LESSON PLAN

ON
UPPER RESPIRATORY
TRACT INFECTIONS

PRESENTED BY
SARANYA.K
LECTURER
ICON
GENERAL OBJECTIVE:

At the end of the class students will be able to gain knowledge about upper respiratory tract infections such as rhinitis,

nasopharyngitis, pharyngitis, sinusitis, choanal atresia,influenza and tonsillitis, thereby develop desirable attitude and skills and apply

this in their day to day practice.

SPECIFIC OBJECTIVE:

At the end of the classroom teaching, the students will be able to

 introduce about respiratory tract infections

 define upper respiratory tract infections

  list out the upper respiratory tract infections

 elaborate the upper respiratory tract infections

INTRODUCTION:
Upper respiratory tract infection is a common viral infection that affects the nose, throat and airways. It usually resolve

within 7 to 10 days. In India, more than 10 million cases per year are affected. It spreads easily and usually self-treatable and

diagnosable. The upper respiratory tract, or upper airway, consists of oronasopharynx, the pharynx, the larynx, and the upper part of

the trachea. Infections often spread from one structure to another because of the contiguous nature of the mucous membrane lining the

entire tract.
S.NO. TIME SPECIFIC CONTENTS TEACHER’S/ AV EVALUATION
OBJECTIVES LEARNER’S AIDS
ACTIVITY
1. 1 min introduce about upper INTRODUCTION: introducing / LCD Introduce about
respiratory tract The upper respiratory tract, or upper airway, consists listening upper respiratory
infection of oronasopharynx, the pharynx, the larynx, and the tract infection
upper part of the trachea. Infections often spread
from one structure to another because of the
contiguous nature of the mucous membrane lining
the entire tract.
2. 1 min list out the upper UPPER RESPIRATORY TRACT INFECTION: listing/ LCD What are all the
respiratory tract  Acute nasopharyngitis listening upper respiratory
infection  Pharyngitis tract infection?
 Influenza
 Tonillitis
ACUTE NASOPHARYNGITIS:
It is called as common cold or Rhinitis
It is caused by rhinovirus, RSV, Adenovirus,
influenza virus and parainfluenza virus.
 SYMPTOMS:
YOUNGER CHILD:
o Fever
o Irritability
3. 30-40 elaborate the upper o Restlessness elaborating/ LCD What are all the
mins respiratory tract o Poor feeding listening causes, signs and
infection o Decreased fluid intake symptoms,
o Sneezing management of
o Vomiting or diarrhea the upper
OLDER CHILD: respiratory tract
o Fever (may reach 104F) infection?
o Headache
o Anorexia
o Dysphagia
o Abdominal pain
o Muscle aches
o Cough
o Sneezing, chilling
o Dryness and irritation
PHYSICAL ASSESSMENT SIGNS:
YOUNGER CHILD:
o Mild to moderate hyperemia
OLDER CHILD:
o Mild to bright red, edematous pharynx
o Hyperemia of tonsils and pharynx,
o May extend to soft palate and uvula
o Often abundant follicular exudate that
spreads and coalesces to form pseudo
membrane on tonsils
o Cervical glands enlarged and tender.
THERAPEUTIC MANAGEMENT:
 Antipyretics are prescribed for mild fever
and discomfort.
 Rest is recommended until the child is free of
fever for at least 1 day.
 The provision of humidified environment
and increasing oral fluids may be beneficial
to some children with cold.
 Decongestants may be prescribed for
children and infants older than 6 months of
age to shrink swollen passages.
  Cough suppressants containing
dextromethorphan may be prescribed for a
dry, hacking cough in older children. It cause
adverse effects such as confusion,
hyperexcitability and sedation, therefore
parents should monitor the child carefully for
potential adverse effects.
 Antihistamines are largely ineffective in What are all the
3. 30-40 elaborate the upper treatment of nasopharyngitis. These drugs elaborating/ LCD causes, signs and
mins respiratory tract have a week atropine-like effect that dries listening symptoms,
infection secretions, but they cause drowsiness or management of
paradoxically, have a stimulatory effect on the upper
children. respiratory tract
NURSING MANAGEMENT: infection?
 Elevating the head of the bed.
 Suctioning and vaporization
 Saline nose drops and gentle suction with a
bulb syringe before feeding and sleep time is
useful
 Maintaining adequate fluid intake is
essential.
 Avoiding contact with affected persons.
  Infection control.
FAMILY SUPPORT AND REASSURANCE:
Support and reassurance are important elements
of care for families of young children with recurrent
upper respiratory infections (URIs). Because URIs
are frequent in children in less than 3 years of age.
They need reassurance that frequent colds are a
normal part of childhood and that by 5 years of age,
their children will have developed immunity to
many viruses. Parents should know the signs of
respiratory complications and should notify a health
professional if complications occur or the child does
not improve within 2 or 3 days.
COMPLICATIONS
 Evidence of earache and restlessness
 Respirations faster than 50 to 60 breaths /min
 Fever over 38.3C(101F)
 Listlessness, Confusion and poor sleep.
 Increasing irritability with or without fever
 Persistent cough for 2 days or more
 Wheezing and crying
 Refusal to take oral fluids and decreased
 urination
PHARYNGITIS:
DEFINITION:
Inflammation of the pharynx. elaborating/
LCD
3. 30-40 elaborate the upper CLINICAL MANIFESTATIONS: listening What are all the
mins respiratory tract o GABHS infection is generally a relatively causes, signs and
infection brief illness that varies in severity from symptoms,
subclinical (no symptoms) to severe toxicity. management of
o Onset is abrupt and characterized by the upper
pharyngitis, headache, fever, abdominal pain respiratory tract
o Tonsils and pharynx may be inflamed and infection?
covered with exudate
o Tongue may appear edematous and red
(strawberry tongue)
o Child may have a characteristics of
erythematous fine sandpaper rash on the
trunk, axillae, elbows and groin
o Uvula is edematous and red
o Anterior cervical lymphadenopathy usually
occurs early and the nodes are often tender
o Dysphagia
o Usually subside in 3 to 5 days
DIAGNOSTIC EVALUATION:
 Throat culture to rule out GABHS
 Rapid identification of GABHS with
diagnostic test kits (rapid antigen detection
test) is possible in clinical setting.
 Because of the high specificity of these rapid
tests, a positive test result generally does not
require throat culture confirmation.
 Confirmatory throat culture is recommended
in patients who have a negative test result.
THERAPEUTIC MANAGEMENT:
 Penicillin (If streptococcal sore throat
infection is present)
 Erythromycin (For children allergic to
penicillin)
 Other antibiotics such as (Azithromycin,
clarithromycin, oral cephalosporin's,
amoxicillin, and amoxicillin with clavulanic
acid
 Acetaminophen and ibuprofen may be
effective in decreasing the throat pain
NURSING MANAGEMENT:
 Instructs the parents about administration of
antibiotics and analgesics as prescribed.
 Parents also need to be aware of residual
tenderness at the injection site.
 Local applications of heat are helpful in
relieving this discomfort.
 Cold or warm compress to neck may provide
relief and warm saline gargles
 Pain may interfere with the oral intake , and
children should not be forced to eat, but fluid
intake is essential and cool liquids or ice
chips are usually more acceptable than solids
 Nurses should remind the children to discard
their tooth brush and replace it with a new
one after they have been taking antibiotics
for 24 hours.
 Parents are cautioned to prevent other
household members, especially if
immunocompromised, from having close
contact with the sick child and avoid sharing
 drinking or eating items.
TONSILLITIS:
Inflammation of tonsils.
DEFINITION OF TONSILS:
The tonsils are masses of lymphoid tissue
located in the pharyngeal cavity. They filter and What are all the
3. 30-40 elaborate the upper protect the respiratory and alimentary tracts from elaborating/ LCD causes, signs and
mins respiratory tract invasion by pathogenic organisms and play a role in listening symptoms,
infection antibody formation. management of
ETIOLOGY: the upper
 Tonsillitis often occurs with pharyngitis respiratory tract
 Causative agent may be viral or bacterial, infection?
because of the abundant lymphoid tissue and
the frequency of URI’s, tonsillitis is a
common cause of illness in young children.
PATHOPHYSIOLOGY:
Due to etiological factors

Process of inflammation originate within the tonsil

Hyperemia and oedema with conversion of

lymphoid follicles in to small abscesses which
discharge into crypts.

Clinical features (When inflammatory exudate

collects in tonsillar crypts these present as multiple
white spots on inflamed tonsillar surface giving rise
of follicular tonsillitis.
CLINICAL MANIFESTATION:
o Palatine tonsils enlarge from edema,
obstructing the passage of air or food.
o Difficulty swallowing and breathing
o Enlargement of the adenoids
o Child breathes through the mouth
THERAPEUTIC MANAGEMENT:
 Antibiotics
 Tonsillectomy – Surgical removal of the
palatine tonsils. Absolute indications for a
tonsillectomy are malignancy, recurrent
peritonsillar abscess, and airway obstruction.
 Adenoidectomy – Surgical removal of the
adenoids ( It is recommended for children
who have hypertrophied adenoids that
obstruct nasal breathing
NURSING MANAGEMENT:
 Nursing care involves providing comfort and
minimizing activities or interventions that
precipitate bleeding
 A soft to liquid diet is preferred.
 A cool-mist vaporizer keeps the mucous
membranes moist during periods of mouth
breathing.
 Warm salt-water gargles, throat lozenges,
analgesics, antipyretic drugs such as
acetaminophen are used to promote comfort.
 Often opioids are needed to reduce pain for
the child to drink.
 Combination of nonopioid and opioid elixirs
or tablets such as acetaminophen with
codeine or with hydrocodone relieve pain
and should be given routinely every 4 hours
POSTOPERATIVE NURSING CARE:
 The throat is sore after surgery.
 An ice collar provides relief.
 Analgesics for at least 24 hours, given
 rectally or intravenously to avoid the oral
route.
 An antiemetic such as ondansetron may be
administered.
 Foods and fluids are restricted until children
are fully alert and there are no signs of
hemorrhage.
 Cool water, crushed ice, flavored ice pops or
diluted fruit juice may be given.
3. 30-40 elaborate the upper  Citrus fruits may cause discomfort and is elaborating/ What are all the
LCD
mins respiratory tract poorly tolerated. listening causes, signs and
infection  The nurse observes the throat directly for symptoms,
evidence of bleeding, using a good source of management of
light and by inserting a tongue depressor. the upper
 Other signs of hemorrhage are tachycardia, respiratory tract
pallor, vomiting of bright red blood. infection?
 Decreasing blood pressure is a late sign of
shock
 Family support and health education
SINUSITIS:
 Sinusitis is inflammation of frontal,
maxillary, ethmoidal and sphenoidal sinuses.
  Bacterial sinusitis is a common complication
of viral upper respiratory infection (URI) or
allergic inflammation.
 Common causative organisms are
S.pneumonia, H.influenza and S.pyogens.
CLASSIFICATION
Acute bacterial sinusitis:
 Bacterialinfection of the paranasal sinuses
lasting less than 30 days in which symptoms
resolve completely.
Sub acute bacterial sinusitis:
 Bacterial infection of the paranasal sinuses
lasting between 30 and 90 days in which
symptoms resolve completely.
Recurrent acute bacterial sinusitis:
 Episodes of bacterial infection of the
paranasal sinuses, each lasting less than 30
days and separated by intervals of atleast 10
days during which the patient remains
asymptomatic.
Chronic sinusitis:
 Episodes of inflammation of the paranasal
sinuses lasting more than 90 days. Patients
exhibit persistent residual respiratory
symptoms such as cough, rhinorrhea, or
nasal obstruction.
 Acute bacterial sinusitis superimposed on
chronic sinusitis:
 Patients with residual respiratory symptoms
develop new respiratory symptoms.When
treated with antimicrobials, these new
symptoms resolve, but the underlying
residual symptoms do not.
CLINICAL FEATURES:
Acute bacterial sinusitis:
Nasal or postnasal discharge, day time cough (which
may be worse at night), headache, retro-orbital pain,
facial pain, tenderness, redness and swelling of the
cheek and near inner canthus of the eyes, fever at
least 102°F (39°C).In severe cases, purulent nasal
discharge present concurrently for at least 3-4
consecutive days.
Chronic bacterial sinusitis:
Persistent or recurrent attack of nasal or
postnatal discharge, low grade fever, malaise,
sniffing, nose twitching, mouth breathing, epistaxis
and ear discharge.
DIAGNOSIS:
 Nasal examination showing musus or pus
 X-ray of paranasal sinus showing air fluid
filled levels and complete opacification
 CT scan
 Nasal swab culture.
MANAGEMENT:
Acute bacterial sinusitis:
 Antibiotic therapy with amoxicillin,
decongestants, mucolytic agents, nasal drops
and avoiding contacts with URI.
Chronic bacterial sinusitis:
 Prolonged antibiotic therapy, nasal drops of
oxymetazoline HCL, breathing exercise,
nose blowing and radical sinus surgery.
CHOANAL ATRESIA:
 Choanal atresia is a congenital disorder
where the back of the nasal passage is
blocked, usually by abnormal bony or soft
tissue due to failed recanalization of the
nasal fossae during fetal development.
 The word ‘choana’ is derived from the greek
word meaning ‘funnel’.The choana is the
posterior nasal aperture by which air flows
from the nasal cavity into the nasopharynx
 It is rare condition occurring in
approximately
1 in 7000 live births, and is common females than in
males.
CLINICAL FEATURES:
 Chest retracts unless the child is breathing
through crying.
 Dyspnea after birth , which may result in
cyanosis, unless infant is crying
 Inability to feed and breathe at same time
 Inability to pass a catheter through each side
of the nose into the throat.
  Persistent one sided nasal blockage or
discharge.
DIAGNOSIS:
 CT Scan
 Endoscopy of the nose
 Sinus X-ray
TREATMENT:
Unilateral choanal atresia: It may initially be
managed with close observation and occasionally
supplemental oxygen, nasal saline until the child
grows older to repair the condition.
Bilateral choanal atresia: The immediate
intervention is to resuscitate the baby if necessary or
placing an airway so that the infant can breathe. In
some cases, intubation or tracheostomy may be
needed.
Surgery repair is done to remove the
obstruction.Surgery may be delayed if the infant can
tolerate mouth breathing. The surgery may be done
through the nose (transnasal) or through the mouth
(transplacental)
COMPLICATIONS:
 Aspiration while feeding and attempting to
breathe through the mouth.
 Respiratory arrsest.
 Renarrowing of the area after surgery.
INFLUENZA:
Influenza or “flu” is caused by
orthomyxovirus, which are antigenically
distinct: types A and B which cause
epidemic disease, and type C, which is
unimportant from an epidemiologic stand
point.
Influenza is spread from one individual to
another by direct contact (large-droplet
infection)
Infection among school age children is
believed to be a major source of transmission
in a community
More common during the winter months and
has a 1 to 3 days incubation period.
The viruses can be isolated from
 nasopharyngeal secretions early after the
onset of infection, and serologic test identify
the type by complement fixation or the
subgroups by hemagglutination inhibition
CLINICAL MANIFESTATION:
o Dry throat and nasal mucosa
o Dry cough
o Tendency towards hoarseness
o Flushed face
o Photophobia
o Myalgia
o Hyperesthesia
o Sometimes exhaustion and lack of energy
accompany a sudden onset of fevr and chills.
o Sub glottal croup is common , especially in
infants
o Symptoms of influenza last of 4 to 5 days
THERAPEUTIC MANAGEMENT:
 Uncomplicated influenza in children usually
requires only symptomatic treatment.
 Acetaminophen and ibuprofen for fever and
sufficient fluids to maintain hydration.
  Amantadine hydrochloride has been effective
in reducing the symptoms associated with
type A disease if administered within 24 to
48 hours after their onset.
 Zanamivir ( inhaled medication-effective for
type A and B influenza, the drug is taken
twice daily for 5 days, it cannot be used for
children less than 5 years of age and
rimantadine have been approved for the
treatment of flu symptoms in children under
18 years of age. (Started within 48 hours of
symptom onset)
 Oseltamivir (Tamiflu) is a neuroaminidase
inhibitor that may be administered orally for
5 days to children over 1 year (and adults) to
decrease the flu symptoms.
PREVENTION:
Two vaccines may be administered to prevent
influenza:
o Inactivated trivalent influenza viral (TIV)
o Live attenuated influenza vaccine (LAIV) –
nasal spray flu vaccine
NURSING MANAGEMENT:
 Nursing care is the same as for any child
with URI, including implementing measures
to relieve symptoms.
 The greatest danger to affected children is
development of a secondary infection.
 Prolonged fever or appearance of fever
during early convalescence is a sign of
secondary bacterial infection and should be
reported to the practitioner for antibiotic
therapy
SUMMARY:
So far, we have seen about upper respiratory tract infections such as acute nasopharygitis, pharyngitis, tonsillitis, influenza, its
definition, causes, signs and symptoms, therapeutic and nursing management. I hope you all have gained knowledge regarding URTI.

CONCLUSION:
Infection of the respiratory tract is the most common cause of illness in infancy and childhood. The incidence and severity of
respiratory tract infections are influenced by the infectious agents involved, the child’s age and the child’s natural defenses. Common
upper respiratory tract infections of childhood include nasopharyngitis (including tonsillitis), pharyngitis, and influenza. The primary
goals in the care of children is to minimize the infection.
BIBLIOGRAPHY:
 WONG’S “Essentials of pediatric nursing” 8th edition, Marilyn J.Hockenberry,David Wilson,Elsevier publication, page no:
755-765
 Panchali pal “Textbook of pediatric nursing” 1st edition, 2016, Paras medical publisher, Page no: 444-456, 272-275
 Manoj Yadav, “Child Health Nursing”, PV Books, 2014, S. Vikas and Company (Medical Publishers) India
 https://www.google.com.tonsillitis
 https://www.managementofrespiratoryinfection
 www.upperrespiratorytractinfection.com