Upper_resp_tract_edited_for_2024_cohort[1].pptx

Upper_resp_tract_edited_for_2024_cohort[1].pptx

1. Upper respiratory tract infections Medical Surgical Nursing 1 2024 COHORT February 2025 By D. Kamalizeni

2. Learning objectives Outline the common URTIs Describe the etiology and pathophysiology of common upper respiratory tract infections Describe clinical manifestations of common upper respiratory tract infections Describe the complications of common upper respiratory tract infections Describe the nursing management of patients with common upper respiratory tract infections

3. Overview of the upper respiratory tract Structures of the upper respiratory tract include: the nose, the nasal cavity, pharynx, epiglottis, Larynx trachea .

4. Key features liable to pathogen infestation include: Nasal mucosa: a sticky mucous membrane that lines the nasal cavity and traps foreign particles Para nasal sinuses: mucosal-lined, air filled cavities in cranial bones (frontal, ethmoidal, sphenoidal & maxillary bones) that surround the nasal cavity; secrete mucus that passes to the back of the nose to moisten the inhaled air. Pharynx or throat

5. Overview of upper respiratory tract infections (URI) Represents the most common acute illness evaluated in the outpatient settings. Range from the common cold—typically a mild, self-limited ailment to life-threatening illnesses such as epiglottitis. Viruses account for most URIs Appropriate management of URI may consist of reassurance, education, and instructions for symptomatic home treatment

6. Definition of common URIs Rhinitis: Inflammation of the nasal mucosa Sinusitis: Inflammation of the paranasal sinuses, including frontal, ethmoid , maxillary, and sphenoid Influenza (Flu) Generalized, acute, febrile, viral disease associated with upper and lower respiratory infections Nasopharyngitis ( rhinopharyngitis or the common cold): Inflammation of the nares, pharynx, tonsils

7. Definition of common URIs CTs Pharyngitis: Inflammation of the pharynx, Epiglottitis ( supraglottitis ): Inflammation of the superior portion of the larynx and supraglottic area Laryngitis: Inflammation of the larynx Laryngotracheitis : Inflammation of the larynx & trachea. Tracheitis : Inflammation of the trachea

8. The common occurring upper respiratory conditions Rhinitis Influenza Sinusitis

9. The common occurring upper respiratory conditions CTs…, Rhinitis Inflammation of the nasal mucosa Can be allergic or viral in origin Allergic Rhinitis Most often, a reaction of the nasal mucosa to a specific antigen Caused by allergy to pollens from trees, flowers, crops Has therefore a seasonal trend

10. Rhinitis CTs Acute Viral rhinitis Also referred to as common cold Caused by virus that invade the upper respiratory tract Highly infectious condition spread by air born droplets Most prevalent in winter months Can be aggravated by chills, fatigue, emotional stress When uncomplicated, it is a self-resolving condition hence ABs are not necessary.

11. Rhinitis CTs Pathophysiology Invasion of the nasal mucosal by the causative agent induces inflammatory rxn There is also leukocytes infiltration and tissue edema because of capillary permeability and vasodilation. This inflammatory response may be confined to the nasal membranes or spread to regions where the nasal mucosa extends: (nasolacrimal/tear ducts, paranasal sinuses, oropharynx) Can also progress to the chest as the nasal mucosal is continuous with the respiratory tract

12. Clinical manifestations of rhinitis Nasal congestion causing obligatory mouth breathing Thin watery nasal discharge Irritating/itchy nasal cavity Sneezing Altered sense of smell

13. Clinical manifestations of rhinitis cts …, Ocular manifestations may include profuse tearing, bilateral conjuctival edema When inflammatory responses extend to the Para nasal sinuses, the air in the sinuses gets absorbed resulting into feeling of partial vacuum and sinus headache localized over the inflamed regions

14. Clinical manifestations of rhinitis CTs Extension of the inflammation to the oropharynx may present with: Cough Hoarseness of voice Snoring Recurrent need to clear the throat Decreased hearing, a sensation of fullness or popping in the ears may be evident of eustachian tube involvement

15. Complications of rhinitis Mostly linked with acute viral rhinitis and these include: Sinusitis Otitis media Pharyngitis Tonsillitis Lung infections

16. Diagnostic approaches Mostly through: Hx taking: ( onset, aggravating factors: environmental related) Physical examination; routine head to toe exam with focus on the general appearance & presentation of the clinical manifestations; the goal being to asses extent and severity of organ involvement Ocular involvement Extent of nasal membrane inflammation Oropharyngeal involvement Check of vital signs Review of lab results (FBC;)

17. Treatment plan for rhinitis Aimed at blocking symptoms Maintaining optimal functioning. Prevent complications

18. Key rx approaches include: Environmental control : identifying and avoiding triggers of the allergic rxns (allergic rhinitis) Drug therapy: ( anti-histamines and decongestants;eg phenylephrine o.25%, 2 drops in each nostril); to manage symptoms: reading assignment on other specific drugs in use Supportive care: Increase fluid intake to liquefy secretions & counter loss from obligatory mouth breathing

19. Nursing management of patients with rhinitis Nursing interventions are directed towards relief of uncomfortable symptoms Increasing fluid intake is key to aid in liquefying secretions Administering the ordered antihistamines and decongestants helps to reduce severity of symptoms

20. Nursing management of patients with Rhinitis CTs Nursing diagnoses Defined according to specific patient presentation Obvious ones could be: Ineffective breathing pattern ……..; further defined in the context of the presence of the following: (Obligatory mouth breathing, dyspnea, snoring) Eg : Ineffective breathing pattern related to nasal mucosal membrane congestion secondary to the disease process(inflammation) evidenced by obligatory mouth breathing

21. Nursing diagnosis CTs Goal of care : Patient to breath at ease and through the nostrils 1 hour after nursing interventions .(specify the easiness of the breathing) Nursing interventions : Explain condition to patient to gain cooperation Elevate head of bed to 45 degrees to facilitate mucous drainage Assess environment for presence of offending allergen and remove it if possible Administer the prescribed decongestant( specify name, dose etc etc ) Emphasize importance of nasal breathing

22. Nursing diagnoses CTs Other nursing diagnoses to address the following: Fluid intake Nutrition Health maintenance (need to prevent symptoms) Susceptibility to infections like infective otitis media, infective conjunctivitis

23. Patient education Key areas to include: Disease process; reinforce the concept of self-care and self management of the disease Environmental control measures and patient`s responsibilities Medications in use, side effects and rationale for use of such medications Importance of monitoring the symptoms, response to therapies, any difficulties, new symptoms etc etc

24. Influenza Disease overview Also termed as Flu Generalized, acute, febrile, viral disease associated with upper and lower respiratory infections There are 3 known groups of flu viruses ( A, B & C), all with many mutagenic strains; ie ; have a remarkable ability to change over time; rendering it a widespread disease C believed to have little pathogenic potential.

25. Pathophysiology Flu viruses are inhaled in mucus droplets from infected persons These then penetrate the surface of upper resp tract mucosal cells causing cell lysis and destruction of the ciliated epithelium This compromises viscosity of mucosa which facilitate spread of virus containing exudate to the lower resp tract An interstitial inflammation and necrosis of the bronchiolar and alveolar result, filling the alveoli with an exudate containing leukocytes, erythrocytes

26. Pathophysiology CTs Regeneration of epithelium slowly begins after 5 th day of the viral infestation reaching maximum within 9 – 15 days; at which time mucous production and cilia begin to appear. Before complete regeneration, the compromised epithelium is prone to bacterial invasion and this can result into pneumonia If virus specific antibodies are adequate, the initial viral invasion can be aborted at the port of entry The disease is usually self limiting; acute symptoms last 2 – 7 days and are followed by convalescent period of about 1 wk

27. Clinical manifestation Onset usually abrupt and characterized by: fever, cough, headache, sore throat If uncomplicated, symptoms may subside within 7 days Complications Mostly pneumonia

28. Diagnostic approaches Hx taking: Hx of having travelled to flu prone regions Sudden onset fever which rises and falls Hx of general body pains, running nose, cough, sore throat Routine physical examination: Check vital signs: high temp, increased resp rate Check for conjunctivitis, erythema of soft palate Review lab investigation results(FBC, sputum culture)

29. Treatment Plan Antipyretic for fever: ASA 600 mgs tds , Decongestants for nasal congestion eg phenylephrine o.25%, 2 drops in each nostril may be prescribed Increase in fluid intake Adequate rest

30. Nursing management Primary goals of nursing care are directed at: Relief of symptoms Prevention of secondary infection: Disease is highly contagious hence adherence to standard IP remains key

31. Nursing management CTs Nursing diagnoses are patient specific and commonly with regard to: Ineffective airway clearance Potential for fluid deficit Activity intolerance Susceptibility to infection; pneumonia Altered comfort Transmission trend of the disease: highly infectious condition

32. Patient education Key Info to include: Bed rest during acute phase Need for isolation Force fluid intake Alertness to symptoms of secondary infection

33. Sinusitis Overview of sinuses Sinuses are air filled spaces in the skull and facial bones. Make up the upper part of the respiratory tract from the nose into the throat. Are located in the forehead (frontal sinuses), inside the cheekbones (maxillary sinuses), and behind the nose ( ethmoid and sphenoid sinuses).

34. Overview of sinuses CTs Overview of sinuses

35. Overview of sinuses

36. Sinusitis Disease overview An inflammatory process that produce changes in the mucosa of the sinus ( Inflammation of the tissues lining the sinuses) Can be caused by bacterial, viral or allergic conditions Frequently follows a common cold as infection spread from the nasal cavity to the sinus. Forceful nasal blowing can also force infected materials into the sinuses Swimming and diving can also cause acute onset of sinusitis

37. Pathophysiology The nasal mucosa extend to the paranasal sinuses Therefore nasal cavity infections spread to these sinuses causing sinusitis (inflamed sinuses) When infected materials block the passageways connecting the sinuses to the nasal cavity, the air in the sinuses gets absorbed; resulting into a partial vacuum and sinus headache localized over the inflamed area. With repeated attacks or infections remain unresolved/treated, the mucosal lining of the sinus may become permanently damaged leading to chronic suppurative sinusitis characterized by continued purulent nasal discharge

38. Clinical manifestation of sinusitis Pain/pressure on the affected site/sinus Purulent nasal discharge Nasal congestion & obstruction Fever, general malaise

39. Treatment plan for sinusitis Use of nasal Decongestants Nasal sprays and nasal decongestants can be used for relief of the symptoms of acute sinusitis. These medications help shrink the inflamed tissues and allow secretions and air to pass through more easily. Over-the-counter nasal spray decongestants should only be used for a maximum of three days. Prolonged use can cause tissues to become more inflamed and lead to a disorder called rhinitis medicamentosa . Consult the doctor before using any drugs to treat sinusitis. Combinations of oral medications and nasal anti-inflammatories may be better options.

40. Treatment plan CTs Use of antibiotics Usually Unnecessary Most cases of sinusitis are triggered by viruses such as the common cold virus hence can not respond to antibiotics. Antibiotics should only be used in cases of sinusitis where a bacteria pathogen is suspected and documented by a culture of the mucus from your sinuses. Home remedies can help relieve some symptoms of sinusitis. (Breathing in warm humidified air can help decrease symptoms of sinusitis.) If symptoms are due to allergies, over-the-counter antihistamines may help.

41. Nursing management Assessment approach; similar to above conditions Nursing diagnoses may include issues of: Alteration in comfort Sensory perceptual alteration: olfactory Sleep pattern disturbances Compromised breathing pattern

42. Nursing interventions May include: Bed rest Elevating head of bed to promote drainage of secretions Applying warm compresses prn for pain relief Administering the ordered analgesics,, antihistamines, Abs as may be ordered IEC on self care and management of the condition

43. IEC Sinusitis Prevention Sinusitis may not be completely avoided; but there are ways to prevent it in some cases: Avoid smoking. Avoid dry environments Use a humidifier when needed Drink plenty of fluids Seek treatment for chronic allergies that can trigger sinus inflammation

44. Other URIs (reading assignment) Nasopharyngitis Pharyngitis Laryngitis Epiglottitis Lryngotrcheitis T racheitis

45. Key issues on URTIs URIs involve direct invasion of the mucosa lining the upper airway. Bacterial/viral inoculation occurs when a person directly inhales respiratory droplets from an infected person who is coughing or sneezing .

46. Key issues cts After inoculation, viruses and bacteria encounter several barriers ( physical, mechanical, humoral, and cellular immune defences): Hair lining the nose filters and traps some pathogens Mucus coats much of the upper respiratory tract, trapping potential invaders The angle resulting from the junction of the posterior nose to the pharynx causes large particles to impinge on the back of the throat Ciliated cells lower in the respiratory tract trap and transport pathogens up to the pharynx; from there they are swallowed into the stomach

47. Key issues CTs Adenoids and tonsils contain immune cells that respond to pathogens. Antigen/antibody rxns act to reduce infections throughout the entire respiratory tract. Resident and recruited macrophages, monocytes, neutrophils, and eosinophils coordinate to engulf and destroy invaders.

48. Key issues CTs A host of inflammatory cytokines mediates the immune response to invading pathogens. Normal nasopharyngeal flora, including various staphylococcal and streptococcal species, help to defend against potential pathogens. Note: Patients with suboptimal humoral and phagocytic immune function are at increased risk for contracting URI, and they are at increased risk for a severe or prolonged course of disease. Inflammation (chronic or acute) from allergy predisposes individuals to URI.

49. References Med/ surg texts