Comon Cold upper respiratory tract infection

Medical surgical nursing diagnosis

1. VIRAL RHINITIS ( COMMON COLD) MEDICAL/SURGICAL NURSING I

2. Introduction 1. The term “common cold” often is used when referring to an upper respiratory tract infection that is self-limited and caused by a virus (viral rhinitis) 2. Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose. It may be classified as nonallergic or allergic 3. Nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise characterize it

3. 4. Specifically, the term “cold” refers to an afebrile, infectious, acute inflammation of the mucous membranes of the nasal cavity 5. It can also be used when the causative virus is influenza (“the flu ”) 6. Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase

4. 7. The common cold is the most common cause of absenteeism from work and school 8. Incidence of viral rhinitis follows a specific pattern during the year, depending on the causative agent 9. Each virus may have multiple strains e.g there are over 100 strains of rhinovirus, which accounts for 50% of all colds

5. 10. The six viruses known to produce the signs and symptoms of the viral rhinitis are rhinovirus parainfluenza virus Coronavirus respiratory syncytial virus ( RSV) influenza virus Adenovirus

6. Transmission D irect contact with infected secretions I nhalation of large particles that land on a mucosal surface from coughing or sneezing I nhalation of small particles (aerosol) that may be suspended in the air for up to an hour Hand washing remains the most effective measure to prevent transmission of organisms.

7. Pathophysiology Nonallergic rhinitis may be caused by a variety of factors , including environmental factors such as changes in temperature or humidity , odors, or foods infection; Age systemic disease drugs (cocaine ) or prescribed medications; or the presence of a foreign body . Drug-induced rhinitis is associated with use of antihypertensive agents oral contraceptives chronic use of nasal decongestants .

8. Pathophysiology The allergen/organism invades the epitherial cells in the nasal cavity, the body immune responds by producing immune mediators and starts and inflamatory response. The body also produces mucus so that they can trap the invading organism or the allergen. With collection of the invading organism/allergen and the body cells that have died and waste products make the mucus thick.

9. Clinical Manifestations/Defining Characteristics nasal congestion runny nose Sneezing nasal discharge nasal itchiness, tearing watery eyes g.) “scratchy” or sore throat h.) general malaise

10. i ) low-grade fever j.) chills k.) headache l.)muscle aches m.) As the illness progresses, cough usually appears n.) In some people, viral rhinitis exacerbates the herpes simplex, commonly called a cold sore The symptoms last from 1 to 2 weeks

11. common cold preventive measures identify strategies to prevent infection and, if infected, to prevent spread of infection to others Perform hand hygiene often Use disposable tissues Avoid crowds during the flu season Avoid individuals with colds or respiratory infections Obtain influenza vaccination, if recommended (especially if elderly or diagnosed with a chronic illness )

12. VI. Practice good health habits Eat a nutritious diet Get plenty of rest and sleep Avoid or reduce stress when possible Exercise appropriately Avoid smoking or second-hand smoke Avoid excessive intake of alcohol Increase humidity in house, especially during winter Practice adequate oral hygiene VII. Avoid allergens, if allergies are associated with upper respiratory infections

13. Medical Management There is no specific treatment for the common cold or influenza Management consists of symptomatic therapy Some measures include: providing adequate fluid intake encouraging rest preventing chilling increasing intake of vitamin C using expectorants as needed Warm salt-water gargles soothe the sore throat and

14. Medical Management nonsteroidal anti-inflammatory agents (NSAIDs) such as aspirin or ibuprofen relieve the aches, pains, and fever Antihistamines are used to relieve sneezing, rhinorrhea, and nasal congestion Topical (nasal) decongestant agents may relieve nasal congestion ; however , if they are overused they may create a rebound congestion that may be worse than the original symptoms

15. Medical Management zinc lozenges may reduce the duration of cold symptoms if taken within the first 24 hours of infection Amantadine ( Symmetrel ) or rimantadine ( Flumadine ) may be prescribed prophylactically to decrease the signs and symptoms as well NB: Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications

16. NURSING MANAGEMENT Using the Nursing Process to Manage the patient

17. 1. Assessment Identify the patient in more than 2 ways Airway - Secretions, Obstructions Respiration/ Breathing - Type, Patterns, sounds, rate,volume, rythm, effort, chest movement Circulation- coldness, fatigue, SpO 2 oximetry Vital Signs - Respiration and Temperature Patient’s history

18. vi) Distention/Drugs - Vein, Artery, any medication vii) Pain – OLDCART viii) Others - Any visible traumas, fractures,wounds, tubes ix) Underlying conditions x)Nutrition xi) Elimination xii)Activity, Sleep and rest pattern xiii) Cleanliness - maintain self and environment(eg keep used tissues away, clean handkerchief when soiled) xiv)Health perception - Management of disease and self xv)Cognitive perception - Smell and taste xvi) Coping with illnees and aftermath eg miss school or work xvii) Education Needs

19. Diagnosis Acute pain Ineffective Airway clearance/ Compromised nasal patency Altered breathing Fatigue Knowledge deficiency Altered body temperature/hyperthermia Fluid volume; risk for deficiency, risk for overload

20. Plan: Goals Reduce histamine reaction Promote effective airway Reduce anxiety levels Reduce the pain from…to… Patent nose B. Expected Outcome Patient expresses reduced aches and pain, anxiety Patient expresses ability to breathe normally with both nostrils No congestion or runny nose Vitals signs within normal range No Fatigue,dizziness

21. Interventions – Dependent on the Nursing diagnosis, goals and outcome. Comes with a rationale Reassure patient Monitor the patient, vital signs, anxiety levels, pain. Provide a place to dispose off used tissue/material Administer prescribed medication Patient Education

22. Evaluation: Evaluate what you have intervened on Anxiety levels Loss of fluids Airway Breathing Circulation Pain Vital signs Transmission prevention Knowledge needs DOCUMENT

23. Prevention Causes: Allergens, foreign bodies and organisms Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose. transmission Nursing Management Clinical Manifestation/defining charateristics Pathophyysiology Medical Management

24. Colds and Cold sores (Herpes Simplex Virus) The herpes simplex virus (HSV-1) produces the familiar herpes labialis , commonly called a cold sore or fever blister

25. Causes In the past, this painful blisterlike lip sore was thought to be caused by a cold or a fever Herpis Simplex Virus - Human alphaherpesvirus 1 and Human alphaherpesvirus 2 The incubation period is 2 to 12 days

26. Pathophysiology The herpes virus infection remains latent in cells of the lips or nose and is activated by stress, sunlight, and febrile illnesses from the common cold to streptococcal pneumonia, meningococcal meningitis, and even malaria Small vesicles, single or clustered, may erupt on the lips, inside the mouth, including the tongue, soft and hard palate, gums, buccal mucosa, and the pharynx These soon rupture, forming sore shallow ulcers that increase in number

27. TRANSMISSION P rimarily by direct contact with infected secretions The virus may also be transmitted from an asymptomatic person The herpes virus may subside spontaneously in 10 to 14 only to recur when activated

28. NURSING MANAGEMENT Using the Nursing Process to Manage the patient

29. NURSING MANAGEMENT ASSESSMENT Identify the patient in more than ways Vital Signs Skin around mouth Pain Emotional – patient may be angry with the partner for the infection Risk for other Sexually transmitted disease Virology/sample swabing

30. Diagnosis Acute pain Altered Skin intergrity Knowledge deficiency Altered body temperature/hyperthermia Infection Poor coping with diagnosis

31. Plan: Goals Clear infection Alleviate pain Coping with the diagnosis B. Expected Outcome Patient expresses reduced aches and pain, Patient verbalized is able to cope with the diagnosis Vitals signs within normal range No STDs

32. Interventions – Dependent on the Nursing diagnosis, goals and outcome. Comes with a rationale Reassure patient Monitor the patient, vital signs, pain. Speciment collection and laboratory testing Administer prescribed medication Patient counceling Patient Education

33. Evaluation: Evaluate what you have intervened on Cleared infections Pain Vital signs Transmission prevention Knowledge needs DOCUMENT

34. Medical Management acyclovir , an antiviral agent, may be administered orally or topically to minimize the symptoms and the duration or length of the flare-up Analgesics , such as acetaminophen (Tylenol) with codeine or aspirin with codeine, are helpful in relieving pain and discomfort Topical anesthetics, such as lidocaine ( Xylocaine ) or dyclonine ( Dyclone ) may relieve oral pain Applications of drying lotions or liquids may help to dry the lesions.

35. References Smeltzer S.C., Bare B.G., Hinkle J.L., and Cheever K.H. (2012). Brunner and Suddarth Text Book of Medical-Surgical Nursing. Lippincort Williams and Wilkin.

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