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Upper respiratory tract infections ppt

Upper respiratory tract infections (URIs) are the most common acute illnesses, with sinusitis being a significant type characterized by inflammation of the sinus cavities due to infections, which can be viral, bacterial, or fungal. Acute sinusitis can resolve within 12 weeks, while chronic sinusitis persists beyond that with ongoing symptoms, often requiring medical management including nasal corticosteroids, antibiotics, and lifestyle changes. Complications from URIs can include asthma, meningitis, and vision problems, necessitating proper assessment and treatment for effective management.

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Mr. Mahesh Chand Nursing Tutor Manikaka Topawala Institute of Nursing, Changa
INTRODUCTION • Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold--typically a mild, self- limited, catarrhal syndrome of the nasopharynx--to life-threatening illnesses such as epiglottitis. Viruses account for most URIs. Bacterial primary infection or superinfection may require targeted therapy.
ANATOMY AND PHYSIOLOGY
SINUSITIS: DEFINITION: • "Sinusitis" simply means your sinuses are inflamed―red and swollen―because of an infection or another problem
PATO-PHYSIOLOGY VIRAL OR BACTERIAL INFECTION INFLAMMATION, EDEMAAND TRANSUDATION OF FLUID OBSTRUCTION OF SINUS CAVITY SINUSITIS
TYPES OF SINUSITIS • ACUTE SINUSITIS • CHRONIC SINUSITIS
ACUTE SINUSITIS • Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen.
CAUSES: • Viral infection • Bacterial infection • Fungal infection • Allergies such as hay fever • Nasal polyps or tumours • Deviated nasal septum
• Tooth infection • Enlarged or infected adenoids in children • Other medical conditions
RISK FACTORS • Hay fever or another allergic condition • A nasal passage abnormality • A medical condition such as cystic fibrosis, gastroesophageal reflux disease (GERD), or an immune system disorder • Regular exposure to pollutants
SIGN AND SYMPTOMS • Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat • Nasal obstruction or congestion, causing difficulty breathing through your nose • Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
• Aching in your upper jaw and teeth • Reduced sense of smell and taste • Cough, which may be worse at night Other signs and symptoms can include: • Ear pain • Headache • Sore throat
ASSESSMENT AND DIAGNOSTIC FINDINGS • Physical exam
Nasal endoscopy
Imaging studies
Nasal and sinus cultures
Allergy testing
COMPLICATIONS • Asthma • Chronic sinusitis • Meningitis • Vision problems • Ear infection
MEDICAL MANAGEMENT
Saline nasal spray
Nasal corticosteroids
Over-the-counter pain relievers • aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu- like symptoms should never take aspirin
Decongestants • oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine, others) and oxymetazoline (Afrin, others). These medications are generally taken for only a few days at most
Antibiotics • Antibiotics used to treat acute sinusitis caused by a bacterial infection include amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim- sulfamethoxazole (Bactrim, Septra, others).
Antifungal medications • acute sinusitis is caused by a fungal infection, which can be treated with antifungal medication.
Immunotherapy • If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms
LIFE STYLE AND HOME REMEDIES • Get plenty of rest • Drink plenty of fluids • Steam your sinus cavities • Apply warm compresses to your face • Rinse out your nasal passages • Sleep with your head elevated
CHRONIC SINUSITIS • Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen. Chronic sinusitis lasts 12 weeks or longer despite treatment attempts
CAUSES: • Nasal polyps or tumours • Allergic reactions • Deviated nasal septum • Trauma to the face • Other medical conditions • Respiratory tract infections • Allergies such as hay fever • Immune system cells
RISK FACTORS • A nasal passage abnormality, such as a deviated nasal septum or nasal polyps • Aspirin sensitivity that causes respiratory symptoms • A medical condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD)
• An immune system disorder, such as HIV/AIDS or cystic fibrosis • Hay fever or another allergic condition that affects your sinuses • Asthma — about 1 in 5 people with chronic sinusitis have asthma • Regular exposure to pollutants such as cigarette smoke
SIGN AND SYMPTOMS • Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat • Nasal obstruction or congestion, causing difficulty breathing through your nose • Pain, tenderness and swelling around your eyes, cheeks, nose or forehead • Reduced sense of smell and taste
• Ear pain • Aching in your upper jaw and teeth • Cough, which may be worse at night • Sore throat • Bad breath (halitosis) • Fatigue or irritability • Nausea
ASSESSMENT AND DIAGNOSIS • Nasal endoscopy • Imaging studies • Nasal and sinus cultures • An allergy test
COMPLICATIONS • Asthma flare-ups • Meningitis • Vision problems • Aneurysms or blood clots
MEDICAL MANAGEMENT The goal of treating chronic sinusitis is to: • Reduce sinus inflammation • Keep your nasal passages draining • Eliminate the underlying cause • Reduce the number of sinusitis
Treatments to relieve symptoms • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages. • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase AQ).
Oral or injected corticosteroids • These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone
Decongestants • These medications are available in over-the- counter (OTC) and prescription liquids, tablets and nasal sprays An example of an OTC nasal spray is oxymetazoline (Afrin).
Antibiotics • Antibiotics used to treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim- sulfamethoxazole (Bactrim, Septra, others).
Immunotherapy • If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition
SURGICAL MANAGEMENT:
Insertion of a Drainage Tube
Functional Endoscopic Sinus Surgery
Balloon Sinuplasty
Balloon Sinoplasty
Post op care • DIET- Bland light meal or liquid diet on the first day • Regular diet on next day • WOUND CARE & INFORMATION- • Head elevation reduce bleeding and swelling • Do not remove packing • Do not blow yr nose for 1 week •
Non-pharmacological treatment • Humidifier to relieve the drying of mucous membranes associated with mouth breathing • Increase oral fluid intake • Saline irrigation of the nostrils • Moist heat over affected sinus
PREVENTION
RHINITIS:
DEFINITION: • Rhinitis is a reaction that occurs in the eyes, nose and throat when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids
TYPES ALLERGIC RHINITIS • Seasonal • Perennial NON ALLERGIC RHINITIS • vasomotor rhinitis (irritant rhinitis) • eosinophilic • rhinitis medicamentosa • neutrophilic rhinosinusitisnial
CAUSES: • Allergic rhinitis is a very common cause of rhinitis • Seasonal allergic rhinitis (hay fever) is usually caused by pollen in the air, and sensitive patients have symptoms during peak times during the year.
• Perennial allergic rhinitis, a type of chronic rhinitis is a year-round problem, and is often caused by indoor allergens (particles that cause allergies), such as dust and animal dander in addition to pollens that may exist at the time. Symptoms tend to occur regardless of the time of the year
PATHO-PHYSIOLOGY ALLERGENS OR CERTAIN MEDICATIONS IMMEDIATE AND DELAYED RELEASE OF NUMBER OF MEDIATORS (EG. HISTAMINE, TRYPTASE) INCREASE MUCUS SECRETION NASAL CONGESION AND PRESSURE
SIGN AND SYMPTOMS • Itchy nose, mouth, eyes, throat, skin, or any area • Problems with smell • Runny nose • Sneezing • Tearing eyes
Symptoms that may develop later include: • Stuffy nose(nasal congestion) • Coughing • Clogged ears and decreased sense of smell • Sore throat • Dark circles under the eyes • Puffiness under the eyes • Fatigue and irritability
Investigations and Diagnosis • Nasal endoscopy • Imaging studies • Nasal and sinus cultures • X- ray study
Steroid nasal sprays Examples of the nasal steroids include: • beclomethasone (Beconase), • flunisolide (Nasarel), • budesonide (Rhinocort),
Antihistamines • Antihistamines are drugs that block the histamine reaction. These medications work best when given prior to exposure. • Eg.Sedating or first generation [diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). • Non-sedating or second generation [loratadine (Claritin), cetirizine (Zyrtec)].
Decongestant sprays • Examples of decongestant sprays include: • oxymetazoline (Afrin), and • phenylephrine (Neo-Synephrine)
Oral decongestants • Oral decongestants temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction The most common decongestant is pseudoephedrine (Sudafed).
Cromolyn sodium (Nasalcrom) • Cromolyn sodium (Nasalcrom) is a spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine.
Montelukast (Singulair) • Montelukast (Singulair) is an agent that acts similar to antihistamine, although it is involved in another pathway in allergic response
Ipratropium (Atrovent nasal) • Ipratropium (Atrovent nasal) is used as a nasal spray and helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.
Mucus thinning agents • Mucus thinning agents are utilized to make secretions thinner and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin, and Organidin) is a commonly used formulation.
Allergy shots (Immunotherapy) • Allergy shots interfere with the allergic response. After identification of an allergen, small amounts are given back to the sensitive patient
SURGICAL MANAGEMENT • Septal deviation, septal spurs, septal perforation, enlargement of the turbinates, and nasal/sinus polyps can lead to pooling of or overproduction of secretions, blockage of the normal pathways leading to chronic sinusitis, and chronic irritation. The surgery is performed by an ear-nose- throat doctor (otolaryngologist).
EPIGLOTTITIS: • DEFINITION: Epiglottitis is inflammation of the tissue that covers the trachea (windpipe). It is a life-threatening disease
Causes of Epiglottitis • Various organisms that can cause Epiglottitis include Streptococcus pneumonie, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus, among others • Heat damage that results in epiglottitis is also known as thermal epiglottitis.
Signs & Symptoms of Epiglottitis •Severe sore throat •Difficult and painful swallowing •Drooling due to severe pain when swallowing •A muffled or hoarse voice •Harsh, raspy breathing •Difficulty breathing •Blue skin or lips
DIAGNOSTIC FINDINGS: • Blood culture or throat culture • Complete blood count (CBC) • Neck x-ray
NECK X-RAY:
Medical Treatment • Antibiotics • Corticosteroids and epinephrine
Prevention of Epiglottitis • Immunization with the Hib vaccine is an effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: • At ages 2 months • At 4 months • At 6 months • At 12 to 15 months
Complications • Meningitis • Epiglottic abscess • Cervical adenitis • Vocal granuloma • Subsequent necrotizing fasciitis of the head and neck (rare)
• Pneumonia • Pulmonary edema • Empyema • Pneumothorax • Pneumomediastinum (rare) • Pericarditis • Septic arthritis • Cellulitis
SURGERY: EPIGLOTTIDECTOMY
RISKS • Bleeding • Infection • Tooth injury • Difficulty swallowing • Changes in speech • Changes in speech • Continued snoring
LARYNGITIS
DEFINITION • Laryngitis is swelling and irritation of the voice box that is usually associated with hoarseness or loss of voice.
RISK FACTORS • SMOKING • OVERUSING YOUR VOICE • HAVING UPPER RESPIRATORY INFECTION LIKE A COLD , FLU OR BROCHITIS
CAUSES: • Overuse of voice • Allergies • Bacterial infection • Bronchitis • Gastroesophageal reflux disease (GERD) • Injury • Irritants and chemicals • Pneumonia
SIGN AND SYMPTOMS • Hoarseness • Loss of voice • Tickling, scratchiness, and rawness in your throat • A constant urge to clear your throat • Dry throat or cough • Fever, general feeling of lethargy and tiredness, and difficulty breathing are indications of more severe cases
ASSESSMENT AND DIAGNOSTIC FINDINGS LARYNGOSCOPY
• Skin allergy test • Chest and neck x rays • biopsy
MEDICAL MANAGEMENT • STEROIDS • E.g. prednisolon, dexamethasone • It is given either by intramuscular route or orally • Antibiotics:
SURGICAL MANAGEMENT • LASER VAPORIZATION • LAPAROSCOPIC ANTIREFLUX SURGERY
PHARYNGITIS:
DEFINITION • TYPES: • ACUTE PHARYNGITIS • CHRONIC PHARYNGITIS
CAUSES: • Most sore throats are caused by viruses, although a few are due to bacterial infections • Viruses that can cause sore throat include the common cold, the flu, and mononucleosis (often called "mono"). Bacteria like Group A streptococcus (commonly known as strep throat) can also cause pharyngitis.
PATHO-PHYSIOLOGY GROUP A BETA HEMOLYTIC STREPTOCOCCI ANTIGEN AND ANTIBODY REACTION INFLAMMATORY PROCESS PHARYNGIAL SWELLING, FEVER AND ENLARGED LYMPH NODES
Risk Factors • Cold and flu seasons • Having close contact with someone who has a sore throat or cold • Smoking or exposure to second hand smoke • Frequent sinus infections • Allergies
Signs and Symptoms • Sore throat with cold • Sneezing • Cough • A low fever (less than 102 °F) • Mild headache • Sore throat with flu • Fatigue
• Enlarged lymph nodes in neck and armpits • Swollen tonsils • Headache • Loss of appetite • Swollen spleen • Liver inflammation
DIAGNOSTIC FINDINGS • Tests that may be done include: • Blood culture or throat culture • Complete blood count (CBC) • Neck x-ray
COMPLICATION • Abscess around the tonsils or in the back of the throat • Blockage of the airway • Rheumatic fever (complication of strep throat) • Sepsis (life-threatening bacterial blood infection) • Spread of infection
MEDICAL MANAGEMENT • Antibiotics used to treat pharyngitis Amoxicillin (Amoxil) Penicillin V (Veetids)
Analgesics used to treat pharyngitis E.g. • Acetaminophen (Tylenol) • Ibuprofen (Advil, Motrin)
TONSILLITIS:
DEFINITION: • Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection.
CAUSES: • Inflammation of the tonsils may result from bacterial or viral infections. • Bacterias: Tonsillitis is often caused by Group A streptococcal bacteria, resulting in strep throat. • Virus: Tonsillitis may be caused by viruses such as the Epstein-Barr virus (cause of glandular fever) or the Coxsackie virus
TYPES OF TONSILLITIS • Acute tonsillitis: • Subacute tonsillitis: • Chronic tonsillitis:
Signs and symptoms • Difficulty in swallowing • Change in voice • Hoarseness • Bad breath • Cough and nasal congestions
• Headache • Sore glands in throat • Pain in throat and sore throat • Tonsils coated with white or yellow patches • Difficult breathing because of swollen tonsils • Red and sore tonsils • Sore eyes • Body aches • Chills
ASSESSMENT AND DIAGNOSTIC FINDINGS • Blood count • Mononucleosis test • The mononucleosis spot test looks for two antibodies in the blood that indicate infection with the Epstein- Barr virus (EBV).
Rapid strep test
Throat swab culture
MEDICAL MANAGEMENT • NSAIDs, Paracetamol/Acetaminophen, Ibuprofen • If tonsillitis is caused by Group A Beta-Hemolytic Streptococci, antibiotics like penicillin, amoxicillin, erythromycin, or clindamycin • Rest • Hydration • Anti-inflammatory, pain relief, and fever tackling medicines such as ibuprofen, acetaminophen, and aspirin
SURGICAL MANAGEMENT TONSILECTOMY
COMPLICATIONS • Peritonsillitis or Peritonsillar abscess • Acute Suppurative cervical lymphadenitis • Acute gangrenous tonsillitis • Edema of the larynx • Septicaemia
Peritonsillar Abscess or Quinsy • It is a collection of pus between fibrous capsule of the tonsil usually at its upper pole and the superior constrictor muscle of pharynx.
Types • Anterior • Posterior • Lingual • Tonsillar
Etiology • More common in males • Recurrent tonsillitis • Foreign body embedded in the tonsils • Tonsillar tag left behind after tonsillectomy
Pathophysiology Recurrent tonsillitis Fibrosis of tonsillar crypt Closure of tonsillar crypt due to new infections Pus breaks through the capsule of tonsil Peritonsillar cellulitis Peritonsillar abscess
Signs• Ill looking patient • Pyrexia • Often with severe trismus • Striking asymmetry with oedema and hyperaemia of the soft palate. • Enlarged hyperaemic and displaced tonsil • Trismus • Halitosis • Rupture of the abscess
Symptoms • Throat pain • Trismus • Increased salivation • Thick speech
Complications • Parapharyngeal abscess • Phlebitis of the Internal jugular vein • Septecemia • Hemorrhage • Supraglottic edema
Treatment • Analgesics and antibiotics. • Adequate hydration • I & D • Tonsillectomy • Quincy tonsillectomy
Adenoids When hypertrophied nasopharyngeal tonsil starts producing symptoms the condition is referred to as adenoids. The normal involution of nasopharyngeal tonsil starts from the onset of puberty, but sometimes it can persist for a longer period.
Etiology • Between 3-10 years of age. • TB and other infections • Causes similar to tonsillitis.
Clinical manifestations• Nasal obstruction, mouth breathing • Pigeon chest and Harrison’s sulcus • Rhinolalia Clausa (Voice becomes flat and toneless) • E. tube obstruction • Purulent nasal discharge • Post nasal discharge, pharyngitis • Lymphadenitis • OM • Aggravation of asthma and bronchitis
Diagnosis • Clinical manifestations • Posterior rhinoscopy • Digital palpation • Radical examination
Treatment • Antibiotics • Decongestants • Breathing exercises • Adenoidectomy • Antral lavage to drain sinusitis • Grommet may be inserted to ear of a patient having secretary OM
NURSING MANAGEMENT: • Ineffective Airway clearance related to excessive mucus production secondary to retained secretions and inflammations. • Acute pain related to upper airway irritation secondary to an infection.
• Fluid volume deficit related to increased fluid loss secondary to diaphoresis associated with fever. • Impaired verbal communication related to physiologic changes and upper airway irritation. • Anxiety related to outcome of diseases as evidenced by poor concentration on work, isolation from others, rude behaviour
• Knowledge deficit regarding the treatment regimen, prevention of upper respiratory tract infections, surgical procedure or post operative care
DIETARY MANAGEMENT
Vitamin mineral supplements • Older individuals are often deficient in a number of vitamins and minerals, putting them at risk for decreased immune function. • The minerals zinc and selenium are known to be important in immune function and may be responsible for this effect.
Zinc • Zinc is known to decrease viral growth and may enhance functioning of the immune system • Zinc lozenges are maximally effective when used every two hours. Mild irritation of the mouth and stomach is common with zinc lozenges
Vitamin C • The utility of vitamin C for preventing or treating colds is widely accepted in the general population
Vitamin E • High doses of vitamin E may improve immune function. In a study of elderly nursing home residents, 200 IU of vitamin E per day significantly reduced the incidence of common colds and the number of persons who got colds

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Upper respiratory tract infections ppt

  • 1.
    Mr. Mahesh Chand NursingTutor Manikaka Topawala Institute of Nursing, Changa
  • 2.
    INTRODUCTION • Upper respiratorytract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold--typically a mild, self- limited, catarrhal syndrome of the nasopharynx--to life-threatening illnesses such as epiglottitis. Viruses account for most URIs. Bacterial primary infection or superinfection may require targeted therapy.
  • 3.
  • 6.
    SINUSITIS: DEFINITION: • "Sinusitis" simplymeans your sinuses are inflamed―red and swollen―because of an infection or another problem
  • 7.
    PATO-PHYSIOLOGY VIRAL OR BACTERIALINFECTION INFLAMMATION, EDEMAAND TRANSUDATION OF FLUID OBSTRUCTION OF SINUS CAVITY SINUSITIS
  • 8.
    TYPES OF SINUSITIS •ACUTE SINUSITIS • CHRONIC SINUSITIS
  • 9.
    ACUTE SINUSITIS • Acutesinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen.
  • 10.
    CAUSES: • Viral infection •Bacterial infection • Fungal infection • Allergies such as hay fever • Nasal polyps or tumours • Deviated nasal septum
  • 11.
    • Tooth infection •Enlarged or infected adenoids in children • Other medical conditions
  • 12.
    RISK FACTORS • Hayfever or another allergic condition • A nasal passage abnormality • A medical condition such as cystic fibrosis, gastroesophageal reflux disease (GERD), or an immune system disorder • Regular exposure to pollutants
  • 13.
    SIGN AND SYMPTOMS •Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat • Nasal obstruction or congestion, causing difficulty breathing through your nose • Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
  • 14.
    • Aching inyour upper jaw and teeth • Reduced sense of smell and taste • Cough, which may be worse at night Other signs and symptoms can include: • Ear pain • Headache • Sore throat
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
    COMPLICATIONS • Asthma • Chronicsinusitis • Meningitis • Vision problems • Ear infection
  • 21.
  • 22.
  • 23.
  • 24.
    Over-the-counter pain relievers •aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu- like symptoms should never take aspirin
  • 25.
    Decongestants • oral decongestantsinclude Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine, others) and oxymetazoline (Afrin, others). These medications are generally taken for only a few days at most
  • 26.
    Antibiotics • Antibiotics usedto treat acute sinusitis caused by a bacterial infection include amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim- sulfamethoxazole (Bactrim, Septra, others).
  • 27.
    Antifungal medications • acutesinusitis is caused by a fungal infection, which can be treated with antifungal medication.
  • 28.
    Immunotherapy • If allergiesare contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms
  • 29.
    LIFE STYLE ANDHOME REMEDIES • Get plenty of rest • Drink plenty of fluids • Steam your sinus cavities • Apply warm compresses to your face • Rinse out your nasal passages • Sleep with your head elevated
  • 30.
    CHRONIC SINUSITIS • Chronicsinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen. Chronic sinusitis lasts 12 weeks or longer despite treatment attempts
  • 31.
    CAUSES: • Nasal polypsor tumours • Allergic reactions • Deviated nasal septum • Trauma to the face • Other medical conditions • Respiratory tract infections • Allergies such as hay fever • Immune system cells
  • 32.
    RISK FACTORS • Anasal passage abnormality, such as a deviated nasal septum or nasal polyps • Aspirin sensitivity that causes respiratory symptoms • A medical condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD)
  • 33.
    • An immunesystem disorder, such as HIV/AIDS or cystic fibrosis • Hay fever or another allergic condition that affects your sinuses • Asthma — about 1 in 5 people with chronic sinusitis have asthma • Regular exposure to pollutants such as cigarette smoke
  • 34.
    SIGN AND SYMPTOMS •Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat • Nasal obstruction or congestion, causing difficulty breathing through your nose • Pain, tenderness and swelling around your eyes, cheeks, nose or forehead • Reduced sense of smell and taste
  • 35.
    • Ear pain •Aching in your upper jaw and teeth • Cough, which may be worse at night • Sore throat • Bad breath (halitosis) • Fatigue or irritability • Nausea
  • 36.
    ASSESSMENT AND DIAGNOSIS •Nasal endoscopy • Imaging studies • Nasal and sinus cultures • An allergy test
  • 37.
    COMPLICATIONS • Asthma flare-ups •Meningitis • Vision problems • Aneurysms or blood clots
  • 38.
    MEDICAL MANAGEMENT The goalof treating chronic sinusitis is to: • Reduce sinus inflammation • Keep your nasal passages draining • Eliminate the underlying cause • Reduce the number of sinusitis
  • 39.
    Treatments to relievesymptoms • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages. • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase AQ).
  • 40.
    Oral or injectedcorticosteroids • These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone
  • 41.
    Decongestants • These medicationsare available in over-the- counter (OTC) and prescription liquids, tablets and nasal sprays An example of an OTC nasal spray is oxymetazoline (Afrin).
  • 42.
    Antibiotics • Antibiotics usedto treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim- sulfamethoxazole (Bactrim, Septra, others).
  • 43.
    Immunotherapy • If allergiesare contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition
  • 44.
  • 45.
    Insertion of aDrainage Tube
  • 46.
  • 47.
  • 48.
  • 49.
    Post op care •DIET- Bland light meal or liquid diet on the first day • Regular diet on next day • WOUND CARE & INFORMATION- • Head elevation reduce bleeding and swelling • Do not remove packing • Do not blow yr nose for 1 week •
  • 50.
    Non-pharmacological treatment • Humidifierto relieve the drying of mucous membranes associated with mouth breathing • Increase oral fluid intake • Saline irrigation of the nostrils • Moist heat over affected sinus
  • 51.
  • 52.
  • 53.
    DEFINITION: • Rhinitis isa reaction that occurs in the eyes, nose and throat when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids
  • 54.
    TYPES ALLERGIC RHINITIS • Seasonal •Perennial NON ALLERGIC RHINITIS • vasomotor rhinitis (irritant rhinitis) • eosinophilic • rhinitis medicamentosa • neutrophilic rhinosinusitisnial
  • 55.
    CAUSES: • Allergic rhinitisis a very common cause of rhinitis • Seasonal allergic rhinitis (hay fever) is usually caused by pollen in the air, and sensitive patients have symptoms during peak times during the year.
  • 56.
    • Perennial allergicrhinitis, a type of chronic rhinitis is a year-round problem, and is often caused by indoor allergens (particles that cause allergies), such as dust and animal dander in addition to pollens that may exist at the time. Symptoms tend to occur regardless of the time of the year
  • 57.
    PATHO-PHYSIOLOGY ALLERGENS OR CERTAINMEDICATIONS IMMEDIATE AND DELAYED RELEASE OF NUMBER OF MEDIATORS (EG. HISTAMINE, TRYPTASE) INCREASE MUCUS SECRETION NASAL CONGESION AND PRESSURE
  • 58.
    SIGN AND SYMPTOMS •Itchy nose, mouth, eyes, throat, skin, or any area • Problems with smell • Runny nose • Sneezing • Tearing eyes
  • 59.
    Symptoms that maydevelop later include: • Stuffy nose(nasal congestion) • Coughing • Clogged ears and decreased sense of smell • Sore throat • Dark circles under the eyes • Puffiness under the eyes • Fatigue and irritability
  • 60.
    Investigations and Diagnosis •Nasal endoscopy • Imaging studies • Nasal and sinus cultures • X- ray study
  • 61.
    Steroid nasal sprays Examplesof the nasal steroids include: • beclomethasone (Beconase), • flunisolide (Nasarel), • budesonide (Rhinocort),
  • 62.
    Antihistamines • Antihistamines aredrugs that block the histamine reaction. These medications work best when given prior to exposure. • Eg.Sedating or first generation [diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). • Non-sedating or second generation [loratadine (Claritin), cetirizine (Zyrtec)].
  • 63.
    Decongestant sprays • Examplesof decongestant sprays include: • oxymetazoline (Afrin), and • phenylephrine (Neo-Synephrine)
  • 64.
    Oral decongestants • Oraldecongestants temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction The most common decongestant is pseudoephedrine (Sudafed).
  • 65.
    Cromolyn sodium (Nasalcrom) •Cromolyn sodium (Nasalcrom) is a spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine.
  • 66.
    Montelukast (Singulair) • Montelukast(Singulair) is an agent that acts similar to antihistamine, although it is involved in another pathway in allergic response
  • 67.
    Ipratropium (Atrovent nasal) •Ipratropium (Atrovent nasal) is used as a nasal spray and helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.
  • 68.
    Mucus thinning agents •Mucus thinning agents are utilized to make secretions thinner and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin, and Organidin) is a commonly used formulation.
  • 69.
    Allergy shots (Immunotherapy) •Allergy shots interfere with the allergic response. After identification of an allergen, small amounts are given back to the sensitive patient
  • 70.
    SURGICAL MANAGEMENT • Septaldeviation, septal spurs, septal perforation, enlargement of the turbinates, and nasal/sinus polyps can lead to pooling of or overproduction of secretions, blockage of the normal pathways leading to chronic sinusitis, and chronic irritation. The surgery is performed by an ear-nose- throat doctor (otolaryngologist).
  • 71.
    EPIGLOTTITIS: • DEFINITION: Epiglottitis isinflammation of the tissue that covers the trachea (windpipe). It is a life-threatening disease
  • 72.
    Causes of Epiglottitis •Various organisms that can cause Epiglottitis include Streptococcus pneumonie, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus, among others • Heat damage that results in epiglottitis is also known as thermal epiglottitis.
  • 73.
    Signs & Symptomsof Epiglottitis •Severe sore throat •Difficult and painful swallowing •Drooling due to severe pain when swallowing •A muffled or hoarse voice •Harsh, raspy breathing •Difficulty breathing •Blue skin or lips
  • 74.
    DIAGNOSTIC FINDINGS: • Bloodculture or throat culture • Complete blood count (CBC) • Neck x-ray
  • 75.
  • 76.
    Medical Treatment • Antibiotics •Corticosteroids and epinephrine
  • 77.
    Prevention of Epiglottitis •Immunization with the Hib vaccine is an effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: • At ages 2 months • At 4 months • At 6 months • At 12 to 15 months
  • 78.
    Complications • Meningitis • Epiglotticabscess • Cervical adenitis • Vocal granuloma • Subsequent necrotizing fasciitis of the head and neck (rare)
  • 79.
    • Pneumonia • Pulmonaryedema • Empyema • Pneumothorax • Pneumomediastinum (rare) • Pericarditis • Septic arthritis • Cellulitis
  • 80.
  • 81.
    RISKS • Bleeding • Infection •Tooth injury • Difficulty swallowing • Changes in speech • Changes in speech • Continued snoring
  • 82.
  • 83.
    DEFINITION • Laryngitis isswelling and irritation of the voice box that is usually associated with hoarseness or loss of voice.
  • 84.
    RISK FACTORS • SMOKING •OVERUSING YOUR VOICE • HAVING UPPER RESPIRATORY INFECTION LIKE A COLD , FLU OR BROCHITIS
  • 85.
    CAUSES: • Overuse ofvoice • Allergies • Bacterial infection • Bronchitis • Gastroesophageal reflux disease (GERD) • Injury • Irritants and chemicals • Pneumonia
  • 86.
    SIGN AND SYMPTOMS •Hoarseness • Loss of voice • Tickling, scratchiness, and rawness in your throat • A constant urge to clear your throat • Dry throat or cough • Fever, general feeling of lethargy and tiredness, and difficulty breathing are indications of more severe cases
  • 87.
  • 88.
    • Skin allergytest • Chest and neck x rays • biopsy
  • 89.
    MEDICAL MANAGEMENT • STEROIDS •E.g. prednisolon, dexamethasone • It is given either by intramuscular route or orally • Antibiotics:
  • 90.
    SURGICAL MANAGEMENT • LASERVAPORIZATION • LAPAROSCOPIC ANTIREFLUX SURGERY
  • 91.
  • 92.
    DEFINITION • TYPES: • ACUTEPHARYNGITIS • CHRONIC PHARYNGITIS
  • 93.
    CAUSES: • Most sorethroats are caused by viruses, although a few are due to bacterial infections • Viruses that can cause sore throat include the common cold, the flu, and mononucleosis (often called "mono"). Bacteria like Group A streptococcus (commonly known as strep throat) can also cause pharyngitis.
  • 94.
    PATHO-PHYSIOLOGY GROUP A BETAHEMOLYTIC STREPTOCOCCI ANTIGEN AND ANTIBODY REACTION INFLAMMATORY PROCESS PHARYNGIAL SWELLING, FEVER AND ENLARGED LYMPH NODES
  • 95.
    Risk Factors • Coldand flu seasons • Having close contact with someone who has a sore throat or cold • Smoking or exposure to second hand smoke • Frequent sinus infections • Allergies
  • 96.
    Signs and Symptoms •Sore throat with cold • Sneezing • Cough • A low fever (less than 102 °F) • Mild headache • Sore throat with flu • Fatigue
  • 97.
    • Enlarged lymphnodes in neck and armpits • Swollen tonsils • Headache • Loss of appetite • Swollen spleen • Liver inflammation
  • 98.
    DIAGNOSTIC FINDINGS • Teststhat may be done include: • Blood culture or throat culture • Complete blood count (CBC) • Neck x-ray
  • 99.
    COMPLICATION • Abscess aroundthe tonsils or in the back of the throat • Blockage of the airway • Rheumatic fever (complication of strep throat) • Sepsis (life-threatening bacterial blood infection) • Spread of infection
  • 100.
    MEDICAL MANAGEMENT • Antibioticsused to treat pharyngitis Amoxicillin (Amoxil) Penicillin V (Veetids)
  • 101.
    Analgesics used totreat pharyngitis E.g. • Acetaminophen (Tylenol) • Ibuprofen (Advil, Motrin)
  • 102.
  • 103.
    DEFINITION: • Tonsillitis isan inflammation of the tonsils most commonly caused by viral or bacterial infection.
  • 104.
    CAUSES: • Inflammation ofthe tonsils may result from bacterial or viral infections. • Bacterias: Tonsillitis is often caused by Group A streptococcal bacteria, resulting in strep throat. • Virus: Tonsillitis may be caused by viruses such as the Epstein-Barr virus (cause of glandular fever) or the Coxsackie virus
  • 105.
    TYPES OF TONSILLITIS •Acute tonsillitis: • Subacute tonsillitis: • Chronic tonsillitis:
  • 108.
    Signs and symptoms •Difficulty in swallowing • Change in voice • Hoarseness • Bad breath • Cough and nasal congestions
  • 109.
    • Headache • Soreglands in throat • Pain in throat and sore throat • Tonsils coated with white or yellow patches • Difficult breathing because of swollen tonsils • Red and sore tonsils • Sore eyes • Body aches • Chills
  • 110.
    ASSESSMENT AND DIAGNOSTIC FINDINGS •Blood count • Mononucleosis test • The mononucleosis spot test looks for two antibodies in the blood that indicate infection with the Epstein- Barr virus (EBV).
  • 111.
  • 112.
  • 113.
    MEDICAL MANAGEMENT • NSAIDs,Paracetamol/Acetaminophen, Ibuprofen • If tonsillitis is caused by Group A Beta-Hemolytic Streptococci, antibiotics like penicillin, amoxicillin, erythromycin, or clindamycin • Rest • Hydration • Anti-inflammatory, pain relief, and fever tackling medicines such as ibuprofen, acetaminophen, and aspirin
  • 114.
  • 115.
    COMPLICATIONS • Peritonsillitis orPeritonsillar abscess • Acute Suppurative cervical lymphadenitis • Acute gangrenous tonsillitis • Edema of the larynx • Septicaemia
  • 116.
    Peritonsillar Abscess or Quinsy •It is a collection of pus between fibrous capsule of the tonsil usually at its upper pole and the superior constrictor muscle of pharynx.
  • 117.
  • 118.
    Etiology • More commonin males • Recurrent tonsillitis • Foreign body embedded in the tonsils • Tonsillar tag left behind after tonsillectomy
  • 119.
    Pathophysiology Recurrent tonsillitis Fibrosis oftonsillar crypt Closure of tonsillar crypt due to new infections Pus breaks through the capsule of tonsil Peritonsillar cellulitis Peritonsillar abscess
  • 120.
    Signs• Ill lookingpatient • Pyrexia • Often with severe trismus • Striking asymmetry with oedema and hyperaemia of the soft palate. • Enlarged hyperaemic and displaced tonsil • Trismus • Halitosis • Rupture of the abscess
  • 121.
    Symptoms • Throat pain •Trismus • Increased salivation • Thick speech
  • 122.
    Complications • Parapharyngeal abscess •Phlebitis of the Internal jugular vein • Septecemia • Hemorrhage • Supraglottic edema
  • 123.
    Treatment • Analgesics andantibiotics. • Adequate hydration • I & D • Tonsillectomy • Quincy tonsillectomy
  • 124.
    Adenoids When hypertrophied nasopharyngeal tonsilstarts producing symptoms the condition is referred to as adenoids. The normal involution of nasopharyngeal tonsil starts from the onset of puberty, but sometimes it can persist for a longer period.
  • 126.
    Etiology • Between 3-10years of age. • TB and other infections • Causes similar to tonsillitis.
  • 127.
    Clinical manifestations• Nasal obstruction,mouth breathing • Pigeon chest and Harrison’s sulcus • Rhinolalia Clausa (Voice becomes flat and toneless) • E. tube obstruction • Purulent nasal discharge • Post nasal discharge, pharyngitis • Lymphadenitis • OM • Aggravation of asthma and bronchitis
  • 128.
    Diagnosis • Clinical manifestations •Posterior rhinoscopy • Digital palpation • Radical examination
  • 129.
    Treatment • Antibiotics • Decongestants •Breathing exercises • Adenoidectomy • Antral lavage to drain sinusitis • Grommet may be inserted to ear of a patient having secretary OM
  • 130.
    NURSING MANAGEMENT: • IneffectiveAirway clearance related to excessive mucus production secondary to retained secretions and inflammations. • Acute pain related to upper airway irritation secondary to an infection.
  • 131.
    • Fluid volumedeficit related to increased fluid loss secondary to diaphoresis associated with fever. • Impaired verbal communication related to physiologic changes and upper airway irritation. • Anxiety related to outcome of diseases as evidenced by poor concentration on work, isolation from others, rude behaviour
  • 132.
    • Knowledge deficitregarding the treatment regimen, prevention of upper respiratory tract infections, surgical procedure or post operative care
  • 133.
  • 134.
    Vitamin mineral supplements •Older individuals are often deficient in a number of vitamins and minerals, putting them at risk for decreased immune function. • The minerals zinc and selenium are known to be important in immune function and may be responsible for this effect.
  • 135.
    Zinc • Zinc isknown to decrease viral growth and may enhance functioning of the immune system • Zinc lozenges are maximally effective when used every two hours. Mild irritation of the mouth and stomach is common with zinc lozenges
  • 136.
    Vitamin C • Theutility of vitamin C for preventing or treating colds is widely accepted in the general population
  • 137.
    Vitamin E • Highdoses of vitamin E may improve immune function. In a study of elderly nursing home residents, 200 IU of vitamin E per day significantly reduced the incidence of common colds and the number of persons who got colds