Management of Patients with Upper
and irritants (dusts, molds, animals,
Respiratory Tract Disorders
Rhinitis
 inflammation and irritation of the
mucous membranes of the nose.
 It can be acute or chronic, and allergic
or nonallergic.
Clinical Manifestation
 rhinorrhea (excessive nasal drainage,
runny nose)
 nasal congestion
 nasal discharge (purulent with bacterial
rhinitis)
 sneezing
 pruritus (nose, roof of the mouth,
throat, eyes, & ears)
 headache
Medical Management
 Nasal irrigation
 Antihistamines
 Oral decongestants agents
 Intranasal corticosteroids
 Leukotriene modifiers
 Combination medications
 Ophthalmic agents
 Brompheniramine/pseudoephedrine
(Dimetapp)-combination
antihistamine/decongestant
medications.
 Cromolyn (NasalCrom)
 Two inhalations of intranasal
ipratropium (Atrovent)
 Cromolyn ophthalmic solution 4%
Nursing Management
 Instructs the px about the importance
of controlling the environment at home
and at work.
 Teach patients proper nasal hygiene,
including the use of saline nasal sprays
and techniques for nasal irrigation.
 Avoid or reduce exposure to allergens
fumes, odors, powders, sprays, and
tobacco smoke)
Viral Rhinitis (Common Cold)
 The term ‘common cold’ often is used
when referring to a URI that is self-
limited and caused by a virus. It refers
to an infectious, acute inflammation of
the mucous membranes of the nasal
cavity.
 Rhinoviruses are the most likely
causative organisms.
Clinical Manifestation
 low-grade fever
 nasal congestion,
 rhinorrhea and nasal discharge,
halitosis
 sneezing
 tearing watery eyes
 As the illness progresses, cough usually
appears.
Medical Management
 5- to 7-day course of antibiotics
(bacterial cases)-Amoxicillin–clavulanic
acid (Augmentin)
 Intranasal corticosteroids
 decongestants/nasal saline sprays
(guaifenesin/pseudoephedrine [Entex
PSE])
 antihistamines (diphenhydramine
(Benadryl) and cetirizine (Zyrtec),
 Inhalation of steam or heated,
humidified air has been a mainstay of
home remedies to treat the common
cold.
 Alternative medicines (e.g., echinacea,
zinc lozenges, and zinc nasal spray) are
frequently used to treat the common
cold.
Nursing Management
  Provide patient education about
the nature of the common cold,
how it spreads, and the importance
of hand hygiene to prevent
transmission.
 Instruct the patient to practice good
hygiene by covering their mouth
and nose when coughing or
sneezing, using tissues, and
washing hands frequently
Rhinosinusitis
 Formerly called sinusitis, is an
inflammation of the paranasal sinuses
and nasal cavity.
 Rhinosinusitis is classified by duration of
symptoms as acute (less than 4 weeks),
subacute (4 to 12 weeks), and chronic
(more than 12 weeks).
 caused by a bacterial or viral infection.
Acute Rhinosinusitis
 Classified as an acute bacterial
rhinosinusitis (ABRS) or acute viral
rhinosinusitis (AVRS).
Clinical Manifestation
 purulent nasal drainage
 nasal obstruction or a combination of
facial pain, pressure, or a sense of
fullness
 cloudy or colored nasal discharge
congestion, blockage, or stuffiness
 diffuse headache
 high fever
Assessment & Dx
 history and physical examination
 CT scans
 Flexible endoscopic culture techniques
and swabbing of the sinuses
Medical Management
 5- to 7-day course of antibiotics
(bacterial cases)-Amoxicillin–
clavulanic acid (Augmentin)
 Intranasal saline lavage
 Intranasal corticosteroids
 decongestants/nasal saline sprays
 antihistamines
Nursing Management
 Instructs the patient about methods to
promote drainage of the sinuses,
including humidification of the air in the
home and the use of warm compresses
to relieve pressure.
 Instructs the patient to stop smoking
or using any form of tobacco.
 Instruct the patient about the correct
use of prescribed nasal sprays, if an
intranasal corticosteroid is
prescribed.
Chronic Rhinosinusitis & Recurrent
Acute Rhinosinusitis
 It is diagnosed when the patient has
experienced 12 weeks or longer of
two or more of the following
symptoms: mucopurulent drainage,
nasal obstruction, facial pain–
pressure–fullness,or hyposmia
 Diagnosed when four or more
episodes of ABRS occur per year
with no signs or symptoms of
rhinosinusitis between the episodes.
Clinical Manifestation
 Impaired mucociliary clearance and
ventilation
 Cough
 Hoarseness
 Chronic headache (Periorbital)
  Periorbital edema
 Facial pain
 Snoring
 Sore throat
 Adenoidal Hypertrophy
Complications
 Severe orbital cellulitis
 Subperiosteal abcess
 Cavernous sinus thrombosis
 Meningitis
 Encephalitis
 Ischemic Infarction
Intracranial complications
 Epidural abscess
 Subdural empyema
 Meningitis
 Brain abscess
Medical Management
 OTC nasal saline sprays
 Analgesic (Acetaminophen or
NSAIDs)
 Decongestants (Oxymetazoline and
Pseudoephedrine)
 Antibiotics
 Corticosteroids nasal spray
 Leukotriene inhibitors
Nursing Management
 Instruct patient to blow nose gently,
not frequently with force and use
tissue to remove the nasal drainage.
 Advice patient to increase fluid
intake, apply local heat, and elevate
the head of the bed to promote
drainage of the sinuses.
Acute Pharyngitis
 Commonly known as sore throat,
inflammation of pharynx. That is caused
by viral or bacterial infection such as
common cold and flu.
Clinical Manifestation
 Abcess
 Acrlet fever
 Toxic shock syndrome
 Difficulty swalloling
 sore throat
Dx
 RADT (Rapid Antigen detection test
 Throat culture
Medical Management
 Relieving symptoms of relieving
symptoms avoiding exposure to air
dump and collecting any upper
respiratory infection
 Rest, fluids, and throat gargle or
irrigation
 Soft or liquid diet because of
baseball swallowing
 Antibiotics while waiting there is
antibiotics while waiting the results
of throat culture
Nursing Management
 Instructs the patient to stop smoking
or using any form of tobacco.
 Instruct the patient about the correct
use of prescribed nasal sprays, if an
intranasal corticosteroid is
prescribed.
 Educate the patient with the
importance of following the
recommended antibiotic regimen.
Chronic Pharyngitis Nursing Management

 A persistent sore throat that lingers for  History taking

a few weeks or returns frequently.  Vital signs
Clinical Manifestation
Medical Management
 Discomfort or pain in the throat
 A tickling sensation in the throat.  Hydration
 A sensation of something Stuck in  Tonsillectomy
the throat  Adenoidectomy
 Difficulty swallowing  Diet
 A tired voice, more common among
people who sing or speak for a living Peritonsillar Abscess
 Headache  A pus-filled pocket that forms near one
 Fever of your tonsils.

Clinical Manifestation
Medical Management
 The HCP may order a rapid
streptococcal antigen test or a throat
culture and sensitivity test to identify
the causative organism and determine
which antibiotic will be effective.
Nursing Management
 Rest oral Fluids and Salt-water gargling
(For smoothing effect) are The main
supportive measures in patients with
viral pharyngitis
Medical Management
Tonsillitis and Adenoiditis
 Enlarged tonsils and adenoids are also
referred to as tonsillitis, adenoiditis, or
tonsil and adenoid hypertrophy.
Clinical Manifestation
 A collection of infected material in
the area around the tonsils.
 Fever and chills
 Severe throat pain that is usually on
one side
 Ear pain on the side of the abscess
 Difficulty opening the mouth, and
pain with opening the mouth
 Swallowing problems with mouth.
 The patient is hospitalized.
Intravenous fluids are started, as the
patient is usually dehydrated.
 Analgesics and antipyretics are given
to relieve pain and fever.

 Sore throat, Chill and fever

 Pain on swallowing Laryngitis
 Headache 
 Malaise
 Myalgia
 Yellow or white exudate (Tonsils)
 Snoring, a nasal obstruction, and a
nasal tone to the voice (Adenoids)
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