complications from influenza involves a combination of proactive measures to

reduce the likelihood of contracting the flu and to manage its severity if it occurs. Here are
effective strategies to prevent complications:

1. Vaccination

● Annual Flu Vaccine: Getting vaccinated each year is the most effective way to prevent
influenza and its complications. The vaccine is updated annually to address the most
current strains of the virus.
● Special Populations: Encourage vaccination for high-risk groups, including young
children, the elderly, pregnant women, and individuals with chronic health conditions.

2. Early Treatment

● Antiviral Medications: If you develop flu symptoms, especially if you are in a high-risk
group, seek medical attention promptly. Antiviral medications like oseltamivir (Tamiflu)
and zanamivir (Relenza) can reduce the severity and duration of the illness if taken within
48 hours of symptom onset.
● Medical Consultation: Consult with a healthcare provider if symptoms worsen or if you
have underlying health conditions that might complicate the flu.

3. Good Hygiene Practices

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● Hand Hygiene: Wash hands frequently with soap and water for at least 20 seconds. Use
hand sanitizer if soap and water are not available.
● Avoid Touching Face: Minimize touching your face, especially your eyes, nose, and
mouth, to reduce the risk of transferring the virus from surfaces.

4. Respiratory Etiquette

● Cover Coughs and Sneezes: Use tissues or your elbow to cover your mouth and nose
when coughing or sneezing. Dispose of tissues properly and wash your hands
immediately.

5. Avoid Spreading the Virus

● Stay Home When Sick: If you have flu symptoms, stay home to avoid spreading the
virus to others. Rest and avoid going to work or school until you are fever-free for at least
24 hours without the use of fever-reducing medications.

6. Maintain Healthy Lifestyle Habits

● Balanced Diet: Eat a nutritious diet to support overall health and immune function.
● Regular Exercise: Engage in regular physical activity to help strengthen your immune
system.
● Adequate Sleep: Ensure you get sufficient rest to support your body's ability to fight
infections.

7. Manage Chronic Health Conditions

● Regular Check-ups: Keep chronic conditions such as diabetes, asthma, or heart disease
under control with regular medical care and follow your healthcare provider’s
recommendations.
● Medication Adherence: Take prescribed medications as directed and attend regular
medical appointments to manage chronic conditions effectively.

8. Environmental Measures

● Disinfect Surfaces: Regularly clean and disinfect frequently-touched surfaces in your

home, workplace, and other shared spaces.
● Ventilation: Ensure good airflow in indoor environments to reduce the concentration of
airborne viruses.
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9. Public Health Measures

● Community Vaccination Programs: Participate in and support community vaccination

efforts to increase herd immunity and reduce overall flu transmission.
● Stay Informed: Keep up to date with public health guidelines and recommendations for
flu prevention and management.

SIGNS AND SYMPTOMS

● Fever
● Cough
● Sore throat
● Runny nose or stuffy nose
● Muscle or body aches
● Headaches
● Fatigue
● Maybe vomiting and diarrhea (common in children)

DIAGNOSTICS

Diagnosing influenza typically involves a combination of clinical evaluation and

laboratory testing. Here’s an overview of the diagnostic approaches for influenza:

1. Clinical Evaluation

● Medical History: A healthcare provider will review the patient’s medical history,
including recent travel, exposure to sick individuals, and vaccination status.
● Symptom Assessment: Common symptoms of influenza include fever, cough, sore
throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. The provider
will assess these symptoms to evaluate the likelihood of influenza.
● Physical Examination: The provider may perform a physical exam to check for signs of
flu-related complications, such as pneumonia.

2. Laboratory Testing

Laboratory tests can confirm the presence of influenza virus and distinguish it from other
respiratory illnesses. The following tests are commonly used:
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● Rapid Influenza Diagnostic Tests (RIDTs):
○ Description: These tests detect influenza viral antigens in respiratory specimens
(e.g., nasal or throat swabs) and provide results within 15-30 minutes.
○ Accuracy: While RIDTs are convenient, they may have lower sensitivity and are
more likely to miss cases, especially if the patient has a low viral load.
● Polymerase Chain Reaction (PCR) Tests:
○ Description: PCR tests detect the genetic material (RNA) of the influenza virus.
They are considered the gold standard for influenza diagnosis due to their high
sensitivity and specificity.
○ Accuracy: PCR tests are highly accurate and can distinguish between different
influenza subtypes and strains. They typically take a few hours to a day to return
results.
● Viral Culture:
○ Description: This test involves growing the virus from a respiratory specimen in
a laboratory to confirm the presence of influenza.
○ Accuracy: Viral culture is highly specific and can provide information about the
virus strain but takes several days to complete, making it less suitable for rapid
diagnosis.
● Direct Fluorescent Antibody (DFA) Testing:
○ Description: DFA tests use fluorescent dyes to detect influenza antigens in
respiratory specimens.
○ Accuracy: DFA tests are fairly accurate but less commonly used than PCR due to
their lower sensitivity and longer processing time.
● Serologic Tests:
○ Description: These tests detect antibodies against influenza viruses in the blood.
They are generally used for research or retrospective diagnosis rather than acute
diagnosis.
○ Accuracy: Serologic tests can be useful for confirming past infection but are not
typically used for diagnosing current influenza due to the time it takes for
antibody levels to rise.

3. Additional Considerations

● Timing of Testing: Testing is most accurate when performed during the early stages of
illness when viral loads are typically highest.
● Infection Control: While awaiting test results, it’s important to practice good hygiene
and avoid close contact with others to prevent the potential spread of the virus.
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MANAGEMENT

MEDICAL

1. Antiviral Medications

Antiviral drugs can reduce the severity and duration of influenza if started within
48 hours of symptom onset. They are particularly important for high-risk individuals or
those with severe symptoms.

● Oseltamivir (Tamiflu):
○ Form: Oral capsules or liquid.
○ Dosage: Typically taken twice daily for 5 days.
○ Use: Effective against influenza A and B viruses.
● Zanamivir (Relenza):
○ Form: Inhaled powder.
○ Dosage: Usually administered twice daily for 5 days.
○ Use: Effective against influenza A and B viruses.
● Peramivir (Rapivab):
○ Form: Intravenous (IV) infusion.
○ Dosage: Single dose.
○ Use: Effective for severe cases or when oral or inhaled options are not suitable.
● Baloxavir marboxil (Xofluza):
○ Form: Oral tablets.
○ Dosage: Single dose.
○ Use: Effective against influenza A and B viruses, with the benefit of a single-dose
regimen.

2. Supportive Care

● Rest: Adequate rest is crucial to help the body recover from the infection.
● Hydration: Drink plenty of fluids to stay hydrated and help alleviate symptoms like
fever and dehydration.
● Fever and Pain Management: Use over-the-counter medications like acetaminophen
(Tylenol) or ibuprofen (Advil, Motrin) to reduce fever and relieve body aches. Avoid
aspirin in children and teenagers due to the risk of Reye’s syndrome.
● Cough and Throat Care: Lozenges, throat sprays, and honey (for those over 1 year old)
can help soothe a sore throat and reduce coughing.

3. Monitoring and Management of Complications

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● Monitoring: Keep track of symptoms, especially in high-risk individuals or those with
severe illness, to detect any signs of complications early.
● Complications: Be vigilant for complications such as pneumonia, bronchitis, or
exacerbation of chronic conditions. Seek medical attention if symptoms worsen, if there
is difficulty breathing, chest pain, confusion, or severe weakness.

4. Preventive Measures

● Isolation: Patients with influenza should stay home from work, school, or other public
places to prevent spreading the virus to others.
● Hygiene: Practice good hygiene, including frequent hand washing and covering coughs
and sneezes, to minimize the risk of transmission.

5. Special Considerations

● Pregnant Women: Antiviral treatment is recommended for pregnant women who have
influenza, as they are at higher risk of complications.
● Children: Treatment should be initiated as soon as possible if a child shows symptoms of
influenza. Certain antivirals are specifically recommended for pediatric use.
● Elderly: Older adults should be monitored closely for complications and may benefit
from antiviral treatment.

6. Follow-Up

● Reevaluation: Follow-up with a healthcare provider if symptoms persist, worsen, or if

there are any concerns about complications.
● Vaccination: For future prevention, ensure that the patient receives the annual flu
vaccine.

PHARMACOLOGICAL

1. Antiviral Medications

Antiviral drugs are most effective when administered within 48 hours of the onset of influenza
symptoms. They work by inhibiting the replication of the influenza virus.

● Oseltamivir (Tamiflu)
○ Form: Oral capsules and liquid suspension.
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○ Dosage: Typically, 75 mg twice daily for 5 days for adults and children over 1
year old. The dosage may vary based on age and weight.
○ Indication: Used for the treatment of uncomplicated influenza in patients who
have been symptomatic for no more than 48 hours and for prophylaxis in
high-risk individuals.
○ Side Effects: Nausea, vomiting, headache, and, rarely, neuropsychiatric events.
● Zanamivir (Relenza)
○ Form: Inhaled powder via a Diskhaler device.
○ Dosage: 10 mg (two inhalations) twice daily for 5 days.
○ Indication: Used for the treatment of influenza in patients who have been
symptomatic for no more than 48 hours and for prophylaxis. Not recommended
for individuals with underlying respiratory conditions.
○ Side Effects: Cough, throat irritation, and, rarely, bronchospasm.
● Peramivir (Rapivab)
○ Form: Intravenous (IV) infusion.
○ Dosage: A single dose of 600 mg administered IV over 15-30 minutes.
○ Indication: Used for the treatment of acute, uncomplicated influenza in patients
who have been symptomatic for no more than 2 days and are unable to take oral
or inhaled antivirals.
○ Side Effects: Diarrhea, hypersensitivity reactions, and potential for
infusion-related reactions.
● Baloxavir Marboxil (Xofluza)
○ Form: Oral tablets.
○ Dosage: A single dose of 40 mg or 80 mg, depending on the patient’s weight (40
mg for <80 kg and 80 mg for ≥80 kg).
○ Indication: Used for the treatment of uncomplicated influenza in patients who
have been symptomatic for no more than 48 hours.
○ Side Effects: Diarrhea, headache, and nausea.

2. Supportive Medications

Supportive medications are used to manage symptoms and provide comfort:

● Antipyretics/Analgesics:
○ Acetaminophen (Tylenol): Reduces fever and relieves pain. Dosage should be
based on age and weight.
○ Ibuprofen (Advil, Motrin): Also reduces fever and relieves pain. Suitable for
adults and children over 6 months.
● Cough Suppressants and Expectorants:
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○ Dextromethorphan: Used to suppress cough. Available in various
over-the-counter formulations.
○ Guaifenesin: An expectorant that helps loosen mucus and ease coughing.
● Throat Lozenges and Sprays:
○ Lozenges: Contain ingredients like benzocaine or menthol to soothe a sore throat.
○ Throat Sprays: May contain anesthetics or antiseptics to relieve throat
discomfort.

3. Symptom Management

● Hydration: Ensuring adequate fluid intake is essential to prevent dehydration and help
with symptom relief.
● Rest: Encouraging rest to support the body’s recovery process.

4. Special Considerations

● Pregnant Women: Oseltamivir is considered safe during pregnancy and is often

recommended for pregnant women with influenza.
● Children: Antiviral medications like oseltamivir and zanamivir are used in pediatric
patients, with dosages adjusted based on age and weight.
● Elderly: Older adults may require careful monitoring for potential side effects and
interactions.

5. Antiviral Resistance

● Monitoring: It is important to be aware of potential antiviral resistance patterns,

especially in areas with high resistance rates. If a patient’s symptoms do not improve or
worsen despite antiviral treatment, further evaluation may be necessary.

NURSING

1. Assessment

● Initial Assessment:
○ Collect a thorough health history including symptom onset, exposure history, and
vaccination status.
○ Assess vital signs, including temperature, heart rate, respiratory rate, and blood
pressure.
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○ Evaluate symptoms such as fever, cough, sore throat, muscle aches, fatigue, and
any signs of complications like difficulty breathing or chest pain.
● Ongoing Monitoring:
○ Regularly monitor vital signs and assess for any changes in symptoms or new
symptoms.
○ Watch for signs of complications such as pneumonia, dehydration, or
exacerbation of chronic conditions.
○ Monitor for potential side effects of medications, especially antiviral drugs and
supportive treatments.

2. Symptom Management

● Fever and Pain Relief:

○ Administer antipyretics and analgesics like acetaminophen or ibuprofen as
ordered to manage fever and pain.
○ Monitor for effectiveness and adjust dosages as necessary.
● Hydration:
○ Encourage fluid intake to prevent dehydration and help with symptom relief.
○ Monitor for signs of dehydration such as dry mucous membranes, decreased urine
output, and dizziness.
● Respiratory Care:
○ Provide support for cough relief using lozenges or cough suppressants as needed.
○ Encourage deep breathing and coughing exercises to help clear mucus and
improve lung function.
○ Monitor respiratory status and provide supplemental oxygen if required.
● Comfort Measures:
○ Provide comfort measures such as warm fluids, throat lozenges, and humidified
air to soothe a sore throat and alleviate discomfort.
○ Ensure adequate rest and support the patient in a comfortable position.

3. Infection Control

● Isolation Precautions:
○ Implement appropriate infection control measures, such as isolation precautions,
to prevent the spread of influenza to others. This may include using personal
protective equipment (PPE) and maintaining a clean environment.
○ Educate patients and family members about the importance of infection control
practices.
● Hand Hygiene:
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○ Emphasize the importance of frequent hand washing or use of hand sanitizer to
reduce the risk of transmission.

4. Patient Education

● Medication Management:
○ Educate patients about the importance of taking prescribed antiviral medications
as directed and completing the full course.
○ Explain potential side effects of medications and how to manage them.
● Self-Care:
○ Instruct patients on home care measures, including rest, hydration, and symptom
management.
○ Provide information on recognizing signs of complications and when to seek
medical attention.
● Preventive Measures:
○ Reinforce the importance of vaccination for future prevention and good hygiene
practices to reduce the risk of flu transmission.

5. Coordination of Care

● Multidisciplinary Collaboration:
○ Work with other healthcare professionals, including physicians, pharmacists, and
dietitians, to ensure comprehensive care.
○ Coordinate with public health resources if necessary, especially in managing
outbreaks or high-risk populations.
● Follow-Up Care:
○ Arrange for follow-up visits or telephone calls to monitor the patient’s progress
and recovery.
○ Adjust the care plan as needed based on the patient’s response to treatment and
any evolving needs.

6. Documentation

● Accurate Record-Keeping:
○ Document all assessments, interventions, patient responses, and communications
with other healthcare providers.
○ Maintain records of medication administration and patient education.
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HOME CARE GUIDELINES

1. Symptom Management

● Rest:
○ Ensure the patient gets plenty of rest to help their body fight off the infection.
● Hydration:
○ Encourage drinking fluids such as water, herbal teas, and clear broths to stay
hydrated. Avoid caffeine and alcohol, as they can contribute to dehydration.
● Fever and Pain Relief:
○ Use over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen
(Advil, Motrin) to reduce fever and alleviate body aches. Follow dosing
instructions and avoid giving aspirin to children or teenagers due to the risk of
Reye’s syndrome.
● Cough and Sore Throat Relief:
○ Use throat lozenges, warm saltwater gargles, and humidifiers to soothe a sore
throat.
○ Over-the-counter cough suppressants or expectorants can be used to manage
coughing, but consult a healthcare provider before use, especially in young
children.
● Nutrition:
○ Offer light, easily digestible foods like soups, crackers, and fruits. Focus on
providing nutrient-rich foods to support recovery.

2. Infection Control

● Isolation:
○ Keep the patient isolated from others as much as possible, especially from
high-risk individuals such as young children, elderly people, and those with
chronic conditions.
● Hygiene:
○ Practice frequent hand washing with soap and water, or use hand sanitizer with at
least 60% alcohol.
○ Avoid sharing personal items like towels, utensils, and cups.
● Disinfection:
○ Clean and disinfect commonly touched surfaces, such as doorknobs, light
switches, and bathroom fixtures, daily with household disinfectants.
○ Use tissues or elbow to cover coughs and sneezes and dispose of tissues promptly.
Wash hands immediately after.
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3. Medication Management

● Antiviral Medications:
○ If prescribed antiviral medications (like oseltamivir or baloxavir), follow the
healthcare provider’s instructions carefully. Complete the full course of
medication even if symptoms improve.
● Over-the-Counter Medications:
○ Use medications for symptom relief as directed on the label. Avoid using multiple
products containing similar ingredients to prevent accidental overdose.

4. Monitoring and When to Seek Medical Help

● Symptom Monitoring:
○ Monitor symptoms and temperature regularly. Watch for worsening symptoms
such as difficulty breathing, chest pain, persistent high fever, confusion, or severe
weakness.
● Complications:
○ Seek medical attention if the patient shows signs of complications such as
difficulty breathing, confusion, bluish lips or face, or persistent high fever that
does not respond to medication.

5. Patient Education

● Understanding Influenza:
○ Educate the patient and caregivers about the nature of influenza, typical
symptoms, and expected course of illness.
● Self-Care Tips:
○ Provide guidance on managing symptoms at home, including rest, hydration, and
appropriate use of medications.
● Preventive Measures:
○ Emphasize the importance of good hygiene and preventive measures to avoid
spreading the virus to others.

6. Follow-Up Care

● Follow-Up:
○ Arrange for follow-up with a healthcare provider if symptoms do not improve or
if there are any concerns about complications.
● Vaccination:
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○ Encourage getting the annual flu vaccine to prevent future infections and reduce
the risk of severe illness.

IX. OTITIS MEDIA

Definition

Otitis media (middle ear infection) is an infection that causes inflammation (redness
and swelling) and a build-up of fluid behind the eardrum. It is an acute URTI that affects the
respiratory mucosa of the middle ear cleft. It is a common illness in young children (between
ages 3 months and 3 years) and occurs much less frequently in children more than 6 years old.

Classification/Types
● Acute OM (AOM) - defined by convention as the first 3 weeks of a process in which the
middle ear shows the signs and symptoms of acute inflammation. It is the most common
affliction necessitating medical therapy for children younger than 5 years.
● OM with effusion (OME) - is a condition in which there is fluid in the middle ear but no
signs of acute infection. As fluid builds up in the middle ear and Eustachian tube, it
places pressure on the tympanic membrane.
● Chronic suppurative OM - it is a persistent ear infection that results in tearing or
perforation of the eardrum.
● Adhesive OM - occurs when a thin retracted ear drum becomes sucked into the middle
ear space and stuck.

Pathophysiology
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Etiology
1. Viral Infection - often complicated by secondary bacterial infection.
2. Bacterial Infection - the following are the most common bacteria that affects different
ages;
● Neonates - gram-negative enteric bacilli, particularly Escherichia coli, and
Staphylococcus aureus cause acute otitis media.
● Older infants and children <14 - Streptococcus pneumoniae, Moraxella (Branhamella)
catarrhalis, and nontypeable Haemophilus influenzae; less common causes are group A
beta-hemolytic streptococci and S. aureus.
● Patients >14 years of age - S. pneumoniae, group A beta-hemolytic streptococci, and S.
aureus are most common, followed by H. influenzae.

Signs and Symptoms

● Initial symptom is earache, often with hearing loss.
● Pain in 1 or both ears

● Drainage from the ear

● Muffled hearing

● Sore throat

● Fever can occur as well and rarely, one’s balance can be affected.
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● Otoscopic examination can show a bulging, erythematous tympanic membrane with
indistinct landmarks and displacement of the light reflex.
● Air insufflation (pneumatic otoscopy) shows poor mobility of the tympanic membrane.
● Severe headache, confusion, or focal neurologic signs may occur with intracranial spread
of infection.
● Facial paralysis or vertigo suggests local extension to the fallopian canal or labyrinth.

Risk Factors
● Exposure to smoke or are around someone who smokes

● Preceding upper respiratory tract infection

● Have seasonal or year-round allergy symptoms

● Have a cold or other upper respiratory infection

● Living in a low-resource or high air-pollution region

● For infants, being bottle fed instead of breastfeeding

Predisposing Factors
● Family history of otitis media
● Eustachian tube dysfunction - is the most important factor in the pathogenesis of middle
ear infections in both childhood and adulthood.
● Eustachian tube obstruction - anything causing external compression of the Eustachian
tube, or obstruction of the Eustachian tube or of its outlet, can also predispose to AOM,
particularly unilateral AOM.
● Immune dysfunction - The respiratory mucosal membrane that lines the Eustachian tube,
middle ear space, and mastoid air cells presents an immunologic defensive barrier, and
any abnormality of this barrier may increase the risk of infection.

Complications
Complications of acute otitis media are uncommon. In rare cases, bacterial middle ear
infection spreads locally, resulting in acute mastoiditis, petrositis, or labyrinthitis. Intracranial
spread is extremely rare; it usually causes meningitis. Brain abscess, subdural empyema, epidural
abscess, lateral sinus thrombosis, or otitic hydrocephalus may occur. Even with antibiotic
treatment, intracranial complications are slow to resolve, especially in immunocompromised
patients.

Preventions
● Avoid high temperatures and humidity in rooms in the home.
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● Dry ears after a shower or bath and protect them in the winter.
● Take care to dispose of used tissues and wash hands thoroughly after coughing or
sneezing.
● Do not stay in contact with sick people for too long, otitis is indeed a contagious disease.
● Take good care of illnesses like colds or nasopharyngitis.
● Go for a check up if any symptoms suggest ear infections.

Diagnostics/Laboratory Tests

● History collection and physical examination, specifically ear exam.

● Hearing tests. These tests are recommended for children who have had fluid in one or
both ears (otitis media with effusion) for a total of 3 months. The tests may be done
sooner if hearing loss is suspected.
● Tympanometry. It measures how the eardrum responds to a change of air pressure inside
the ear.
● Tympanocentesis. This test can remove fluid if it has stayed behind the eardrum (chronic
otitis media with effusion) or if infection continues even with antibiotics.
● Blood tests. These are done if there are signs of immune problems.

Medical Management
● Analgesics - should be provided when necessary, including to preverbal children with
behavioral manifestations of pain (eg, tugging or rubbing the ear, excessive crying,
fussiness). Oral analgesics, such as acetaminophen or ibuprofen, are usually effective;
weight-based doses are used for children.
● Antibiotics - relieve symptoms more quickly (although results after 1 to 2 weeks are
similar) and may reduce the chance of residual hearing loss and labyrinthine or
intracranial sequelae.
● Topical intranasal vasoconstrictors - such as phenylephrine or oxymetazoline, may
improve eustachian tube function, although the efficacy of these preparations has not
been clearly shown. To avoid rebound congestion, these preparations should not be used
> 3 days.
● Systemic decongestants - (eg, pseudoephedrine 30 to 60 mg orally every 6 hours as
needed) may help relieve sinonasal congestion or pressure.
● Antihistamines - (eg, chlorpheniramine 4 mg orally every 4 to 6 hours for 7 to 10 days)
may improve eustachian tube function in people with allergies but should be reserved for
the truly allergic.

For children, neither vasoconstrictors nor antihistamines are of benefit.

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Surgical Management
● Myringotomy - may be done by a specialist for a bulging tympanic membrane,
particularly if severe or persistent pain, fever, vomiting, or diarrhea is present.
● Tympanometry - is used to monitor tympanic membrane movement; the patient's
hearing and tympanic membrane appearance and movement are monitored until normal.

If facial nerve palsy or weakness occurs in patients with acute otitis media, patients must be
urgently referred to a specialist for possible myringotomy and placement of a tympanostomy
tube.

Nursing Management

Independent Nursing Interventions

● Assessment. Do a thorough history taking and perform physical examination.
● Monitor and record vital signs closely.
● Monitor for relief of pain and any side effects of medication. Provides information
about the effectiveness of the medication and prevents untoward effects.
● Have the patient sit up, put pillows behind the head, or lie on the unaffected ear.
Elevation promotes drainage and reduces pressure from fluid.
● Reassure parents that the discomfort usually subsides within a day on antibiotics but
reinstruct the importance of compliance with the whole prescription.
● Instruct the use of a warm heating pad or an ice pack application. Advise to turn the
heating pad on low and cover it with a towel to ensure safety. Heat promotes vasodilation
thus reducing discomfort; Cold compress may decrease edema and pain.
● Reduce unnecessary environmental noise.
● Encourage increased fluid intake, good nutrition, and adequate rest. Decreases the
susceptibility to infection.

Dependent Nursing Interventions

● Administer pain medication such as acetaminophen or ibuprofen as prescribed.
Analgesics such as acetaminophen and ibuprofen alter response to pain.

Collaborative Nursing Interventions

● Notify the caregiver of changes in hearing ability or drainage from the affected ear.
Complications of OM may include perforation of the eardrum, mastoiditis, or conductive
hearing loss.

Educative Nursing Interventions

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● Advise family members on handwashing techniques and the importance of covering
their mouths and noses when sneezing or coughing. Proper hygiene prevents the
spread of pathogens.
● Limit visitors and avoid exposure to people with existing upper respiratory
infections. Other people can spread infections or colds to a susceptible patient through
direct contact, contaminated objects, or through air currents.
● Eliminate allergens and airway irritants such as tobacco, smoke, and dust. Passive
smoking contributes to increasing the incidence of otitis media.
● If infection occurs, teach the patient to take antibiotics as prescribed. Instruct
patients to take the full course of antibiotics even if symptoms improve or disappear.
Completing the duration of the prescribed antibiotics lessens the chance for growth of a
microorganism. Not completing the prescribed antibiotic regimen can lead to drug
resistance in the pathogen and reactivation of symptoms.
● Explain possible causes of OM: exposure to illness of others, and irritation from
environmental smoke. Provides information about health promotion.

Home Care Guidelines

● Take pain medicines exactly as directed.
○ If the doctor prescribed a medicine for pain, take it as prescribed.
○ If not, take an over-the-counter medicine, such as acetaminophen (Tylenol),
ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions
on the label.
○ Do not take two or more pain medicines at the same time unless the doctor
advised it. Many pain medicines have acetaminophen, which is Tylenol. Too
much acetaminophen (Tylenol) can be harmful.
● Plan to take a full dose of pain reliever before bedtime. Also, have adequate rest and
sleep.
● Try a warm, moist face cloth on the ear. It may help relieve pain.
● If the doctor prescribed antibiotics, take them as directed. Do not stop taking them until
the full course of antibiotics.

XI. CROUP
Definition: Croup is characterized by the abrupt onset, most commonly at night, of a barking
cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction.
This upper respiratory infection mostly affects babies or young children. Croup is uncommon
after 6 years of age. Older children can get the same viruses but the breathing tube becomes
wider and stronger so the virus doesn't usually cause croup. However, teenagers and, very rarely,
adults can get croup.
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Etiology:
Croup is caused by a variety of viral agents and Mycoplasma pneumoniae. Croup viruses also
include parainfluenza, influenza, respiratory syncytial virus (RSV), measles and adenovirus.
Viral croup causes your child’s upper airways to swell, making it difficult for them to breathe.

Signs & Symptoms:

● Difficulty Breathing
● Restlessness or Nervousness
● Retractions
● Cyanosis (blue-tinged skin)
● Fever
● Rash
● Eye Redness (conjunctivitis)
● Swollen Lymph Nodes

Assessment:
- Assess the child for breathing pattern, rate, and effort.
- Observe for signs of respiratory distress such as retractions, stridor at rest, changes in
skin color or cyanosis.
- Assess the child's level of anxiety or distress. Crying or agitation can worsen symptoms,
so note how calm or upset the child appears.
- Assess for signs of dehydration, such as dry lips, reduced urine output, and lethargy,
especially if the child is not drinking well.
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- Observe the child’s level of alertness and responsiveness, noting any signs of lethargy or
altered mental status, which can indicate severe hypoxia or exhaustion.

Diagnostics: Usually, you can determine whether your kid has croup by looking at their
symptoms and indications. The most typical symptoms are stridor and a barking cough. Fall and
winter months see an exceptionally high prevalence of this illness. A doctor could recommend
X-rays and lab testing if your child's illness is severe, although this is not common.

Medical Management:
- Oral dexamethasone is the chosen steroid because of its long-lasting benefits in lowering
edema and inflammation in the airways. Give one dosage of this medication.
Intramuscular or intravenous routes may be utilized if oral delivery is not feasible.
- For moderate to severe croup, use nebulized epinephrine to quickly decrease edema in the
airways. Because of its brief duration of action and the requirement for monitoring for
potential side effects, such as rebound symptoms, this is usually administered in a
hospital environment.
- Reduce temperature and pain with acetaminophen (paracetamol) or ibuprofen; these
medications can also aid with breathing and lessen agitation.

Nursing Management:
- Keep the child calm and reassured. Minimize distress by speaking softly and maintaining
a comforting presence to reduce the risk of worsening breathing difficulties.
- Position the child in an upright posture or a position that the child finds most
comfortable. This can help improve airway patency and ease breathing.
- Monitor the child's temperature regularly. Administer antipyretics like paracetamol or
ibuprofen to reduce fever, following the appropriate dosage for the child's age and
weight.
- Encourage the child to drink cool fluids to stay hydrated. Offer small sips frequently to
ensure they are receiving enough fluids.
- If safe and appropriate, take the child outside into the cool air or use a cool mist
humidifier to help reduce swelling in the airway and make breathing easier.
- Regularly assess the child's breathing pattern, rate, and effort. Look for signs of
worsening respiratory distress, such as stridor at rest, retractions, or changes in skin color,
and be prepared to seek emergency medical care if necessary.
- Teach parents or caregivers about signs of worsening croup, when to seek medical
attention, and ways to keep the child calm and comfortable during episodes.