The document provides a comprehensive overview of upper respiratory tract infections, focusing on sinusitis, nasopharyngitis, stridor, pharyngitis, tonsillitis, and croup, including definitions, causes, symptoms, diagnostic approaches, and treatment methods. It details the necessary medical and nursing management for each condition, emphasizing symptom relief, hydration, and possible surgical interventions. The document also highlights the importance of health education for caregivers and parents in managing these conditions.

1. UPPER REPIRTORY
TRACT INFECTION
Presented by:
Ms. Manisha Thakur
Nursing Tutor
Child Health Nursing

3. SINUSITIS

4. SINUSES:
 The sinuses are small air
pockets located behind
your forehead, nose,
cheekbones, and in
between the eyes.
The sinuses produce
mucus, which is a thin and
flowing liquid that
protects the body by
trapping and moving
INTRODUCTION

5. SINUSITIS:
 It refers to the inflammatory conditions
involving the four paired structures surrounding
the nasal cavities.
 Most frequently maxillary sinus is involved
followed by ethmoid, frontal, and sphenoid
sinuses.
 It is usually precipitated by congestion from
viral URI’s.
DEFINITION

7. Acute Lasts less than 4 weeks and gets better with treatment.
Sub acute This type of infection does not get better with treatment initially
and symptoms last for 4 to 8 weeks
Chronic Repeated acute infections. The symptoms last for 8 weeks or
longer.
Recurrent Three or more episodes of sinustis occur in a year
Types

8. Infectious: It can be caused by variety of organisms such as :
Viruses: rhinovirus, parainfluenza &influenza virus.
Bacteria: S.pneumonia and H.influenzae.
Fungi: rhizopus,mucor, rhizomucor.
Non-infectious: it include
 Allergic rhinitis
Cigarette smoke exposure.
Nasal or sinus tumors and Nasal polyp
Infection from tooth.
ETIOLOGY

9. Clinical features
Younger children
 Running nose
 Night time cough
 Occasional daytime cough
 Swelling around the eyes
Older children and adults
 Running nose
 Postnasal drip ( secretions from
the nose that drains down into
the throat causing congestion
and cough)
 Headache
 Facial discomfort
 Cough
 Fever upto 102 0F
 Sore throat
 Periorbital swelling

10.  Childs medical and physical examination
 Sinus x ray : show fluid in sinus and thick mucus.
 CT scan ( obstructed sinus)
 Culture from sinuses
Diagnostic approaches

11. Medical management:
 Antibiotic medication: for 10 to 14 days)
 Anti-histamines (used to decrease secretions &
congestion)
 Topical decongestants and mucous thinner : e.g.
Guaifenesin
 Nasal sprays: to reduce inflammation
 Acetaminophen: for pain and discomfort
Endoscopic sinus surgery, if other treatment fails.
Management

12.  Nose drops or sprays containing phenylephrine 0.25% to 0.125%
are administered as prescribed after cleaning the nasal passages.
 Humidifier may be used to increase the water vapour in the air,
liquify the secretions and facilitate the drainage.
 Warm moist compresses may be applied to the affected area.
 Temperature monitoring
 Sponge baths and prescribed antipyretics may be given to reduce
fever.
 Position the child with his or her head elevation which will ease in
breathing.
 Increased fluid intake to keep nasopharynx mucosa moist and
prevent dehydration.
Nursing management

13.  Increased fluid intake
 Observing for the complications such as cry, ear ache
 Administer Systemic antibiotics are given as
prescribed after cultures are done.
Cont…

14.  Ineffective Airway Clearance related to airway obstruction due to thick mucus
production as evidenced by the monitoring of SPO2.
 Acute Pain related to inflammation of the sinusitis as evidenced by the
verbalization of the patient.
 Imbalanced Nutrition: Less than Body Requirements related to decreased
appetite secondary to sinus inflammation as evidenced by monitoring of intake
output chart.
 Disturbed Sleep Pattern related to clogged nose, nasal inflammation secondary
pain as evidenced by verbalization of the client.
 Anxiety related to lack of knowledge about diseases and medical procedures as
evidenced by the continues questioning by the parents.
Nursing diagnosis

15. NASOPHARYNGITIS

16. It is also known as common cold or rhinosinusitis
, this is one of the common illness leading to
maximum of doctor visits, absence from school
and work.
DEFINITION:
Nasopharyngitis is defined as inflammation of the
nasopharynx.
Nasopharyngitis
asopharyngitis

17.  Children have about 6-10 episodes of cold per year,
usually winters and spring.
 Adenovirus, Rhinovirus (most common), influenza,
parainfluenza virus, enterovirus, respiratory syncytial
virus etc.
 The commonest virus responsible is Rhinovirus.
Etiology

18. Pathophysiology
Like cytokines: chemokines will be
secreted leading to inflammatory
reaction

19. 1. Rhinorrhea
2. Nasal congestion
3. Breathing difficult
4.Sore throat
5. Sneezing
6.Cough and low grade fever
7. Muscle aches
8.Malaise
9.poor appetite
Clinical features

20.  There is no specific treatment for cold. Treatment
involves symptomatic and supportive care.
1. Analgesics and antipyretic to reduce discomfort and
fever.
2. Decongestant nose drops and cough suppressant to
to relieve congestion.
3. Older children: gargles with warm saline solution.
Management

21. • Anti-histamines: for sneezing, itching, rhinorrhoea.
• Increased intake of vit.C
• Adequate rest
• Administer Increased amount of fluids
Management

22.  Collecting patients history.
 Physical examination: nasal discharge, hydration
status and other symptoms of respiratory distress.
 Children with nasopharyngitis are managed at home,
so health education should be provided.
Nursing Management

23. Health education:
1. Position the child with his or her head
elevation which will ease in breathing.
1. Increased fluid intake to keep nasopharynx
mucosa moist and prevent dehydration.
2. Cool mist humidifier can be placed in childs
room.
3. Saline nose drops and gentle suction with a bulb
syringe before feeding and sleep time may
be useful.
4. Child is kept away from the smoke and dust,
as they cause nasopharyngeal irritation.
5. Teach him to cover mouth and nose with
handkerchief when sneezing and coughing
occur.
6. Handwashing by caregiver and child after
blowing nose and sneezing the nose.

25.  Ineffective airway clearance related to mechanical obstruction of
the airway secretions and increased production of secretions.
 Ineffective breathing pattern related to the inflammatory process
in the respiratory tract.
 Imbalanced Nutrition: Less than Body Requirements related to
decreased appetite secondary to disease condition
 Disturbed Sleep Pattern related to clogged nose, nasal
congestion
 Anxiety related to lack of knowledge about diseases and medical
procedures
Nursing diagnosis

26. STRIDOR

27. Stridor is high pitch sound produced due to the
obstruction or narrowing of the childs upper
airway. Stridor can be heard well when a childs
breath in ( inspiration) and can be heard during
expiration
Definition

28.  Inspiratory stridor
 Expiratory stridor
 Biphasic stridor
Types of stridor

29. CAUSES
congentital
laryngomalacia
Subglottic stenosis
Subglottic
hemangioma
Traumatic:
fracture of neck
Forgien body
Swallowing of
harmful
substance
Infectious
Croup
Epiglottitis
Bronchitis
tonsillitis
Etiology

31. 1. Medical and physical examination
2. Chest and neck x ray
3. Bronchoscopy ( A bronchoscope is introduced
into the airway to visualize any abnormalities)
4. Pulse oximetry
5. Sputum culture
Diagnostic Evaluation

32. Once the diagnosis has been made treatment of exact cause can be
made.
 Nebulization with adrenaline epinephrine in cases where
airway edema may be the cause of the stridor.
 Use of dexamethasone.
 Use of inhaled Heliox (70% helium, 30% oxygen); Helium,
being a less dense gas than nitrogen, reduces turbulent flow
through the airways.
 Some conditions (ex: epiglottitis, bacterial infection) may require
antibiotics, while steroids may be useful in other situations.
Management

33.  Administer oxygen as prescribed.
 Steam inhalation can be given incase of excessive mucus
production.
 Antipyretic can be given if patient is having fever.
 Referral to ear, nose and throat specialist for evaluation
of the cause of stridor.
Cont…

34. PHARYNGITIS
TONSILLITIS

35. Pharyngitis is inflammation of the pharynx,
which is in the back of the throat.
Tonsillitis is defined as the inflammation of the
tonsils ( lymphoid tissue located in the
oropharynx)
Pharyngotonsillitis : inflammation of the
pharynx and tonsils
Definition

36. Waldeyer ring of tonsils

37. Etiology
Bacterial and viral infection can cause
tonsillitis during droplet infection:
Viruses: adenovirus, influenza virus, epstein
barr virus, herpes virus.
Bacteria: group A Hemolytic streptococci,
neisseria gonorrhea, haemophilus influenza.
Fungi: candida species
Parasitic infestation

38. Clinical manifestations
( pharyngitis and tonsillitis)

39.  History and physical examination
 WBC Count
 Throat culture
Diagnostic approach

40.  Antibiotics are used to treat acute tonsillitis.
 Increase adequate amount of fluid intake.
 Saline throat irrigation or gargles may relives
the discomfort.
 Anti pyretics
 Throat lozenges: dissolve slowly in the mouth to
temporarily suppress the cough, and lubricate and soothe
irritated tissues of the throat.
Surgical management
 Surgical removal of the tonsils ( tonsillectomy)
Management

41. 1. Make pre- operative assessment.
2. Lab investigations: bleeding time, clotting
time.
3. Consent for the surgery should be taken.
4. Answer the queries of the parents and child.
Pre-operative care

42.  Watch and control hemorrhage.
 Monitor vital sign of the patients.
 Notice for the increase pulse rate, pallor, any bleeding from nose and
mouth and frequent swallowing.
 Suctioning should be done in case of excessive secretions.
 Control fever:
 Monitor temperature
 Encourage fluid intake.
 Administer prescribed antipyretics.
 Promote hydrations:
 Maintain IV fluids
 Start oral fluid if child is concious
 Give small and frequent icechips , cold water
 Relieve anxiety of child and parents
Post-operative care

43.  Ineffective air way clearance related to pus or mucous
formation secondary to inflammation
 Acute pain related to the presence of inflammation in
tonsils.
 Imbalanced Nutrition Less Than Body Requirements
related to inadequate intake.
 Hyperthermia related to acute infection by
microorganisms.
 Disturbed Sleep Pattern related to the pain in the tonsil
Nursing diagnosis

44. CROUP

45. Croup (or laryngotracheobronchitis) is a respiratory
condition that is usually triggered by an acute viral
infection of the upper airway.
Croup refers to an infection of the upper airway, which
obstructs breathing.
Croup produces the classic symptoms of
"barking/brassy" cough, stridor, and a hoarse voice.
Definition

47. Childrens are affected between 3 months to 5 years of age.
The incidence is higher in males and can occur throughout the
year with peaks in winter and late fall.
Commonly causedvirus
 RSV, influenza virus, measles, adenovirus and enterovirus.
 Rarely caused by bacteria: Mycoplasma pneumoniae,
Corynebacterium diphtheriae, Staphylococcus aureus
 Allergies.
Etiology
Incidence

48. Child get in direct contact with a secretions or
infected person
Infection begins in upper respiratory tract and
travels down
Inflammation, hyperemia, edema causes
narrowing of the airway lumen( mucosa and
submucosa of layrnx, trachea and bronchi)
Production of stridor, cough, hoarsness
Pathophysiology

50. 1. Barking cough
2. Respiratory distress: nasal flaring, supraclavicular,
epigastric/subcoastal , intercoastal retractions
3. Tachpnea
4. Stridor
5. Hoarsness
6. Fever
7. Rapid pulse
8. Anxiety
9. Restlessness
10. Dysphagia
Clinical features

51. Supra clavicular
Intercoastal

52.  History and physical examination
 Neck and chest x ray
 Blood tests: culture
 Broncoscopy
 Pulse oxymetry
DIAGNOSTIC EVALUATION

53.  Supportive care including intravenous fluids to
maintain hydration and oxygen inhalation to relieve
hypoxia has to be given.
 A single dose of dexamethasone 0.6 mg/kg may
decrease the severity and duration of illness.
 Nebulization by epinephrine may decrease the
symptoms of stridor and respiratory distress
immediately.
 Antibiotics in case of infection.
Management

54.  Steam inhalation to moisten the thick mucus
secretions.
 Humidifier can be used in the room to moisten and
soothen the mucosa and submucosa of the airway.
 Chest physiotherapy and suctioning may be done to
remove the excessive secretions.
 Encourage child to increase fluid intake.
 Positoning in fowlers can ease in breathing.

55.  Ineffective air way clearance related to mucous formation
secondary to inflammation.
 Acute pain related to the presence of inflammation in upper
respiratory tract.
 Imbalanced Nutrition Less Than Body Requirements related to
inadequate intake and dysphagia.
 Hyperthermia related to acute infection by microorganisms.
 Disturbed Sleep Pattern related to the pain in the throat and
continuous cough at night.
 Knowledge deficit related to the treatment and prognosis of the
disease.
Nursing management