1. UPPER RESPIRATORY INFECTIONS
It may become complicated by a bacterial infection.
Sinus congestion causes an increase in sinus drainage, post-nasal drip, throat irritation, HA, and earache.
Adult Health Nursing 7th Ed

2. ACUTE RHINITIS Coryza, “common cold” Etiology and pathophysiology
-An inflammatory condition
- mucous membranes of the nose and
accessory sinuses
-Caused by one or more viruses.
-signs/symptoms-evident hours after exposure
Characterized by edema of the nasal mucous membranes

3. ACUTE RHINITIS If uncomplicated, it subsides in a week.
CLINICAL MANIFESTATIONS
Sinus congestion
-increased sinus drainage
- postnasal drip
- throat irritation
- headache
- earache
Productive cough.
Fever.
If uncomplicated, it subsides in a week.

4. Acute Rhinites SUBJECTIVE: 1. Pt. complaints of symptoms OBJECTIVE:
1. Color , consistency of nasal discharge.
2. Visual exam the throat for redness,
edema, local irritation.
3. Presence and duration of fever

5. Diagnostic Tests
Throat and sputum cultures.

6. MEDICAL MANAGEMENT -prevention of complications.
-Accurate diagnosis
-prevention of complications.
-No specific treatment
-Aspirin or Tylenol
- analgesia/fever
-Cough suppressant
- dry, nonproductive cough.
-Cough expectorant
- productive cough
-antibiotic
- bacterial infection .
Vit C, lozenges

7. NURSING INTERVENTIONS
-Promote comfort.
-Encourage fluids.
-Apply warm, moist packs to sinuses.

8. PATIENT AND FAMILY TEACHING
-proper hand washing
-disposal of tissues
-limit exposure to others during the first
48 hours
-check body temp. every 4 hours.

9. Ineffective airway clearance, related to nasal exudate
NURSING DIAGNOSIS
Ineffective airway clearance, related to nasal exudate
Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection
AHN p419
Fluids to liquify secretions and aid in expectoration.
Use vaporizer to moisten mucous membranes.
Health maintenance behaviors. (proper hand washing, disposal of used Kleenexes, etc.
2.Adequate fluids and nutrition.

10. ACUTE FOLLICULAR TONSILLITIS
Etiology and pathophysiology
-Acute inflammation of the tonsils.
-Result of an air- or food borne
bacterial infection
-often Streptococcus
-Can be viral

11. Acute Follicular Tonsilitis
-If it is caused by Group A β-hemolytic Streptococci, sequelae can occur: -Rheumatic fever -Carditis -Nephritis. -Most common in children.
Sequelae: resulting from a disease or condition

12. CLINICAL MANIFESTATIONS
-sore throat
-fever
-chills
-malaise
-enlarged, tender, cervical lymph
nodes.
-general muscle aching.
-Labs
-CBC reveals an increased WBC count.

13. MUSCLE ACHE, ENLARGED CERVICAL NODE

14. -patient complains of: - severity of the sore throat - ear pain
ASSESSMENT
SUBJECTIVE:
-patient complains of:
- severity of the sore throat
- ear pain
- headache
-joint pain

15. OBJECTIVE DATA:
1. Visual exam:
- throat secretions
- enlarged, reddened tonsils.

16. DIAGNOSTIC TESTS 1. Throat culture 2. CBC to check the WBC count
With bacterial infection, WBC can rise to 10-20,000
Throat culture will identify the causative microorganism, most commonly β-hemolytic strep.

17. MEDICAL MANAGEMENT -Early antibiotics - specific to the bacteria.
-Tonsillectomy and adenoidectomy (T&A)
- usually done in people who have
recurrent attacks
-Medications:
- antipyretics, analgesics, and antibiotics
-Warm, saline mouth gargles. ,
Chloraseptic spray, lozenges
T&A local or general

18. NURSING INTERVENTIONS
-Thorough oral care
- promotes comfort
- reduces/prevents infection.
Post-OP care: IV fluids until the nausea subsides, then the pt. may begin drinking ice cold fluids slowly.
Advance the diet to soft liquids, then to a regular diet.

19. NURSING INTERVENTIONS
-Post-operative
- observe for:
- bleeding.
- fever
- check V.S.
- provide physical and emotional comfort
- postioning
- support
- pain medication
- apply an ice collar to the neck
- comfort and vasoconstriction.
Watch for s/sx; elevated temp

20. Nursing Diagnoses
Pain, related to inflammation/irritation of the pharynx.
Risk for deficient fluid volume, related to inability to maintain usual oral intake because of painful swallowing
Risk for aspiration, related to postoperative bleeding
Assess the degree of pain and the need for analgesics.
Offer warm, saline gargles, ice chips, and/or ice collar.
Document

21. Nursing Interventions
-Maintain patent airway - keep the pt. lying on his side - prevents aspiration. -Observe for frequent swallowing - may indicate bleeding - check the back of the throat with a flashlight for blood trickling down.
(if there is vomitus, check the color. Dark brown may indicate swallowed blood.)
(skin turgor, mucous membranes, urine output).
(ice cream, sherbet, puddings, yogurt, etc)

22. Nursing Interventions
- assess hydration status. - encourage ice chips, popsicles, and cold fluids. - avoid citrus fluids -may irritate the throat - measures to avoid vomiting

23. VOMITING

24. Patient and family Teaching
- Complete the prescribed antibiotic - Tonsillectomy patient - instruct on the dietary precautions. - avoid clearing his throat, vigorous coughing, sneezing, or nose blowing after surgery for 1-2 weeks. - may cause bleeding
Post op- IV until nausea gone,then drink ice cold liquids then custard & ice cream then normal.
Ice collar comfort measures .; watch for hemmorhage

25. Patient and Family Teaching
- notify the PCP if there are any
complications.
- void ASA or other blood-thinning
medications

26. LARYNGITIS Etiology/pathophysiology Inflammation of the larynx
- due to virus or bacteria
May cause severe respiratory distress in children under 5 years old
-small larynx of the young child
- subject to spasm when irritated or infected
- becomes partially or totally obstructed
Dx thru laryngoscopy to reveal edema, drainage and erythematous laryngeal mucosa

27. LARYNGITIS Clinical manifestations/assessment Hoarseness Voice loss
Scratchy and irritated throat
Persistent cough

28. Assessment Subjective Patient report of: Progressive hoarseness
Productive/non-productive cough
Exposure to inhaled irritants
Objective
Evaluate patient’s voice quality
Sputum characteristics

29. DIAGNOSTIC TESTS Laryngoscopy - edema
- drainage of vocal cords and laryngeal
mucosa

30. MEDICAL MANAGEMENT Viral—no specific treatment Bacterial—antibiotics
Analgesics
Antipyretics
Antitussives
Warm or cool mist vaporizer
Limit use of voice

31. Pain, related to pharyngeal irritation
NURSING DIAGNOSES
Pain, related to pharyngeal irritation
Impaired verbal communication , related to edematous vocal cord
Pain level, offer meds & steam inhalation
REST VOICE, communicate thru writing, gestures, anticipate pt needs

32. NURSING INTERVENTIONS
Encourage oral intake
Encourage adequate rest
Use of vaporizer  increase humidity  keep secretions thin and easier to expectorate
Medication teaching
Avoid exposure to inhaled irritants
Preventive measures

33. PHARYNGITIS Etiology/pathophysiology Inflammation of the pharynx
Chronic or acute
Frequently accompanies the common cold
Viral, most common
Bacterial – a severe form of pharyngitis – strep throat
It is the most common throat inflammation. Strep throat

34. PHARYNGITIS Clinical manifestations/assessment Dry cough
Tender tonsils
Enlarged cervical lymph glands
Red, sore throat
- scratchy  difficulty swallowing
Fever

35. PHARYNGITIS - Medical Management
Antibiotics
Penicillin, Erythromycin
Treat severe infections
Prevent superimposed infections in people with cardiac history
Analgesics
Antipyretics
Warm or cool mist vaporizer

36. Nursing Interventions/ Patient Teaching
Offer throat gargles/rinses
Adequate Rest
Adequate oral fluids
Use of vaporizer
Medications: pain meds, antibiotic, antipyretic

37. Impaired oral mucous membrane, related to edema
NURSING DIAGNOSES
Impaired oral mucous membrane, related to edema
Deficient fluid volume, risk for, related to decreased oral intake as a result of painful swallowing
Warm saline, lozenges level of pain, & meds, fluids
Observe & record hydration status, I&O, temp, IV therapy if needed

38. SINUSITIS Etiology/pathophysiology Underlying pathophysiology:
Inflammation of the sinuses
Usually begins with an upper respiratory infection
Viral or bacterial
Chronic or acute
Underlying pathophysiology:
Begins with a URI  sinus infection

39. SINUSITIS Clinical manifestations Constant, severe headache
Pain and tenderness in involved sinus region
Purulent exudate
Malaise
Fever

40. SINUSITIS Assessment: Subjective: Patient report of: Objective
Decrease appetite or nausea
Generalized malaise, headache, pain in the sinus region
Objective
VS – esp. temp
Character and amt of drainage

41. SINUSITIS
DIAGNOSTIC TESTS: Sinus Radiographs – reveals cloudy or fluid filled sinuses Transillumination – shining a light in the mouth with the lips closed around it. Infected sinuses will look dark and normal sinuses will transilluminate

42. MEDICAL MANAGEMENT Surgical interventions: Nasal Windows –
- allows better drainage and removal of
diseased mucosal tissue
Antibiotics
Analgesics
Antihistamines
Vasoconstrictor nasal spray (Afrin)

43. NURSING INTERVENTIONS/Diagnoses
Warm mist vaporizer
Warm, moist packs
Nursing Diagnoses
Ineffective breathing pattern, related to nasal congestion
Pain, related to sinus congestion