Allergies and Inflammation in Nasal Tissues

Upper Respiratory Conditions

• Inflammation in nasal tissue often leads to chronic inflammation and congestion.
• Common physical exam findings include nasal congestion, turbinate hypertrophy (boggy and pale), clear drainage, and throat redness due to post nasal drip.
• Lung exams are generally normal and ears should appear unaffected.
• Diagnostic tests might show elevated eosinophils and basophils in CBC; allergy testing can involve skin tests or specific IgE testing.
• Management includes minimizing symptoms, reducing inflammation, limiting medications, and increasing tolerance to triggers.
• Second-generation antihistamines like Zyrtec, Clarinex, and Allegra are preferred for their safety and efficacy in reducing secretions and itching but are ineffective against congestion.
• Decongestants require caution in patients with cardiovascular issues, hypertension, or diabetes, and are essential for all sinusitis cases.

Influenza (Flu)

• Influentially contagious disease, affecting 5-20% of the population annually with approximately 20,000 deaths and 200,000 hospitalizations yearly.
• Influenza types:
  • A: Infects both animals and humans; capable of quick mutations.
  • B and C: Exclusively human infections.
• Transmission can occur via animal-human contact, contaminated surfaces, or fecal material, with peak risk from 1 day before symptoms to 5-7 days afterward.
• The incubation period is typically 1-4 days.
• Goals of treatment focus on preventing complications like pneumonia and sinusitis, which can occur due to blockages in the sinus mucosa from inflammation.
• Chronic sinusitis and potential bacterial infections are complications, commonly associated with dental abscesses and allergic triggers.

Pharyngitis

• Characterized by inflammation of the pharynx, can be acute bacterial, viral, or chronic (often noninfectious).
• Physical signs include varying throat redness and possible exudate, particularly with strep infections that present with white patches.
• Treatment differs: viral pharyngitis focuses on symptom relief, while bacterial infections require antibiotics like penicillin or erythromycin for patients allergic to penicillin.
• Throat care includes fluids, mouth care, and in bacterial cases, targeted antibiotic therapy.

Lower Respiratory Problems

Acute Bronchitis

• Predominantly viral, characterized by inflammation of the bronchi, lasting up to 3 weeks with symptoms like cough, fever, and malaise.
• Physical exam may reveal rhonchi or crackles, with treatment aimed at symptom relief.

Pneumonia

• Acute lung inflammation from infections, varying types include community-acquired, hospital-acquired, aspiration, and opportunistic pneumonia.
• Symptoms include fever, cough (with or without sputum), chills, and possible shortness of breath, especially in elderly patients.
• Diagnostic tests entail chest X-ray, CBC, and sputum culture, while nursing management focuses on respiratory assessment, medication administration, and patient support.

Tuberculosis

• Chronic infectious disease mostly impacting lungs, marked by inflammatory responses to TB nuclei imprinted in alveoli.
• Pathophysiology includes immune reactions leading to scar and granuloma formation.

Chronic Respiratory Conditions

Chronic Bronchitis

• Defined by excessive mucus production and productive cough lasting over 3 months, with structural airway changes.
• Key symptoms include dyspnea, increased respiratory rate, and tenacious sputum.

Emphysema

• Permanent enlargement of airspaces distal to bronchioles, correlating with bronchial wall destruction.
• Loss of elastic recoil and increased airway resistance lead to symptoms like dyspnea, barrel chest, and accessory muscle use.

Diagnostic Tests for COPD

• Bronchoscopy allows visualization of lungs using a camera to assess and sample lung tissue.
• Chest X-rays and pulmonary function tests (PFT) evaluate lung volumes, highlighting discrepancies in FEV1/FVC ratios indicative of obstructive versus restrictive diseases.

PFT Findings in COPD

• Decreased FEV1 often indicates airflow restriction, with a corresponding lowered FEV1/FVC ratio.
• TLC measures total inspiratory capacity; obstructive patterns reveal air trapping and reduced FEV1 with a decreased ratio.
• Restrictive patterns show decreased FEV1 and FVC while maintaining a normal FEV1/FVC ratio.

General Examination

• Monitoring lung sounds through percussion and auscultation provides additional diagnostic information on respiratory conditions.