UPPER RESPIRATORY TRACT INFECTIONS

ANATOMIC AND PHYSIOLOGIC OVERVIEW

 The respiratory system is composed of the upper and
lower respiratory tracts.
 Together, the two tracts are responsible for ventilation
(movement of air in and out of the airways).
 The upper respiratory tract, known as the upper airway,
warms and filters inspired air so that the lower
respiratory tract (the lungs) can accomplish gas exchange
or diffusion.
 Gas exchange involves delivering oxygen to the tissues
through the bloodstream and expelling waste gases, such
as carbon dioxide, during expiration. The respiratory
system depends on the cardiovascular system for
perfusion, or blood flow through the pulmonary system
 Upper airway structures consist of the nose; paranasal
sinuses; pharynx, tonsils, and adenoids; larynx; and
trachea.
PARASANAL SINUSES
 Carbon dioxide transport
o At the same time that oxygen diffuses from the blood
into the tissues, carbon dioxide diffuses from tissue
cells to blood and is transported to the lungs for
excretion
 Neurologic Control of Ventilation
o Resting respiration is the result of cyclic excitation of
the respiratory muscles by the phrenic nerve. The
rhythm of breathing is controlled by respiratory
centers in the brain. The inspiratory and expiratory
centers in the medulla oblongata and pons control the
rate and depth of ventilation to meet the body’s
metabolic demands
GAS EXCHANGE PROCESS
Presence of
CO2

Main source: OXYGEN

through inhalation Alerts the brain

Activates central
Body needs clean air chemoreceptors

Absence of CO 2 Activates
phrenic nerve
FUNCTION OF THE RESPIRATORY SYSTEM
 Oxygen Transport Diaphragm will push off CO 2 away from
o Oxygen is supplied to, and carbon dioxide is removed the body through exhalation
from, cells by way of the circulating blood through the
thin walls of the capillaries.
 Respiration
o Gas exchange between atmospheric air and the blood MEDICAL TERMS
and between the blood and cells of the body
 Ventilation Dyspnea Difficulty of breathing (subject)
o movement of air in and out of the airways Hypoxemia Low oxygen level in blood
o When the capacity of the chest is increased, air Orthopnea Shortness of breath while lying flat
enters through the trachea (inspiration) and moves relieved by standing/sitting
into the bronchi, bronchioles, and alveoli, and inflates Stridor High-pitched sound during inspiration
the lungs. Wheezing High-pitched sound during expiration
o When the chest wall and the diaphragm return to their (Asthma); inspiration (bronchitis)
previous positions (expiration), the lungs recoil and Hemoptysis Expectoration of blood from respiratory
force the air out through the bronchi and the trachea. tract
 Pulmonary diffusion & Perfussion Eupnea Normal breathing; 12-20cpm/breaths
o Pulmonary diffusion: exchange of gas molecules per minute
(oxygen and carbon dioxide) from areas of high Bradypnea Slow breathing but normal in depth;
concentration to areas of low concentration <12 or <10 cpm
o Pulmonary perfusion: blood flow through the Tachypnea Rapid and shallow breathing; >20/ >24
pulmonary vasculature. cpm
 Gas Exchange Hypoventilation Shallow and irregular breathing
o Gas exchange is the process by which oxygen and Hyperpnea/ Increased rate & depth results in
carbon dioxide move between the bloodstream and Hyperventilation decrease in PaCO2 level
the lungs. Apnea Period cessation of breathing sleep

A.Y. 2023-2024 | BSN 3-B 1

 Cheyne-stokes Regular cycle where rate & depth of
breathing increases then decrease until
apnea
Biot’s Periods of normal breathing for 3-4
Respiration cycles/ breaths then apnea (for 10-
60secs) ; Ataxic breathing
 Avoid/ reduce exposure to allergens, irritants & tobacco
smoke
 Use upper-arm when sneezing; cover mouth when coughi
PATHOPHYSIOLOGY

NURSING DIAGNOSIS FOR UPPER AIRWAY

Causes: Viral/ Allergens
INFECTIONS (Virus / changes in weather /pollen / dust / mites /pets)
 Impaired airway clearance
 Acute pain associated with upper airway irritation
 Impaired verbal communication Gets into the nose
 Hypovolemia associated with decreased fluid intake
 Lack of knowledge regarding URIs
Dendritic Cells
(type of immune cells that gobbles up foreign particles)
UPPER AIRWAY INFECTIONS
 Upper respiratory tract disorders are those that involve the
nose, paranasal sinuses, pharynx, larynx, trachea, or T cells is activated and release cytokines
bronchi. Many of these conditions are relatively minor, and
their effects are limited to mild and temporary discomfort
and inconvenience for the patient. Cytokines will then get to other immune cells
 A URI is often defined as an infection of the mucous
membranes of the nose, sinuses, pharynx, upper trachea, T cellls gather (primed)
or larynx
 URIs affect the nasal cavity; ethmoidal air cells; and
frontal, maxillary, and sphenoid sinuses; as well as the T cells imbalance
pharynx, larynx, and upper portion of the trachea.

RHINITIS AND VIRAL RHINITIS B cells will produce IgE

 is a group of disorders characterized by inflammation and
irritation of the mucous membranes of the nose.
 may be acute or chronic, and allergic or nonallergic IgE will then go into the bloodstream
 Allergic rhinitis is further classified as seasonal or
perennial rhinitis and is commonly associated with Mast Cells (code; primed)
exposure to airborne particles such as dust, dander, or
plant pollens in people who are allergic to these
substances. Histamine
(causes capillaries to dilate; signs and symptoms manifest)
SIGNS & SYMPTOMS OF RHINITIS
 Nasal discharge
 Nasal congestion
 Rhinorrhea (excessive nasal drainage, runny nose); MEDICAL MANAGEMENT
 Sneezing;  Pharmacologic Therapy
 Red, itchy, swollen eyes o Antihistamines (tidines/ zines)
 Headache  Loratidine (e.g. Allerta)
 Cetirizine (e.g. Virlix)
SIGNS & SYMPTOMS OF VIRAL RHINITIS o Nasal sprays
o NSAIDs / Analgesics
 Low-grade fever
 Sore throat  Ibuprofen; Paracetamol; Naproxen; Mefenamic
Acid
 Coughing
o NO ANTIBIOTICS
 Halitosis (bad breath)
 The body may develop resistance to antibiotics
 Sneezing
 Chills
 General malaise RHINOSINUSITIS
 Headache  “Sinusitis”
 Classified into 3:
NURSING INTERVENTIONS o Acute: <4 weeks; ABRS & AVS
 Proper handwashing o Chronic: >12 weeks or longer
 Educate patient about self care o Recurrent / Subacute: 4 to 12 weeks

A.Y. 2023-2024 | BSN 3-B 2

  4 or more episodes of ABRS occurrences in a  Adeno Virus
year without signs and symptoms  Influenza Virus
 Epstein-Barr Virus
SIGNS AND SYMPTOMS  Herpes -simplex Virus
 Nasal Obstruction  5-15% - GBHS /GAS (GROUP A STREPTOCOCUS)
 Headaches o Strep throat/ strep pharyngitis
 High-grade fever
 Hyposmia (decrease sense of smell) SIGNS AND SYMPTOMS
o Anosmia- total loss of smell  Pain
 Dysphagia
TYPICAL PATHOGEN:  Malaise
 Haemophilus Influenzae  Fever
 Streptococcus Pneumoniae  Edema
 No cough
LESS COMMON PATHOGEN:  Headache
 Staphylococcus Aureus  Myalgia (muscle pain)
 Painful cervical adenopathy
ABRS: SIGNS & SYMPTOMS (10 DAYS) o abnormal enlargement of lymph nodes
 Nausea
 High grade fever
 Facial- pain- pressure fullness
SIGNS & SYMPTOMS (GAS AS CAUSE)
 Nasal congestion/Obstruction with cloudy colored nasal
discharged  Vomiting
 Anorexia/ loss of appetite
*ABRS- Acute bacterial rhinosinusitis  Scarlet fever

AVRS: < 10 DAYS SIGNS AND SYMPTOMS NURSING INTERVENTIONS

 Same with ABRS without high fever and facial- pain-  Same with Rhinosinusitis
pressure fullness
MEDICAL MANAGEMENT
*AVRS- Acute viral rhinosinusitis  Antibiotic therapy
 NSAID’s /Analgesic
NURSING INTERVENTION  Antipyretic
 Proper Handwashing
 Increase OFI (Oral Fluid Intake) SURGICAL MANAGEMENT
 Rest  Tonsillectomy
 Apply local heat/warm compress
 Avoid smoking (Health Education on Smoking Cessation) TONSILITIS/ADENOIDITIS
 Elevate the head of bed to promote drainage of the  Inflammation of the tonsils; Inflammation of the adenoids
sinuses  Acute & Chronic
ABRS: NURSING/ MEDICAL MANAGEMENT CAUSE
 Antibiotic Therapy (14 days) (5-7days) to reduce antibiotic  Virus (EBV: Epstein-Barr Virus)
resistance  Bacteria (GAS)
 Pain reliever- NSAIDs
 Nasal Decongestant (OTC) WALDEYER’S RING
o Neozep , Nasatapp, Symdex-D
 consists of four tonsillar structures
o Adenoids
AVRS: NURSING/ MEDICAL MANAGEMENT
o Tubal Tonsils
 Oral decongestant o Palatine Tonsils
 Nasal Saline Lavage o Lingual Tonsils
PHARYNGITIS
SIGNS AND SYMPTOMS
 Inflammation of the pharynx; infection
 Painful  Sore throat
 Sore throat  Fever
 Acute and chronic  Dysphagia
 Ear pain
CAUSE/RISK FACTORS:  Voice impairment
 Headache

A.Y. 2023-2024 | BSN 3-B 3

 Halitosis  CBC
 Otitis Media (ear infection) o Increase WBC, low platelet(thrombocytopenia)
 Snoring  Serum creatine, urea
 Noisy Breathing  Throat swab (GAS)

COMPLICATIONS NURSING INTERVENTION

 Splenic Rupture  Hand washing
 Leukoplakia (thick, white patches on the inside surfaces of  Bed rest
your mouth)  Increase oral fluid intake
 Burkitt’s Lymphoma (aggressive B-cell non-Hodgkin  Health education about oral hygiene
lymphoma)
NURSING/ MEDICAL MANAGEMEN FOR EBV
(VIRAL)
 Analgesics
 Steroids
 Intubation
 Surgery
o tonsillectomy
 Amoxicillin/ ampicillin
PATHOPHYSIOLOGY o May manifest antibiotic induced rash; NOT ALLERGY

Cause: Bacteria/ Virus

infection without symptoms

if with symptoms: Infectious mononucleosis (Kissing Disease; through saliva)

PERITONSILLAR ABSCESS
 Complication of the sore throat
target B-cell oropharynx (tonsils)
PATHOGEN
 Streptococcus Aureus
replicate and conquer  Neisseria Species
 Corynebacterium Species
 Streptococcus Pyogenes
body will build up immune response
SIGNS & SYMPTOMS
 Severe sore throat
client will manifest edema, hypertrophy, redness (erythema) &  Fever
pain  Spasm
 Dysphagia
inflammation may affect other areas of the beack of the throat:  Odynophagia (pain when swallowing)
Adenoids & Lingual Tonsils  Trismus (difficulty of opening the mouth)
 Drooling
 Severe pain
produces exudates (white/ gray/yellow discharge)  Otalgia (pain in the ear)
 Cervical lymph adenopathy

inflamed pharynx MEDICAL MANAGEMENT

 Antibiotics
 Steroids
o hydrocortisone
Edema -> Airway Obstruction -> Death
o corticosteroids
 Analgesics/pain meds:
o tramadol
o ketorolac
ASSESSMENT FINDINGS /DIAGNOSIS
SURGICAL MANAGEMENT

A.Y. 2023-2024 | BSN 3-B 4

 Tonsillectomy o instructs the patient to refrain from speaking as
 Needle aspiration much as possible and, if possible, to communicate in
 I&D (Incision and Drainage) writing instead
o use alternative forms of communication, such as a
memo pad, bell, or a smartphone or other electronic
LARYNGITIS devices to signal for assistance.
 Inflammation of larynx  Encourage Fluid Intake
 Associated with GERD o Upper airway infections lead to fluid loss so
 Due to abuse of voice, exposure to dust, chemicals, encourage the patient to drink 2 to 3 L of fluid per day
smoke and other pollutants  Promoting Home, Community-Based, and Transitional
 Often associated with allergic rhinitis or pharyngitis. Care
o Educating patients about self-care
CAUSE o Continuing and Transitional Care
 Viral/ Bacterial  Monitor & Manage Potential Complication
o families must be instructed to monitor for signs and
 Allergic
symptoms and to seek immediate medical care if the
patient’s condition does not improve or if the patient’s
SIGNS & SYMPTOMS
physical status appears to be worsening
 Acute .
o Hoarseness
o Aphonia (loss of voice)
o Dry sore throat worsens at night
o Dry cough
o Tickle in the throat
 Chronic
o Persistent hoarseness

MEDICAL MANAGEMENT
 Antibiotics
 Steroids
 Proto Pump Inhibitors
o “prazole”; example: omeprazole

NURSING INTERVENTION
 Rest
 Avoid exposure to irritants (smoking)
 Inhaling cool steam or an aerosol
 Maintain a well-humidified environment
 Increase oral fluid intake
o 2 to 3L/day; to thin secretion
 Instruct patient about signs and symptoms that requires
immediate medical attention:
o loss of voice with sore throat
o hemoptysis
o noisy respiration

GENERAL NURSING INTERVENTIONS FOR URIs

 Maintain Patent Airway
o Increasing fluid intake helps thin the mucus
o Use of steam inhalation also loosens secretions and
reduces inflammation of the mucous membranes
o Elevation; to enhance drainage from the sinuses
 Promote Comfort
o pain intensity rating scale may be used to assess
effectiveness of pain relief measures
o Oral Hygiene
o Warm water gargle
o Encourage rest
 Promote Communication

A.Y. 2023-2024 | BSN 3-B 5