UPPER RESPIRATORY INFECTIONS.

1. UPPER RESPIRATORY
DISEASES &
DISORDERS
MRS. PALLAVI CHAUHAN

2. EPISTAXIS
(NOSEBLEED)

3. EPISTAXIS (NOSEBLEED)
 A hemorrhage from the nose, referred to as
epistaxis, is caused by the rupture of tiny,
distended vessels in the mucous membrane
of any area of the nose.

4.  Most commonly, the site is the anterior septum, where three
major blood vessels enter the nasal cavity:
 (1) the anterior ethmoidal artery on the forward part of the roof
 (2) the sphenopalatine artery in the posterosuperior region, and
 (3) the internal maxillary branches
 There are a variety of causes associated with epistaxis, including
 trauma, infection, inhalation of illicit drugs, cardiovascular
diseases,
 , nasal tumors, low humidity, a foreign body in the nose.

5. CONT…D
Sitting position leaning forward.
5

6.  Medical Management
 Management of epistaxis depends on the location of the bleeding site.
 If nosebleeds originate from the anterior portion of the nose. Initial treatment
may include applying direct pressure.
 The patient sits upright with the head tilted forward to prevent swallowing and
aspiration of blood and is directed to pinch the soft outer portion of the nose
against the midline septum for 5 or 10 minutes continuously. If this measure is
unsuccessful, additional treatment is indicated.
 In anterior nosebleeds, the area may be treated with a silver nitrate applicator
and Gelfoam, or by electrocautery. Topical vasoconstrictors, such as adrenaline
(11,000), cocaine (0.5%), and phenylephrine may be prescribed.
 If bleeding is occurring from the posterior regions, cotton pledgets soaked in a
vasoconstricting solution may be inserted into the nose to reduce the blood flow
and improve the examiner’s view of the bleeding site.
 Alternatively, a cotton tampon may be used to try to stop the bleeding. Suction
may be used to remove excess blood and clots from the field of inspection.

7. NASAL
OBSTRUCTION

8. NASAL OBSTRUCTION
 The passage of air through the nostrils is frequently obstructed
by a deviation of the nasal septum, hypertrophy of the turbinate
bones, or the pressure of nasal polyps, which are grapelike
swellings that arise from the mucous membrane of the sinuses,
especially the ethmoids.
 This obstruction also may lead to a condition of chronic
infection of the nose and result in frequent episodes of
nasopharyngitis.
 When sinusitis develops and the drainage from these cavities is
obstructed by deformity or swelling within the nose, pain is
experienced in the region of the affected sinus.

9. MEDICAL MANAGEMENT
 The treatment of nasal obstruction requires the removal of the obstruction,
followed by measures to overcome whatever chronic infection exists. In many
patients an underlying allergy requires treatment.
 At times endoscopic surgery is necessary to drain the nasal sinuses. The
specific procedure performed depends on the type of nasal obstruction found.
 Usually, surgery is performed under local anesthesia.
 If a deviation of the septum is the cause of the obstruction, the surgeon makes
an incision into the mucous membrane and, after raising it from the bone,
removes the deviated bone and cartilage
 with bone forceps.
 The mucosa then is allowed to fall back in place and is held there by tight
packing. Generally, the packing is soaked in liquid petrolatum so that it can be
removed easily in 24 to 36 hours.
 This operation is called a submucous resection or septoplasty.
 Nasal polyps are removed by clipping them at their base with a wire snare.

10. RHINITIS

11. RHINITIS

12.  Rhinitis is a group of disorders
characterized by inflammation and
irritation of the mucous membranes of
the nose. It may be classified as
nonallergic or allergic.
 Rhinitis is irritation and inflammation of
the mucous membrane inside the nose.
Common symptoms are a stuffy
nose,runny nose, sneezing, and post-
nasal drip

13.  Caused by viruses, bacteria, irritants
or allergens. The most common kind of
rhinitis is allergic rhinitis, such
as pollen and dander.

14. TYPES
 Infectious : Common cold and Sinusitis
 Rhinitis is commonly caused by
a viral or bacterial infection, including the common
cold, which is caused
by Rhinoviruses, Coronaviruses, and influenza
viruses, others caused byadenoviruses, ETC .
 Symptoms of the common cold include rhinorrhea,
sneezing, sore throat
(pharyngitis), cough, congestion, and slight headache

15. Nonallergic rhinitis
 Nonallergic rhinitis refers to rhinitis that is not
due to an allergy.
 It was formerly known as vasomotor rhinitis as
the cause was thought to be vasodilation
caused by an overactive parasympathetic nerve
response.

16.  Allergic rhinitis
 Allergic rhinitis or hay fever may follow when an
allergen such as pollen, dust, is inhaled by an
individual with a sensitized immune system,
triggering antibody production.
 These antibodies mostly bind to mast cells, which
contain histamine.
 When the mast cells are stimulated by an allergen,
histamine (and other chemicals) are released. This
causes itching, swelling, and mucus production.

17. PATHOPHYSIOLOGY
Allergy , infection , structural deformity
Rhinorhea
Nasal congestion
Inflammation
Rhinitis

18. Clinical Manifestations
 Rhinorrhea (excessive
nasal drainage, runny
nose),
 nasal congestion, nasal
discharge (purulent with
bacterial rhinitis),
 nasal itchiness, and
sneezing.
 Headache may occur,
particularly if sinusitis is
also present

20.  Management
 The management of rhinitis depends on the
underlying cause.
 For allergic rhinitis,
intranasal corticosteroids and antihistamines
can be used to suppress inflammation and
control symptoms.

21. GENERAL MANAGEMENT
 Anti microbal agent
 Corticosteroid
 Antihitamanic drugs
 Avoid allergy
 Saline nasal drop

22. VIRAL RHINITIS (COMMON
COLD)

23.  VIRAL RHINITIS (COMMON COLD)
 The term “common cold” often is used when
referring to an upper respiratory tract infection
that is self-limited and caused by a virus (viral
rhinitis).
 Nasal congestion, Rhinorrhea, sneezing, sore
throat, and general malaise characterize it.

24.  A chronic inflammation of the nasal mucosal
membrane characterized by increased nasal
mucus.
Cause
 Repeated acute infection or allergy.
 Chronic irritation by nasal drug
 Rhinovirus
 influenza virus
 corona virus,
 adenovirus.

25. Clinical Manifestations
 nasal congestion,
 runny nose, sneezing,
 nasal discharge, nasal itchiness,
 tearing watery eyes,
 “scratchy” or sore throat, general malaise,
 low-grade fever, chills, and often headache and muscle aches
 cough usually appears.
 In some people, viral rhinitis exacerbates the herpes simplex,
commonly called a cold sore (Chart 22-1).
 The symptoms last from 1 to 2 weeks.
 Allergic conditions can also affect the nose, mimicking the
symptoms of a cold.

26. Medical Management
 Providing adequate fluid intake, encouraging rest,
 Warm salt-water gargles soothe the sore throat and
nonsteroidal anti-inflammatory agents (NSAIDs) such as
aspirin or ibuprofen relieve the aches, pains, and fever in
adults.
 Antihistamines are used to relieve sneezing, rhinorrhea, and
nasal congestion. Topical (nasal) decongestant agents may
relieve nasal congestion.
 Antimicrobial agents (antibiotics) should not be used
because they do not affect the virus or reduce the incidence
of bacterial complications.

27. SINUSITIS
 It is an inflammation of the mucous
membranes in the sinuses.
 Sinusitis can be;
1. Acute bacterial.
2. Sub acute.
3. Chronic.
27

28. ACUTE SINUSITIS

29. ACUTE SINUSITIS
 Acute sinusitis, also
called acute rhinosinusitis, is a short-
term infection or inflammation of the
membranes that line your sinuses. It
prevents mucus from draining from your
nose.
 Acute sinusitis, also called acute rhino
sinusitis.
 It is a short-term infection or
inflammation of the membranes that
line your sinuses.

30. What Causes Acute Sinusitis?
 colds
 bacterial upper respiratory tract infections
 fungal sinus infections
 allergies that cause mucus production in the sinuses
 lack of cilia motility, caused by disease (cilia are the
small hairs located in your sinuses that move to push
mucus out of your sinuses)
 nasal polyps or tumors
 infected tooth (in rare cases bacteria can spread from
the infected tooth to the sinuses)

31. Who Is at Risk for Acute Sinusitis?
 Allergies
 Nasal passage abnormalities, such as a
deviated septum or nasal polyp
 Smoking or frequent breathing in of
pollutants
 Diseases that affect the function of cilia, such
as (a lung disease that affects cilia motility)
 A weakened immune system

32. PATHOPHYSIOLOGY
Infection ,allergy , structural deformity
narrowing of sinus
stagnet secretion
inflammation

33.  What are the Symptoms of Acute Sinusitis?
 Nasal Congestion
 Thick, Yellow, Or Green Mucus Discharge From The Nose
 Sore Throat
 A Cough (Usually Worse At Night)
 Drainage Of Mucus In The Back Of Your Throat
 Headache
 Pain, Pressure, Or Tenderness Behind Your Eyes, Nose, Cheeks, Or
Forehead
 Earache
 Toothache
 Bad Breath
 Reduced Sense Of Smell
 Reduced Sense Of Taste
 Fever
 Fatigue

34. How Is Acute Sinusitis Diagnosed?
 Diagnosing acute sinusitis usually involves a physical exam.
 doctor will gently tap your sinuses with his fingers to identify an
infection.
 The exam may involve looking into your nose with a light to
identify inflammation, polyps, tumors, or other abnormalities.
 Nasal Endoscopy
 Imaging Tests : may order a CT scan or MRI to look for
inflammation or sinus abnormalities.

35. How Is Acute Sinusitis Treated?
 Saline nasal sprays, used several times a day to clear your nasal
passages
 Drinking plenty of fluids in order to thin mucus
 Nasal corticosteroid sprays, such as flonase or nasonex, to reduce sinus
inflammation
 Decongestants, to dry up mucus
 Pain relievers, to relieve sinus pain
 Sleeping with your head elevated to encourage your sinuses to dry
 Antibiotics, anti-fungal medications, or allergy shots for severe acute
sinusitis infections.

36. CHRONIC SINUSITIS

37. CHRONIC SINUSITIS
 Chronic bacterial sinusitis develops when irreversible
mucosa damage occurs.
 Damage can result from recurrent attacks of acute
sinusitis or either being untreated or inadequately
treated during the acute or sub acute phase.
Etiology
 S.aureus
 H. influenza
 Anaerobes (Klebsiella)
37

38. CHRONIC SINUSITIS
 Chronic sinusitis is an
inflammation of the sinuses
that persists for more than 3
weeks in an adult.

39.  Pathophysiology
 Due to etiological factors
 Inflammation of mucosal membrane of sinuses
 A narrowing or obstruction
 preventing adequate drainage to the nasal passages.
 Blockage that persists for greater than 3 weeks in an adult may
occur because of infection, allergy, or structural abnormalities.
 This results in stagnant secretions,
 cause chronic sinusitis.

40. Clinical Manifestations
 Impaired mucociliary clearance and ventilation,
 cough
 Chronic hoarseness,
 facial pain.
 Fatigue.
 A decrease in smell and taste and a fullness in the ears.
 Nasal congestion, Thick, green purulent discharge, Fever ,

41.  Assessment and Diagnostic Findings
 A careful history and diagnostic assessment,
 Computed tomography scan
 Magnetic resonance imaging
 Nasal endoscopy

42.  Medical Management
 The antimicrobial agents of choice include amoxicillin or
ampicillin (Ampicin).
 Clarithromycin (Biaxin) and third-generation cephalosporins
such as cefuroxime axetil (Ceftin), cefpodoxime (Vantin),
and cefprozil (Cefzil) have also been effective.
 Decongestant agents,
 Antihistamines, nasal sprays.

43. SURGICAL MANAGEMENT
 When standard medical therapy fails, surgery,
 usually ENDOSCOPIC, may be indicated to correct structural deformities that obstruct the
(openings) of the sinus.
 EXCISING AND CAUTERIZING NASAL POLYPS, incising and draining the
sinuses, aerating the sinuses, and removing tumors are some of the specific
procedures performed.
 Oral and topical cortico-steroids are usually prescribed.
 Antimicrobial agents are administered before and after surgery. Some patients
with severe chronic sinusitis obtain relief only by moving to a dry climate.

44. ANATOMIC AND PHYSIOLOGIC
REVIEW OF THROAT
44

45. PHARANGITIS

46. ACUTE PHARYNGITIS CHRONIC PHARYNGITIS

47. .
ACUTE PHARYNGITIS
Pharyngitis, or sore throat, is discomfort, pain,
or scratchiness in the throat. It often makes it
painful to swallow.
Acute pharangitis is a febrile inflammation of
the throat that is caused by hemolytic
streptococci, staphylococci.
It is the most common throat inflammation.
47

48. CAUSES
Pharyngitis is caused by swelling in the
back of the throat (pharynx) between the
tonsils and the (larynx).
Most sore throats are caused by colds, the
flu, Adeno virus, herpes simplex virus
Bacteria that can cause pharyngitis in
some cases.
•Strep throat is caused by group A
streptococcus.
•Less commonly, bacteria such as
gonorrhea, and chlamydia can cause sore
throat.

49. PATHOPHYSIOLOGY
Viral infection (adenovirus,influenza,herpes
simplex) & bacterial (group A beta hemolytic
streptococcus)
Leads to inflammatory response(in pharynx)
Result in pain ,fever, edema, tissue damage,
redness, & swelling in tonsils & soft palate
Pharyngitis

50. CONT…D
Clinical manifestation
 Fiery read throat and pharyngeal membrane and
tonsils
 Sever pain which lead to difficulty in swallowing
 Enlarged and tender cervical lymph nodes
 Fever
 Malaise
 Sore throat
 Hoarseness
 cough
 Rhinitis
50

51. CONT…D
Diagnosis
 Throat culture.
 Nasal swabbing and blood culture may be done.
51

52. CONT…D
Medical management
 Analgesics such as NSAIDs and acetaminophen can help reduce
the pain associated with a sore throat.
 Steroids (such as dexamethasone) have been found to be useful
for severe pharyngitis.[19][20]
 Viscous lidocaine relieves pain by numbing the mucus
membranes.
 Antibiotics are useful if a bacterial infection is the cause of the
sore throat. For viral infections, antibiotics have no effect.
 Oral analgesic solutions, the active ingredient usually
being phenol, chloride and menthol.
52

54. CHRONIC PHARYNGITIS
It is a persistent inflammation of the
pharynx.
Risk factors
Work or live in dusty surroundings, use their voice to
excess, suffer from chronic cough, an habitually use
alcohol and tobacco.
54

55. THREE TYPES OF CHRONIC
PHARYNGITIS ARE RECOGNIZED:
Hypertrophic:-general thickening
and congestion of the pharyngeal
mucous membrane
Atrophic: probably a late stage of
the first type (the membrane is
thin, whitish patches, glistening,
inflamed )
Chronic granular : characterized by
numerous swollen lymph follicles
on the pharyngeal wall.

57. CONT…D
Clinical Manifestations;
 a constant sense of irritation or fullness in the throat,
 Fever
 Sore, swollen glands in your neck or jaw
 Swollen, red tonsils
 White patches or pus on your tonsils
 Hoarse or muffled voice
 mucus that collects in the throat and can be expelled by coughing
 difficulty swallowing.
Medical Management;
 Nasal sprays.
 Antihistamine, decongestant medications{tramazoloine,epinephrine}
 Anti-inflammatory and analgesic agent like Aspirin or acetaminophen.
 Antibiotic therapy
57

58. TONSILLITIS AND ADENOIDITIS
 Tonsillitis is inflammation and
enlargement of the tonsil tissue. Tonsil
tissue are situated on each side of the
oropharynx
Cause
 Group A streptococcus is the most common
organism associated with tonsillitis.
 Adenoiditis is the inflammation of
the adenoid tissue, usually caused by
an infection
 Adenoiditis is inflammation of the
adenoid tissue. The adenoid consist of an
abnormally large lymphoid tissue mass
near the center of the posterior wall of the
nasopharynx.
 Infection of the adenoids frequently
accompanies acute tonsillitis. 58

59. CAUSES OF TONSILLITIS
 When caused by a bacterium belonging to
the group A streptococcus, it is typically
referred to as strep throat
 viral infection and
includes adenovirus, rhinovirus, influenza, co
ronavirus,

60. CAUSES OF ADENOIDITIS
 Viruses that may cause adenoiditis
include adenovirus, rhinovirus and paramyxovirus.
 Bacterial causes include Streptococcus
pyogenes, Streptococcus pneumoniae, and
various species including Staphylococcus
aureus.

61. CONT…D
Clinical manifestation
Tonsillitis
Sore throat
 red, swollen tonsils
 pain when swallowing
 high temperature (fever)
 coughing
 headache
 tiredness
 chills
 a general sense of feeling unwell (malaise)
 white pus-filled spots on the tonsils
 swollen lymph nodes (glands) in the neck
 pain in the ears or neck
 weight loss
 difficulty ingesting and swallowing meal/liquid intake
 difficulty sleeping
61

62. SIGNS AND SYMPTOMS {ADENOIDITIS}
 Fever,
 Runny Nose,
 Earache
 Nasal Airway Obstruction
 Bad Breathing,
 Snoring And Sleep Apnea,
 Rhinorrhoea
 Mucous-purulent Secretion.
 Adenoiditis Is Sometimes Accompanied By Tonsillitis.
 Repeated Adenoiditis May Lead To Enlarged Adenoids.

63. CONT…D
Diagnosis
 Hx.
 P/E.
 Culture of tonsil swab.
 Audiometric examination (hearing loss).
63

64. CONT…D
Treatment
 Pain Relief,
 Anti-inflammatory, fever reducing medications
(paracetamol/acetaminophen and/or ibuprofen)
 Sore throat relief (warm salt water gargle,
lozenges, dissolved aspirin.
 If the tonsillitis is caused by group A streptococcus,
then antibiotics are useful,
with penicillin or amoxicillin
 Tonsillectomy
 Adenoidectomy
 Mouth care may for comfort
64

65. CONT…D
 In cases of adenoiditis, treatment with
 analgesics or antipyretics
 antibiotics, such as amoxicillin or a cephalosporin.
 In case of adenoid hypertrophy, adenoidectomy may be
performed to remove the adenoid.
65

66. LARYNGITIS
 It is inflammation of the larynx.
Predisposing factor /associated to;
 Voice abuse.
 Exposure to dust.
 Chemicals.
 Smoke and other pollutants.
66

67. CONT…D
Etiology
 Almost alloys is a virus bacterial invasion may be
 Acute rhinitis or
 Naso pharyngitis.
 The onset of infection may be associated with
exposure to sudden temperature change.
 Diet as deficiencies
 Lack of immunity
Laryngitis is common in the winter and is
easily transmitted.
67

68. PATHOPHYSIOLOGY
Exposure to dust , chemicals, smoke, infection
inflammation (involving vocal cord)
hoarseness
aphonia (loss of voice)

69. CONT…D
Clinical manifestation
 Chronic laryngitis
 Persistent hoarsoness.
 Hoarseness or complete loss of voice
(aphonia).
 Severe may be a complication of chronic
sinusitis and chronic bronchitis.
69

70. CONT…D
Management
 resting the voice,
 Avoid smoking,
 Resting in bed , and
 inhaling cool steam or an aerosol
 For chronic laryngitis
 Resting the voice.
 Eliminating any primary respiratory tract
infection.
 Restricting smoking.
70

71. CONT…D
 Nursing interventions
 The patient is instructed to rest the voice and to
maintain a well humidified environment.
 High fluid intake.
71

72. CANCER OF LARYNX

73. CANCER OF LARYNX
 Cancer of the larynx is a
malignant tumor in the
larynx (voice box).
 Laryngeal cancer, also known
as cancer of the larynx or laryngeal
carcinoma, are mostly squamous cell
carcinomas, reflecting their origin from
the skin of the larynx.

74.  Risk Factors for Laryngeal Cancer
 Carcinogens
 Tobacco (smoke, smokeless)
 Combined effects of alcohol and tobacco
 Second-hand smoke
 Paint fumes
 Wood dust
 Cement dust
 Chemicals
 Tar products
 Mustard gas
 Leather and metals
 Other Factors
 Chronic laryngitis
 Nutritional deficiencies (riboflavin)
 History of alcohol abuse
 Familial predisposition
 Age (higher incidence after 60 years of age)
 Gender (more common in men)
 Race (more prevalent in African Americans)
 Weakened immune system

75.  Clinical Manifestations
 The symptoms of laryngeal cancer depend on the size
and location of the tumour. Symptoms may include the
following:
 Hoarseness or other voice changes
 A lump in the neck
 A sore throat or feeling that something is stuck in the
throat
 Persistent cough
 Stridor - a high-pitched wheezing sound indicative of a
narrowed or obstructed airway
 Bad breath
 Earache ("referred")
 Difficulty swallowing

76.  Assessment and Diagnostic Findings
 A complete history and physical examination of the head and
neck.
 An indirect laryngoscopy,
 The TNM classification system, to classify head and neck tumors.
The classification of the tumor determines the suggested
treatment modalities.
 Computed tomography and magnetic resonance imaging
 (MRI).
 Positron emission tomography (PET scan).

77. Medical Management
 Treatment of laryngeal cancer depends on the staging of the tumor, which
includes the location, size, and histology of the tumor and the presence and
extent of cervical lymph node involvement.
 Treatment options include surgery, radiation therapy, and chemotherapy. The
prognosis depends on a variety of factors: tumor stage, the patient’s gender and
age, and pathologic features of the tumor, including the grade and depth of
infiltration.
 Surgery and radiation therapy are both effective methods in the early stages of
cancer of the larynx.
 Chemotherapy traditionally has been used for recurrence or metastatic disease.
 It has also been used more recently in conjunction with either radiation therapy
to avoid a total laryngectomy or preoperatively to shrink a tumor before surgery
 A complete dental examination is performed to rule out any oral disease.

78. SURGICAL MANAGEMENT
 Depending on the location and staging of the tumor, four
different types of laryngectomy (surgical removal of part
or all of the larynx and surrounding structures) are
considered:
 • Partial laryngectomy
 • Supraglottic laryngectomy
 • Hemi laryngectomy
 • Total laryngectomy

79.  UPPER AIRWAY INFECTIONS 495
 Rhinitis 495
 Viral Rhinitis (Common Cold) 496
 Acute Sinusitis 497
 Chronic Sinusitis 499
 Acute Pharyngitis 500
 Chronic Pharyngitis 501
 Tonsillitis and Adenoiditis 501
 Peritonsillar Abscess 502
 Laryngitis 502
 CANCER OF THE LARYNX 508

80.  LOWER RESPIRATORY DISORDER
 ATELECTASIS 519
 RESPIRATORY INFECTIONS 521
 Acute Tracheobronchitis 521
 Pneumonia 522
 Nursing Process: The Patient With Pneumonia 531
 Pulmonary Tuberculosis 534
 Nursing Process: The Patient With Tuberculosis 538
 Lung Abscess 540
 PLEURAL CONDITIONS 542
 Pleurisy 542
 Pleural Effusion 542
 Empyema 543
 PULMONARY EDEMA 544
 ACUTE RESPIRATORY FAILURE 545
 ACUTE RESPIRATORY DISTRESS SYNDROME 546
 PULMONARY HYPERTENSION 548
 PULMONARY HEART DISEASE (COR PULMONALE) 549
 PULMONARY EMBOLISM 550
 SARCOIDOSIS 554
 OCCUPATIONAL LUNG DISEASES: PNEUMOCONIOSES 554
 Silicosis 555
 Asbestosis 555
 Coal Workers’ Pneumoconiosis 555
 CHEST TUMORS 556
 Lung Cancer (Bronchogenic Carcinoma) 556
 Tumors of the Mediastinum 559
 CHEST TRAUMA 559
 Blunt Trauma 560
 Penetrating Trauma: Gunshot and Stab Wounds 562
 Pneumothorax 563
 Cardiac Tamponade 564
 Subcutaneous Emphysem