LESSON NOTES ON URTI

Introduction:
Upper Respiratory Infection:
An upper respiratory infection affects the upper part of
respiratory system, including sinuses and throat. Upper respiratory
infection symptoms include a runny nose, sore throat and cough.
Treatment for upper respiratory infections often includes rest, fluids
and over-the-counter pain relievers. Infections usually go away on
their own.
What is a respiratory infection?
A respiratory tract infection affects the respiratory system,
the part of body responsible for breathing. These infections can affect
sinuses, throat, lungs or airways. There are two types of respiratory
infections:
 Upper respiratory infections.
 Lower respiratory infections.
What is an upper respiratory infection?
These infections affect sinuses and throat. Upper respiratory
infections include:
 Common cold.
 Epiglottitis.
 Laryngitis.
 Pharyngitis (sore throat).
 Sinusitis (sinus infection).
What is a lower respiratory infection?
A lower respiratory infection affects the airways and lungs. In
general, lower respiratory infections last longer and are more serious.
These infections include:
 Bronchitis, a lung infection that causes coughing and fever.
 Bronchiolitis, a lung infection that mostly affects young
children.
 Chest infection.
 Pneumonia.
What is the common cold?
The common cold refers to at least 200 different
viruses that cause a cold. Colds often go away on their own.
Colds can:
• Occur at any age.
• Have a wide range of symptoms.
• Spread through direct contact with respiratory secretions,
like saliva, mucus or phlegm.
• Last about seven to 10 days, though a cough can last up to
three weeks.
• Lead to complications such as ear infections, eye
infections, sinus infections and pneumonia.
• Treating a cold can help you feel better: Use
acetaminophen (Tylenol®) for body aches and fever.
• Stay hydrated. Make sure to drink a lot, especially fluids
such as water, tea and broth.
• Get plenty of rest.
What is epiglottitis?
The epiglottis is the top part of trachea, breathing tube.
It sits far back in mouth, at the base of tongue. Epiglottitis is
when the epiglottis gets inflamed. This condition can be serious.
If the epiglottis swells from inflammation, it can block airway.
may have trouble breathing.
Symptoms of epiglottitis include:
• Difficulty breathing or swallowing.
• Fever.
• Severe sore throat.

Epiglottitis requires treatment at a hospital or medical facility.

Healthcare providers first need to check oxygen levels and
protect airway. Patient may need supplemental oxygen if
oxygen levels are too low. may also need:
• IV fluids to keep hydrated until they can swallow without
problems.
 • Antibiotics, if health care provider thinks patient may have
a bacterial infection.
• Steroids to reduce the swelling.
What is laryngitis?
larynx is the voice box. Laryngitis is when the larynx
becomes inflamed. Usually, a virus infects the upper airways,
leading to laryngitis. The main symptom of laryngitis is a voice
change.
• Become very hoarse.
• Only be able to talk at a low volume.
• Lose voice entirely.
fever, have difficulty swallowing and have a sore throat.
• voice rest. Try not to speak.
• Drink plenty of extra fluids.
• Breathe in steam.
• Use cough suppressants.
What is pharyngitis?
Pharyngitis is also known as a sore throat. It’s usually
caused by a virus. Sometimes, bacteria called group A
Streptococcus can cause a type of sore throat called strep throat.
Strep throat is more common in children between ages 5 and 15.
Symptoms of a sore throat may include:

• Severe throat pain.

• Difficulty swallowing and speaking.
• Ear pain.
• Tender lymph nodes in the neck.
• Swollen, red tonsils.
• Over-the-counter pain relievers, such as acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs), to help with
throat pain.
• Gargling with warm salt water to soothe throat.
• A single dose of a steroid to help with symptoms.
What is a sinus infection?
 Sinusitis, or a sinus infection, is a common problem. It
happens when sinuses become inflamed. Sinuses are hollow spaces
located behind the bones of face. Inflammation occurs in
• Cheeks.
• Behind forehead and eyebrows.
• On the sides of nose bridge.
• Beyond nose, in front of the brain.
• Most often, viruses infect the sinuses, causing
inflammation. may feel or have: Postnasal drip, when patient
feels mucus dripping into their throat.
• Green mucus from nose.
• Stuffiness or congestion.
• Pain when pressing the face, especially on the bones right
under eyes.
• Bad breath.
• Cough.
• Fatigue.
• Fever.
• Headaches.
What causes upper respiratory infections?
when a virus (or bacteria) enters respiratory system. For
example, person might touch an infected surface or shake hands with
a person who’s sick. Then touches mouth, nose or eyes. The germs
from hands enter and infect body.
Causative factors:
Common cold continues to be a large burden on society,
economically and socially. The most common virus is rhinovirus.
Other viruses include the influenza virus, adenovirus, enterovirus, and
respiratory syncytial virus. Bacteria may cause roughly 15% of
sudden onset pharyngitis presentations. The most common is S.
pyogenic, a Group A streptococcus.
Risk factors for a URTI:
 Close contact with children: both day-cares and schools increase
the risk of URTI
  Medical disorder: People with asthma and allergic rhinitis are
more likely to develop URTI
 Smoking is a common risk factor for URTI
 Immunocompromised individuals including those with cystic
fibrosis, HIV, use of corticosteroids, transplantation, and post-
splenectomy are at high risk for URTI
 Anatomical anomalies including facial dysmorphic changes or
nasal polyposis also increase the risk of URTI
Pathophysiology:
A URTI usually involves direct invasion of the upper airway
mucosa by the organism. The organism is usually acquired by
inhalation of infected droplets. Barriers that prevent the organism
from attaching to the mucosa include 1) the hair lining that traps
pathogens, 2) the mucus which also traps organisms 3) the angle
between the pharynx and nose which prevents particles from falling
into the airways and 4) ciliated cells in the lower airways that
transport the pathogens back to the pharynx.
The adenoids and tonsils also contain immunological cells that
attack the pathogens.
Influenza
The incubation period for influenza is 1 to 4 days, and the time
interval between symptom onset is estimated to be 3 to 4 days. Viral
shedding can occur 1 day before the onset of symptoms. It is believed
that influenza can be transferred among humans by direct contact,
indirect contact, droplets, or aerosolization. Short distances (<1 meter)
are generally required for contact and droplet transmission to occur
between the source person and the susceptible individual. Airborne
transmission may occur over longer distances (>1 m). Most evidence-
based data suggest that direct contact and droplet transfer are the
predominant modes of transmission for influenza.
Common Cold
The pathogens are responsible for causing the common cold
include rhinovirus, adenovirus, parainfluenza virus, respiratory
syncytial virus, enterovirus, and coronavirus. The rhinovirus, a
species of the Enterovirus genus of the Picornaviridae family, is the
most common cause of the common cold and causes up to 80% of all
respiratory infections during peak seasons. Dozens of rhinovirus
serotypes and frequent antigenic changes among them make
identification, characterization, and eradication complex. After
deposition in the anterior nasal mucosa, rhinovirus replication and
infection are thought to begin upon mucociliary transport to the
posterior nasopharynx and adenoids. As soon as 10 to 12 hours after
inoculation, symptoms may begin. The mean duration of symptoms is
7 to 10 days, but symptoms can persist for as long as 3 weeks. Nasal
mucosal infection and the host's subsequent inflammatory response
cause vasodilation and increased vascular permeability. These events
result in nasal obstruction and rhinorrhoea whereas cholinergic
stimulation prompts mucus production and sneezing.
Mode of transmission:
Direct contact and air-borne.
Diagnosis:
 Lung (chest) X-ray.
 Lung CT scan.
 Lung (pulmonary) function test to see how your lungs are
working.
 Nasal swab.
 Throat swab.
 Sputum test, when you cough up some sputum (phlegm from
your lungs) for examination.

Symptoms:
 Acute upper respiratory tract infections include rhinitis,
pharyngitis, tonsillitis, and laryngitis. Symptoms of URTIs commonly
include:
 Cough
 Sore throat
 Runny nose
 Nasal congestion
 Headache
 Low-grade fever
 Facial pressure
 Sneezing
 Malaise
 Myalgia
The onset of symptoms usually begins one to three days after
exposure and lasts 7–10 days, and can persist up to 3 weeks.

Complication:
Respiratory failure
Prevention:
 Practice good hygiene
 Wash hands, especially before eating or preparing food.
 Sneeze and cough into arm or a tissue and wash hands after.
 Live a healthy lifestyle:
 Avoid contact with people who are sick.
 Drink plenty of fluids.
 Get enough sleep.
 Stop smoking.
 Seek health care provider
 Keep up with routine check-ups and immunizations.
 Ask health care provider if there is a possibility to get the
pneumococcal vaccine, which prevents pneumonia.
Management:
Pharmacological:
The goal of treatment for the common cold is symptom
relief. Decongestants and combination antihistamine/decongestant
medications can limit cough, congestion, and other symptoms in
adults. Avoid cough preparations in children. H1-receptor antagonists
may offer a modest reduction of rhinorrhoea and sneezing during the
first 2 days of a cold in adults. First-generation antihistamines are
sedating, so advise the patient about caution during their use. Topical
and oral nasal decongestants (i.e., topical oxymetazoline, oral
pseudoephedrine) have moderate benefit in adults and adolescents in
reducing nasal airway resistance.
Early antiviral treatment for influenza infection shortens the
duration of influenza symptoms, decreases the length of hospital
stays, and reduces the risk of complications. [ Recommendations for
the treatment of influenza are updated frequently by the Centres for
Disease Control and Prevention based on epidemiologic data and
antiviral resistance patterns. Give antiviral therapy for influenza
within 48 hours of symptom onset (or earlier), and do not delay
treatment for laboratory confirmation if a rapid test is not available.
Antiviral treatment can provide benefit even after 48 hours in
pregnant and other high-risk patients.
 Vaccination is the most effective method of preventing influenza
illness. Antiviral chemoprophylaxis is also helpful in preventing
influenza (70% to 90% effective) and should be considered as an
adjunct to vaccination in certain scenarios or when vaccination is
unavailable or not possible. Generally, antiviral chemoprophylaxis is
used during periods of influenza activity for (1) high-risk persons who
cannot receive vaccination (due to contraindications) or in whom
recent vaccination does not, or is not expected to, afford a sufficient
immune response; (2) controlling outbreaks among high-risk persons
in institutional settings; and (3) high-risk persons with influenza
exposures.
Non-pharmacological:
According to a Cochrane Review, vitamin C used as daily
prophylaxis at doses of =0.2 grams or more had a "modest but
consistent effect" on the duration and severity of common cold
symptoms (8% and 13% decreases in duration for adults and children,
respectively). When taken therapeutically after the onset of
symptoms, however, high-dose vitamin C has not shown clear benefit.
Nursing management:
Change position frequently and provide good pulmonary hygiene.
Promotes expectoration, clearing of infection. Pulmonary hygiene
helps the clearance of secretions and prevention and relief of
atelectasis. The most effective method of clearing secretions is
changing body position and vigorous coughing by the patient.
Conclusion:
Respiratory tract infection is one of the common infection occurs
to the individuals which can be treated in the early stage of diagnosis.