RESPI PT 2

Rhinitis

- inflammation and irritation of hte mucous membranes of the nose

- allergic or non-allergic

Allergic Rhinitis

- Seasonal Rhinitis

- Perennial Rhinitis

Seasonal Rhinitis

occurs during pollen seasons

Perennial Rhinitis

occurs throughout the year

Factors that may lead to Rhinorrhea

- changes in temperature or humidity

- odors

- infection

- age

- use of OTC

Factors that may lead to Rhinorrhea

- presence of foreign body

- exposure to allergens

- food

- medication

- particles both indoor and outdoor

Factors that may lead to Rhinorrhea

- non allergic (common colds)

- drug induced

Drugs that may induce Rhinorrhea

- ACE inhibitors (-prils)

- beta blockers (-olols)

- "statins"

- antidepressants

- antipsychotic

- aspirin

- antianxiety

Rhinorrhea

runny nose

symptoms of Rhinitis

- rhinorrhea

- nasal congestion

- nasal discharge

- sneezing

- pruritus of nose, roof of mouth, throat, eyes, ears

Management of Rhinitis

- depends on the cause

- Antihistamines: symptom relief

- Saline nasal spray

- avoid or reduce exposure to allergens and irritants

Meds to relieve symptoms

management of viral rhinitis

allergy tests

- management of allergic rhinitis

- done to identify possible allergens

antibiotics

management of bacterial rhinitis

refer to EENT

management for nasal and septal deformities

saline nasal spray

mild decongestant and can liquefy mucus to prevent crusting

Nasal spray

1 Instruct the patient to blow the nose before applying the medication

2. Keep the head upright

3. Spray quickly and firmly into each nostril away from nasal septum

4. Wait atleast 1 minute before administering the second spray (if 2 sprays per nostril)

5. After care (clean) and never share to avoid cross contamination.

Viral rhinitis

- common cold

- most frequent viral infection in the general population

- often is used when referring to a URI that is self-limited and caused by a virus

- cold temperatures and exposure to cold rainy weather do not increase the incidence or severity

Symptoms of Viral Rhinitis

- low-grade fever

- nasal congestion

- rhinorrhea

- nasal discharge

- halitosis

Symptoms of Viral Rhinitis

- sneezing

- tearing watery eyes

- "scratchy" or sore throat

- general malaise

- chills

Symptoms of Viral Rhinitis

- headache

- muscle aches

- As the illness progresses, cough usually appears

- virus exacerbates herpes simplex (cold sore)

- symptoms may last from 1 to 2 weeks

Management of Viral Rhinitis

- Adequate fluid intake, rest, prevention of chilling, and the use of expectorants as needed

- Wam salt-water gargles

- NSAIDs

- Antihistamines

- Topical nasal decongestants/spray

- hand hygiene to reduce transmission

warm salt-water gargles

soothes sore throat

NSAIDs

- aspirin and ibuprofen

- relieves aches and pains

Antihistamines

relieve sneezing, rhinorrhea, and nasal congestion

Topical nasal decongestants

- Phenylnephrine nasal and oxymetazoline nasal

- should be used with CAUTION

- overuse can produce rhinitis medicamentosa

Rhinitis Medicamentosa

rebound rhinitis

Rhinosinusitis

- formerly called sinusitis

- an inflammation of the paranasal sinuses and nasal cavity

- may be acute, subacute, chronic

- can be viral or bacterial

Acute Rhinosinusitis

- type of rhinosinusitis that lasts for less than 4 weeks

- can be viral or bacterial

Subacute Rhinosinusitis

type of rhinosinusitis that lasts for 4 to 12 weeks

Chronic Rhinosinusitis (CRS)

type of rhinosinusitis that lasts for more than 12 weeks of two or more of the following:

- Mucopurulent discharge

- Nasal obstruction

- Facial pain-pressure fullness

- Hyposmia

Pathophysiology of Rhinosinusitis

unresolved viral or bacterial infection/exacerbation of allergic rhinitis

↓

Obstruction of sinus openings

↓

Secondary infection (progress to an acute suppurative process)

↓

Nasal congestion leads to obstruction of the sinus cavities

↓

Bacterial growth

causes of obstruction of sinus openings

- deviated septum

- hypertrophied turbinates

- nasal polyps

Other factors for Rhinosinusitis

- Abnormal structure of nose

- Diving and swimming

- Tooth infection

- Trauma

- Tumors

- Pressure of foreign objects

- Environmental hazards (exposure to paint, dust, chemicals)

Acute Bacterial Rhinosinusitis (ABRS)

- purulent nasal discharge accompanied by nasal obstruction or a combination of facial pain

- localized or diffuse headache

- high fever

- occurrence of symptoms for 10 days or more

Acute Viral Rhinosinusitis (AVRS)

- same with ABRS but without fever

- nasal discharge is clear, not purulent

- facial pain may be absent

- occurrence of symptoms less than 10 days

Complications of Rhinosinusitis

- osteomyelitis and mucocele

- rare: meningitis, brain abscess, ischemic brain infarction, and severe orbital cellulitis

- meningitis: watch out for fever, severe headache, nuchal rigidity

Mucocele

cyst of the paranasal sinuses

Management for Rhinosinusitis

- Antibiotic therapy (14 days course treatment for ABRS)

- nasal saline lavage and decongestants (for AVRS)

- amoxicillin, amoxiclav, levofloxacin or moxifloxacin can be prescribed

- Topical decongestants

- Air humidification

- Warm compress

- Avoid swimming, diving, and air travel during infection

Amoxicillin/Amoxicillin-Clavulanic Acid

DOC for Rhinosinusitis

Recurrent acute rhinosinusitis

diagnosed when four or more episodes of ABRS occur per year with no signs or symptoms of rhinosinusitis between the episodes

Clinical Manifestation of CRS

- Impaired ventilation

- Cough

- Chronic headaches in the periorbital area

- periorbital edema, and facial pain

- Pt breathes through mouth

Complications of CRS

- meningitis

- encephalitis

- osteomyelitis

Management of CRS

- same with acute rhinosinusitis

- antibiotic treatment 2-4 weeks

Functional endoscopic sinus surgery

surgical management of CRS

Patient education for CRS

- blow the nose gently

- encourage oral fluids

- application of hot wet packs

- positioning: HOB elevated

Acute Pharyngitis

- sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils

- commonly referred to as a sore throat

Most common causes of Viral Pharyngitis

- Adenovirus

- Influenza virus

- Epstein-Barr virus

- Herpes simplex virus

GABHS (Group A Beta-hemolytic streptococcus)

cause of bacterial pharyngitis

Viral Pharyngitis

if uncomplicated, usually subside 3-10 days after onset

Signs and Symptoms of Acute Pharyngitis

- fiery-red pharyngeal membrane and tonsils

- lymphoid follicles that are swollen and flecked with white-purple exudate

- enlarged and tender cervical lymph nodes, and no cough

- Fever and malaise may be present

- Bad breath is common

Penicillin

DOC for Acute Pharyngitis

Penicillin V Potassium

- DOC for Acute Pharyngitis

- oral for 10 days

IV Penicillin

- DOC for Acute Pharyngitis

- recommended only if there is a concern that the patient will not adhere to therapy

Cephalosporin (Cefuroxime)

- DOC for Acute Pharyngitis for those allergic to Penicillin

- 1 tab 2x a day for 5-10 days

Macrolides (Azithromycin)

- DOC for Acute Pharyngitis for those allergic to Penicillin

= 1 tab OD for 3 days

Acetaminophen

given for pain relief for Acute Pharyngitis

Management for Acute Pharyngitis

- liquid or soft diet

- encourage oral fluids

- warm liquids, cool beverages, and flavored frozen desserts

- warm saline gargles every after oral care

- do not share utensils

- cough etiquette

- replace toothbrush

Rheumatic Heart Fever

potential complication for Acute Pharyngitis

Chronic Pharyngitis

- persistent inflammation of the pharynx

- common in adults who work in dusty surroundings, use their voice to excess, suffer from chronic cough, or habitually use alcohol and tobacco

3 types of chronic pharyngitis

1. Hypertrophic

2. Atrophic

3. Chronic granular

Hypertrophic chronic pharyngitis

characterized by general thickening and congestion of the pharyngeal mucous membrane

Atrophic chronic pharyngitis

probably a late stage of the first type (the membrane is thin, whitish, glistening, and at times wrinkled)

Chronic granular pharyngitis

characterized by numerous swollen lymph follicles on the pharyngeal wall

Signs and Symptoms of Chronic Pharyngitis

- constant sense of irritation

- fullness in the throat

- mucus that collects in the throat and can be expelled by coughing

- difficulty swallowing

- often associated with intermittent postnasal drip that causes minor irritation and inflammation of the pharynx

Management of Chronic Pharyngitis

- same with Acute Pharyngitis

- avoidance of alcohol, tobacco, second hand smoke, occupational pollutants

- encourage oral fluids (plenty)

- gargle with warm saline

- lozenges to moisten the throat

tonsillectomy

surgical management of chronic pharyngitis

N95 mask

type of mask to be worn for chronic pharyngitis

GABHS (Group A Beta-hemolytic Streptococcus)

most common organism causing bacterial tonsillitis and adenoiditis

Epstein-Barr Virus/Cytomegalovirus

organism causing viral tonsillitis and adenoiditis

Signs and Symptoms of Tonsillitis and Adenoiditis

- sore throat

- fever

- snoring

- difficulty swallowing

Signs and Symptoms of Tonsillitis and Adenoiditis

Enlarged adenoids may cause:

- mouth breathing

- earache

- draining ears

- frequent head colds

- bronchitis

- foul-smeling breath

- voice impairment

- noisy respiration

Complications of Tonsillitis and Adenoiditis

- Infection can extend to middle ear-otitis media

- mastoiditis

- deafness

RADT (rapid antigen detection test) or throat swab culture

- diagnostic tests for Tonsillitis and Adenoiditis

- used to determine whether bacterial or viral

Penicillin or Cephalosporins

DOC for bacterial tonsillitis and adenoiditis

Tonsillectomy

- surgical management for tonsillitis and adenoiditis

- may be with or without adenoidectomy

Indications for Tonsillectomy

- if the patient has had repeated episodes of tonsillitis despite antibiotic therapy

- hypertrophy of the tonsils and adenoids that could cause obstruction and obstructive sleep apnea

- repeated attacks of purulent otitis media; and suspected hearing loss

Indications for Adenoidectomy

- chronic nasal airway obstruction

- chronic rhinorrhea

- ear infections and abnormal speech

Prone with head turned to side

positioning of patient immediate post-op for tonsillectomy and adenoidectomy

Nursing Considerations for Tonsillectomy and Adenoidectomy

- application of ice collar to the neck

- watch out for bleeding: patient is expectorating bright red blood before swallowing it

- Increase PR, Increase temp, patient is restless- NOTIFY the PCP immediately- risk for shock

Materials at bedside for post-op tonsillectomy and adenoidectomy

- light

- a mirror

- gauze

- curved hemostats

- waste basin

Nursing Considerations for Tonsillectomy and Adenoidectomy

- if no bleeding, water and ice chips may be given

- instruct patient ot refrain from too much talking and coughing

- instruct the importance of antibiotic compliance

- explain to the patient that a sore throat, stiff neck, minor ear pain, and vomiting may occur in the first 24 hours

Nursing Considerations for Tonsillectomy and Adenoidectomy

- soft diet

- avoid spicy, hot, acidic, or rough foods

- avoid milk and milk products (removal of mucus more difficult

for some patients)

- maintain good hydration

Nursing Considerations for Tonsillectomy and Adenoidectomy

- avoid vigorous toothbrushing or gargling because these activities can cause bleeding

- air humidifier at home

- avoid smoking and heavy lifting for 10 days

Peritonsillar Abscess

- also known as quinsy

- most common major suppurative complication of sore throat

- the infection can spread over the palate and to the neck and chest

Causative agents of Peritonsillar Abscess

- S. pyogenes

- S. aureus

- Neisseria species

- Corynebacterium species

Edema

- complication of peritonsillar abscess

- obstruction of airway

- life threatening

Signs and Symptoms of Peritonsillar Abscess

- severe sore throat

- fever

- trismus

- drooling

- difficulty to swallow saliva

trismus

inability to open the mouth

Penicillin

DOC for Peritonsillar Abscess

Management of Peritonsillar Abscess

- Antibiotic

If abscess does not resolve:

- Needle aspiration

- Incision and drainage (I&D) under local and GA with simultaneous tonsillectomy

- Gargle gently, using saline or alkaline solutions

40.6° to 43.3°C/105° to 110°F

temperature of saline or alkaline solutions for peritonsillar abscess

Needle aspiration

preferred management of peritonsillar abscess, high efficacy, low cost, and patient tolerance

Laryngitis

- an inflammation of the larynx

- can occur as a result of voice abuse, exposure to dust, chemicals and other pollutants

reflux laryngitis

laryngitis associated with gastroesophageal reflux

virus

common cause of laryngitis

Signs and Symptoms of Laryngitis

- aphonia

- severe cough

- sudden onset made worse by cold dry wind

- throat feels worse in the morning and improves when the patient is indoors in a warmer climate

aphonia

loss of voice

Management of Lryngitis

- resting the voice

- avoiding the irritants (smoking) including second hand smoking

- if bacterial: antibiotics to eliminate infection

- Corticosteroids

- PPI

Beclomethasone

- corticosteroid for laryngitis

- anti-inflammatory