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Upper Respiratory Tract Disorders

• Upper respiratory infections are the most common cause of illness, health care visits, and absences from school and work.
• URIs can be minor, acute, chronic, severe, or life-threatening.
• Early symptom detection and intervention can avoid complications.
• Management includes patient teaching focusing on prevention and health promotion
• Rhinitis and rhinosinusitis can be acute, chronic, bacterial, or viral.
• Other URIs are pharyngitis, tonsillitis, and laryngitis.

Viral Rhinitis (Common Cold)

• Symptoms appear 2-3 days after infection and includes a runny nose, watery eyes, nasal congestion, sneezing, coughing, sore throat, fever, headache, and fatigue.
• Usually lasts 7-10 days.
• Symptom relief is the primary management; antibiotics are not used.
• Rest, fluids, antipyretics, and analgesics are recommended.
• Warm salt gargles can provide relief.

Management of Viral Rhinitis

• Symptom relief, not antibiotics, is key.
• Instruct on rest, fluid intake, antipyretics, and analgesics.
• Warm salt gargles are beneficial.
• Offer saline nasal sprays.
• Suggest using lozenges or ice chips.
• Education involves recognizing worsening symptoms, avoiding crowds/sick individuals, practicing good hand hygiene, and watching for sputum changes, SOB, and chest tightness if a chronic disease is present.

Influenza

• Highly contagious with high morbidity and mortality rates.
• Classified into types A, B, C, and D.
• Common symptoms include chills, fever, myalgia, headache, cough, sore throat, and fatigue lasting about 7 days.
• Management focuses on symptom relief with rest, hydration, analgesics, antipyretics, and antiviral medications like Tamiflu; prevention.

Nursing Interventions for URI Patients

• Elevate the head.
• Use an ice collar to reduce inflammation and bleeding.
• Apply hot packs to reduce congestion.
• Administer analgesics for pain and topical anesthetics.
• Monitor for severe complications.
• Encourage liquids to keep secretions loose.

Epistaxis (Nosebleed) First Aid

• Maintain a sitting position, lean forward, with the head tilted forward, and apply direct pressure to the lower part of the nose for 5 to 15 minutes.
• Medical management may include packing, balloon insertion, vasoconstrictors, chemical or thermal cauterization, or embolization.
• Monitor respiratory status, LOC, VS, pulse oximetry, dyspnea, and dysphagia.
• Administer analgesia and antibiotics as needed.
• Humidifier or nasal spray is beneficial.
• Sneeze with the mouth open, avoid aspirin and NSAIDs, and avoid vigorous nose blowing or strenuous activity for 4-6 weeks after nose picking.
• Seek medical attention if bleeding does not stop in 15 minutes.

Oncologic Disorders: Cancer Prevention and Management

• Goals of cancer care include prevention, diagnosis, cure, control, and palliation.
• Chemical, radiation, and viral agents are carcinogenic.
• Smoking, alcohol, diet, and obesity are lifestyle factors that increase cancer risk.
• Metastasis is the spread of cancer.

Prevention of Cancer

• Public education and encouraging health-promoting behaviors are key.
• Recommended cancer screenings and self-examinations aid prevention.
• Avoid/reduce carcinogen exposure like cigarette smoke and excessive sun.
• Maintain a balanced diet and limit alcohol.
• Exercise regularly, maintain a healthy weight, and get adequate rest.
• Have regular health examinations and be familiar with family history and risk factors.

Cancer Classification

• Benign tumors are noncancerous, whereas malignant tumors are cancerous.
• Histology and grading indicate severity.

Extent of Disease (Staging)

• Stage 0: Cancer in situ
• Stage I: Localized tumor growth.
• Stage II: Limited local spread.
• Stage III: Extensive local & regional spread.
• Stage IV: Metastasis
• Diagnose cancer through tumor markers, CT scans, MRI, ultrasound, radioisotope scans, X-rays.

Cancer Management Goals include

• Cure and eradication
• Control
• Palliation, and relief of symptoms

Radiation Therapy

• Targets rapidly multiplying cells but can harm other cells.
• Used for cure, control (with surgery & chemotherapy), or palliative care.
• Low-energy beams expend energy quickly and are useful for skin lesions.
• Optimal dosing of internal targets while sparing skin.
• Doses are typically divided and given once a day for 5 days a week for 2-8 weeks.

Chemotherapy

• Antineoplastic therapy using chemicals.
• Can provide cure, control, or palliative care, having an effect on cells.
• Classified by molecular structure and mechanism of action.
• Affects normal tissues as well as cancer cells.

Nursing Issues with Chemotherapy

• It requires specific training.
• Teach patients about side effects and routes which includes oral, IM, and IV.
• Central venous access devices (CVAD) can be required for regional drug delivery directly into the tumor.
• Drugs may be absorbed through the skin or inhaled during handling.
• Properly trained personnel should handle cancer drugs.

Cancer Management

• Common side effects include bone marrow suppression (infection, fatigue), GI disturbances (N&V), integumentary and mucosal reactions, and pulmonary effects.
• Hematopoietic Stem Cell Transplantation (HSCT)/Bone Marrow Transplant (BMT) allows high doses of treatment and can develop resistance.
• Tumor cells are eliminated, and bone marrow is rescued by infusing healthy cells.

Immunotherapy and Targeted Therapy

• Immunotherapy uses the immune system to fight cancer.
• Targeted therapy interferes by targeting cell receptors involved in tumor growth.
• Anorexia/weight loss, weakness, and tachycardia are common side effects.

Hormone Therapy

• Blocks the effects of hormones and stops cancer cell growth.
• Surgical interventions can remove hormone effects.
• Used in combination with drug regimens to curb side effects.
• Tissue integrity, nutrition, and infection are key.

Allergic Rhinitis

• Classified as seasonal or perennial, episodic, intermittent, or persistent.
• Symptoms include sneezing, watery eyes, altered smell, thin watery nasal discharge, postnasal drip, and cough.
• Chronic exposure can cause headaches, sinus pressure, nasal congestion, and hoarseness.
• Identify and avoid triggers and decrease inflammation and symptoms.
• Nasal corticosteroid sprays, antihistamines, decongestants, and immunotherapy are all treatment options.

Chest and Lower Respiratory Problems: Atelectasis

• It is the closure or collapse of alveoli.
• Risk factors include post-operative, symptoms include dyspnea, cough, crackles, decreased breath sounds, sputum production
• Chronic Symptoms: are similiar to acute

Nursing Interventions for Atelectasis

• Promote frequent turning and early mobilization.
• Incentives Spirometer
• Voluntary deep breathing
• Secretion management

Acute Tracheobronchitis

• Inflammation of lower respiratory tract with possible infection.
• Cough is the most common symptom.
• Other symptoms include HA, fever, malaise, dyspnea, chest pain and crackles or wheezes.
• Diagnosed from symptoms and consolidation on X-ray, the goal is to prevent pneumonia and treat symptoms.
• Treatments include: Cough suppressants, oral fluid intake, humidifier

Pneumonia

• Lung tissue infection.
• Risk factors include risk factors in Table 30.1 and entry to lungs.
• Community acquired (CAP): Not hospitalized within onset.
• Healthcare asscoiated (HCAP): acquired/Hospital acquired (HAP)•48 hrs. after hospitalization & not present on admission Ventilator-associated (VAP)•Multidrug-resistant organisms•48 hrs. after mechanical ventilation.

Clinical Manifestations

• Cough (productive or nonproductive) with sputum, fever, chills, dyspnea, tachypnea, pleuritic chest pain, orthopnea
• Crackles, consolidation - older or exhausted
• Diaphoresis, H/A, anorexia, fatigue

Diagnostic Tests

• History, physical exam, chest x-ray
• Sputum gram stain, culture & sensitivity
• Before antibiotics are started- CBS w/ Diff, ABGs
• Blood cultures possibly
• Prevention with vaccines: Prevnar (children over 5, adults 65+ ), Pneumovax -adults 65+
• Increase fluid- at least 3L/day, thin & loosen secretions
• Increase small, frequent, high calorie, nutritious meals

Nursing Management

• Encourage fluids = thin & loosen secretions
• Encourage small nutritious meals: high calorie
• Prevent spread- use tissues or elbow to cough or sneeze.
• Implement ambulation and therapeutic positioning.
• Take the full course of antibiotics, handwashing, vaccines.

Complications of Pneumonia

• Multidrug-resistant (MDR) pathogens, risk factors, advanced age, immunosuppression, history of antibiotic use,Atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, Acute respiratory failure, Sepsis/septic shock, Lung abscess
• Emypema

Pulmonary Tuberculosis

• Caused by Mycobacterium tuberculosis
• Risk factors include: poor, underserved, & minorities
• Transmitted by airborne droplets
• Diagnosed by - Microscopic sputum analysis, Chest X-Ray, and blood test

Clinical Manifestations

• Include a cough lasting 2-3 weeks, pain in chest, weakness or fatigue.
• Other symptoms include malaise, anorexia, weight loss, low grade fever, night sweats, hemoptysis & dysnea

Nursing Issues with TB include

• ER admits w/ respiratory symptoms are screened and they get airborne isolation, using negative pressure room and HEPA masks. They also provide:
• Teach pt. to cover mouth w/ tissue when coughing, flush or in paper
• Bag in trash, handwashing after handling sputum-soiled tissues •Pt. to wear standard isolation mask when out of the room •Identify & screen close family contacts

Lung Cancer

• The leading cause of cancer death in U.S.
• One is smoking
• There are high levels of pollution, radiation, radon, asbestos, coal dust, formaldehyde, beryllium, smoking (smoked & secondhand), silica
• Most in segmented bronchi or beyond in upper lobes.

Clinical Manifestations

• Non-specific & only late in the disease- depends on type, location, &metastatic spread
• Thoracentesis may reveal malignant cells •Small cell & Large cell are rapidly growing
• Lung biopsy for definitive diagnosis
• Treatment Depens on health promotion, pt. & family support, symptom management

Pertussis

• Is a highly contagious infection Bordetella pertussis
• Treatment includes antibiotics and monitoring for respiratory distress
• One-time Tdap recommended for all adults