1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Respiratory Tract Conditions Chapter 22

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Lungs Occupy majority of thoracic cavity Primary bronchial tubes Alveoli

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Upper Respiratory Tract Infections Often caused by viruses No participation in physical activity –Fever (≥100.5°F) –Severe malaise –Myalgias –Weakness –Shortness of breath –Dehydrated

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Common Cold Contagious –Person–person contact –Airborne droplets Key—prevention!!!!

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Common Cold (cont.) S&S (begin 1–2 days after exposure and last 1–2 weeks) –Rhinorrhea –Sneezing –Nonproductive cough –Eye irritation –Malaise –Sore throat –Low-grade fever/chills Management –No cure—viral; OTCs can alleviate symptoms –Rest; fluids –Vitamin C; zinc gluconate

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Sinusitis Inflammation of the paranasal sinus Bacterial, viral, allergy, or environmental factors Often triggered by obstruction of passageway between the sinuses S&S –Congestion –Facial pain (behind cheeks and eyes, above teeth) –Purulent discharge possible –Coughing –Swelling of eyes –Fever and chills

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins

8. Sinusitis (cont.) Bacterial infection—drainage will be dark; other causes— clear Management –Physician referral –Control infection, reduce mucosal edema, and allow for nasal discharge

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Pharyngitis Viral, bacterial, or fungal infection of the pharynx, leading to a “sore throat” S&S –Throat—dark red –Tonsils swollen and red (possible pus present) –Swallowing—painful –Ear pain (due to swallowing) –Rhinorrhea –Lymphangitis –Headache –Cough –Low-grade fever

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Pharyngitis (cont.) Management –Physician referral—must rule out “strep”; requires antibiotic –Otherwise, treat symptoms—rest, fluids, warm saline gargles, lozenges, and analgesics

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Laryngitis Tissues below level of epiglottis are swollen and inflamed S&S –Weak, hoarse, gravely voice –Sore throat –Fever –Cough (usually dry and nonproductive) –Difficulty swallowing Management –Self-limiting –Decrease talking! –Treat symptoms

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Tonsillitis Lymph glands located at back of throat Help protect the pharynx by filtering disease-producing bacteria S&S –Inflamed and enlarged tonsils –Fever –Painful swallowing –Sore throat –Slight voice change Acute cases: treated with antibiotics Chronic: surgical removal

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Allergic Rhinitis (Hay Fever) Seasonal allergic rhinitis –Involves a specific period of symptoms in successive years –Caused by airborne pollens or fungus spores associated with that season Perennial allergic rhinitis –Occurs year-round if continually exposed to allergens

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Allergic Rhinitis (Hay Fever) (cont.) S&S –Postnasal drainage leads to chronic sore throat and bronchial infection Take a complete history Management –Limiting exposure to allergen –Suppressive medication to alleviate symptoms

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchitis Inflammation of mucosal lining of tracheobronchial tree Acute –Commonly seen in physically active individuals –Involves bronchial swelling, mucus secretion, and increased resistance to expiration –S&S Coughing Wheezing Large amounts of purulent mucus

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchitis (cont.) Chronic bronchitis –Can progress to serious illness –S&S Marked cyanosis Edema Large production of sputum Abnormally high levels of CO 2 and low levels of O 2

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchitis (cont.) Management –Viral—no specific therapy available –Bacterial—treated more effectively with macrolides –Chronic—medical supervision to control symptoms and prevent systemic failure

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchial Asthma Caused by: –Constriction of smooth bronchial muscles –Increased bronchial secretions –Mucosal swelling Leads to inadequate airflow during respiration (especially expiration)

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchial Asthma (cont.) S&S –Wheezing –Rapid fatigue –Acute attack –Thick yellow/green sputum –Anxiety –Sweating –Rapid heart rate –Cyanosis, ↓ LOC in severe cases

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Bronchial Asthma (cont.) Management –Seek medical help if no medications have been prescribed –Administer prescribed medications

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Exercise-Induced Bronchospasm Various factors can contribute to severity; ↑ risk with allergies, sinus disease, hyperventilation Key—amount of ventilation and temperature of inspired air –↑ ventilations in cold, dry, air → ↑ EIB risk –↑ strenuous exercise → ↑ ventilations Use of peak flowmeter –Normal: up to a 10% ↓ in FEV 1 after exercise –Mild EIB: ↓ 10%–20% –Moderate to severe EIB: ↓ 20%–40% –Severe EIB: >40%

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Exercise-Induced Bronchospasm (cont.) S&S –Chest pain and tightness –Regular dry cough –SOB after or during exercise –Symptoms appear after 8–10 minutes of activity and may worsen after activity stops –Refractory period

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Exercise-Induced Bronchospasm (cont.) Management –Prescribed medications –Use of inhaler –Proper warm-up and cool-down

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Influenza Viral bronchitis caused by Haemophilus influenzae type A, B, or C Often epidemics—immunization available S&S –↑ temperature –Chills –Malaise –Headache –General muscle aches –Hacking cough –Inflamed mucous membranes –Rapid onset within 24–48 hours of exposure

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Influenza (cont.) Management –Rest and fluids –Cough medications and analgesics for pain and fever –Referral—fever does not reduce within 24 hours or fever >103°F

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Pneumonia Inflammation and infection of lungs Caused by bacteria, viruses, mycoplasmas, and other infectious agents S&S (can vary with type of organism causing infection) –Bacterial pneumonia Often follows URI Symptoms appear suddenly Shaking, chills, a high fever, sweating Chest pain (pleurisy) Cough that produces thick, rust-colored, greenish or yellow phlegm

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins Pneumonia (cont.) –Viral pneumonia Starts with a dry (nonproductive) cough, headache, fever, muscle, and fatigue Progression—may become breathless and develop cough that produces phlegm Risk of developing a secondary bacterial pneumonia as well Management –Bacterial pneumonia—antibiotics –Viral—rest and fluids; antibiotics are not effective