Adult Nursing I: Upper Respiratory Disorders

Course Information

• Course name: Adult Nursing I/ Theory
• Course number: 0301215
• Lecture title: Upper Respiratory Tract Disorders
• Date of lecture: 12/15/2024

Learning Outcomes

• Recognize causes, diagnostic studies, and clinical manifestations of upper respiratory tract disorders.
• Demonstrate knowledge of management strategies for upper respiratory tract disorders.
• Explain nursing interventions in the care of patients with upper respiratory tract disorders.
• Use the nursing process as a framework for care of patients with upper respiratory tract disorders.

Upper Respiratory Tract Anatomy

• The upper respiratory tract includes the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi.
• Structures of the upper respiratory tract are detailed in images. Regions of the pharynx are shown, including nasopharynx, oropharynx, and laryngopharynx
• The nose includes internal and external nares.
• Structures of the nasal cavity like turbinates, conchae are shown
• Other parts include: hard palate, soft palate, tongue, uvula, epiglottis, larynx, and esophagus

Upper Respiratory Tract Disorders

• Upper respiratory tract disorders involve the nose, paranasal sinuses, pharynx, larynx, trachea, or bronchi.
• Upper airway/respiratory infections can be acute or chronic.
• Infections affect the mucous membranes of the nose, sinuses, pharynx, upper trachea, or larynx.
• Viruses are the most common initial cause of infection followed by bacterial infections.

Rhinitis

• Rhinitis is the inflammation and irritation of the mucous membranes of the nose, which can be acute or chronic, and allergic or non-allergic.
• The common cold is a common cause of non-allergic rhinitis.
• Allergic rhinitis, also known as seasonal rhinitis, is associated with exposure to allergens like foods, medications, and indoor/outdoor particles.
• Risk factors include changes in temperature, humidity, odors, infections, age, systemic diseases, and use of OTC/prescribed nasal decongestants.

Clinical Manifestations and Management of Rhinitis

• Manifestations include Excessive nasal drainage (rhinorrhea), nasal congestion, nasal discharge (purulent in bacterial cases), sneezing, and pruritus (itching) of the oropharynx, eyes, and ears.
• Medical management includes: corticosteroids, antibiotics, antihistamines, pseudoephedrine, saline nasal spray, ipratropium for rhinorrhea, and ophthalmic agents (cromolyn).
• Nursing management includes avoiding or reducing exposure to allergens and irritants, controlling the environment at home and work, instructing patients on proper administration of nasal medications, and reviewing/practicing hand hygiene in cases of infectious rhinitis.

Viral Rhinitis (Common Cold)

• Viral rhinitis is an acute inflammation of the nasal cavity's mucous membranes.
• It is highly contagious.
• Common causes are rhinoviruses (over 200 types), coronavirus, adenovirus, respiratory syncytial virus, influenza virus, and parainfluenza virus.
• Each virus type may have multiple strains.
• Symptoms include low-grade fever, nasal congestion, rhinorrhea, and nasal discharge; halitosis, sneezing, tearing watery eyes, sore throat, malaise, chills, headache, muscle aches, and cough.
• Medical management: adequate fluid intake, rest, prevention of chilling, expectorants, warm salt-water gargles, NSAIDs, antihistamines, and petroleum jelly for irritated skin.
• Symptoms typically last 1-2 weeks, and Herpes simplex (cold sores) may be exacerbated by some cases/infections.

Acute Pharyngitis

• Acute pharyngitis is a sudden, painful inflammation of the pharynx (sore throat).
• Pathophysiology: typically caused by viral infections (Adenovirus, influenza virus, Epstein-Barr virus, herpes simplex). Bacterial infections (Group A Streptococcus or GAS, and groups B and G streptococci), occur in some cases
• Manifestations include: swollen, flecked throat with white/purple exudate in pharyngeal membrane; swollen or tender cervical lymph nodes; fever (greater than 38.3°C); and malaise; and other symptoms like nausea, vomiting, anorexia, rash, headache, muscle aches, sore throat, painful cervical adenopathy, and bad breath.
• Complications: severe and life-threatening (rhinosinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis, sepsis, pneumonia, meningitis, rheumatic fever, and glomerulonephritis).
• Assessment and diagnostic findings include determining the cause (viral or bacterial), rapid antigen detection tests (RADTs), and throat cultures.
• Medical Management includes: supportive and symptom management for viral cases and antibiotics for bacterial cases.
• Pharmacologic therapies include penicillin, erythromycin, and cephalosporins.
• Nutritional therapy includes a liquid or soft diet, cool beverages, warm liquids, and flavored frozen desserts; IV fluids may be needed in severe cases.
• Nursing management includes instruction for patients on reporting symptoms (difficulty swallowing, dyspnea, drooling, inability to open mouth); and recommendations to stay in bed during the febrile stage; rest; and infection prevention measures.

Chronic Pharyngitis

• Chronic pharyngitis is persistent inflammation of the pharynx.
• Risk factors include: exposure to dust, excessive voice use, chronic cough, heavy consumption of tobacco and alcohol.
• 3 types: - Hypertrophic: thickening and congestion of the pharyngeal mucous membrane. - Atrophic: thin, whitish, glistening pharyngeal mucous membrane that can be wrinkled. - Chronic granular: swollen lymph follicles in the pharyngeal mucous membrane.
• Clinical manifestations: a constant sense of irritation or fullness in the throat, mucus production that can be coughed up, and difficulty swallowing.
• Medical management: avoidance of irritants, short-term use of nasal sprays; antihistamines/decongestants (pseudoephedrine, brompheniramine, or pseudoephedrine); for adults, tonsillectomy might be considered as an option.
• Nursing recommendations for chronic pharyngitis include avoiding alcohol, tobacco, exposure to environmental pollutants, and drinking plenty of fluids.

Tonsillitis and Adenoiditis

• Tonsillitis and adenoiditis are infections of the tonsils and adenoids.
• Tonsils are lymphatic tissue on each side of the oropharynx.
• Adenoids are lymphatic tissue in the nasopharynx.
• Infections frequently accompany acute tonsillitis.
• Etiology includes bacterial (Group A Streptococcus–most common) and viral (Epstein-Barr virus, cytomegalovirus).
• Clinical manifestations include sore throat, fever, snoring, difficulty swallowing, enlarged adenoids (causing mouth breathing, earache, drainage from ears, frequent head colds, bronchitis, bad breath, voice impairment, noisy respiration), and nasal obstruction.
• Complications include acute otitis media, spontaneous rupture of tympanic membranes, mastoiditis, and permanent deafness.
• Assessment and diagnostic findings include determining viral or bacterial pathogens through RADTs and throat swabs.
• Medical management includes increasing fluid intake, salt-water gargles, and rest; penicillin or cephalosporins for bacterial infection; tonsillectomy (with or without adenoidectomy) for chronic or repeated infections.
• Postoperative care includes observing for hemorrhage, positioning the patient to promote drainage, avoiding removal of oral airway until gag/swallowing reflexes return, applying ice to the neck, providing basin/tissue for blood/mucus, allowing water/ice chips.
• Patient education for self-care includes avoiding spicy, hot, acidic, or rough foods; milk/dairy products; vigorous toothbrushing or gargling; smoking, heavy lifting, or exertion for 10 days post-surgery. Also, teach fluids, and use of liquid acetaminophen and alkaline mouthwashes/warm saline as needed.