This document discusses the management of upper respiratory tract infections. It begins by outlining the objectives and topics to be covered, including viral rhinitis, acute and chronic pharyngitis and tonsillitis, epistaxis, and cancer of the larynx. For each condition, it describes the etiology, clinical manifestations, diagnostic findings, medical management, and nursing management. Surgical procedures for cancer of the larynx and postoperative care are also outlined. The document provides a comprehensive overview of assessing and treating various upper respiratory infections and conditions.

1. Management of Patients with
Upper Respiratory Tract
Infection
Mrs. Basma Al-Mahrouqi.
AHNI-AY 2022-2023
Page: 552-582

2. Objectives
 Compare the upper and lower pulmonary infections with
regard to its causes, clinical manifestations, assessment
findings, medical, surgical, nursing management,
complications, and prevention.
 Utilize the nursing process as a framework for care of patients
with upper airway infection and patients undergoing
laryngectomy.

3. TOPICS
UpperAirway Infections:
• Viral Rhinitis (Common Cold).
• Acute & Chronic Pharyngitis.
• Acute and Chronic Tonsillitis.
Trauma of the Upper RespiratoryAirway:
• Epistaxis.
• Cancer of the Larynx.

4. REVIEW OF ANATOMY AND PHYSIOLOGY OF
RESPIRATORY SYSTEM

5. Anatomy of the Upper
Respiratory Tract

6. 6

7. Viral Rhinitis
• Most frequent viral infection in the
general population.
• Common cold - URI that is self-limited
& caused by virus.
Causes:
• Influenza (flu), Rhinovirus, Corona,
adenovirus (200 viruses).
• Cold - infectious, acute inflammation of
the mucous membranes of the nasal cavity

8. Viral Rhinitis
• An acute upper respiratory infection (URI).
• Rhinitis, pharyngitis, and laryngitis distinguish the sites of the
symptoms.
• Highly contagious - virus shed for about 2 days before the
symptoms appear & during the first part of the symptomatic phase.
• Rhinoviruses - occur in the early fall and spring.
• Other viruses - cause winter colds.
• Seasonal changes in relative humidity.
• Most common cold: humidity is low, in the colder months of the year.

9. Clinical
Manifestations
• Low grade fever.
• Nasal congestion.
• Rhinorrhea.
• Nasal discharge.
• Halitosis.
• Sneezing.
• Tearing watery eyes.
• Scratchy or sore throat.
• General malaise.
• Headache & Muscle aches.
• Cough.
• Herpes simplex – cold sore.
• Last from 1-2 weeks.
9

10. Medical Management
Symptomatic therapy:
• Adequate fluid intake, rest, preventing chilling.
• Expectorants as needed (Guaifenesin).
• Warm salt-water gargles - sore throat.
• NSAID - aspirin or ibuprofen.
• Antihistamines.
• Petroleum jelly.
• OTC Medications.
• Topical (nasal) decongestant – phenylephrine.
• Alternative medicine:
– echinacea, zinc lozenges, zinc nasal spray
• Steam inhalation or heated humidified air. 10

11. Nursing
Management
• Teach how to
break the
chain of
infection
11

12. Nursing Management
• Teach how to break the chain of infection:
– Appropriate hand hygiene measures - the most effective
measure to prevent transmission of organisms.
– The use of tissues to avoid the spread of the virus
through coughing and sneezing.
– Cough or sneeze into the upper arm if tissues are not
readily available.
• Instruct about methods to treat symptoms.
12

13. Acute Pharyngitis
• Sudden painful inflammation of the
pharynx, the back portion of the throat
(posterior third of the tongue, soft palate,
and tonsils.
• Commonly referred to as sore throat.
• Due to environmental exposure to viral
agents and poorly ventilated rooms.
• incidence of viral pharyngitis peaks
during winter and early spring in regions
that have warm summers and cold
winters.
13

14. Etiology of Pharyngitis
• Viral - influenza virus, adenovirus, Epstein Barr, Herpes simplex.
– Most common.
– Spreads in droplets of coughs & sneezes.
– Unclean hands due to contaminated fluids.
• Bacterial - groupAbeta-hemolytic Streptococcus (GABHS):
– streptococcus pharyngitis, strep throat.
• Groups B & G streptococcus:
- Mycoplasma pneumoniae, Neisseria gonorrhoeae, and C-
Pneumoniae.
14

15. Clinical Manifestations
• Fiery red pharyngeal membrane & tonsils.
• Lymphoid follicles (swollen and flecked with white-
purple exudates).
• Enlarged & tender cervical lymph nodes.
• Fever & malaise, sore throat.
• Scarlatina forms a rash with urticarial–scarlet fever.
15
A. Redness and vascularity of the pillars and
uvula are mild to moderate
B. Redness is diffuse and intense

16. Assessment/
Diagnostic Findings
• Screening tests for streptococcal
Antigens:
– RapidAntigen Detection Testing
(RADT).
– Throat Culture:
• To confirm if negative
16

17. Medical
Management
• Antimicrobials agents in cases of bacterial infections:
– Penicillin - treatment of choice – 5 days.
– Macrolides –Azithromycin once for 3 days.
– Cephalosporin - Cefuroxime – 5 or 10 days.
– Analgesics – aspirin & acetaminophen.
– Gargles with benzocaine.
• Nutritional management:
– Liquid or soft diet.
– Cool beverages, warm liquids, frozen desserts.
– Encourage to drink 2-3 liter fluids if tolerable.
– I.V. Fluids 17

18. Nursing Management
• Instruct to have plenty of rest.
• Examine the skin once or twice daily for possible rash,
because acute pharyngitis may precede some other
communicable diseases (i.e. rubella).
• Warm saline gargles.
• Drinking warm liquids.
• Encourage oral care and changing toothbrushes.
• Emphasize on full course of antibiotics- to
prevent nephritis & rheumatic fever.
• Ice collar.
• Preventive measures.
18

19. Chronic Pharyngitis
• Persistent inflammation of the
pharynx.
Etiology:
• Adults working in dusty
surroundings.
• Use their voice to excess.
• Suffer from chronic cough.
• Habitually use alcohol and tobacco.
19

21. Clinical Manifestations
• Constant sense of irritation.
• Fullness in the throat.
• Mucus collection &
expelled by coughing.
• Difficulty in swallowing
• Intermittent postnasal drip.
• Avoid exposure to irritants.
Correcting upper respiratory,
cardiac, and pulmonary conditions.
• Nasal sprays: (Phenylephrine) to
relieve nasal congestion.
• Antihistamines decongestant: -
Pseudoephedrine.
• Analgesics: aspirin or
acetaminophen.
• Tonsillectomy. 21
Medical Management

22. Nursing Management
• Teach patient to :
– Avoid smoking & tobacco, and alcohol.
– Minimize exposure to cold or
environmental or occupational pollutants:
• Wear disposable face mask.
– Drink plenty of fluids.
– Have warm saline gargles.
– Take Lozenges - keep the throat moist.
22

23. Tonsillitis
• Tonsils - composed of lymphatic tissue which
frequently serve as the site of acute infection.
• Chronic - less common and may be mistaken for
allergy, asthma, and rhinosinusitis.
• Infection of the adenoids frequently accompanies
acute tonsillitis.
Etiology:
• Bacteria - GABHS, the most common.
• Viral - Epstein-Barr - most common.
• Can occur in adults.
23

24. Clinical
Manifestations
Tonsillitis:
• Sore throat.
• Fever,
• Snoring.
• Difficulty swallowing.
Adenoiditis:
• Mouth-breathing.
• Earache.
• Draining ears.
• Frequent head colds.
• Bronchitis.
• Foul-smelling breath.
• Voice impairment.
• Noisy respiration.
• Nasal obstruction.
• Infection can extend to the middle
ears (acute otitis media).
24

25. Assessment/
Diagnostic Findings
– Physical assessment and history
Rapid Antigen Detection Testing
(RADT)
– Throat Swab Culture
– Comprehensive audiometric exam
Cytomegalovirus infection
- differential diagnosis for
HIV, hepatitisA, and rubella
Adenoiditis- recurrent
of suppurative otitis media
result in hearing loss.
25

26. Tonsillitis:
Medical Management
• Antibiotics ( Penicillin, Cephalosporin).
• Teach patients to complete medication courses.
Bacterial
Infections
• Increased fluid intake, Analgesics.
• Salt water gargles & rest.
Supportive
measures
• Repeated episodes of tonsillitis despite antibiotic therapy.
• Hypertrophy of the tonsils could cause obstruction and
obstructive sleep apnea.
• Chronic nasal airway obstruction, chronic rhinorrhea.
Tonsillectomy
&
Adenoidectomy

27. Providing Postoperative
Care
Educating Patients about
Self care
• Alkaline mouthwashes and warm saline
solution - removal of thick mucus and
halitosis.
• Sore throat, stiff neck, minor ear pain
vomiting – 1st 24 hours.
• Adequate diet with soft foods &Avoid
spicy, hot, acidic, or rough foods.
• Restrict milk and milk products &
maintain good hydration.
• Use ofa cool mist vaporizer or humidifier
• Avoid vigorous tooth brushing or
Gargling.
• Avoid smoking and heavy lifting or
exertion for 10 days.
• Continuous nursing observation (risk of
hemorrhage).
• Observe for frequent swallowing
(indicates hemorrhage).
• Position patient in a prone, with the
patient’s head, turned to the side (allows
drainage from the mouth and pharynx).
• Do not remove the oral airway until
the patient’s gag and swallowing reflexes
have returned.
• Apply an ice collar to the neck & Provide
• A basin and tissues & Give water and ice chips.
• Instructed to refrain from too much talking and
coughing.

28.  EPISTAXIS
 CANCER OF THE LARYNX

29. Epistaxis
(Nose Bleed)
• A hemorrhage from the
nose, caused by the
rupture of tiny, distended
vessels in the mucous
membrane of any area of
the nose.

30. Epistaxis (Nosebleed)
• Most common site is - Anterior
septum, where three major blood
vessels enter the nasal cavity.
• (1) Anterior ethmoidal artery on the
forward part of the roof (Kiesselbach’s
plexus).
• (2) Sphenopalatine artery in the
posterosuperior region.
• (3) Internal maxillary branches (the
plexus of veins located at the back of
the lateral wall under the inferior
turbinate).

31. See Page 569

32. Medical Management
Initial Treatment:
Apply direct pressure.
Uncontrolled bleeding:
Visible bleeding sites may be cauterized with silver nitrate or
electrocautery (high-frequency electrical current).
A cotton tampon may be used to try to stop the bleeding.
Educating about self-care
Avoid vigorous exercise for several days,Avoid hot or spicy foods and tobacco Avoid straining,
high altitudes, and nasal trauma, prevent drying of the nasal passages.
• Sits upright with the head tilted forward
(prevents swallowing & aspiration of blood )
• Pinch the soft outer portion of the nose
against the midline septum for 5 or 10
minutes continuously
• Apply nasal decongestants
Vasodilation

33. Medical Management
Packing to control bleeding from the
posterior nose (Balloon- inflated
catheter).
• A. Catheter is inserted and packing is
attached.
• B. Packing is drawn into position as the
catheter is removed.
• C. Strip is tied over a bolster to hold the
packing in place with an anterior pack
installed “accordion pleat” style.
• D. Alternative method, using a balloon
catheter instead of gauze packing.
Antibiotics – to prevent iatrogenic sinusitis and sepsis

34. Nursing Management
• Assess vital signs.
• Assess amount of bleeding.
• Give assurance in a calm and efficient manner.
• Teach to avoid vigorous exercise, avoid hot and spicy
foods, avoid nasal blowing, straining, high altitude and
nasal trauma.
• Administer IV crystalloid solution as prescribed.
35

35. Cancer of the Larynx
• Half of the neck and head cancer.
• Most common in people Older than 65.
• 4x more common in men.
• 5-year survival rate – 32% - 90%.
• Classified as Squamous cell carcinoma.
• 55% with lymph node involvement.
• Carcinogens: Tobacco (smoke,
smokeless) and asbestos, paint fumes,
wood dust, chemicals, tar products,
leather, and metals.

36. 37
See page 558)

37. Clinical Manifestations
Initial symptoms
• Hoarseness - tumor
impedes the action of
the vocal cords
during speech
• Persistent cough
• Sore throat or pain,
burning in throat
• Lump in neck
Later symptoms
• Dysphagia
• Dyspnea
• Unilateral nasal
obstruction or
discharge
• Persistent hoarseness
• Persistent ulceration
• Foul breath
Metastasis
• Unintentional weight
loss
• General debilitated
state
• Cervical
Lymphadenopathy
• Pain radiating to ear

38. Cancer of the Larynx
Assessment and Diagnostic Findings
• History & Physical Examination.
• Indirect / direct laryngoscopy.
• Mobility of the vocal cords.
• Fine NeedleAspiration Biopsy
(FNAB).
• Barium swallow.
• Endoscopy, Laryngoscopy.
• CT or MRI Scan – regional adenopathy.
• PET Scan.
39

39. Cancer of Larynx Assessment
Direct laryngoscopy
(under LA/ GA)
To evaluate all
areas of the
larynx
CT and MRI
To stage and
determine the
extent of a tumor
Post Tx….to
detect a
recurrence

40. Medical Management
Goals:
• Cure; preservation of safe, effective swallowing; preservation of useful voice; and
avoidance of permanent tracheostomy.
Treatment Options:
• Surgery - Partial vs. total laryngectomy – Stage 3 & 4.
• External Beam Radiation therapy & conservation surgery – Stage 1 & 2.
• Adjuvant chemo-radiation therapy.
• Speech therapy.
• Artificial larynx.
41

41. • Vocal Cord Stripping - used to treat
dysplasia, hyperkeratosis, and
leukoplakia and is often curative for
these lesions; involves removal of the
mucosa of the edge of the vocal cord,
using an operating microscope.
• Cordectomy - excision of the vocal cord,
is usually performed via transoral laser;
used for lesions limited to the middle
third of the vocal cord.
Surgical Management

42. • Laser microsurgery - well known to have
several advantages for the treatment of early
glottic cancers; shorter Treatment and
recovery with fewer side effects, and
treatment may be less costly.
• Partial laryngectomy (laryngofissure–
thyrotomy) - used in the early stages of
cancer in the glottic area when only one vocal
cord is involved; associated with a very high
cure rate; A portion of the larynx is removed,
along with one vocal cord and the tumor; all
other structures remain.
Surgical Management

43. •
•
A. Normal airflow
B. Airflow after total laryngectomy
Changes in Airflow with
Total Laryngectomy
Total laryngectomy
• Complete removal of the larynx
(total laryngectomy) can provide a
cure for most advanced laryngeal
cancers.
• the laryngeal structures are
removed, including the hyoid
bone, epiglottis, cricoid cartilage,
and two or three rings of the
trachea.
• The tongue, pharyngeal walls,
and most of the trachea are
preserved.
• results in permanent loss of the
voice and a change in the airway,
requiring a permanent
tracheostomy.

44. Speech Therapy
Esophageal Speech
The patient needs the ability to compress
air into the esophagus and expel
it, setting off a vibration of the pharyngeal
esophageal segment for
esophageal speech.
Artificial Larynx
If esophageal speech is not successful, or until
the patient masters the
technique, an electric larynx may be used for
communication. This batterypowered
apparatus projects sound into the oral cavity.
When the mouth
forms words (articulation), the sounds from

45. Speech Therapy
Esophageal Speech -The patient needs the ability to
compress air into the esophagus and expel it, setting off a
vibration of the pharyngeal esophageal segment for
esophageal speech.
Artificial Larynx - an electric larynx that is battery powered
apparatus that projects sound into the oral cavity. When the
mouth forms words (articulation), the sounds from the electric
larynx become audible words.
Tracheoesophageal puncture - A valve is placed in the tracheal
stoma to divert air into the esophagus and out the mouth,
once the puncture is surgically created and has healed, a voice
prosthesis (Blom- Singer) is fitted over the puncture site.

46. Nursing Interventions
Provide Preoperative Patient education
• If a complete laryngectomy is planned, the patient must understand that the NATURALVOICE
WILLBE LOST.
– Special training can provide a means for communicating.
– Until training is started, communication will be possible by using the:
• Call light.
• Writing.
• Using a special communication board.
– Give adequate time to communicate his or her needs.
– Be aware that the patient may become impatient and angry when not understood.

47. Nursing Interventions
Teaching Patient Preoperatively
• Review equipment and treatments for postoperative care (tracheostomy care,
etc) with the patient and family.
• Teach about coughing and deep breathing exercise.
• Provide the patient and family with opportunities to ask questions, verbalize
feelings, and discuss perceptions.
• Promote feeling of comfort - listening to music, reading, guided imagery,
meditation – to reduce anxiety.

48. Maintaining a Patent Airway
To decrease surgical edema and
promotes lung expansion
• Position the patient in the semi-Fowler’s or Fowler’s
position after recovery from anesthesia.
• Observe the patient for restlessness, labored
breathing, apprehension, increased pulse rate &
decreasing saturation.
To identify possible respiratory or
circulatory problems
To detect impending complications
• Assess the patient’s lung sounds and reports changes
• Encourage the patient to turn, cough, and take deep
breaths.
• Careful suctioning without disruption of sutures.
To remove secretions
• Encourage and assist the patient with early
Ambulation.
To prevent atelectasis, pneumonia,
and deep vein thrombosis

49. • Advice:
– Avoid sweet foods as they increase salivation.
– Rinse mouth with warm water/mouthwash after oral feeding.
Promoting Adequate
Nutrition & Hydration
• Postoperatively, the patient may not be permitted to eat or drink for several days (7 days):
– IV fluids.
– Enteral feedings through a nasogastric or gastrostomy tube.
– Parenteral nutrition.
To avoid irritation to the sutures.
To reduce the risk of aspiration.
• Oral feeding is initiated only after a swallow study (radiology procedure).
• Provide thick liquids.
Stay with patient during initial oral feedings
Keep a suction set-up at the bedside

50.  Instruct the patient and caregiver:
– Perform suctioning
– Gently cover the stoma with a loose plastic bib, or even a hand, when
showering or bathing to prevent water from entering the stoma.
– Cover the stoma with a loose-fitting, not tight, cloth to protect it.
– Keep his/her house humidified to prevent irritation of
the stoma that can occur in low humidity.
– Avoid swimming, because it's possible for water to enter the stoma and then
enter the patient's lung, causing him/her to drown without submerging
his/her face.
Teaching Home &
Community Based Care