Respiratory Health and Tonsillitis Quiz

Nursing Interventions for Respiratory Disorders

• Nursing interventions are crucial for patients with respiratory disorders.
• Respiratory disorders affect the upper and lower respiratory tracts.
• Ventilation (movement of air in and out of the airways) is a critical function of the respiratory system.
• The upper airway warms and filters inspired air, enabling gas exchange in the lungs.
• Gas exchange delivers oxygen to tissues and removes carbon dioxide during expiration.

Anatomy of the Upper Respiratory Tract

• Upper airway structures include the nose, sinuses and nasal passages, pharynx, tonsils and adenoids, larynx, and trachea.

Nose Anatomy

• The external portion is prominent and supported by nasal bones and cartilage.
• The internal cavity is divided into right and left nasal cavities by the septum.
• Highly vascular ciliated mucous membranes (nasal mucosa) line the nasal cavities.
• Mucus, secreted by goblet cells, covers the nasal mucosa and is propelled to the nasopharynx by cilia.

Cont... (Nose)

• The nose acts as a passageway for air to and from the lungs.
• It filters, warms, and humidifies inhaled air.
• It is responsible for olfaction (smell) due to olfactory receptors in the nasal mucosa.
• Olfactory function diminishes with age.

Paranasal Sinuses

• These include four pairs of bony cavities lined with nasal mucosa and ciliated pseudostratified columnar epithelium.
• These air spaces are connected by ducts that drain into the nasal cavity.
• Sinuses are named by their location (frontal, ethmoidal, sphenoidal, and maxillary).
• A prominent function of the sinuses is to serve as a resonating chamber in speech.
• Sinuses are a common site of infection.

Pharynx, Tonsils, and Adenoids

• The pharynx connects the nasal and oral cavities to the larynx.
• It is divided into three regions: nasal, oral, and laryngeal.
• The nasopharynx is located behind the nose and above the soft palate.
• The oropharynx houses the tonsils.
• The laryngopharynx extends from the hyoid bone to the cricoid cartilage.
• The epiglottis forms the entrance to the larynx.
• Adenoids or pharyngeal tonsils are in the roof of the nasopharynx.
• Lymph tissue encircles the throat, acting as part of the lymphatic system's defenses against infection.

Larynx

• The larynx, or voice organ, is a cartilaginous, epithelium-lined structure connecting the pharynx and trachea.
• Its major function is vocalization.
• It protects the lower airway from foreign substances and facilitates coughing.

Trachea

• The trachea, or windpipe, is composed of smooth muscle with C-shaped rings of cartilage.
• Incomplete rings provide firmness, preventing collapse.
• The trachea serves as the passageway between the larynx and the bronchi.

Anatomy of the Lower Respiratory Tract: Lungs

• The lower respiratory tract consists of the lungs, which contain the bronchial and alveolar structures needed for gas exchange.

Lungs

• Paired elastic structures enclosed in the thoracic cage (airtight chamber with distensible walls).
• Ventilation requires movement of the thoracic cage and diaphragm.
• Thoracic cavity expansion/ contraction causes changes in lung capacity.
• Air enters (inspiration) when chest capacity increases due to lower pressure creating an air pressure differential.
• Air is expelled (expiration) when chest capacity returns to resting positions by lung recoil.
• The lungs' volume changes with each breath.

Pleura

• The lungs and thorax wall are lined with a serous membrane.
• Visceral pleura covers the lungs, while parietal pleura lines the thorax.
• Pleural fluid lubricates the thorax and lungs, allowing smooth motion during breathing.

Mediastinum

• The mediastinum is centrally located in the thorax, between pleural sacs containing the lungs.
• It contains thoracic tissue outside the lungs.
• Extends from the sternum to the vertebral column.

Lobes

• Each lung is divided into lobes.
• The left lung has two lobes, while the right lung has three.
• Each lobe is further divided into segments separated by fissures.

Bronchi and Bronchioles

• Bronchi within each lung lobe have several divisions.
• Lobar bronchi divide into segmental bronchi.
• Segmental bronchi subdivide into subsegmental bronchi.
• Identifying segmental bronchi is vital for postural drainage positioning.

Alveoli

• The lungs are composed of approximately 300 million alveoli arranged in clusters of 15 to 20.
• The numerous alveolar surfaces, unified into a single sheet, cover about 70 square meters, comparable to a tennis court.
• Three alveolar cell types exist.

Alveolar Cells

• Type I alveolar cells form the alveolar walls, and type II alveolar cells secrete surfactant to prevent alveolar collapse.
• Type III alveolar macrophages are large phagocytic cells, ingesting foreign materials (e.g., mucus, bacteria) and functioning as important defense mechanisms.

Function of the Respiratory System

• Body cells derive energy from oxidizing carbohydrates, fats, and proteins.
• This process requires oxygen.
• Vital tissues (e.g., brain, heart) need a continuous oxygen supply for survival.
• Oxidation in tissues produces carbon dioxide, which must be removed to prevent buildup of waste products.
• The respiratory system facilitates breathing, ventilation, gas exchange, and oxygen transport, fulfilling crucial life-sustaining functions.

Oxygen Transport

• Oxygen is delivered to, and carbon dioxide removed from, cells by the circulating blood.
• Capillaries' thin walls facilitate easy gas passage.
• Oxygen diffuses from capillaries to interstitial fluid then cells.
• The movement of carbon dioxide is in the opposite direction (cells to blood).

Respiration and Ventilation

• Oxygen diffuses from alveoli's higher concentration to blood's lower concentration.
• Carbon dioxide diffuses from blood's higher concentration to alveoli's lower concentration.
• The constant influx and outflow of air (ventilation) in the lungs replenishes oxygen and clears carbon dioxide waste.
• The overall process of gas exchange is termed respiration.

Gas exchange

• Diagram representing normal gas exchange in the alveoli. Distinguishing different types of disorders relating to blockages in the alveoli (Shunt, Blockage).

Assessment of the Respiratory System

• Health history includes smoking, previous personal/ family history, occupational history, and exposure to allergens/environmental pollutants.
• Examination of the thorax involves inspection, palpation, percussion, and auscultation.

Physical Examination: Posterior Chest

• Inspect the posterior chest, noting shape and configuration of the chest wall.
• Spinous processes should appear in a straight line.
• Evaluate for symmetry of the chest and scapulae and the anteroposterior diameter relative to the transverse diameter.
• Abnormalities (e.g., barrel chest) should be noted.

Physical Examination: Palpation - Symmetric Expansion

• Palpate the posterolateral chest wall using your hands, checking for equal expansion by the patient's movement.
• Note any asymmetry and lag during deep breathing.

Tactile Fremitus

• Assess tactile fremitus (palpable vibration).
• Sounds from the larynx are transmitted through bronchi and lung parenchyma to the chest wall, felt as vibrations.

Percussion of the Posterior Chest

• Start at the apices (tops of the shoulders) and percuss interspaces systematically.
• Compare sides to detect areas of abnormal density (dullness) that can point to pneumonia or other pulmonary conditions.

Auscultation of the Posterior Chest

• Auscultate the chest wall for characteristic breath sounds emitted by air moving through the tracheobronchial tree.
• Sounds may vary depending on the condition of respiratory passageways and lung tissue. Breath sounds (bronchial, bronchovesicular, and vesicular).

Adventitious Sounds

• Listen for added sounds not normally heard—crackles (rales), wheezes, or rhonchi.
• These extra sounds signal lung conditions, such as fluid buildup or airway obstructions.

Voice Sounds

• Auscultate with a stethoscope while the patient repeats phrases like "ninety-nine" or "Arba-Arat."
• Identify areas where voice transmission is abnormal (muffled, unclear, or intensified), indicating lung pathology (e.g. pneumonia).

Tonsillitis

• Tonsillitis is inflammation or infection of the tonsils.
• Tonsils are protective lymph glands in the throat and part of the immune system.
• They combat bacteria and viruses entering the body through the oral/nasal cavities.

Tonsillitis Anatomy

• Tonsils are typically a pink color resembling surrounding tissues, with similar size.
• They along with adenoids form the first line of defense against infections

Tonsillitis Pathology

• Inflammation causes redness and swelling of the tonsils.
• Pus pockets and discharge can develop.
• Repeated infections may cause tonsils to swell and touch each other.
• Tonsillitis is prevalent among children, without any specific gender predilection.

Tonsillitis Causes

• Bacterial and viral infections, often via droplet transmission.
• Common bacteria are Streptococcus bacteria.
• Other viruses may include adenoviruses, influenza virus, Epstein-Barr virus, and parainfluenza viruses.

Tonsillitis Triggering Factors

• Artificial food colors and preservatives.
• Peanuts.
• Cold foods/drinks/ice creams.
• Extreme cold/damp weather.
• Exposure to pollution.
• Sour fruits (lemons, pineapples, grapes, oranges).

Tonsillitis Signs

• Red and swollen tonsils.
• White spots (patches) on the tonsils.
• Enlarged lymph nodes in the neck.
• Bad/foul breath.
• Cough.
• Running nose.

Tonsillitis Symptoms

• Sore throat.
• Difficulty/pain in swallowing.
• Pain/discomfort while swallowing saliva.
• Changes in voice.
• Ear pain (common nerve supply).
• Headache.
• Malaise/tiredness, especially in infants.
• Difficulty in taking feeds in babies.

Types of Tonsillitis

• Catarrhal tonsillitis: Tonsils inflamed as part of generalized infection affecting the oropharyngeal mucosa.
• Membranous tonsillitis: Exudation from crypts merges to form a membrane over the tonsil surface.
• Parenchymatous tonsillitis: Uniform congestion and swelling of the entire tonsil.

Tonsillitis Diagnosis

• Throat examination (redness, swelling, pus pockets, discharge).
• Tonsillar site culture to detect bacterial infection.
• Audiometric examination in adenoiditis cases.
• Shift in involved tonsil towards the throat center, with uvula deviation in peritonsillar abscess cases.
• Throat swab for secretion samples.
• Monospot test for antibodies indicating mononucleosis.
• Epstein-Barr virus antibody tests for possible mononucleosis in negative monospot cases.
• Complete blood count (CBC) to confirm infection presence.

Tonsillitis Management

• Bed rest and plenty of fluids.
• Analgesia (Aspirin/NSAIDs).
• Gargling with warm saline or aspirin.
• Antimicrobial medication (Penicillin is the drug of choice), given for 7 to 10 days.
• Tonsillectomy may be necessary for recurrent tonsillitis cases or when medical treatment fails with severe hypertrophy, asymmetry, or peritonsillar abscess.

Adenoiditis

• Adenoiditis is an infection affecting the adenoid tissue.
• Adenoids are located at the posterior wall and roof of the nasopharynx, consisting of lymphoid tissue.
• Adenoids are often associated with repeated infections like rhinitis, tonsillitis, and sinusitis, leading to potential hypertrophy.

Adenoiditis Symptoms

• Nasal obstruction.
• Mouth breathing.
• Nasal discharge.
• Elongated face, dull expression, and a prominent upper lip.
• Nasal discharge.
• Open mouth.
• Upper overcrowded/high arched palates

Adenoiditis Diagnosis

• Nasopharyngoscopy.
• X-ray nasopharynx lateral view.

Adenoiditis Management

• For non-severe symptoms: decongestant nasal drops and antihistamines.
• For severe symptoms: adenoidectomy.

Pharyngitis

• Pharyngitis is inflammation of the pharynx, often resulting in a sore throat.
• It can be acute or chronic, with acute pharyngitis encompassing a sudden painful inflammation involving the back part of the throat, including the posterior third of the tongue, soft palate, and tonsils.

Pharyngitis Causes

• Viral agents (adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus).
• Bacterial infection (ten percent of adults with pharyngitis have group A beta-hemolytic streptococcus [GABHS], commonly referred to as group A streptococcus [GAS] pharyngitis).
• Other bacteria (Mycoplasma pneumoniae, Neisseria gonorrhoeae, H. influenzae type B).
• Poorly ventilated rooms.

Pharyngitis Signs and Symptoms

• Persistent cough (two weeks or more)
• Low-grade fever.
• Fatigue.
• Anorexia.
• Weight loss.
• Night sweats.
• Chest pain.

Pharyngitis Diagnosis

• History of recent upper respiratory tract infections (UTIs).
• Physical examination.
• Chest X-ray.
• Blood culture.
• Sputum examination.
• Rapid streptococcal antigen test (RSAT).

Pharyngitis Management

• For viral pharyngitis: symptomatic treatment.
• For bacterial pharyngitis: antibiotic therapy.
• Typical antibiotics prescribed, depending on culture results: Doxycycline 100mg bid for 5 to 7 days, Azithromycin once daily for 3 days due to extended half-life, or a 5-10 days cephalosporin course.
• An anti-inflammatory (ibuprofen), potassium permanganate gargles, and a soft, bland, warm diet.

Nutritional Therapy for Pharyngitis

• Liquid or soft diets.
• Cool beverages, warm liquids.
• In severe cases, intravenous fluids.

Chronic Pharyngitis

• Chronic pharyngitis is persistent pharynx inflammation.
• It's frequently caused by environmental factors such as irritants, excessive voice use, chronic cough, and alcohol/tobacco use.
• Patients experience persistent throat irritation/fullness, mucus buildup, cough, and potential swallowing difficulties.

Chronic Pharyngitis Management

• Reduce exposure to irritants.
• Manage upper respiratory illnesses.
• Evaluate for underlying pulmonary or cardiac conditions.

Nasal Congestion Relief

• Decongestant nasal sprays or medications that contain ephedrine sulfate or phenylephrine hydrochloride can help.

Allergy-Related Pharyngitis Management

• If allergies are a factor, use antihistamines.

Acute Laryngitis

• Laryngitis is the inflammation of the larynx (voice box).
• It's often caused by overuse/abuse or exposure to irritants (dust, chemicals, smoke, pollutants), upper respiratory tract infection.
• Rare instances of vocal cord infection.

Laryngitis Causation

• Viral infections are almost always the cause.
• Bacterial infections can develop secondarily.
• Conditions associated with allergic rhinitis or pharyngitis.
• Exposure to sudden temperature changes, dietary problems, malnutrition can exacerbate the infection.
• Viral laryngitis is common during winter and is easily transmitted.

Laryngitis Clinical Manifestations

• Acute laryngitis: hoarseness or aphonia (a complete loss of voice), severe cough
• Chronic laryngitis: persistent hoarseness.
• Laryngitis can develop as a consequence of upper respiratory illnesses.

Laryngitis Management

• Acute laryngitis: rest voice/exercise, avoid smoking, inhale cool steam, and use an aerosol.
• Secondary or severe bacterial/bacterial organism related infection: antibiotic treatment.

Atelectasis

• Atelectasis refers to alveolar collapse or closure.
• It's often related to x-ray findings and clinical symptoms.
• Acute atelectasis is common after surgery or in immobilized patients with shallow breathing.
• Excess secretions or mucus plugs may obstruct airflow and form atelectasis in the lung.
• Patients with chronic lung obstructions like lung cancer can experience insidious-onset obstructive atelectasis.

Atelectasis Clinical Manifestations

• The onset is usually insidious (gradual).
• Signs/symptoms include cough, sputum production, mild fever.
• In acute cases, involving large areas like lobar atelectasis, significant respiratory distress is seen.
• Additional symptoms include dyspnea (shortness of breath), tachycardia (rapid heartbeat), tachypnea (fast breathing), pleural pain, and central cyanosis (bluish discoloration of the skin).

Atelectasis Diagnosis

• The diagnosis relies on a patient's history (recent upper respiratory infections) and observed physical examination.
• Chest X-ray (detect patchy infiltrates or consolidated areas).
• Determining oxygen level via pulse oximetry (low saturation = <90%, lower than normal PaO2).

Atelectasis Management

• Treatment focuses on improving ventilation and removing secretions.
• Interventions include frequent repositioning, early ambulation, lung volume expansion maneuvers (e.g. deep breathing exercises, incentive spirometry), and coughing techniques.
• Bronchoscopy aids in treating and preventing atelectasis.

Bronchitis

• Bronchitis is the inflammation of the bronchi, categorized as acute or chronic.
• Acute bronchitis often follows upper respiratory tract infections (URTIs).

Bronchitis Causation

• Viral infections (influenza A or B, adenovirus, rhinovirus, para-influenzae, coronavirus, Respiratory Syncytial Virus [RSV], human metapneumovirus).
• Bacterial infections (Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis, Streptococcus pneumoniae, and H. influenzae).

Bronchitis Risk Factors

• Chronic sinusitis.
• Chronic obstructive pulmonary disease (COPD).
• Asthma.
• Immunodeficiency.
• Smoking.
• Secondhand smoke.
• Air pollutants, environmental factors, alcoholism.
• Gastroesophageal reflux disease (GERD).
• Wood stoves.
• Mould.

Bronchitis Clinical Manifestations

• Fever, headache, malaise, mucopurulent sputum, dry irritating cough, wheezing, and inspiratory stridor.

Bronchitis Diagnosis

• Patient history (recent RTI).
• Physical examination.
• Culture of sputum sample.
• Chest X-ray.

Bronchitis Management

• Symptomatic treatment (e.g., rest, steam inhalation).
• Expectorants (like Beranthin cough syrup).
• Increased fluid intake.
• Antibiotics if severe with purulent sputum.

Chronic Bronchitis

• Productive cough lasting three months annually, for two consecutive years defines chronic bronchitis.
• Accumulated secretions in bronchioles obstruct breathing.
• Individuals with chronic bronchitis are more vulnerable to recurrent lower respiratory tract infections (LRTIs).

Chronic Bronchitis Pathophysiology

• Constant airway irritation leads to increased mucus-producing cells and goblet cells.
• Cilia function impairs and increased mucus production.
• Narrowing, damage, and fibrosis characterize the bronchi near the alveoli, leading to long-term lung changes.

Chronic Bronchitis Clinical Manifestations

• Persistent productive cough (exacerbated by lung irritants).
• Increased susceptibility to recurrent respiratory infections.

Chronic Bronchitis Diagnosis

• Patient history (symptoms, recent UTIs).
• Physical examination.
• Chest X-ray.
• Sputum culture can identify potential pathogens.

Chronic Bronchitis Management

• Antibiotics guided by culture results and sensitivity tests, plus bronchodilators.
• Fluid intake enhancement, and supportive care are crucial.

Pneumonia

• Pneumonia is an inflammatory process in the lung parenchyma often caused by infectious agents.

Pneumonia Classification

• Community-acquired pneumonia (CAP).
• Hospital-acquired pneumonia (HAP)/Nosocomial pneumonia.
• Pneumonia in immunocompromised hosts.
• Aspiration pneumonia.

Community-Acquired Pneumonia (CAP)

• CAP is acquired outside healthcare facilities or within 48 hrs of admission.
• Common causative agents include Streptococcus pneumoniae, Haemophilus influenzae, Legionella, Pseudomonas aeruginosa, and other gram-negative rods.
• Streptococcus pneumoniae is most prevalent, especially for adults under 60 without or over 60 with comorbidities.
• Other prevalent agents include Haemophilus influenzae for elders and immunocompromised individuals.

Hospital-Acquired and Ventilator-Associated Pneumonia (HAP/VAP)

• HAP/VAP are community-acquired pneumonia diagnoses made more than 48 hours after hospitalization.
• Pathogens such as Enterobacter species, Escherichia coli, Haemophilus influenzae, Klebsiella species, Proteus, Serratia marcescens, Pseudomonas aeruginosa, and Staphylococcus pneumoniae are culprits.
• Patients experiencing HAP are often colonized by multiple organisms and have underlying chronic illnesses (e.g., COPD, alcoholism, diabetes mellitus).
• Staphylococcal pneumonia may result via inhalation or hematogenous spread, requiring prompt treatment, and carries a high mortality rate.

Pneumonia in Immunocompromised Hosts

• The most common viral pathogen in adults with compromised immunity is cytomegalovirus.
• Herpes simplex virus, adenovirus, and respiratory syncytial virus are other prevalent viral agents.

Aspiration Pneumonia

• Aspiration pneumonia results from exogenous/endogenous substances entering the lower airways.
• Predominant pathogens are bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, which normally occupy the upper respiratory tract.
• Gastric contents, chemicals, and irritating gases can be aspirated, resulting in pneumonia.

Risk Factors for Pneumonia

• Underlying heart and/or lung disease (COPD).
• Diabetes mellitus, Alcoholism, AIDS
• Cigarette smoking.
• Upper respiratory infections
• Corticosteroid therapy
• Advanced age
• Recent influenza infections
• Pre-existing lung disease

Pneumonia Clinical Manifestations

• Varying presentation depending on the type, cause, and comorbidities.
• Includes fever, chills, cough, sputum production with characteristics of color and consistency, pleuritic chest pain, shortness of breath, use of accessory respiratory muscles, and central cyanosis.
• Mild cases may only display low grade fever and slight respiratory alterations.
• Severely affected patients often exhibit increased respiratory rate and rapid pulse commensurate with the temperature elevation.
• Relative bradycardia (pulse lower than expected) can be an indicator of viral or mycoplasma infection; in patients with pneumonia and upper respiratory infection-nasal congestion and sore throats.

Pneumonia Diagnosis

• History of recent RTI/ pneumonia, Patient/Exam Findings, Chest X-ray, cultures (blood, sputum) are essential for proper diagnosis, along with relevant tests for different types of pneumonia.

Pneumonia Management

• Treatment focuses on addressing the infection or inflammation with appropriate antibiotics.
• Antibiotic selection is determined through culture and Gram stain results.
• When diagnosis of the causative organism is delayed, guidelines are used to choose appropriate antibiotics considering factors such as the prevalent pathogens, resistance patterns, patient comorbidities, treatment settings (outpatient vs. inpatient), and antibiotic availability cost considerations.

Nursing Management for Pneumonia

• Administering the appropriate antibiotic.
• Monitoring/treating for hypoxia with supplemental oxygen.
• Encourage rest and energy conservation.
• Increase hydration, and comfort measures.
• Pain control is necessary.

Additional Notes

• Pages 176-179: Contains images related to asthma triggers and images.
• Pages 186-188: Contains images related to asthma progression, causes, and symptoms.
• Pages 200-201: Contains images related to interventions and environmental elements for asthma prevention.
• Pages 202-242: Contains images relevant to Tuberculosis classifications, pathology, and management.
• Pages 243-246: Contains thank you slides/ images, not relevant to study notes.
• Diagrams/images are integrated throughout this document to visualize concepts.

Test your knowledge on respiratory health and tonsillitis management. This quiz covers key topics such as throat swabs, tonsillectomy indications, respiratory anatomy, and more. Perfect for students and healthcare professionals alike!