UPPER RESPIRATORY

INFECTIONS


 ALLERGIC RHINITIS

Is clinically defined as a symptomatic disorder of the nose

induced an IgE-mediated inflammation after exposure of the
membranes liningthe nose
Onset is common in childhood, adolescence and early adulthood

Symptoms often wane in older adults, but may develop or persist at any

No apparent gender selectivity or predisposition for developing allergic rhinitis

May contribute to other conditions such

 Sleep disorders

 Fatigue

 Learning problems
The Allergic Reaction
 How are the symptoms
caused?
➘ Irritation of endings

➘ Itching and sneezing

➘ Increased mucus production

➘ Rhinorrhoea

➘ Vasodilation

➘ Congestion

➘ Increased vascular permeability

➘ Edema
 Clinical Manifestations

 Nasal congestion

 Postnasal drainage

 Nasal pruritus

 Ear symptoms

 Watery rhinorrhea

 Eye symptoms

 Repetitive sneezing
 Diagnosis of AR

 History

 Physical / Nasal Examination

 LaboratoryTesting
 Skin Prick Test

 Peak Nasal Inspiratory Flow Rate

 Rhinomanometry
 Management of AR

 Allergen Avoidance

 Pharmacotherapy

 Immunotherapy
 Medications used to treat
allergic rhinits:
 Antihistamines – chlorpheneramine

 Decongestants – oxymetaxoline

 AH--D combinations

 Corticosteroids – beclomethasone

 MastCell stabilizers

 Cromolyn sodium

 Anticholinergics

 Antileukotrienes
 Antihistamines

Act by preventing histamine from binding to the H11 receptors

Primarily helpful in controlling: Sneezing, itching & rhinorrhoea

Ineffective in releiving nasal blockage

1st generation anti-histamines 2nd generation antihistamines

chlorpheniramine cetrizine

diphenylhydramine azelastine

fexofenadine

loratadine
 VIRAL RHINITIS

Common causative organisms:

 Rhinovirus 1° causative organism

 Respiratory syncytial virus

 Adenovirus

- mainly spreads by droplet infection

 Clinical Manifestations

 Rhinnorea

 Sneezing

 Nasal congestion

 Sore throat

 Lethargy

 Fatigue
 Complications

 Pharyngitis

 Sinusitis

 Otitis media

 Tonsilitis

 Chest infections
 RHINOSINUSITIS

 Formerly called sinusitis

 An inflammation of the paranasal sinuses and nasal cavity

 Classified by duration of symptoms:

 Acute (less than 4 weeks)
 Subacute (4-12 weeks)
 Chronic (more than 12 weeks)
 Signs & Symptoms

 Purulent nasal drainage

 Facial pain-pressure-fullness

 Cloudy or colored nasal discharge

 Localized or diffused headache

 ACUTE PHARYNGITIS

Sudden, painful inflammation of the pharynx.

Commonly referred to as “sore throat”.

 Clinical Manifestations

 Fiery-red pharyngeal membrane and tonsils

 Swollen lymphoid follicles flecked with white-purple exudate

 Enlarged and tender cervical lymph nodes

 ( - ) cough

 Fever (higher than 38.3°)

 Malaise

 Sore throat
 Diagnosis of AP

 Culture study / swab specimens

(Posterior pharynx and tonsils)

 RSAT
 Medical Management

 Viral: Supportive measures

 Bacterial:
 Antibiotics
 Penicillin
 Cephalosporins
 Macrolides (clarithromycin, azithromycin)
 Analgesics
 Aspirin, acetaminophen
 Nursing Management

 Oral hygiene (salt-water gargle)

 Liquid or soft diet

 Cool beverages, warm liquids and flavored frozen desserts

 Increase fluid intake

 Assess skin for rashes

 Signs of Complications

 Dyspnea

 Drooling

 Inability to swallow

 Inability to fully open mouth

 CHRONIC PHARYNGITIS

 Persistent inflammation of the pharynx

 Risk Factors:
 Dusty surroundings
 People who use their voice to excess, suffer from chronic cough
 Habitual use of alcohol and tobacco
 Medical Management

 Avoid exposure to irritants

 Relief of nasal congestion by short term use of decongestants

 Ephedrine sulfate (Kondon’s Nasal)
 Phenylephrine hydrochloride (Neo-synpehrine)
 Pseudoephedrine (Sudafed)
 Brompheneramine

 Surgery
 TONSILLITIS AND
ADENOIDITIS

 GABHS (Group A Beta Hemolytic Streptococcus)

 Epstein-Barr, Cytomegalovirus

 Signs and Symptoms:  Signs and Symptoms:

(Tonsillitis) (Adenoiditis)
 Sore throat  Mouth-breathing
 Fever  Earache
 Snoring  Draining ears
 Difficulty swallowing  Voice impairment
 Noisy respiration
 Management

 Increase fluid intake

 Administer analgesics

 Salt-water gargles

 Promote rest

 Surgery
 Tonsillectomy
 Adenoidectomy

 Pharmacologic therapy
 Penicillin
 Cephalosphorins
 PERITONSILLAR ABSCESS

Epidemiology:
 Accumulation of pus between the tonsillar capsule and the
surrounding tissues.
 Also called ”quinsy”
 More common in adolescents than in children
 Greatest risk to airway – Spontaneous rupture
of abscess
 SIGNS & SYMPTOMS

 Appear acutely ill

 Deviation of tonsil toward midline with rotation of anterior or
tonsillar pillar
 Dysphagia
 Enlargement of the tonsil
 Fever
 Trismus
 Drooling
 Hoarse, muffled “hot potato” voice
 Ipsilateral ear pain and torticollis
 Refusal of food and, in severe cases, liquids
 Diagnosis

 Uvular deviation
 Marked soft palate displacement
 Severe trismus
 Airway compromise
 Localized areas of fluctuance
 Treatment

1. If patient is nontoxic-appearing, has findings most consistent with

peritonsillar cellulitis and has good follow up with PCP or ENT
then may tx as outpatient with penicillin, a macrolide, or
clindamycin
2. Definitive tx for PTA is either I&D in OR or needle aspiration in
E.D. or ENT office
Continue as above with ATBX and pain controlASD
3. Tonsillectomy
 Management

 Encourage the use of prescribed topical anesthetic agents

 Assist with throat irrigation (Saline or alkaline gargles)
 Adequate hydration
 Observe and instruct the client for signs of complications
(hemorrhage)
 LARYNGITIS

 Inflammation of the larynx

 Commonly, viral

 Often as a result of:

 Voice abuse
 Exposure to dust, chemicals, smoke, and other pollutants
 Signs and Symptoms

 Hoarseness

 Aphonia

 Severe cough
OBSTRUCTION AND
TRAUMA OF THE
UPPER
RESPIRATORY
AIRWAY


 OBSTRUCTION DURING
SLEEP

Recurrent episodes of upper airway obstruction and a reduction in

ventilation.

Defined as cessation of breathing (apnea) during sleep.

 Risk Factors

 Obesity

 Male

 Postmenopausal stage

 Advanced age
 Clinical Manifestations

 Frequent and loud snoring with apnea for 10 seconds or

longer, 5 episodes per hour, followed by awakening abruptly
with a loud snort.

 Gasping

 Choking
 Diagnosis of OSA

 Sleep study (Polysomnographic finding) which includes the

following:
 EEG
 Electro-oculogram
 ECG
 Respiration
 Oximetry
 Medical Management

 Weight management and avoidance of alcohol and hypnotic

medications
 CPAP, BiPAP

 Surgery:
 Tonsillectomy
 Uvulopalatopharyngoplasty
 Nasal septoplasty
 Tracheostomy
 Pharmacologic Therapy

 Modafinil (Provigil)

 Protriptyline (Triptil)

 Medroxyprogesterone acetate (Provera)

 Acetazolamide (Diamox)
 EPISTAXIS (NOSEBLEED)

Bleeding from the nose caused by rupture of tiny, distended

vessels in the mucus membrane

Most common site: Anterior septum

Causes:
 Trauma
 Infection
 Hypertension
 Blood dyscracisa, nasal tumor, cardio diseases
 Management

 Position patient: Upright, leaning forward, head tilted

 Apply direct pressure. Pinch nose against the middle septum, 5-

10 minutes
 If unrelieved, administer topical vasoconstrictors

(silver nitrate, gel foams)

 Assist in electrocautery and apply nasal packing for posterior
bleeding
 NASAL OBSTRUCTION

Sense of blockage within the nose or difficulty breathing out of one

or both sides.

Two major components of the nasal passages are the septum and the
turbinates.
 Causes

Anatomic: Non - Anatomic:

Deviated septum Chronic sinusitis
Nasal polyps Allergies
Large adenoids Overuse of nose sprays
Nasal foreign body
Birth control pills
Hypertrophic turbinate
bones Hypertension

·           Thyroid abnormality      

 Medical Management

 Surgical
 Functional Rhinoplasty

 Pharmacologic
 Nasal corticosteroids
 Leukotriene inhibitors
 Antibiotics
 Astringent (for hypertrophied turbinates)
 Nursing Management

 Position: Elevate the head of the bed.

 Oral hygiene

 Instruct to avoid blowing the nose with force

 Observe for signs of complications, notify the physician

 Bleeding
 Infection
 FRACTURES OF THE NOSE

 Bones of the nose are broken more often than any other facial
bone.

 May affect the ascending process of the maxilla and the

septum.
 Clinical Manifestations

 Pain

 Bleeding from the nose (Externally and Internally into the pharynx)

 Swelling of the soft tissues

 Periorbital ecchymosis

 Nasal obstruction

 Deformity
 Assessment & Diagnosis

 Intranasal examination to rule out septal hematoma

 Clear fluid draining from either nostril suggests a fracture of

the cribiform plate with leakage of cerebrospinal fluid.

 Deviations of the bone or disruptions of the nasal cartilages

 X-ray
LARYNGEAL OBSTRUCTION

 Serious, often, fatal condition

 Clinical Manifestations

 X-ray confirms the diagnosis

 May have lowered oxygen saturation

 Retractions in the neck or abdomen during inspirations

 Assessment and Diagnosis

 Patient’s history

(heavy alcohol or tobacco consumption, current medications,

history of airway problems, recent infections, pain or fever,
dental pain or poor dentition, previous surgeries, radiation
therapy or trauma)
 Medical Management

 Ensure patent airway

 Finger sweep
 Subdiaphragmatic abdominal thrust maneuver
 Tracheotomy

 Pharmacologic
 Epinephrine
 Corticosteroid

 Ice compress on the neck to reduce edema

 CANCER OF THE LARYNX

Also known as laryngeal cancer.

It can develop in any part of the larynx. Most begin in the glottis

Etiology: Unknown
 Risk Factors

 Age. Over the age of 55.

 Gender. Men

 Race. African Americans

 Smoking.

 Alcohol.

 A personal history of head and neck cancer.

 Occupation. Exposure to sulfuric acid mist, nickel and asbestos.

 Diet low in vitamin A
 GERD
 Signs & Symptoms of LC

 Hoarseness or other voice changes

 A lump in the neck

 A sore throat or feeling that something is stuck in your throat

 A cough that does not go away

 Problems in breathing

 Bad breath

 An earache

 Weight loss
 Diagnosis

 Physical exam

 Indirect laryngoscopy

 Direct laryngoscopy

 CT scan

 Biopsy
 Medical Management

 Radiation therapy
 Radiation therapy combined with surgery
 Radiation therapy combined with chemotherapy

 Surgery
 Total laryngectomy
 Partial laryngectomy (hemilaryngectomy)
 Supraglottic laryngectomy: The surgeon takes out the supraglottis, the top part
of the larynx.
 Cordectomy: The surgeon removes one or both vocal cords.

 Chemotherapy
 Nursing Management

Pre-operative
 Provide the patient pre-operative teachings
 Clarify misconceptions
 Tell that the natural voice will be lost
 Teach communication alternatives

 Reduce anxiety
 Provide opportunities for patient and family to ask questions
 Referrals to previous patients with LA and cancer groups

 Maintain patent airway

 Position: Semi or High Fowler’s
 Suction secretions
 Encourage to deep breath, turn and cough
 Nursing Management

Post-operative:

 Administer care of the laryngectomy tube

 Suction as needed
 Cleanse the stoma with saline
 Administer humidified oxygen
 Laryngectomy tube is usually removed within 3-6 weeks after surgery

 Promote alternative communication methods

 Call bell or hand bell
 Magic slate
 Hand signals
 Collaborate with speech therapist
 Nursing Management
Post-operative:

 Provide adequate nutrition

 NPO after operation for 10 days
 IVF, TPN are alternative nutrition routes
 Start oral feedings with thick liquids, avoid sweets

 Promote positive body image and self-esteem

 Encourage verbalization of feelings
 Allow independence in self-care

 Monitor for signs of complications

 Respiratory distress
 Hemorrhage
 Wound infection and breakdown
 Increased temperature, purulent drainage and redness/tenderness
 Nursing Management

 Administer antibiotics

 Clean and change dressing OD

 Humidification system at home

 Avoid swimming

 Cover the stoma with hands or plastic bib over the opening

 Advise beauty salons to avoid hair sprays, powders and loose hair near
the opening
 Frequent oral hygiene