Upper respiratory infections slide

1. UPPER RESPIRATORY
TRACT INFECTIONS
BY: MTEWELE & FRANCIS

2. UPPER RESPIRATORY TRACT
• Is apart of respiratory system being located above the chest
cavity.
• It consists of upper trachea, pharynx, larynx and nose cavity.
• These parts are colonized by many normal flora that limit
growth of pathogenic micro-organisms.
• Also are adapted to have cilia, mucus secreting cells,
secretory IgA and cough reflex for defense against inhaled
micro organism and dust particles.

3. UPPER RESPIRATORY TRACT INFECTIONS
• Infections of the throat (larynx), or the main airway (trachea), or the
airways going into the lungs are common. These infections are
sometimes called laryngitis, tracheitis, or pharyngitis. The term upper
respiratory tract infection (URTI) include any, or all, of these
infections.
• These are the infections which affect the upper parts of the respiratory
system. Also known as upper air ways infections
• Most of these infections are limited to mild and temporary discomfort.
However some are acute, severe and life threatening and may cause
permanent alteration in breathing and speaking.

4. UPPER AIRWAY INFECTION
• Most common cause of patient illness
• Also known as URTIs
• About 90% are viral.
– This is important in treatment approach and antibiotic resistance.

5. ETIOLOGY OF URTI´s
• Upper respiratory tract infections occurs when a micro organisms
either virus or bacteria are inhaled.
• Examples of viruses that causes URTIs includes; rhinovirus,
coronavirus, coxsackie virus, Influenza virus and Adenovirus
• Examples of bacteria which causes URTIs includes:
• Haemophilus influenza
• S. pneumoniae
• S. pyogenes and
• C. diphtheriae.

6. SPECIFIC DISORDERS
The upper respiratory tract infections are classified according to the part
they affect. These includes;
• Laryngitis
• Epiglottitis (supraglottitis)
• Pharyngitis
• Otitis media
• Rhinitis
• Diphtheria

7. RHINITIS
• Is the inflammation and irritation of the mucous membrane of the nose.
• This condition co-exist with other respiratory problem like asthma.
• Rhinitis may be acute or chronic, allergic or non allergic
• Allergic rhinitis may occur when a person is exposed to air borne particles such
as dust, dog dander, cat dander, cockroach droppings, and plant pollen.
• Non allergic rhinitis or viral rhinitis or common cold- This refers to URTI that
is self limited and caused by virus like influenza virus, rhinovirus(50%) and
coronavirus.
• Common cold is an infectious, acute inflammation of the mucous membrane of
the nasal cavity characterized by nasal congestion, rhinorrhea, sneezing, sore
throat and general malaise.

8. PATHOPHYSIOLOGY
• Symptoms of the common cold are believed to be associated to the
immune response.
• The causative agent of cold does not cause any structural damage or
nasal epithelial damage.
THE TYPICAL SYMPTOMS AND SIGNS INCLUDES;
• Cough(50% of cases), Runny nose, Nasal congestion, Rhinorrhea
Sore throat (40% of cases) and Muscle pain.

9. DIAGNOSIS
• Allergy test is also performed.
• Careful history and physical examination is performed
to identify possible exposure to allergens at home,
environment and working places.
• A blood test for IgE antibodies may also be done to
determine if allergies are the cause.

10. MEDICAL MANAGEMENT
• Depending on the cause of the infection;
• If it is because of the allergens a patient is advised to avoid
exposure to allergens.
• If is of viral cause medication may be prescribed to relieve
symptoms, desensitizing immunization and corticosteroids
may be required.
• If is of bacterial cause antihistamines and corticosteroids
nasal sprays may be applied to relieve symptoms.

11. NURSING MANAGEMENT
• Teaching a patient self care;
• A Nurse instruct a patient with allergic rhinitis to avoid exposure to
allergens and irritants
• A Nurse instruct a patient the importance of controlling the environment
at home and workplace.
• A Nurse instruct a patient to correct administer nasal medication. E.g.
blowing a nose before applying any medication in order to have maximal
relief.
• A Nurse instructs a patient to practice hygiene technique so as to break
infection chain

12. SINUSITIS
• Sinusitis-affects 35 million people a year. Sinuses are normally
protected from infection by mucociliary action. If cilia action is
impaired or mucus openings are obstructed mucus can accumulate and
thus become an infection. Blockage of mucus openings may be due to
a deviated nasal septum, bony abnormalities, congenital
malformations, infections, or allergies.
.

13. SYMPTOMS AND DIAGNOSIS
• Diagnosis is suggested by clinical findings and confirmed by x-ray.
• These findings include fever and chills along with headaches and
facial pain exacerbated with bending, pain or numbness in the
upper teeth, and a purulent or discolored nasal discharge may be
present.
• Pt may also have fatigue, ear pain, sore throat, cough, and
periorbital edema. XRays will show opacification of the sinuses,
thickened mucous membranes, and an air-fluid level
• DX: pain with palpation and decreased transillumination, cultures via
aspiration/swabbing.

14. MEDICAL MANAGEMENT
Antibiotics to manage the bacterial infection
Decongestants to reduce nasal edema
 Corticosteroid nasal sprays to reduce mucosal inflammation
Humidification to prevent nasal crusting and to moisten
secretions.
Sinus lavage or surgical procedures such as functional
endoscopic sinus surgery (FESS), External
Sphenoethmoidectomy, and Caldwell-Luc Procedures in
cases not responding to treatment

15. NURSING MANAGEMENT
• Teach patients to humidify air, use steam inhalation, or warm
compresses
• Avoid tobacco, swimming, diving, and air travel
• Teach concerning meds and rebound congestion with nasal sprays
• Teach s/s of complications which include fever, severe headache, and
nuchal rigidity.
• For the post op patient: assess for profuse nasal bleeding, respiratory
distress, ecchymosis, and orbital and facial edema for the first 24
hours.
• Semi-High flowler’s position for 24-48 hours
• Mild analgesics as necessary – Teach clients to increase fluid intake to
thin secretions, avoid blowing the nose for 7-10 days (snif or spit),
sneeze with mouth open, limit strenuous activity for ~ 2 weeks

16. PHARYNGITIS
• This is the inflammation and irritation of the pharynx. This condition
may be acute or chronic
• Acute pharyngitis; is a sudden painful inflammation of the pharynx,
the back portion of the throat that includes posterior third of the
tongue, soft palate and tonsils.
• Chronic pharyngitis; is the persistent inflammation of the pharynx.
Symptoms may last for a long time
• Pharyngitis occurs due to environmental exposure to viral agents and
poor ventilated rooms.
• Most acute cases are caused by viral infections (40-80%), the
remainder caused by bacterial infections, fungal infection and irritants
like pollutants

17. AETIOLOGY
Most acute cases of pharyngitis are caused by viral infections
(40-80%), the most common causative agents of viral
pharyngitis includes; adenovirus, influenza virus, EBV and
HSV the remainder caused by bacterial infections, fungal
infection and irritants like pollutants
• The most common causative agent of bacterial pharyngitis is
streptococcus pyogenes.
• Pharyngitis occurs due to environmental exposure to viral
agents and poor ventilated rooms.

18. PATHOPHYSIOLOGY
• The symptoms of pharyngitis are due to immune response in which the
body responds by triggering inflammatory reaction in the pharynx.
This results into pain, fever, vasodilatation, edema and tissue damage,
manifested by redness and swelling in the tonsillar pillar, uvula and
soft palate.
Diagnostic method
• Diagnosis is made by examining the throat, observing its appearance
like white patches, swelling and redness and felling the neck for
swollen lymph nodes.
• Also swab throat may be preformed

19. SIGNS AND SYMPTOMS
• The symptoms that accompany pharyngitis vary depending on the
underlying condition, includes;
• Sneezing, runny nose, headache, cough, low grade fever, swollen
lymph nodes, difficult in swallowing, difficult in opening fully the
mouth, red throat with white patches.

20. MEDICAL MANAGEMENT
• Viral pharyngitis is treated with supportive measures but bacterial
pharyngitis is treated with antimicrobial agents like penicillin and
erythromycin.
Nursing management
• Nursing care for patient with viral pharyngitis basing on symptomatic
management;
• For a patient presenting strep throat and have history of rheumatic fever,
who appear toxic, who have clinical scarlet fever, Nursing care here focuses
on prompt initiation and administration of antibiotics therapy prescribed
• Also to relieve pain warm saline gargles(40.2C) or an ice collar may be
used

21. Complications
• Rheumatic fever; this is a fever associated with the
inflammation of the connective tissues and joints.
Believed to be caused by Abs cross-reactivity that can
involve the heart, joints, skin and CNS
• Glomerulonephritis; this is the inflammation of the
glomerulus may be of either kidneys presents with
haematuria, proteinuria.

22. LARYNGITIS
• This is the inflammation and irritation of the voice
box/larynx. The inflammation causes narrowing of the upper
airways which leads to a hoarseness of the voice, in some
circumstance aphonia ( complete loss of voice)
• Laryngitis may be acute, if it lasts less than three weeks or
chronic, if it lasts over three weeks.
• Usually this condition is associated with hoarseness or
complete loss of voice.
• Often caused by the pathogens that cause common cold and
pharyngitis

23. AETIOLOGY
• This condition is caused by both virus and bacteria, but the
most common cause is virus.
• Bacteria that cause laryngitis includes H.influenzae,
S.pneumoniae
• An acute laryngitis can be caused by either infection or
damage/trauma to the mucous membrane of the larynx, other
causes include overuse of your voice like shouting/singing
too loud.
• Laryngitis is also associated with a gastro esophageal reflux
(reflux laryngitis), in which regurgitated stomach acidic
content causes inflammation and irritation of the larynx

24. EPIGLOTTITIS
• This is the swelling and irritation of the cartilage that
covers the trachea/epiglottis/windpipe
• This condition is caused by bacteria and virus, but the
most common cause is virus, example of bacteria that
cause this condition include H.influenzae, S.pyogenes
and S.pneumoniae.

25. PATHOPHYSIOLOGY
•Most of the symptoms are due to the immune
response , in which the body triggers
inflammatory reactions which results into
erythema (reddening), edema of epiglottis.

26. SIGNS AND SYMPTOMS
• Dysphonia; hoarseness
• Aphonia; inability to speak
• Dry, sore, burning throat
• Coughing
• Dysphagia; difficult in swallowing
• Swollen lymph nodes in the chest, throat or face
• Hemoptysis A
• Dyspnea

27. DIAGNOSTIC METHOD
• Dx of laryngitis based on the symptoms and
appearance of the larynx
• Special mirror or endoscope are used to directly look
at the vocal cord
• Also throat swab may be performed to examine
presence of viral or bacteria characteristics.
• Impaired verbal communication related to swelling of
the larynx secondary to an infection.

28. MEDICAL MANAGEMENT
• Resting the voice and avoid irritants like smokes
• Resting and inhaling cool steam or aerosols
• Treating any primary respiratory tract infections
• If is due to gastro esophageal reflux, a patient is
instructed to take proton pump inhibitors like
omeprazole.
• Corticosteroids may be used

29. NURSING MANAGEMENT
• A Nurse instruct a patient to rest their voice and maintain
well humidified environment.
• A Nurse encourage the patient to take enough fluids daily (2-
3L/day) to thin secretions.
• A nurse also instructs the patient the importance for taking
prescribed medications like proton pump inhibitor.
• A nurse instruct a patient the signs and symptoms that
requires to seek health care like loss of voice with sore throat
that makes swallowing for saliva difficult, hemoptyesis and
noisy respiration.

30. Complication
• The complications due to laryngitis are rarely as majority of patient
recovers with conservative treatments but elderly may have
pneumonia.

31. DIPHTHERIA
• Is the upper respiratory tract illness caused by C.diphtheriae
• It is a severe form of the pharyngitis
• It is characterized by sore throat ,low grade fever(38C) ,plaque like
pseudomembraneous on the tonsils, pharynx and nasal cavity.
• The disease is spreaded by direct physical contact or breathing
aerosolized secretions of the infected person.
• Symptoms begins two to seven days after person being infected.

32. SIGNS AND SYMPTOMS
• Difficult and painful swallowing
• Difficult in breathing
• Foul smelling bloodstaining nasal discharges
• Lymphadenopathy

33. DAGNOSIS
• Upper respiratory tract illness with sore throat.
• An adherent, dense, grey pseudomembrane covering the posterior
aspect of the pharynx
• Low grade fever (non specific)
• Swollen neck (bull neck).

34. MEDICAL MANAGEMENT
• No antibiotic has been demonstrated to affect healing of local
infection in diphtheria patient treated with ant toxin.
• Antibiotic are used in patient or carrier to eradicate c. diphtheriae and
to prevent its transmission to other.
• The CDC recommend the use of metronidazole, Erythromycin
penicillin G
• For those with allergy to penicillin G or Erythromycin are given
Rifampin or Clindamycin.
• Vaccination (DPT) are given to travellers and school children.

35. NURSING MANAGEMENT
• Encourage the patient to rest
• Promote comfort by giving a patient pain killers like paracetamol.
• Encourage adequate fluid intake to thin secretion.
• Maintain patent air ways.

36. Complications
•Respiratory failure
•Myocarditis
•Pneumonia
•Kidney failure

37. OTITIS MEDIA
• This is the inflammation of the fluids or an exudates of the middle ears
• Microorganism causes blockage of Eustachian tube thus leads to
swelling of mucous membrane of the tube.
• This condition caused by S.Pneumoniae, S.pyogenes and
H.influenzae.
• symptoms
• Ear pain, otorrhea, damage of the eardrum

38. Management
• The pain caused by otitis media can be alleviated by
the use of pain killer applied either topically or orally
example ibuprofen, paracetamol, benzocaine ear drops
• A nurse instruct the patient to rest and how to use
correctly ear drops.

39. TONSILLITIS
• Tonsils are lymph nodes located on each on sides of back of your
throat. They function as defence mechanism, help to prevent the
infection from entering the rest of your body. If they become infected
called tonsillitis
• Tonsillitis This is the inflammation of the tonsils .
• This condition may be acute or chronic, however chronic tonsillitis is
less common
• Most are caused by viral or bacteria infection
• Children are mostly affected.

40. Signs and symptoms
• Sore throat
• Difficulty opening the mouth ( trismus)
• Bad breath( halitosis)
• Red, swollen tonsils
• Voice impairment
• Noisy respiration
• Difficult in breathing

41. Diagnosis
• Diagnosis is based on physical examination of the throat and may
include throat culture.
• Difficult in swallowing related to sore throat secondary to an infection
or swelling.

42. MANAGEMENT
• Supportive measures to relieve pain includes;
• Warm salt-water gargles
• Pain killer
• Increased fluids intake and rest
• In case of bacteria infection use penicillin, pain killers like
paracetamol
• Tonsillitis generally resolves completely within 7-10 days

43. NURSING CARE OF PATIENT WITH URTIS
Assessment
• A health history of the patient may reveal the signs and symptoms such
as sore throat, headache, pain around the eyes and on either sides of the
nose, difficult in swallowing, cough, hoarseness, fever, general
discomfort and fatigue.
• Determine the history of allergy.
• Inspect nasal mucosal for abnormal findings like increased redness,
swelling, exudates, and polyp.
• Inspect the throat for redness, asymmetry, drainages, ulceration,
enlarged tonsils and pharynx .
• Palpate the neck lymph nodes for enlargement and tenderness

44. NURSING DIAGNOSIS
• Ineffective airway clearance as related to excessive mucus
production secondary to retained secretion and inflammation
• Acute pain related to upper airway irritation secondary to an
infection
• Difficult in breathing related to narrowing of upper airways
manifested by noisy respiration
• Impaired verbal communication related to narrowing and
irritation of upper airway secondary to infection or swelling

45. NURSING MANAGEMENT OF PATIENT
WITH URTIS
• Maintain patent airways by appropriate positioning and
managing secretion
• Encourage the patient to take more fluids (2-3L/day)
• Promote comfort by either giving a patient pain killer like
paracetamol, hot packs, warm salt water gargles and encourage
to rest
• Encourage the patient to take prescribed antibiotics accurately
.
• Teach the patient the signs and symptoms that require them to
seek health care

46. LIST OF REFFERENCES
• Brunners and suddarth(2000).Medical surgical nursing, Management of patient
with upper respiratory tract infection, 1(1) ,518-533.
• W . S. Linda, H. D. Paula (2007). Medical surgical Nursing. Management of the
patient of upper respiratory tract Infection, 3edition, 577-589.
• Brumer and Suddarth. Medical Surgical Nursing. Lippincott Williams & Wilkins,
London.
• Lewis, M.L, Heitkemper, M.M. & Collier, CI. Medical-Surgical Nursing:
Assessment and Management of Clinical Problems, Mosby, Philadlphia.
• Goldman, M. A. Pocket Guide to the Operating Room, F.A Davis Company,
Philadelphia.
• Williams, L. S. and Hopper, P.D. Understanding Medical Surgical Nursing. F. A.
Davis Co. Philadelphia.
• Lewis, S.L., Dirksen S.R., Heitkemper and Bucher, L. Clinical Companion to
Medical-Surgical Nursing: Assessment and Management of Clinical Problems.
Mosby, Philadelphia.
• Matheny, M.N. Fluid and Electrolyte Balance: Nursing Considerations. Lippincott
Williams, London.